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Blundering the NPfIT?

Last week, I attended a presentation by David Craig (a pseudonym) who wrote Plundering the Public Sector, which criticises the cost, justification and management of NHS Connecting for Health's National Programme for IT (NPfIT). Book and presentation contain nuggets of wisdom tarnished by uneveness and inaccuracy.

In the book, Mr. Craig claims that the total cost of NPfIT could be as high as £50bn. Even if this is correct (and I'll address that shortly) that is £5bn a year from a total NHS budget of about £70bn year. I consider a 9 percent IT spend (adding non-NPfIT) modest for a sector whose basic currency is information. At least 12 percent would be in line with similarly dependent sectors like banking and finance.

He also states NPfIT's headline cost of £6.2bn is dwarfed by the likely costs of implementation. This may be true, but I suspect his estimates include the full replacement cost of staff during training. In my experience, such costs are economic rather than real, because staff are often not replaced for short periods and their costs are already met. Further, the NHS already spends about £1bn a year on IT, at least some of which could be diverted to implementation.

Mr. Craig is scathing of Choose and Book (C&B) an IT system that will allow GPs to make direct outpatient appointments at a patient's choice of hospital.

He estimates the costs of C&B at £200m for development, £122m annual running costs and £100m for existing systems modification. In the book, he says that amounts to £125 a booking (page 216). However, in last week's presentation he revised that to a more arithmetically correct £15—I presume by using 9.4m GP bookings a year for ten years as the denominator for total costs for the same period.

However, his arguments seem tendentious when he makes no assessment of the likely cash-releasing benefits of C&B, such as reducing admin costs in the current system of letter and telephone tag, or the potential for transformation of the acute sector that using C&B may have when combined with Payment by Results and Practice Based Commissioning .

In the presentation, Mr. Craig asserted that the NHS could have saved on C&B by buying an airline booking system and adapting it. Further, most of the systems procured by NPfIT are available off-the-shelf in the US, he says. In this he seems to rely on an early report, apparently written by McKinsey, that concludes the whole lot could be done for £2bn by such adaptation—though we are not told the basis of that estimate either.

Now, I favour an off-the-shelf IT product meeting most user needs that can be adapted, rather than a development from scratch, but Mr. Craig's assessment seems superficial. IT systems are available in the US, but invariably need modification for the NHS by the suppliers who invariably underestimate the effort needed. This leads to extra cost for them (at least in my procurements) and long delays for users.

Moreover, even the US does not use healthcare IT well, for example read this assessment on Dale Hunscher's blog.

Mr. Craig has it in for management and IT consultants—blatant in his previous book Rip Off! In the presentation, he exposed their sales techniques, which he rather incongruously referred to as "all great fun".

I spent 7 years in sales and marketing (not for management consultancy) and recognise many of these assessments and techniques. I believe most are not exclusive to consultancy and are used by many service industries.

Nonetheless, he gives sound advice on employing consultants: define scope and client and consultant responsibilities, insist on skilled staff, pay by deliverables and so on. But this advice can be had free in publications from the UK's Office of Government Commerce (OGC) and Audit Commission.

Eager whistle blowers apparently inundated Mr. Craig with material allowing him to draft his recent book in a few weeks. It shows. He should have taken the time to carry out a more balanced assessment and to have at least got the Programme's name right.

Also see this article by the Guardian Online's Mike Cross on E-Health-Insider.


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As regards using off the shelf US systems for the NHS. Consider the problems that IDX if having using its system for the NHS. The anglicasation of any of these systems is considerable it involves diffierent terminology, different working practices, similar grades of staff doing jobs and so on. It is far from a trivial task

I am afraid US companies underestimate the differences between theirs and our healthcare systems.

Fundamentally, the databases underlying their software are different from those needed by the NHS. This is the hardest problem to fix, as it means cumbersome workarounds or a rewrite--which few are ready to undertake.

E-Health-Insider reports today that IDX (now GE Healthcare) is about to exit the London cluster of NPfIT--perhaps an illustration of what a challenge anglicisation of US healthcare products really is.

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