Survey shows waning support for NPfIT

20 Nov 2007

Waning enthusiasm from doctors for the National Programme for IT (NPfIT) is recorded in a Medix survey of medical opinion prepared for E-Health Insider and other media.

Only 30% of GP respondents say the programme is an important priority, compared to an all-time high of 70% in a similar survey in November 2004. A parallel decline is recorded among non-GPs whose rating of the programme as an important priority has dropped from a high of 80% to 45%.

Although 23% and 35% of GPs and non-GPs respectively said they were enthusiastic about the programme, the ratings stood at 56% and 75% four years ago.

Asked to rate the programme’s progress, the vast majority (71%) scored it as poor or unacceptable. No respondent checked the box for ‘excellent’ and only 1% thought NPfIT was making good progress.

Connecting for Health, the agency responsible for the programme, says the results of the survey do not appear to reflect the general picture on the ground or chime with other recent comprehensive surveys.

The Medix survey is the latest in a series that started over four years ago. It was conducted at the end of October and beginning of November, gathering the views of 1,064 doctors - just over 1% of the medical profession in England - comprising 44% GPs and 56% doctors practising in other areas, predominantly hospitals.

In both groups, large numbers of respondents maintained a positive belief in the programme’s potential to deliver benefits for patients, with 48% of GPs and 60% of non-GPs foreseeing a positive effect on clinical care in the longer term. About half of these respondents also believed there would be benefits in the next year or two.

However, the doctors were divided on the question of whether there would be improvements in their own working lives with 50% of non-GPs seeing the potential for gains in the longer term - but only 27% of GPs holding the same view.

There was a continuing high degree of pessimism about the effect on patient confidentiality of the Care Records Service (CRS), which will see much wider use of electronic records. Over three quarters of GP (76%) and more than half (55%) of the non-GPs felt the new service would make confidentiality worse.

On the upside, however, 47% of the total sample thought the CRS would enable better decision making by giving clinicians access to up-to-date information.

Some of these enthusiasts appear to believe that some loss of confidentiality might be price worth paying for better information. Nearly half (44%) of respondents who had answered positively to the question about improving clinical decision making felt that some additional risk to confidentiality with the advent of the CRS would be acceptable.

Among the specific NPfIT initiatives, Choose and Book continued to be most controversial. There was evidence of substantial numbers of GPs becoming familiar with the choice and e-referral programme; 74% said they had some experience of using the service and, of these, about half used it for more than 40% of referrals.

Among free text comments recorded by the survey it was hard to find anyone with a good word to say about Choose and Book, though some respondents conceded it was a sound idea in principle and others thought local implementation, rather than the national application, was the source of problems.

“Hopelessly slow and wasteful of resources”; “out of focus and off-plot for the tasks in hand” and “unsupportable and a colossal waste of resources and clinicians’ time” were among the comments made.

A copy of the survey was sent in advance to Connecting for Health and a spokesperson commented: "NHS Connecting for Health engages in active and ongoing consultation with a wide range of clinicians, across all elements of the National Programme for IT, both in the development of systems and in their ongoing use. Only today [Thursday 15 November] 200 clinicians gathered in London to meet with the programme's senior management.

"We take the views of the public, patients and front-line NHS staff very seriously. We would view these results in light of what patients tell us. For example on the positive contribution Choose and Book has made to patient referral times and the early signs from those areas introducing the Summary Care Record about the improvement this will make to patient safety.

"In the light of all of this wider experience and evidence, the results of the Medix survey do not appear to reflect the general picture on the ground or chime with other recent comprehensive surveys.”

Link

8th Medix Survey re the NHS National Programme for IT

Linda Davidson

Reader's Comments

Other comprehensive surveys ...

20 Nov 07 09:46

After a fruitless search I'm wondering which encouraging reports these might be? Can anybody point me in the right direction please?

Management by Fact or Management by Fiction?

20 Nov 07 16:43

Truth and honesty required please from the folks handling PR at CfH not further spin. By being in denial of the realities of the perception that exist (some of which could be unfounded) will only make things worse and inevitably increase the risk of total failure - the opportunity cost of that far outweighs the escalating cost to taxpayers.

Only by facing up to the facts as they are now and confronting the issues head on - Impossible contracts / escalating costs / non-delivery / lack of confidence over the details of the NCRS (sealed envelope being one example) being implementable in any reasonable timescale etc., etc., ...will there be any possibility of faith being restored. Denial at this stage is yet further evidence that the 'Big Elephant in the Room' is just being ignored again and again. Sadly it's likely that we shan't even be able to see the elephant shortly for the long grass.

In Strategic Management - the use of Force Field Analysis as a tool to improve business performance and achieve desired outcomes is used successfully by many organisations. One of the tenets for using this method is to accept the Forces against Change at face value and only by doing this is it really possible to manage the Forces FOR Change.

