NHS IT

Today I posted a comment in response to an article about NHS IT by the Guardian's Michael White that appeared in the HSJ.  As always, Michael's analysis is perceptive and relevant whilst also managing to be clear and entertaining.  His two key point on NHS IT were:

1. The public sector does not have the monopoly on failure, but the private sector manages to hush it up.
2. Some parts of the National Programme have been a succuess - he cites Choose and Book, although this, and any other possible candidates is/are debatable in my opinion.

My comments were intended to augment these points with some specific issues relating to the strategic failure of NPfIT in spite of any tactical successes.  I'm not sure this was wholly successful, but it does help to clarify some long-standing thoughts about the problems with the programme.


The points that you 'gently' make are correct, but I think there are other significant issues that have acted to stymie the National Programme:

Firstly, the arrogance and hubris of key decision makers who want to inflate the scope and complexity of such projects so they can take short-term credit for their visionary leadership (ie the largest civil IT project in the world etc) even if it then fails in the long-term (the NHS failed to deliver).

Secondly, the blind faith of those decision makers in private sector ethos - NPfIT was largely conceived, lead and managed by management consultants or former management consultants.  Even today, key parts of NHS Connecting for Health are staffed by these people, some of whom have been retained at public expense for a decade.  Whilst creating the impression of intense activity, many of the decisions made by these people have been ill judged and self serving.

Thirdly, the complex organisational dynamics between the DH, its quangos and the many quasi-independent NHS organisations.  This results in a constant tension as each organisation seeks to exert control, but has also generated a culture of 'constructive disobedience' in local organisations.  It is this that has enabled the leaders of those organisations to resist taking nationally procured systems that benefit the NHS as a whole but may not represent a significant improvement locally.

I'm sure there are many many more points that could be made, but these are three areas where i can't see any prospect of change occuring any time soon.

HealthSpace - stuck in policy purgatory

It comes as little surprise that the NHS HealthSpace system si to be reviewed yet again.  Anyone familiar with this online 'personal health organiser' (and there are precious few of them) will be aware that it provides very little functionality that is not better provided elsewhere. 

Having been thrown together hastily by a government / Department of Health keen to be seen as at the cutting edge of Web 2.0, it has had next to no development or investment, whilst the decision to tie it in to Summary Care Record (SCR) rollout has added and unwelcome political dimention.  The unfortunate truth is that the SCR in its current form will not pull ih the crowds for HealthSpace.

So what are we to make of the decision to continue with the service pending another review?  Trisha Greenhalgh, the lead reviewer for the UCL team looking into the SCR and HealthSpace is scathing of NHS Connecting for Health for not recognising the system's failings and taking the bull by the horns:

“It shows a bit of a lack of courage from NHS Connecting for Health that it can’t actually look squarely at something that hasn’t taken off and
say ‘well that didn’t work did it? Let’s stop pouring money into it’ – they kind of just left it hanging.”

Whilst the sentiment is quite correct - someone in authority ought to make this decision - the problem is that it's not CFH's call to do so.  Saddled with a government policy to deliver the thing, CFH cannot just turn it off without the policy owner in the Department of Health taking responsibility for the decision.  As is so often the case, nobody in the DH is actually willing to take that decision.

So we have an impasse: people in CFH know that HealthSpace is a crock, but lack the authority to do anything about it.  The people responsible for the policy in DH can't or won't make a decision.  So CFH must continue to provide the bare minimum life support for a service it thinks is pointless and rubbish, but DH continue to keep it on the policy roster and occasionally big it up for a soundbite.

Ah, the machinations of government.