NHS IT programme faces cuts

1

Pass the switch

07 Dec 09 00:48

So as the Conservatives stumble around in the dark will they realise before its too late that as they throw the big switch on the supercomputer, that they just switched PACS off, and all that sort of thing? Do they have extensive share holdings in Kalamazzoo perhaps?

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2

Lobbyists Gone Wild

07 Dec 09 05:38

Ashish Jha et al at Harvard have shown that hospitals using electronic health records do not have better quality as reported in the New York Times on 15 November 2009.

David Himmelstein et al also at Harvard conclude, recently reported in AJM, that hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.

Thus, there is developing proof that computerization is not all that the HIT vendors and HIMSS lobbied it to be. Shadow Health Minister O’Brien articulated this circa October 2008. On these pages of e-Health Insider, it is noted “once major IT suppliers had become involved…this had translated into a programme that aimed to drive rather than support change in the health service”, an uninvited invasion, if you will.

O’Brien astutely observed, “the government was seduced by a dream of IT, instead of seeing it as an enabler of a better health service”. How did this come to be?

The HIMSS’ lobbyists “educated” government officials and continues to promote HIT industry devices (Jeremy Thorp at the “Global Summit”, 18 October 2009) despite assuredly no proof of efficacy with many being "not fit for purpose", as described at the Milton Keynes.

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3

Not Fit For Purpose

07 Dec 09 06:20

The Chancellor is to be commended for recognizing the benefits of limiting expenditures on things with no proven efficacy and only theorized safety benefits. Better late than never.

Wisdom ought to bring them to demand the MHRA to require scientific study to prove safety and efficacy, as Sweden has done. The current state of affairs appears to enrich the HIT vendors and no one else, while doctors and patients have suffered at several of the trusts.

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4

At long last ...

07 Dec 09 07:46

This is surely the best news in UK health IT for 7 years!

Most of us NPfIT sceptics thought that the present government would string it out until the next general election when it looks as if it would then have become someone else's problem. It will be interesting to see whether the real Granger legacy has been nothing more than to lock the NHS into a set of expensive and unsatisfactory contracts.

At least by admitting defeat at this stage - and removing just some of the carriages from this particular gravy train - they will thankfully save at least half a year on numerous redundancy payment entitlements!

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5

Going to be tough........

07 Dec 09 08:35

I assume the Chancellor is referring to the CRS projects that are currently with BT and CSC.

The NISP projects are all  in place and arguably working well.

I suspect BT might be relived at a cash payout to walk away, assuming its large enough to satisfy their finance team. They had already declared part of thier whole so you would think it would be easier for them to accept some cash and walk quietly. BT also only have contracts for approx 25% of the country.

CSC however I suspect need the contract to run for along time to get thier pay back. And with 60% of the country committed to them thier compensation discussion will be somewhat more difficult to negotiate.

Either way the CRS programme is dead. No trust in their right mind will move forward now with a CfH deployment knowing that all three political parties have torpedoes armed and locked ready to fire. Indeed the first torpedo may explode before Wednesday when Andy Burnham declares his hand.

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6

Before you start dancing...

07 Dec 09 09:06

Well I can’t say I’m surprised at this decision, the lack of “visible” progress in the front line services was always going to be a problem. However, before we start to dance on the grave of the NPfIT we should remember some of the successes it has had.... (ten seconds later).... okay that's that done... just kidding... RiO in London has been a success, the national spine works, a lot of mobile technology and acute technologies have been installed and work. It is easy to be cynical about the National programme but a swift move to ASCC to deliver electronic care records, where organisations can select spine compliant applications would deliver a large chunk of the benefits without the unnecessary expense of the LSP solution.....

I hate to say it but I do support the decision to cut "delay" some of the programme, just give the Trusts the funding to buy their own systems as long as they are compliant with the spine... Bobs yer uncle...

 

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7

Two comments....

07 Dec 09 09:12

1. To say that the system does not benefit the front line is a load of tosh. IF the system worked as planned then there would be MASSIVE benefits to the front line (as i'm sure would have been pointed out in numerous business cases in the past). The problem lies with the fact that the damn system doesnt work properly (referring to LR1 + LR1.9 here). If the government had sorted the contractual issues out early doors then we would not be in this situation.