Simply put - Enough is enough CfH (who should that be now?), admit there is a problem and deal with it in an adult and professional way and you'll earn far more respect that way. One thing's for sure it certainly won't fix itself.

Management by Fact or Management by Fiction?

22 Nov 07 12:56

Some very good points made in this comment. What if NPfIT can not be fixed? What if it is the strategy and whole approach that is wrong? It is my belief and that of many people I talk too, that a centralised electronic health record system is fundamentally a bad thing. There are many reasons but here are only a few that are becoming more and more obviously visible.

1) The system will need to be astoundingly complex and is therefore more vulnerable to failure and difficult to implement. Result, delayed implementation and huge reliance on work arounds.

2) The strategy destroys any meaningful health PAS software devlopment market in the UK (if it ever does replace all the systems that is). That means you can kiss goodbye to targetted, benefit driven innovation in speacialist areas of service. When there are only two suppliers there will be no meaningful competition and the system will stagnate.

3) If the system ever gets off the ground changing it will affect everyone in the NHS, so it will cost millions in change management, so they wont. Same affect as point 2.

4) The system will have billions of transactions. Anyone who says they can meet the care records guarantee in this hugely complex and fast moving environment, without applying huge amounts of administrative resource, isnt telling the truth. Every transaction is a potential security hole.

5) if successful we will be putting the entire operation of the NHS into two (admittedly very complex and large) baskets. High availability and resiliance will be hugely complex to set up and administer, so there are huge and many possibilities for failure. As the airline crash investigation process has shown, if a complex set of events can cause a catastrpophic failure you cab be certain that they one day will. One hoptial losing a system for a week is a local problme. 300 hospitals all losing thier out patient data for a week is a national disaster. Its not an if, its a when.

There are more. I have been saying for the past four years that NPfIT is simply the wrong way to do this. You can have the benefits of joined up EPRs without a single PAS contract. Set standards for data interoperability and sharing, publish them and review them. Set up an accreditation process and police it properly. Make meeting those standards mandatory in all NHS IT procurements. Inject the cash directly into the health care provider organisations, by passing the huge swathes of accountants and administrators employed by the NHS just to organise yet more work shops. Sit back and watch the structure grow as thousands of exisiting NHS IM&T staff are mobilised to introduce benefits driven systems, instead of sitting waiting for the centre to do something. Watch the NHS IT market grow as cash is injected and due diligence is observed. The tradgedy is that the Government can never and will never admit they got this horribly wrong. Our best bet is that they apply massive spin and pretend a standards apporach is what they meant from the start. Why not? Its just as rediculous as saying NPfIT has delivered real benefits to doctors.

CRS and C and B distract and detract from patient care

24 Nov 07 10:54

PACS is brilliant - it does what clinicians need and want - delivers radiology pictures and results rapidly to the workplace.

CRS, certainly Cerner Millennium, actually distracts and detracts from patient care. So much time is spent with highly paid doctors and nurses feeding the ravenous beast with data to no benefit to patient, doctor or nurse. All data must be entered real time so that the patient may move on to the next ward, yet the data quality is low, the process time consuming, cumbersome, non intuitive and plain slow (If it were an Internt site, I would never revisit it, except as a demonstartion of how not to do it!). This week I have seen doctors and nurses with their backs to the patients struggling to recall how to data input months after go-live! Data inputting by doctors and nurses taking longer than the episode of care. It does not do what patients, doctors and nurses need it to do, and takes away time that should be the patients. It is a distraction from care, not an aid to care.

Similarly C and B does nothing a GP and Consultant want. It does not improve data quality in the referral, it does not speed the overall process, it is so hard to find the right clinic, it undermines the personal professsional relationship between patient, GP and Consultant.

Had the NPfIT developers ever stopped to find out how healthcare works in the UK, they could then have downloaded systems (e.g. the Veterans Admin softwarer FOR FREE) and developed it into a UK NHS version, instead of lining International Corporations' pockets with patients gold, and producing systems that detract and distract from patients care.

PACS - brilliant or just shiny brass ?

24 Nov 07 20:35

As the previous post suggests, PACS is brilliant, but the delivery via LSPs appears the most extravagant way to waste public money. In particular the central archive still does not allow sharing of images, and the transient technologies like CR have been charged for the full contract period.

And they won an award for it. Scandalous

Fact, Fiction and Corporate Amnesia

colin@clinformation.com

26 Nov 07 09:23

NPfIT's approach too technically complex? Centralisation not the right strategy? Benefits of the "EHR" unclear?

All these inconvenient truths were evident years ago (ERDIP programme findings etc). It's fascinating to watch and see how long DH can allow the CfH debacle to run before having to concede (inevitably I'd suggest) that it's failed! At the same time, it's a great pity that so many NHS resources that could be put to better use are being deployed into this programme.