SINCE RICHARD Granger was appointed NHS IT tsar in October 2002, he has attracted all the media attention and many of the brickbats for the potential for disaster of the National Programme for Information Technology. He, knowingly or unknowingly, has been diverting these brickbats from their proper targets: the NHS structures and individual managers of NHS quangos. While in 18 months, Granger has transformed the way the NHS procures vast infrastructure projects with utter ruthlessness, the NHS agencies have been carrying on in the traditional academic and consensual way that has slowed IT progress over decades.
This is serious, because it is the NHS agencies and the royal colleges who are responsible for deciding the important things like what information should be held in the national electronic care record – or “spine”, as it is called. And they should be launching crash-programmes to persuade GPs, hospital doctors, clinicians and nurses to accept e-booking of appointments, e-prescriptions and e-records. And of course, they should be training all these staff, all 850,000 of them, about how electronic working fundamentally differs from the paper-based ways they have always used so far.
The NHS agencies should have completed all this around now. It is this month that e-booking is to start its roll-out, and Phase 1 Release 1 of the National Care Record is due to be released, the foundation stone of all that is to follow. But they haven’t even started.
My own enquiries to my GP and hospital doctors about what they know about the National Programme for Information Technology draw blank looks. More scientific surveys back up my findings, with an 85 per cent figure for lack of information among clinicians. A survey published this week of 200 NHS managers showed that 60 per cent felt that they had insufficient information about the programme. This particular survey must hurt Richard Granger, a management consultant himself, as it comes from the Management Consultants’ Association.
Health minister John Hutton showed last month that he was worried that NHS agencies were not shaping up to these challenges, by axing some of them. Overall, he plans to reduce NHS quangos by 50 per cent and the number of posts will be cut by 25 per cent. The agencies covered include the NHS Purchasing and Supplies Authority, the NHS Information Authority, NHS Direct and the NHS Modernisation
Agency, all deeply involved in the NPfIT. The Modernisation Agency alone has 760 staff and a £230 million budget. John Hutton explained: “There are too many overlapping and duplicated functions; there are some unnecessary regulatory and policy activities; back-office functions such as human resources, finance, IT and estates could be rationalised; many bodies could be merged, thus reducing overheads and integrating similar functions”. It is perhaps surprising that this was not realised, when the NPfIT was launched, back in 2002 – as pH7 pointed out in February 2003.
Whether it is prudent to change the structure of these agencies just now is debatable – rather like revamping the command structure of the Normandy landings on D-day. In today’s civil service, such tinkering usually inserts a three-month delay or more into all projects, particularly as the general-in-charge also has changed recently. In March, Professor Aidan Halligan was appointed as joint Director General of the NPfIT, with a remit to take on the lead responsibility for clinical involvement. He was taking over from Sir John Pattison, previously the main NHS old-timer in the NPfIT, and titular boss of Richard Granger.
Then in April, Professor Peter Hutton – appointed only last October as head of the National Clinical Advisory Board – re-signed abruptly. His main task had been to get clinical involvement in the programme. It is now up to Aidan Halligan to do in weeks what Peter Hutton had been trying to do in months, and what most project managers would consider doing in years– changing a culture.
Since then, Aidan Halligan has praised the European Computer Driving Licence initiative, in which 60,000 NHS staff – including Halligan himself – are learning to be confident in the use of computers. This is a start, but 60,000 is a drop in the ocean compared with the 850,000 who have to be trained. And the ECDL will not cover the disciplines of how to transcribe the records accurately or insert the right codes and interpret the data standards. Halligan also wants to start an NHS IT academy, to train the leaders. It could be argued that, to be effective, the leaders should already have been trained years ago.
In the face of all these loose ends, Aidan Halligan or the minister, John Hutton, might be tempted to slow down the Granger Juggernaut, while he sorts out the organisation of the NHS quangos, while some clear definitions and disciplines are worked out for NHS data, and while the NHS staff from top to bottom are retrained for the brave new electronic world. This is unlikely to happen for political reasons.
Instead, what may already be happening is that primary care trusts and hospital trusts are voting a delay with their feet. A confidential report picked up by Computer Weekly shows that BT is worried that trusts have only asked for 19 “bundles” of e-booking and e-care record systems rather than the 86 expected in the first year. Then, in the second year, 2005/6, there is greater demand than anticipated, 141 bundles rather than 50 expected. The Department of Health says that these figures are already out of date, but it does seem that PCTs and hospitals feel they are unready for a 2004/5 start – or that the “entry-level” e-bundles on offer do not give advantages over what is already implemented in local computer systems. Therefore, they plan to sit on their hands for a year while they prime their staff, clinical and administrative, for the electronic revolution. This will make a mess of the carefully framed contracts worked out between Richard Granger and his commercial suppliers, but it might be the safer way to go.
