Intended for healthcare professionals

Information In Practice

Ten ways to improve information technology in the NHSCommentary: improve the quality of the consultationCommentary: Clinical focus might make it work

BMJ 2003; 326 doi: (Published 25 January 2003) Cite this as: BMJ 2003;326:202

The NHS can succeed in IT

Professor Majeed, Dr de Lusignan and Ms Teasdale offer excellent
advice to Mr Granger on the need for clinical/patient focus and the
valuable experience of general practice computerisation. The exceedingly
ambitious timescales involved and the viewpoint that the NHS "cannot
afford to fail" in IT (information technology) are of great concern.

A comfort to Mr Granger is the notion that, in spite of some highly
publicised failures [1] [2], the NHS can succeed in IT. Computerising 10
000 general practices, perhaps 250 000 healthcare workers and over 50m
patients in some 15 years is a success. There are NHS developed hospital
systems too that have had operational lifetimes of 20 years or more (as of

IRC patient administration; introduced 1969

SPS payroll software; introduced circa 1975

IRIS financial software; introduced circa 1975

WIMS estate management software; developed circa 1979.

Even complex, national-scale NHS initiatives have succeeded:

National child health system [3] with practically every child in
the UK registered for decades

PACT prescription information with the majority of prescriptions
recorded for many years

Exeter system [4], 1983, to oversee general practice management,
transfer patients between practices and administer cervical screening.

One hopes that Mr Granger’s experience as a management consultant should
help him "manage expectations" in terms of scope and timescales. One
hopes, too, that he understands the difficulties of central IT initiatives
in a functionally decentralised organisation with multiple loosely-coupled
chains of command and an overall complexity unparalleled in commerce. His
job is not impossible - previous successes suggest that it can be done.


[1] Collins T. A very British scandal. Computer Weekly 1993;October 9:12-

[2] Page D, Williams P, Boyd D. London Ambulance Service Inquiry. London:
Inquiry Team, 1993 February.

[3] Rigby MJ. The national child health system in practice. In: Bryant JR,
Roberts J, Windsor P, Boyde E [eds]. Current Perspectives in Health
Computing. Weybridge: BJHC Books, 1987:107-13.

[4] Johnson G. The FHS Millennium Project. In Smith MF, Dowd C [eds]. Year
2000 and Healthcare Computing. Sheffield: Sheffield Academic Press,

Competing interests:  
The author is a director of Medix UK

Competing interests: No competing interests

24 January 2003
Michael F Smith
Visiting Professor, Medical Information and Measurement Centre, City University
17 Braganza Street, London SE17 3RD