I have in front of me two newspaper articles. The headlines tell it all. Nick Cohen asked us to, ‘Just imagine what the NHS could do with the £20bn wasted on sick IT.’ (Observer 4 June, 2006). The Guardian's health correspondents (13 June, 2006) wrote, ‘Doctors fight to save drug guidance from government axe.’ Cohen's story is not just of the runaway costs of the government's determination to bring in a comprehensively computerised NHS, but of the large amounts of money paid to management consultants. These are the people to whom our elected representatives turn for advice, to avoid asking anyone who knows about the subject. They charge enormous fees, add on enormous expenses, and suggest systems that don't work. I have only Cohen's word for it, but ‘26-year-olds can charge an NHS trust £3000 a day for their services’.
Unlike Drug and Therapeutics Bulletin, the Guardian's subject, the IT programme does not strike as good value for money. Anyone familiar with even small computer programs knows that it's best to go for simplicity. When you have as many different institutions needing to use the systems as the NHS has, the best bet would be a core with easily followed specifications, so that locally sourced programs could interlink with it.
Set against the IT costs, £1.4m providing a paper copy and online access to the DTB for all doctors is negligible. It is impossible not to think that the DTB's stance on, for example, drugs for multiple sclerosis and dementias, upset someone, a someone with a lever on the Department of Health. The DTB did not need to pull any punches, so the DoH has decided to stop it punching. NICE does not render all other medical advice redundant. NICE has too many problems with political direction (even if not interference), lobby groups, and Big Pharma. There have been times when NICE has been ‘privately furious’ with ministers but, as Professor Joe Collier — who was editor of the DTB for a long time — pointed out, that is dishonest. And to weigh against DTB's £1.4m, Big Pharma spend £33bn persuading us which drugs to use. Although it wouldn't have to be so much, a drug company spokesman explained, if they were able to advertise directly to patients. The word for this is ‘chutzpah’, witness another Guardian headline (26 June, 2006): ‘Kickbacks, cartels and chatrooms: how unscrupulous drug firms woo the public’.
But Patrician Hewitt has more important things on her mind: she has to explain how selling off the commissioning work of the PCTs to BUPA and friends is not privatisation.