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 entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
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