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A problem shared

It has not been a happy new year for the NHS, reports Michael Cross

Thursday January 27, 2005
The Guardian

The £6bn programme to modernise the NHS's computer systems is having a rocky month. The National Audit Office revealed that electronic booking, the programme's highest-profile component, is behind schedule. One finding grabbed the headlines: instead of the target of 205,000 bookings handled by the end of December, the new system carried only 63.

To add to managers' embarrassment, two NHS organisations have broken away from the programme and decided to buy their own next-generation systems, rather than waiting for national IT to come along. Meanwhile, a simmering row with the company that supplies a majority of GP systems has deteriorated into a public trading of allegations.

Elsewhere, the programme is having a new stab at its longest-running campaign - selling to 1m NHS employees and 50m patients in England. Fears are growing that a significant number of patients may exercise their right to opt out of having their health records shared across the new Care Records Service.

This week, the Department of Health appointed a top public relations firm, Porter Novelli, at a "substantial six-figure sum", to help persuade patients that the new IT programme will be more secure than today's envelopes stuffed with paper.

None of this is likely to deflect the government from its plan to create a joined-up system of electronic health records by 2010. However, it does dent the NHS's ambition to break the mould of government IT projects. The programme's head, Richard Granger, is expected to move on following the likely general election in May. Questions are also being asked about whether major contractors signed up to unrealistic promises to meet political targets.

The National Audit Office report gives a hint of the technical, organisational and cultural hurdles that the programme faces. It says electronic booking ran into delays because of an "intermittent fault" with logging on to the system, reluctance of new users to engage, the limited number of GP computers that are compliant and "the limited number of GPs who were willing to use the system in the first place".

It also warns that the lack of agreement with the main supplier of GP computers, Emis, puts the implementation of booking hospital appointments from doctors' desktops at risk. Emis is a privately held firm based in Leeds, claiming to supply systems used by 55% of GP practices. It was too small and specialised to bid as a prime contractor to the programme and has failed to reach agreements as a sub-contractor. Relations between the firm and the national programme deteriorated last month when it published a leaflet entitled "Fact not Fiction", correcting what it describes as "continuing misinformation".

The national programme responded with a statement accusing Emis of providing "misleading" information and pointing out that other independent suppliers have had no difficulty signing.

One of the main reasons behind the national programme was to do away with the practice of every NHS organisation choosing its own IT, which was wasteful and created incompatabilities. However, at least two trusts have decided to break ranks with the new standardised approach: Sunderland primary care trust, which is advertising in the open market for bids to computerise 28 GP practices, and Wirral hospitals trust on Merseyside.

Wirral attracted attention within the NHS because it was an IT pioneer. In the mid-1990s, it was one of the first hospitals in the world where doctors prescribed drugs electronically - one of the national programme's central ambitions. However, Wirral's IBM mainframe-based technology is now obsolete and the national programme will not have a replacement with the same functionality until "after 2007".

The national programme says Wirral is in a "unique position", but is worried about it setting a precedent. One of the difficulties of dealing with the NHS is that it does not work like a central government department - each hospital and GP practice believes itself to be unique.

Although no one from the programme was available for interview, the view from inside is upbeat - the world's largest single civil IT procurement is still broadly on schedule. However, managers are aware that there is a tipping point in perception, beyond which a project becomes automatically labelled a disaster.

The hope is that as new technology begins to be installed this spring, credibility will build. Much is resting on systems that display x-rays and other images on screen, which look good and save hospitals money.

Another step will be taken when the NHS accepts it must go digital in the same way other industries have done, whatever the pain.

One anonymous contributor to e-Health Insider, an online news service, sums up the mood: "When are we going to switch from whingeing 'Told you it was rubbish' mode, and just get on with it?"

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