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First Metre contempt by sofa-bound mandarins (October 2007)

The NHS National Programme for IT is claimed to be the largest non-military ICT project in the world. In a recent BBC Radio 4 interview (October 25)it was revealed for the first time how little attention was given to the decision to proceed with it by the then Prime Minister, Tony Blair, and his so-called advisors. It was in 2002 that Sir John Pattison at the Department of Health and colleagues were invited to Downing Street and given just 10 minutes to explain their vision for a computerised NHS.  Their plan was for an electronic network connecting all parts of the NHS centred on three major components - electronic patient records; booking of appointments and issuing of prescriptions. 

Sir John recalls that "I suggested it would take three years.” He admits that he failed to stress that the quoted time-frame of three years and budget of £2.4bn was just for the first phase and thinks that this is possibly where current concerns about delayed implementation and cost over-runs has come from. Now the project has a 10-year timescale with an estimated budget of £12.4bn. The director of the project, Richard Granger, resigned in June 2007.

Ludicrously the managing director for BT Health, Patrick O'Connell, excused the slow start on the grounds that “most major programmes do…..there is a certain amount of coming together of ideas with practicalities. Some capabilities turn out to be less important. Some capabilities turn out to be more important and get brought forward in time. And some things people decide they really want to have like PACS, the picture archiving system that puts everything online - that wasn't there on day one - but it came in later. We will probably finish not quite the same system that people thought they were going to buy on day one but a much richer, much fuller system and probably much more relevant."

In April 2006 Martyn Thomas was one of 23 computer science academics who wrote an open letter to the government expressing concerns about the project and calling for an independent review. Thomas and his fellows were invited to a meeting with the then director of the IT project, Richard Granger. Apparently Granger welcomed a review but was blocked by the Department of Health. While the independent review never happened, by June 2006 the National Audit Office reported on the NHS IT programme, allegedly completed in draft form a year earlier.

The editor of Computer Weekly, Tony Collins, says that the draft version of the report was radically different to the final one after the Department of Health had changed content from criticism to praise. About 20 pages were added to the final report praising the national programme. "There has been a suppression of dissent and a degree of control of information never seen before on an IT project," said Collins.

Despite the optimistic tone of the NAO report, within three months two major suppliers - IDX and Accenture - withdrew from the project and a new NHS executive manager, David Nicholson, was appointed to oversee the National Programme for IT.

Earlier this year Nicholson rejected fresh calls by the 23 academics for an independent review while later announcing that the National Local Ownership Programme. This dismantled in part the original vision of a centralised IT delivery system in favour of a regional solution. This change of direction followed consultation with health professionals and trusts about their needs. The BMA applauded the change pointing out that, for instance, a GP needs completely different records to those required by psychiatrists, anaesthetists or radiologists.