National programme for information technology

With the national programme for information technology, the NHS in England has set itself an enormous task. A programme of this size has never been attempted in the United Kingdom and, in many respects, elsewhere in the world. But what is the national programme, why is it so important to the government and to the viability of the NHS, and is it on course to succeed?

The national programme means an investment of £6.2bn (€9.2bn, $11.1bn) over a 10 year programme of change. It promises to modernise information and communications technology across the NHS and provide the tools to help streamline the healthcare services. It will create a basic health record for all 50 million patients, enabling quick and easy access to the essential information that anyone making health decisions about a patient needs to know. It will connect more than 30 000 general practitioners and 270 acute, community, and mental health trusts in a secure system. It promises to “improve the convenience and quality of care” by having the right information in the right place at the right time. It will sustain the NHS reform programme and support patients' choice.

That is the hype, but why does the NHS need such a national programme? For many years the NHS has been flirting with information and communications technology. This has resulted in a multitude of disparate systems many of which are unable to share information. The publication in 2002 of the Wanless report (a review of the long term trends affecting the health service and the resources required over the next 20 years) convinced the Department of Health to commit to a fully integrated national system.¹ The report concluded that “without a major advance in the effective use of information and communications technology, the health service will find it increasingly difficult to deliver the efficient high quality service, which the public will demand.” The Department of Health thought that information and communications technology in the NHS needed to be managed and controlled at a national level. The increasing complexity of health care, the need for timely access to quality data and the latest information by healthcare professionals, and the need to reduce clinical errors demanded a revolution in information and communications technology.

The term national programme for information technology is misleading because the programme isn't just about technology. Its successful implementation will affect the ways in which people work and services are delivered. (A good example is the electronic booking of appointments, which will require clinicians—who have traditionally been very independent—to relinquish some control over their diaries.) The national programme must spend money on facilitating these changes. Otherwise, the result could be good information and communications technology but no change in the way things are done.

A basic rule in project management is to gain the support and commitment of the senior management and all stakeholders. The programme has the endorsement of the senior project team, which includes the minister of state for health, John Hutton, the newly appointed deputy chief medical officer, Aidan Halligan, and the programme's director general, Richard Granger. The level of investment also confirms the commitment of the government and the NHS. But winning the hearts and minds of two other stakeholders—healthcare professionals and the public—will be more difficult. These two groups can make or break the project. They need to be convinced that the endeavour is worth the investment and the initial pain and that the future of the NHS depends on it. Unfortunately, as shown by the BMA's demand for greater involvement in the national programme, the involvement of these user groups to date has been poor.²

Two major bodies have been established to tackle the involvement of the health professionals and the public. The National Clinical Advisory Board represents healthcare professionals in the national programme. The public and patients have their voice through the Public Advisory Board.³ Aidan Halligan's appointment also highlights how seriously the national programme is taking the importance of clinical engagement. However, the recent resignation of Peter Hutton from the chair of the National Clinical Advisory Board after just six months in office highlights how difficult this process has and will continue to be.

Will the national programme work? In a recent article in the Financial Times, Nicholas Timmins highlighted some major concerns about the programme.⁴ He reports suggestions that Peter Hutton was “frozen out” of the programme after expressing serious concerns. The programme has been criticised as being too secretive, even excluding many NHS employees from its development. Peter Hutton also raised concerns over how uniformity and continuity of care will be achieved across different local service providers, stating that local variations would raise “major safety and training implications.” EMIS, the largest supplier of primary care systems in the United Kingdom, announced that it would not sign current contracts with any of the local service providers appointed to deliver the national programme.

With so many concerns, and we have looked at just a few, one wonders how the national programme will succeed. However, far too much is at stake for it to fail. The consequences of failure are too ghastly to imagine. Billions of pounds invested in the programme will be wasted and the reputation of information and communications technology for healthcare destroyed. Without a national information technology programme the NHS of the future would be quite different. Equitable healthcare free at the point of need, financed through taxation, would be unsustainable and the rising costs prohibitive.

If the national programme can address effectively its political, logistical, technical, and contractual issues and win over and sufficiently engage healthcare professionals, patients, and the public while taking their concerns and views seriously then it just might succeed—for all our sakes.