2. How about slimming down the SHA's and saving some money there ????

and before anyone attempts to shoot em down in flames .. YES I have used LR1 and LR1.9... YES I have tried both systems out robustly and YES they dont work like they should.

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8

Not dancing, waving...

07 Dec 09 09:45

I think it's far too early to get any useful information from what Darling has said in a 20 second part of a TV interview.  To be fair, it won't be the first time a senior member of this government has said something as a sound bite, and then ignored it and no action has followed.

I don't imagine for a moment that he has looked (yet) at the costs of cancelling all or part of the National Programme - I also don't imagine for a moment that he really understands what it is - he is still referring to it as 'The NHS IT System' - rather than the collection of software suites and infrasctructure that makes a small part of the IT in any NHS Trust!

It will be interesting to hear what comes from Wednesday's speech, but I seriously doubt it will clarify matters very much. In the meantime many Trusts are working hard (under pressure from SHA's and CSC) to produce and sign off PID's for Lorenzo - presumably in an attempt to pre-empt this statement and to ensure that the Trusts are 'engaged' in the process which will allow CSC to be paid for the completed system as if it had been deployed.  Remember, even the PAC were not allowed to see these contracts - there will be plenty on devil in the details to ensure that even if this government cancels or scales back the programme, future governments (and tax payers) will still be arguing over the why's and wherefore's for years to come.

The story is not over yet - I don't think it's even half-way through yet.

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9

Schadenfreude abounds...

07 Dec 09 10:09

"they will thankfully save at least half a year on numerous redundancy payment entitlements!"

What kind of comment is that? Some self righteous person sat on the bylines gloating over thousands of job losses, just to enjoy the chance to shout "I told you so!". I'd dearly love to know on what your scepticism was based - was it industry based experience, or a clinician's ego railing against being told there may be a better way to work?

One cannot wait for similar cuts to be enforced in the NHS, removing all the pointless levels of managment and clinicians' treats (4 days weeks or subsidised BMW for example), to see what the reactions by the current glee club will be.

Before people start bouncing round in glee, remember this - this is not money recovered from a project which had produced results, to be fed into an NHS which wastes more on middle management than is spent on CfH. This is a government proved both incompetent and impotent, trying to claw back money wasted propping up bankers and industries which can't run themselves without loss.

Cutting CfH out as is will result in incomplete implementations, wasting even more money on bringing in short term fixes to cover the replanning and deployment of long term solutions. I doubt this will come from a CfH legacy fund, rather it will come from your usual budgets.

No matter your opinion on NPfIT, the genie has been let out of the bottle; people have seen the benefits upgrading all of the outdated equipment and software being used by the NHS. Improved care resulting from previously unavailable resources has been noticed by patients, an unfortunately silent group in this argument. It would have been nice to see a report based on patient experiences in trusts using NPfIT architecture compared to those in areas without.

This attitude that the NPfIT experiment has been an unmitigated disaster, and yes there have been huge mistakes resulting from both mismanagement and active resistance, is going to make it a very brave minister who will in the future raise the suggestion of trying again - you're shooting yourselves in your collective foot by celebrating a desperate attempt to balance a budget as an admission that the project's a failure.

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10

Re: Schadenfreude

07 Dec 09 11:00

Actually, a clinician with years of experience in NHS IT management.

It looks as if the programme will be cut back radically - this now seems inevitable whatever the impact and the regrets about "might have beens" and "just as it was beginning to deliver".

So - with this in mind and for the benefit of the taxpaying public - the sooner the cutbacks bite and the lay-offs start the better.  Not Schadenfreude - just Realismus and a bit of recessionary Zeitgeist.

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11

Sorry...

07 Dec 09 12:27

In my experience, which is extensive, both as an ex employee of CFH and as someone who has worked in Trusts with them, CFH is full of people who work extremely hard, under constant pressure, in a desperately unsupportive environment and many of them very ably.

The problem is that all this activity is to deliver things that (at best) the NHS is not very interested in. At worst things that are actively unhelpful.

It is tragic and my heart goes out to those people who have worked for this orgnanisation, but like others who have posted above, i will not be mourning its passing