Everyone wants it to work

That the National Programme for Information Technology (NPfIT) is of profound importance, there can be no doubt. Equally, there can be no doubt that everybody wants it to succeed. Interest in its progress is immense, both in the Service, and in the industry. Both this and the next issue of the Journal will be devoted to it, and the July 2005 issue is already earmarked to carry articles covering those areas where success has already been achieved.

Why is this Programme any different from those that have gone before and what are the potential outcomes ahead? Remembering that this is the world’s largest civil IT project, will it prove, in its implementation, to be the best thing since sliced bread? Will it, like so many government IT projects, end up in dreary afternoons spent with the Parliamentary Committee on Accounts, explaining the self evident, and being rapped on the knuckles? Or will it, after the election, follow TS Eliot’s view of the end of the world, and gently fade away, not with a bang, but a whimper?

On this occasion, England’s NPfIT has everything going for it. The NHS Plan, with its concept of a patient-centred service cannot possibly succeed without the IT support that NPfIT proposes. More importantly still, ministers, usually only concerned with tomorrow’s headlines, and notoriously averse to anything long-term, like IT, have actually shown that on this occasion they realise its importance, by providing sizeable long-term central funding. There will need to be further sizeable funding to be found from within the Service, but the central contribution is a vital start. The vigour to drive the Programme is there, as witnessed by the speed with which the contracts with local-service providers (LSPs) have been developed and awarded. Even greater evidence of the central determination to succeed is provided by the slowly emerging terms of the contracts to which LSPs are committed. Above all, everyone within the Service who understands these matters is determined that the project should, indeed must, succeed.

Where then are the concerns? If we set aside for our next issue the paramount need to involve clinical staff, and how this is to be achieved, there are two major, interconnected, areas. The first relates to the organisations on the ground and the way in which their relationship with their LSP is to develop. What precisely, for example, is a ‘core’ system, over which the LSP has total control? Are the full terms of the national contract with LSPs going to be made available to NHS authorities so that they can with confidence continue work on ‘non-core’ systems, if their own priorities demand it? Questions of this type need speedy resolution if inertia and disillusion are not to occur at ground level — which is the only place where NPfIT will succeed or fail.

A second major area of concern lies in the relationship of LSPs and a legion of other, smaller, contractors upon whom it seems inevitable that LSPs will rely to fulfil at least some parts of their major contracts on time.

As was evident at a recent conference for small and medium-sized enterprises, the uncertainty surrounding the precise terms of LSP contracts and exactly what they cover is contributing to an inertia that NPfIT can ill afford.

The articles in this issue demonstrate a wide range of views on the current situation. In his article, Paul Charnley, the Regional Implementation Director for the North West and West Midlands Cluster, describes the steps that NPfIT are taking to elicit the co-operation so necessary at ground level. In his article, Andrew Haw, Director of ICT and EPR at the University Hospital Birmingham NHS Foundation Trust, describes some of the detailed aspects of implementation at trust level. In the second article from an IM&T director of an acute trust, its author casts a coldly reasoned eye over the process, and the elements that potentially will bring success or failure to the Programme. Our final article is a snapshot of three actions taken during the summer to clarify the state of the overhauled marketplace, particularly for the existing small and medium-sized suppliers who vastly outnumber the ‘big boys’ holding the lion’s share of current installations of systems and service contracts.

 It will be apparent from our contributors that there is still a wide breadth of views about NPfIT. They range from considerable optimism to serious and considered doubt — and certainly there are many points that have yet to become clear. For all that, however, whatever the point of view, there is a desperate desire that this IT initiative will succeed. The NHS needs it.

Michael Fairey