Why the NHS IT system was doomed from the start

It doesn't work
The Royal Free Hospital in London complained this week that the new computer system had damaged the service to patients, frustrated staff and cost an extra £10 million. The programme is running at least four years behind schedule, costs have risen from £5 bn to at least £12 bn and that excludes additional costs that have to be met by local hospitals. By the end of 2008 we were assured that all patients would have a computerised medical record that could be used by all doctors nurses and other clinicians that were treating them and that patients themselves could view from their own home.

And what has happened? The company that is meant to be supplying Shrewsbury and the whole of the Midlands, East Anglia and the North of England has not yet got a working computer programme. For years they have been making proud presentations based on simulations of how they think their new system will work when it is finally ready. The system being sold to London hospitals comes from a company that has been producing systems in the USA for years, but it still doesn't work here. A Department of Health spokesman said: "Many elements of the programme are complete..." The Chief Executive of the Hospital is wishing that they had waited until the whole system was complete. While the rest of the world is moving to eMail systems that can be used anywhere on computers, or blackberries and iphones; the NHS has replaced an eMail system that was a bit clumsy but worked with one that cannot be used by many doctors unless they are actually in NHS premises.

It is insecure
GPs have grave concerns about the security of all the information that will become available through the national Care Record. Commentators have noted with some concern that the children of MPs will be exempt for registration on the national database of children, the so-called Cf ContactPoint.

It is expensive
The National Programme for IT in the NHS is costing every man woman and child in England about £240 and if each hospital suffers the losses that The Royal Free has suffered it will cost more than £270 per person. Rotherham NHS Trust has decided to buy a computer system outside the National Programme for IT. It will cost them £30-£40 million, but they feel that they need something that will work. Rotherham would have been expected to use the same supplier as Shrewsbury and Telford Hospitals Trust.

Why was it doomed to failure?
"This IT programme was in trouble from the beginning," said Dr Charles West of Shrewsbury Liberal Democrats. "It was politically driven, designed to meet the needs of Tony Blair not of the NHS. In 2002 when the Programme was announced we were told it would deliver four things in time for the 2005 General election. Those of us working in the field could see that two of those would be difficult if not impossible to achieve in the time, and the other two were things that were not really a priority for the NHS. In the event, of course, none of the four items were delivered in time for Tony Blair to claim his success."

"When Richard Granger was appointed as the highest paid civil servant to run the project, he systematically ignored or abolished the user groups and consultative committees that had been built up throughout the NHS. He employed instead his own advisers and a large number of management consultants. It was as if her were saying 'Don't bother me by telling me what they want, I'll tell them what they are going to get.' "

"The latest report from the House of Commons Public Accounts committee makes pretty sorry reading. Almost nothing is going according to plan. What saddens and surprises me, is that when the project was first examined by the members of the Public Accounts Committee in 2006, Richard Granger was able to pull to wool over their eyes and they did not realise the monumental wasted of money and the tragic wasted opportunity that this project was becoming."

There have been successes in the delivery of IT in the NHS. Computerised X-rays (PACS) have been introduced. PACS greatly increases the efficiency of X-ray departments and increases patient safety. PACS, however was not originally part of the National Programme for It in the NHs, and could have been introduced anyway. The introduction of PACS is partly due to pressure from two Shropshire doctors: Dr Michael Dean, a Shrewsbury Radiologist, and Dr Charles West at the NHS Information Authority.

"The great tragedy." said Dr West. "is that so much could have been done. The NHS should have adopted an incremental approach, using systems that had been tried and tested, setting standards for intercommunication and enabling links between Primary and Secondary Care. And it should have involved the users."