NHS boss says NPfIT 'was not in right place'

12 Mar 2008

NHS chief executive David Nicholson says the NHS IT programme had become too centralised to support the move to a health service based on plurality and far more locally-based decision making by clinicians and patients.

Speaking at the World Healthcare Congress in Berlin on Monday Nicholson explained why the introuduction of the NHS National Programme for IT (NPfIT) Local Ownership Programme had become necessary to support the future structure and achieve a far more integrated and devolved health service, in which services are “wrapped around patients”.

Nicholson said: “It felt we’d reached a position where the balance was not in the right place”. The challenge he said was extremely difficult, “How does a very central system adapt to becoming a very local one.”

The NHS chief executive said that as a result of listening to the views of clinicians and patients the NHS IT programme was being reviewed and reshaped. “We are working through that now.”

Nicholson concluded by stressing the CfH programme was a critical part of wider NHS system reforms, now underway. “It is a programme that gives us the potential to make that extra leap to have a world class healthcare service.”

He stressed that systems changes on the scale being attempted by the NHS – including NHS IT - were difficult and often painful, but said benefits were being delivered, from reduced waiting lists, to increased patient choice, significant reductions in hospital acquired infections and the NHS set to achieve a £1.5bn surplus.

Nicholson spoke of the large amount of work that has had to happen in the background in the early years of the NHS IT programme, not always apparent to clinicians or politicians. “You have to put a lot of investment and time into things that don’t have an immediate payback.”

He said that politicians have been remarkably steady in their support of the programme, taking a long term view of its strategic importance to the future of the health service, despite a lot of negative press coverage. “Credit to politicians who have taken a large amount of criticism for little obvious benefit.”

But he acknowledged that such support could not be taken for granted and said that recent “losses of data”, such as the HMRC loss of data, had led to a “loss of public confidence” in government IT and information governance that created a potential risk to the aims of the NHS IT programme.

Turning to difficulties experienced with implementing systems, he said one of the problems is that users often bridle at efforts to standardise. “If you are doing a system implementation you should go for rapid standardisation, but the people who operate the health service hate that.”

Nicholson said the NHS IT programme he said it had proved difficult “We have to make sure we have the IT processes absolutely right”, but added benefits were already being delivered, thanks to new IT systems.

Despite difficulties and changes to the programme now underway, Nicholson said the health service’s IT programme had achieved significant benefit, already saved 400 lives. It also highlighted efficiency savings saying a quarter of a million paper prescriptions had so far been eliminated. “We are already seeing real benefits and real problems as well.”

Jon Hoeksma

Reader's Comments

Evidence of benefit and improved outcomes

12 Mar 08 15:27

Have I missed a published evaluation of NPfIT? Where is the evidence of increased benefit achieved and how it was measured and of the 400 lives saved?

Incipient schizophrenia

12 Mar 08 21:27

Dear Mr Nicholson,

Do you want a 'devolved health service, in which services are “wrapped around patients”' or 'rapid standardisation'

Choose one. You can't have both

Yours sincerely

The NHS

Credit to politicians for criticism?

ernst.nieschmidt@centrallancashire.nhs.uk

13 Mar 08 08:37

Oh, the poor politicians! It's a hard life being criticised. What about those of us tasked with implementing NPfIT and all the NHS staff using these systems. These are the people who deserve the real credit continuing to use systems which don't always do what it says on the tin and doing their best to make them work.

Cost effective NPfIT?

13 Mar 08 20:41

£2.4 billion for 400 lives? How does that reconcile with the economics used by NICE when it makes its decisions on new treatments?

Re: 400 lives saved

14 Mar 08 10:16

David Nicholson is quoted here as claiming that the NPfIT programme had "already saved 400 lives". However, there is no mention of that in the recently published National Programme for IT Benefits Statement 2006/07. http://www.connectingforhealth.nhs.uk/about/benefits/statement0607.pdf

Does anyone know the origin of the claim?

99.99% cost saving had the focus been on standards...

14 Mar 08 10:34

There is no evidence of a split personality in what is being said; just a realisation of the truth: billions have been wasted. Standards do not require centralisation around LSPs or a new hardware system (e.g. the spine & data centers). Also they are a successful way of working: videos took off after effective standardisation on the VHS format; arguably PCs became ubiquitous when Windows standardised the interface to hardware and Blu-ray is likely now to replace DVDs as a result of Toshiba conceding that this will be the standard. NPfIT could have been implemented for very little if the focus had been on developing standards for an electronic record, a security model and a user interface as well as ensuring that suppliers met them. Small companies could have worked with trusts to implement locally effective solutions rather than be forced to consolidate to deliver a monolith that continues to fail to meet staff needs. The necessary innovation in the health care IT marketplace could have been maintained rather than lost, perhaps forever, as a few large foreign companies attempt to deliver inadequately and late, software for NPfIT.

Grasping at straws

14 Mar 08 11:00

So "a quarter of a million paper prescriptions have been saved". Let's put this in perspective...

>>in England, an annual average of 512,524,000 prescription items have been dispensed in the community in recent years. Should the current rate of increase continue there will be an estimated 791,550,000 prescription items dispensed in the community by 2010. Please note this figure does not include prescriptions dispensed in hospitals.<< Source - "Integrated Care Records Service PART III – COMMON REQUIREMENTS Output Based Specification version 2.0" 2003

Let's give David Nicholson the benefit of the doubt and assume "a quarter of a million paper prescriptions" have been saved >per year< by NPfIT with a very generous ten items per prescription.

That is 0.5% of the total number of prescriptions issued.

Straws that don't add up

14 Mar 08 14:22

I'm no NPfIT aplogist but the figures you give on prescriptions are worse than Nicholsons. "In recent years" is the least specific measure I have seen this month, even taking into account the DoH website.

re: Straws that don't add up

14 Mar 08 16:30

Those are not "my figures" - they are cited as per reference by CfH and by Nicholson himself in the above article.

Once again for those not paying attention

>>Nicholson .... saying a quarter of a million paper prescriptions had so far been eliminated.<< See above

Meanwhile "community pharmacies in England and Wales ... dispense 665 million prescriptions per annum"

http://www.pharmafield.co.uk/article.aspx?articleID=255&issueID=8

Therefore electronic transfers of prescriptions with dispensing as an outcome (as opposed to an ETP message sent to the great bit bucket in the sky) remain in the ballpark of next to nothing - unless of course you come back and tell us Wales accounts for 99% of those 665 million scripts.

Clutching at broken straws

16 Mar 08 17:13

Oh perlease !

0.5% of scripts bearing a barcode does not mean that the paper scripts have been eliminated. That is the plan for Release 2 of EPS, which is not yet with us. I do not believe a single script has become paperless.

For now, a tiny percentage of the total bear barcodes, and a tiny percentage of those are being scanned. Why ? Because the NPfIT systems are too slow for pharmacists to use. And even if they scan the script, many pharmacists complain of inadequate information, or repeats of abbreviations they had corrected previously.

Just like with Choose and Bicker, this is also down to the integration with other systems, but to claim the paper has been saved is plain wrong.

And of course, the Care Record, which has not even delivered a good Patient Administation System for Acute hospitals yet (when we know community care is the growth industry), shows how woefully out of touch the programme was all along.