NHS IT: A Bleak House re-write

Yesterday the DH and the two remaining Local Service Providers (LSPs) were interviewed before the PAC following the NAO report on the NHS IT programme.  It was a mix of Alice in Wonderland, a fantasy where everything gets bigger and smaller, and Bleak House where when Chancery finally decides on Jarndyce and Jarndyce and there is no money left. Yesterday seeing it did not mean believing it!

Alistair McGowan in the BBC's Bleak House

We at 2020health have long campaigned for a fundamental review of the NHSIT programme, but yesterday gave us no comfort. Last year our report (Fixing NHS IT) stated that in order to move forward 10 basic criteria needed to be met for the programme to be successful. Yet we saw limited evidence of compliance with the questions we posed.

  1. Are the future deployment plans credible and realisable? Do they match up to the evidence of recent deployments? Have the products and deployment approach been fully stress tested?
  2. Where necessary and demanded by the Trusts, is there a satisfactory direct ‘customer’ relationship between Trust and application supplier? (So that the specific expertise of the application provider is directly and readily available locally);
  3. Is the value add of the LSP model worthwhile (e.g. programme management, technology infrastructure, systems integration)?
  4. To what degree is local choice enabled and on what basis might other application providers compete?
  5. How will Trusts who opt-out of the LSP Programme be handled? Are the alternative arrangements equitable?
  6. Do the arrangements represent value for money, benchmarked against other UK and international procurements?
  7. How will local configuration be allowed to meet specific Trust needs?
  8. Is there a workable, practical and cost-effective split of responsibilities between Trust and contractor, particularly in areas such as data cleansing, data migration and training?
  9. What flexibility exists in the implementation roadmaps and integration of existing systems? Can Trusts choose a model that meets their own capability and maturity? Does it provide an open, low-cost platform that other specialist application providers can readily leverage?
  10. How will the arrangements enable and bring about joined-up care (around the detailed sharing of records) at the local health community level?

After the PAC hearing the machinations and finances of the programme still remain a mystery. For LSPs to claim that there was project creep when they had no product to deliver on time is unacceptable. Of course we have creep, they are delivering four years too late and needs have moved on.  Furthermore, they must have known that when you don’t talk to the users things will go wrong, or were they to greedy to care?

As CSC has no credible product how is that not a breach of contract? To deploy in only one trust to date is surely a failure? Yet we are to give them more chances and waste more money.

The DH has mismanaged the programme and should seek to extract itself as soon as feasibly possible. The solution would be to terminate the CSC contract, let the BT contract run and not renew it and allow local health economies to decide what to deploy using the money left over from the current debacle.

There is no doubt that an integrated care record will be essential at local level if we are to enable the integration of health and social care, deliver care closer to home and indeed in the home. This does not need a national programme but agreed standards and joined up local thinking.


About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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