Swindells to urge NHS IT pros to play part

1

The devil is in the detail

21 Apr 08 07:51

Sorry to be "picky" but surely it's GOOD information that saves lives (timely, accurate, reliable, unambiguous etc etc).

For many of us health IT professionals, it's still unclear how CfH's offerings will deliver the quality of information required to support safe patient care.

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2

Too Late

21 Apr 08 10:29

A belated and somewhat lame attempt to engage those members of staff utterly excluded from the NPfIT programme. From the outset of NPfIT, the incumbent IT staff in the NHS were regarded suspiciously as 'part of the problem' and all of us old fuddy duddies were going to be swept away by a tidal wave of young, inspired centralised talent. The private sector were the saviours and IT managers in hositals were seen as a barrier to be sidelined or ignored. The HC conference at Harrogate was ignored and sidelined, with NPfIT staff either not turning up or barracking us from the stand as being reactionary old farts. Richard knew all and we were the problem.

Of course we knew we werent the problem. 20 years plus of under investment was the problem. Only when we get a strategy which values the opinions and expertise of the IT staff who are working with clinicians every day, an open and involving strategy based on trusting the knowledge of those at the 'coal face', will there be any progress. We need to mobilise the talent we have and make change from the bottom up. Everything else has failed and will continue to fail.

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3

put up or shut up

21 Apr 08 11:16

I would like to heartily endorse the comment above. The NHS IT community were systematically denigrated and ignored by CFH and DH, to the extent that Lord Hunt described the NHS as having effectivly no IT. This attitude prevailed throughout the Granger years and as far as i can see still prevails. Lets face it, while there are endless warm words spoken about clinical engagement, there has been a complete and utter lack of professional enagagement. In fact, i dont beleive i have ever seen these words written down.

If the DH now - belatedly - wants to engage then it is they who need to step up to the mark, stop kow-towing to CFH and come and listen to the profession

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4

Right diagnosis, wrong treatment?

22 Apr 08 09:47

Mr Swindells comments have obviously hit a raw nerve, but prior to NPfIT the IT landscape was pretty dire. The fact that GPs were at the cutting edge of NHS IT shows how low the bar was set. Then there's the mystery of the disappearing IfH millions.

So whilst it's understandable for local IT people to vent a bit of spleen over their hurt feelings, shouldn't they also reflect a little on the widespread failure and lack of foresight that made NPfIT seem like such a good idea?

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5

thank you, doctor

22 Apr 08 11:45

I so enjoy venting my spleen, always a fruitful treatment i'm sure you'll agree. lets get straight your diagnosis: We (the NHS IT managers) failed to make Information for Health work because the funding was siphoned off by finance directors looking to plug funding gaps elsewhere. GPs on the other hand had protected funidng for IT under GMS and an vibrant user community comitted to making the products work for them.

As a result someone woke up and said:

'Something Must Be Done'

'NPfIT is Something'

'Ergo, we must do NPfIT, QED'

So instead of learning from the GP experience - protect funding and meet buisness need - we bought services that have proved impossible to deploy, becasue they were not what we wanted in the first place

....and now here we are being called on to ride to the rescue and make NPfIT work.

I'm just popping off now. I can feel my speen engorging

beta-blockers anyone?

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6

hurt feelings?

22 Apr 08 11:47

"I would like to heartily endorse the comment above. The NHS IT community were systematically denigrated and ignored by CFH and DH" After ten years within the medical IT industry, I'd like to know where these wise and respectable NHS IT people have been hiding.

After dealing with various health organisations, from primary care environments, through secondary care, up to PCTs all over the UK, I came to the conclusion that the standard NHS IT organisation revolved around a self proclaimed guru who sends minions to do his bidding while making himself indispensible to the higher echelons. The same was true of several of the software suppliers I had the dubious pleasure of working with. As with most generalisations, there have been individuals whose ability and attitude earned a great deal of respect; unfortunately they were greatly in the minority, which is why I don't think leaving the NHS IT collective out of the loop has been a great loss. I'm not saying it was a deliberate decision by CfH, but gift horses and all that. I completely agree that the tech architects and system designers should have drafted in the end users from the start, but Linux loving geeks who spend meetings whinging about the evils of Microsoft and how we should only be using open source (i.e. generally unsupported) software are no loss at all.

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7

Re: Right diagnosis

22 Apr 08 13:55

Dire landscape? Widespread failure? Lack of foresight?

I just don't recognise these as features of the pre-NPfIT era. However since the summer of 2003 .....

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8

Weather report: risk of high pressure

22 Apr 08 16:27

'....and now here we are being called on to ride to the rescue and make NPfIT work.'

