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Changing the System: NAO’s report on the NHS IT project

For weeks the UK’s media have been cleaning and oiling their guns preparing to lay a broadside on the NHS IT Project.

Last Friday, on the morning of the release of the National Audit Office’s report on the NHS National Programme for IT (NPfIT), even my favourite BBC Breakfast news presented by the elfin Sîan Williams and the grounded Bill Turnbull could not resist a ranging shot: the NAO report would “criticise” the NHS IT project.

So, what did it say? Broadly, NPfIT is in good shape.

Yes, it is about two years behind plan.

Yes, it has not sufficiently engaged NHS staff but intended to do so when the risk of raising false expectations was lower. (This decision seems to have been sound.)

Yes, it has spent some money, but was under budget overall (£654m compared to £1.4bn) because it has not paid contractors who have failed to deliver—a principle I also employ in my IT contracts.

The NAO estimates that the overall cost will be £12.4bn, but admits that ignores likely savings. For example:

  • Spend on existing IT due for replacement;

  • Savings from centralised purchasing--independently estimated at £4.5bn; and

  • Human effect of medication errors £2.5bn.

Duplicate diagnostic tests, adverse events that affect 900K inpatients a year and clinical negligence claims that cost the NHS more than £400m a year are also likely to be reduced.

The NAO is also positive about the robust management structure and style—which has also been independently assessed.

On a smaller scale, I have faced similar challenges to those faced by the NPfIT. Any major change programme that drives the free flow of information across disciplinary and organisational boundaries will meet resistance. Perhaps Machiavelli explained it when he wrote:

There is nothing more difficult to plan, more doubtful of success, more dangerous to manage than the creation of a new system. The innovator has the enmity of all who profit by the preservation of the old system and only lukewarm defenders in those who would gain by the new system.

The NAO report adds much needed rationality to the public debate about the NHS IT Project. The critics' guns have fallen silent—for a while.


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And now we find http://www.e-health-insider.com/comment_and_analysis/index.cfm?ID=149 that the Audit Commission were worn down to an insipid report, and did not look at the Detailed Care Record or LSP performance at all.

Good to hear from you, Andy.

Yes, E-Health-Insider has argued that. The NAO has provided us with a view, but we don't like it. Let's send it away again until it finds the one we want: is that it?

The NAO report has added rationality to a debate that was verging on hysteria. The NHS IT Project is not a catastrophe: let's deal with that finding.

Sure, the main objective of NPfIT must be the delivery of a multi-disciplinary EPR, and that has plainly not been done.

On the other hand, under performing software providers and LSPs have also not been paid, which--though it seems common sense--is uncommon in public sector IT.

A rescoping of LSP deliverables and the appearance of new suppliers seem likely. EHI has also suggested the London LSP's software supplier (GE Healthcare, formerly IDX) is likely to be changed.

Please, let's now concentrate on the real problems, which may be LSP delivery, but may also be intransigence by some and the lack of an operational vision for the NHS.

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