NHS IT condemned...by NHS Trust

September 12, 2008 11:38 AM

The NHS National Programme for IT (NPfIT) has a bad reputation - it's over budget, running late, losing contractors, saddled with poorly negotiated contracts and at the end of it, it may not produce anything particularly useful. That's not a new opinion; you'll regularly hear politicians, journalists, industry analysts and members of the public say the same thing - in varying degrees of tact and clean language. Until this week, though, it hadn't been a view publicly espoused by NHS Trusts.


Newcastle upon Tyne Hospitals Foundation Trust has this week officially left the NPfIT on the basis that it's "taking forever" and, according to the article, also doubt whether the programme will ever deliver at all. They're right - the NHS database was meant to be in place by 2010, but the NAO now reckon 2015 is the most optimistic forecast.


Newcastle Hospitals have decided to buy another patient records system from the University of Pittsburgh Medical Center in the USA, which is currently used in 20 Pittsburgh hospitals. As the article points out, there could be problems with the system they buy, but the shocking thing about this news is that it has come to this at all.


Under NPfIT, the Trusts who are to be made to use whatever system emerges from it (if any do at some unspecified point in the future) have no say in the contracts, no direct recourse to legal action if things go wrong and in fact have been totally disenfranchised from the outset. It's no wonder that Newcastle Hospitals have quit the scheme when they are essentially treated by the Government as serfs rather than customers of NPfIT.


If even NHS Trusts feel that they aren't being listened to and are being centrally dictated to, it's clear that the situation for taxpayers and patients is even worse.

The failure to fundamentally reform the NHS by introducing at minimum proper accountability and a clear allocation of power and responsibility has led to this bizarre situation. Follow this, if you can:

1) An NHS Trust is nominally, to a certain extent in charge of its own finances.
2) The income it actually gets, though, is decided at a number of other points, although the amount of treatment they carry out is an important factor in the calculation.
3) To prove they have carried out a particular number of treatments, though, they need a computer system that accurately records those figures in full.
4) That system, they are told, is going to be given to them by NPfIT, over which they have no control. That means that if NPfIT fails to produce a decent system, then they will have waited for ten years for nothing.
5) To get it installed they have to apply to the Minister in charge of NPfIT, not the system provider. The Minister or their delegated committee will assess the Trust's application and then instruct the provider in the Trust's area.
6) If the system then fails in some unspecified way, the Trust has no recourse to sue the supplier, as they themselves have never dealt with them directly.


It's not just a mess, it's a governmental spaghetti junction. There are risks in what Newcastle Hospitals Trust is doing, but they've been driven to the decision by the absurd and inefficient structure of our Government. A lot more Trusts are going to get fed up of waiting in the next 7, 10, 12 15 or however many years and decide they and their patients would be better off with a system now that they know actually works. If, and it's a big if, the NPfIT produces a workable system in 10 years time there will as a result of this chaos still be a lot of people left wondering whether it was worth the £12bn in the first place.

The NHS National Programme for IT (NPfIT) has a bad reputation - it's over budget, running late, losing contractors, saddled with poorly negotiated contracts and at the end of it, it may not produce anything particularly useful. That's not a new opinion; you'll regularly hear politicians, journalists, industry analysts and members of the public say the same thing - in varying degrees of tact and clean language. Until this week, though, it hadn't been a view publicly espoused by NHS Trusts.


Newcastle upon Tyne Hospitals Foundation Trust has this week officially left the NPfIT on the basis that it's "taking forever" and, according to the article, also doubt whether the programme will ever deliver at all. They're right - the NHS database was meant to be in place by 2010, but the NAO now reckon 2015 is the most optimistic forecast.


Newcastle Hospitals have decided to buy another patient records system from the University of Pittsburgh Medical Center in the USA, which is currently used in 20 Pittsburgh hospitals. As the article points out, there could be problems with the system they buy, but the shocking thing about this news is that it has come to this at all.


Under NPfIT, the Trusts who are to be made to use whatever system emerges from it (if any do at some unspecified point in the future) have no say in the contracts, no direct recourse to legal action if things go wrong and in fact have been totally disenfranchised from the outset. It's no wonder that Newcastle Hospitals have quit the scheme when they are essentially treated by the Government as serfs rather than customers of NPfIT.


If even NHS Trusts feel that they aren't being listened to and are being centrally dictated to, it's clear that the situation for taxpayers and patients is even worse.

The failure to fundamentally reform the NHS by introducing at minimum proper accountability and a clear allocation of power and responsibility has led to this bizarre situation. Follow this, if you can:

1) An NHS Trust is nominally, to a certain extent in charge of its own finances.
2) The income it actually gets, though, is decided at a number of other points, although the amount of treatment they carry out is an important factor in the calculation.
3) To prove they have carried out a particular number of treatments, though, they need a computer system that accurately records those figures in full.
4) That system, they are told, is going to be given to them by NPfIT, over which they have no control. That means that if NPfIT fails to produce a decent system, then they will have waited for ten years for nothing.
5) To get it installed they have to apply to the Minister in charge of NPfIT, not the system provider. The Minister or their delegated committee will assess the Trust's application and then instruct the provider in the Trust's area.
6) If the system then fails in some unspecified way, the Trust has no recourse to sue the supplier, as they themselves have never dealt with them directly.


It's not just a mess, it's a governmental spaghetti junction. There are risks in what Newcastle Hospitals Trust is doing, but they've been driven to the decision by the absurd and inefficient structure of our Government. A lot more Trusts are going to get fed up of waiting in the next 7, 10, 12 15 or however many years and decide they and their patients would be better off with a system now that they know actually works. If, and it's a big if, the NPfIT produces a workable system in 10 years time there will as a result of this chaos still be a lot of people left wondering whether it was worth the £12bn in the first place.

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