Intended for healthcare professionals

Letters There IT goes again

NHS IT is at the mercy of the civil service and “gifted amateurism”

BMJ 2011; 343 doi: (Published 15 November 2011) Cite this as: BMJ 2011;343:d7037
  1. Grant S-B Kelly, general practitioner, hospital quality adviser1
  1. 1NHS South East Coast, Horley RH6 7DE, UK
  1. grant{at}

Greenhalgh and Bowden comment on New Zealand’s learning environment for health informatics versus our own cathedral approach.1 2 I suggest we are unlikely to change our approach until we escape from the civil service.

As a clinical adviser to the NHS National Programme for IT, I was repeatedly told that civil servants knew better than the clinicians destined to use the systems in anger. There was no evidence for this and plenty to the contrary; the requirements for systems never became subject to clinical discipline or learning and the programme lost its way.

We now face the same problem again, with the new Department of Health draft report for clinical commissioning groups suggesting that their systems and business intelligence requirements will be best done “at scale,” through a national approach. Once again, those on the ground will simply have to take what they are given and like it.

This inability to learn comes directly from the civil service. The assumption is that if you are clever and a civil servant, then you can pick up what really matters in a short time and do better than those who work in the field. This approach was fine for a simpler age, but in these days of failed IT procurements how much more evidence is needed before we are allowed to bin this “gifted amateur” approach in exchange for a true learning environment?


Cite this as: BMJ 2011;343:d7037


  • Competing interests: GS-BK is past clinical adviser to the NHS National Programme 2003-8 and past chair, Joint General Practice IT Group.


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