A pregnant spring?
Perhaps appropriately at the time of HC2005, this issue of the Journal
takes the opportunity to look at the National Programme for IT (NPfIT) and
some of the issues surrounding it.
Take first the very considerable positive side. For the first time,
ministers have been persuaded to back major expenditure on IT infrastructure
— normally not a topic to grab political attention in any serious way. By
its very nature, infrastructure is long term, and not something that is
going to dominate tomorrow’s headlines and produce immediate political gain.
Now, however, it has become absolutely essential if the Government’s
aspirations for the Health Service are to have any chance of success. In
consequence, there is a larger sum than ever before — £6.3bn — available for
centrally funded schemes in NHS computing. Eight major contracts have been
placed, on terms that are said to be highly favourable, and in record time.
All this is positively encouraging, with the potential for very real
progress.
In his address to the World Health Care Congress in January, Richard
Granger, Director General of the NPfIT, was unhappy that media coverage of
the Programme had focused on its difficulties, while neglecting its
successes. He accepted, however, that “some things are proving more
difficult than was anticipated; some are proving easier ... we’re finding
all sorts of interesting challenges”.(1)
There are indeed challenges, which have to be met if the Programme is to
fulfil its potential. There are still major uncertainties about the concept
of standardisation of systems across the country, or at the least across a
cluster. Is this to mean that all field authorities have to have the same
systems (regardless of their present capability)? Or does it mean that all
systems have to be interoperable? The latter is a view that will attract far
more positive support.
Another serious cause of uncertainty relates to funding. As clearly
explained in Information for health there are three potential sources of
funds for IT development: central funds, funds made available by field
authorities, and savings derived from the benefits that implemented schemes
achieve.
Central government funds are on the table; time alone will tell whether
they are sufficient. Funds from field authorities are a different matter:
recent experience shows that pressures on them to meet all of the demands
upon their resources — many of them centrally generated — frequently push IT
expenditure to the back of the queue. And the extraction of savings from IT
schemes has to be carefully planned from the very start if it is to be
achieved: improvements in efficiency or output can lead to greater, not
lesser, expenditure. There is no doubt that obtaining all the funding needed
to achieve the entire Programme will require a great deal of ‘hard sell’.
There is general agreement that without the co-operation of the clinical
community the Programme will fail. To secure that involvement, the NPfIT has
created a network of advisory bodies, and embarked upon determined publicity
campaigns. The task is huge, however, and the audience difficult to reach.
Just how difficult is shown by the latest Medix Survey (reported in
detail in the Journal’s February issue). Sixty-four per cent of the doctors
surveyed said that they had either little or no information about the
overall programme. Forty per cent of all doctors — and 56% of general
practitioners — thought that it would effect no difference to, or even
worsen, clinical care in the next two years (though for the longer term 40%
of GPs, and 50% of all doctors surveyed thought that it would improve care).
The promise of ‘jam tomorrow’ is not really enough to secure whole-hearted
clinical support.
Three of our articles and the first news stories cover some of the
aspects that have already been briefly described. In his article, Dr Jo
Milan, Director of IT for the Royal Marsden NHS Foundation Trust describes
the tension between maintaining and extending a sophisticated existing
system, while attempting to adhere to the timetable of the local cluster.
Robin Guenier, Chairman of Medix UK, brings his wide range of experience in
a number of IT fields to analyse the paramount need for widespread
consultation at grass-roots level if the National Programme is to succeed.
And, in the first news item, some of the current worries about the
Programme, and ways in which they might be handled centrally, are set out.
A tiny harbinger of eventual success, however, may be seen in the article
by Rhona Collins and her colleagues from Barnsley Health and Social Care
Community, a Choose and Book early adopter site. They report on how they
very recently achieved their first 100 online bookings.
It is, quite evidently, far too soon to take a balanced view about what
the NPfIT might achieve. It is a massive project, and, after a remarkably
rapid start, must take time for its potential to be fully appreciated and
implemented. It would be a very great sadness if, in that inevitable waiting
period, the brouhaha of an imminent general election demands claims for its
performance that cannot be merited, and worse, if, after the election,
investment in the main objective of the NPfIT is allowed gently to fade
away.
Michael Fairey
Reference
1. Dempsey P. Mixed results for delivery. HSJ 2005;
115(5942): 9. (to reference in text)
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