At the risk of exacerbating the hypertension, no, you're being asked to behave in a mature and professional manner and put the best interests of patients in front of a lot of petty internal bickering.

And really, anyone who's thinking back to the halcyon days of the IA, probably ought to read http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=14§ionId=1.

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9

one foot in the grave

22 Apr 08 17:12

wow, a whole profession that is suffering from Alheimer's (classy touch that humourous link above), hypertension and splenomegaly. No wonder we are all a bunch of unprofessional self-appointed gurus.

despite our apparently terminal medical issues, I do think that my colleagues have done the mature and professional thing. They have put the needs of patients first, and the requirements of their organisations to meet those needs.

That's why they havent gone with CFH

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10

Re: Weather report

23 Apr 08 07:42

Forgive me for being blunt ... but the sort of arrogance implicit in the idea that CfH has a monopoly on understanding what is best for patients exemplifies the approach of NPfIT over the last 5 years and has - in no small way - contributed to its alienation from NHS professionals and its consequent failure to deliver.

I didn't write the posting to which the response refers but I fully agree with its sentiments. There can be no "one best way" of deploying information systems across an organisation as complex as the NHS - but looking at the project manager's so-called "impossible triangle" it seems that when you balance costs + timescales + delivered benefits NPfIT comes out rather worse than either the NHSIA or IMG.

Real maturity and professionalism involves acknowledging mistakes and learning from experience and we don't see much of either from CfH. In contrast, those working in its predecessor organisations seemed better able to work openly with stakeholders and respond to challenges in - dare I say? - a more grown-up way.

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11

Hurt feelings..

23 Apr 08 09:51

'After dealing with various health organisations, from primary care environments, through secondary care, up to PCTs all over the UK, I came to the conclusion that....blah blah'

First of all I dont 'deal with' various health organisations, I've worked in them and more importantly for them. You'll find that this actually gives you some insight and also importantly some 'buy in' to the actual organisation. I dont have much respect for someone who has 'dealt with' the NHS. In fact, in most ways I can see, you are the problem. And our feelings arent hurt. We are a lot tougher than you think. We will still be here managing services when those 'dealing' with our hospital have moved on to sell photocopiers or worse 'consultancy services'.

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12

Back to the point

24 Apr 08 12:24

These days, it's rather handy to be able to mobilise the 'best interests of patients' as a justification for doing something that's actually just the best interests of the organisation or the people working for it.

Nobody has the monopoly on what's in patient's interests, although there's a debate to be had about whether an IT-focused national agency is more or less likely to be able to identify this than a delivery focused local one.

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13

Dumped on, not empowered

28 Apr 08 16:18

“Information saves lives, so information professionals need to step forward and play their part in creating an NHS that is founded on quality, evidence and empowerment,” Swindells is quoted as saying.

As an IT professional who has worked exclusively in the NHS for the last 15 years, in a variety of healthcare settings, I know there has been no void around here, and lack of money at the coalface, and diversion from real progress by a series of grand centralised schemes have been the problem. Of these NPfIT was the biggest and most squanderous.

The Legacy Systems that CfH starved of resources because their vapourware would quickly replace them have been supported by .. Oh let's see - NHS IT professionals, and existing system suppliers.

The attempts to get the N3 network structured to support a sensible transition, and not just the grand vision... I recall a small band of NHS IT professionals trying to get BTN3 and NPfIT to act sensibly.

And digesting many massive documents, given to us late, with little time for review, and very significant potential impact on design, support and compatability. Yes, alongside the few clinicians who have been involved, many NHS IT professionals have been busy.

I for one, feel mostly dumped on through the whole process, actually right back from Frank Burns description of the profession as a bunch of Anoraks, but mostly by NPfIT and CfH and their hired hands.

There has been quality, and evidence of the ability to support the clincial process from many of our local projects, and that is what keeps us working for the NHS. Beyond the rhetoric, I truly struggle to consider an NPfIT project that has delivered. GP2GP is closest, and that still has significant problems.

Plus ca change.

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14

Do not knock the legacy

28 Apr 08 17:31

Not that I want money diverting to do it, but if you look at some systems since computing came into the NHS (early 1960s - thankyou 'UK Health Computing : Recollections and Reflections'), they actually had considerable longevity and when the sums were done they gave good value for limited money. So they did not interface with each other slickly - that was par for the course at that time .... and who designed, developed, delivered and kept them running? - the guys who stayed around in the NHS and working in partnership with it, who went native and worked locally - caring about what they provided to managers and clinicians who knew them well and were prepared to pull together to make things work! Any lessons unlearned there???