Stylitism
St Simeon Stylites, a strange 5th century Egyptian, considered that the
world, and its trappings, impeded not only his ability to think straight,
but — of much greater importance — his ability to communicate with the
Almighty. He therefore took to living on top of a pillar, at first only nine
feet high, but later and in gradual stages, he transferred to a pillar
allegedly 50ft high. Of this the Catholic encyclopaedia rather sweetly
observes that “however extravagant this lifestyle may seem, it undoubtedly
produced a strong impression on his contemporaries”. So strong indeed was
the impression that hundreds flocked to take his advice; and, even when the
pillar was 50ft tall, they used to climb up ladders in order to hear him.
This issue of the Journal has one telling resemblance to St Simeon. Like
him, our three contributors are not involved in the day-to-day hurly-burly —
in their case that of implementing the National Programme for IT in the NHS
in England. But, also, like the Saint, they bring to their various
observations a wide range of experience. Ted Woodhouse brings integration
and management of large-scale and successful hospital IT systems; Murray
Bywater many years of senior managerial experience in the IT industry, and
latterly in consultancy; and the Commissioning Editor of the Journal
experience both of central government and of pioneering large-scale hospital
IT systems. This is the background to the articles of three contributors,
all of whom have a passionate interest in the National Programme and a
desire to see the objectives that it embodies succeed.
What, therefore, are the common themes that emerge? The first is that the
vital elements of infrastructure that the NPfIT is driving are of paramount
importance. It is almost impossible to overstate the value that the
achievement of those basic elements will give to the Service. It will no
longer be necessary to contend with apathy on the part of politicians, who
either do not comprehend its value or can see no party advantage to be
gained from it, and who are, therefore, unwilling to fund it. More
importantly, it will provide a framework for the future, whatever
application elements of the current programme — or indeed alternatives —
finally come to fruition, even over an extended timescale.
The second major theme is the debilitating effect of uncertainty upon the
Programme. That uncertainty stems from frequent changes in structure: from
changes — almost as frequent — in the way in which the several elements of
the Service are funded (without taking into account any of the current
financial plight); and from the future role of pre-NPfIT systems, upon which
so many activities rely, not only today, but — at the present rate of
achievement — probably for some long time to come.
The third theme is the need to accept that the task facing NHS Connecting
for Health is only incidentally about the centralised acquisition and
distribution of major systems. The task is, in fact, about achieving
fundamental change in the basic working practices of a myriad of healthcare
providers. To achieve that will be a gargantuan undertaking — and one that
has to be appreciated and understood centrally if there is to be any chance
of overall success.
These are themes common to all our three contributors. Significantly,
they are not alone in their perception. A recent study from the London
School of Hygiene and Tropical Medicine, and published in the British
Medical Journal,1 set out to observe the context for implementing the NPfIT,
the actual and perceived barriers and to identify opportunities for
facilitating its implementation. It concluded: “The sociocultural challenges
to implementing the NPfIT are as daunting as the technical and logistic
ones. Senior NHS staff feel that these have been neglected. We recommend
that national programme managers prioritise strategies to improve
communications with, and to gain the co-operation of, front line staff . . .
The NPfIT is likely to succeed or fail according to the groundswell of
opinion, as well as its technical performance.”
There is another positive, if implicit, strand against which to view
these very real concerns. Everyone understands that in the early stages of a
big programme there will be setbacks. The recent issue by the Nuffield
Orthopaedic Hospital of a serious untoward-incident report, resulting from
its experience with the nascent Care Records Service,2 will not be the only
problem to be encountered but, among all the difficulties and (frequently
justified) criticisms of the Programme, there are very few voices saying it
should not go ahead. There is a widespread realisation that as information
systems have so much to offer the NHS and the sensible elements of The NHS
plan that failure is too uncomfortable to contemplate. That at least is a
positive feature upon which CfH should begin to build.
Michael Fairey
References
1. Hendy, et al. Challenges to implementing the National Programme for
Information Technology (NPfIT): a qualitative study. BMJ 2005; 7512:
331–4.
2. Hall C. Hospital computer may ‘lose’ patients. Daily Telegraph
14 March 2006; 10. Buy this
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