Dr Phil Hammond, GP and broadcaster

The Government’s absurdly ambitious NHS IT programme is destined not to work. So says Dr Paul Cundy, chairman of the GPC’s IM&T subcommittee, who also argues for some input from those who actually clip the toenails and change the bandages. And he’s not alone in his misgivings.

I went to an IT conference where the head of an NHS health informatics service expressed the view that the national strategy smacked of a last ditch effort from a desperate Department of Health to retain credibility for a project that would "melt down" within 18-24 months.

That was 18 months ago, it has to be said, and no-one’s admitting to meltdown. But a recent poll of IT experts found that 92% felt that key targets for the integrated care record service (ICRS) will not be met.

Now, if you haven’t got much of a clue about ICRS, you’re in good company. Despite all the Government talk about devolving power to the front line, the IT strategy has been very tightly and secretly controlled from the centre.

True, you can now find reams about strategy on the DoH website, but there’s no sense that those in the front line have been involved in designing a new system fit for the purpose.

This seems a huge missed opportunity. The reason GP computing is 10 years ahead of that in hospitals is because front-line GPs got together with IT designers to come up with systems such as EMIS that did exactly what they needed them to do.

Most GP surgeries now rely heavily on these systems to provide good quality care and proof for payment for reaching ever-increasing targets. At this year’s EMIS national users’ group conference there was a real worry that they would be landed with a watered down NHS-wide ‘one size fits all’ service which just doesn’t do the business.

I have some sympathy for the civil servant charged with delivering the IT strategy. Given previous fiascos in NHS computing, there is some logic in trying to keep a handle on it centrally, but in a service already driven by political deadlines he is trying to do too much, too fast.

At present, the NHS is riddled with different IT systems, few of which are compatible. Doctors transferring records from one system to another can lose data and often find the process near-impossible. Which is why the transfer to a new system must not be rushed, and must involve those who need to use it.

The IT programme is also not without risk to patients. The image of the NHS as one big happy family where information shared throughout it will remain confidential is very optimistic.

Just who will have access to your electronic records? For example, will the NHS tracing service be used to track errant parents who are behind with their maintenance payments?

Under ICRS, patients will have no choice as to whether or not their records are kept on the central ‘data spine’. The aim is for the data to be ‘pseudonymised’ for use in planning and research, and only to be shared with consent. However, clinicians will be able to override patients’ instructions in some circumstances.

New Labour are investing £2.3 billion over 3 years to kick-start the NHS IT programme, but its ultimate success will depend on recurrent funding. Large corporations spend 5-10% of their annual budget on IT, whereas the NHS spends just 1.8%.

The NHS needs to spend a minimum of £9 billion on IT by 2010, but there is no sign of the resources being committed. Staff shortages will be another barrier to implementation ­ who will keep NHS IT working while staff are training to use the new system?

If you’ve got a system that works for you, my advice is to hang on to it for as long as possible.

Guidelines in Practice, October 2003, Volume 6(10)
© 2003 MGP Ltd
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