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BMA says clinicians and patients must direct NHS IT

Doctors toughen stance as MPs and Cabinet Office begin National Programme reviews

The British Medical Association has called on the NHS to "take stock" on the national programme and reconsider its remit, as a series of tough parliamentary reviews began and a lead supplier proposed a strategy U-turn.

Dr Chaand Nagpaul, a member of the doctors' association IT industry party, told Computerworld UK: "Too often the programme has been aimed at supporting a political ambition instead of taking account of the real needs of the NHS. The programme's remit must be decided by clinicians and patients."

Today, the Public Accounts Committee and a unit of the Cabinet Office - the Efficiency and Reform Group - begin an investigation into the programme, after last week's National Audit Office report concluded it would not deliver value for money or its original clinical aims. The Department of Health has acknowledged the original view was "flawed".

With the parliamentary reviews proceeding, it was a chance for the government to step back and reassess the scheme, Nagpaul said. "The imperative has to be patient care," he said, adding that IT investment offered major potential when used wisely.

The programme's timescales were a key issue, he said. "The reality is that the NHS is now working in significant financial constraints and the time plans have to reflect what is affordable."

CSC, a key supplier with a £3 billion contract, has offered a new strategy for its work in order to win a go-ahead on the programme. The prime minister has publicly warned that all or part of the contract could be cancelled following the parliamentary reviews. The other lead supplier, BT, has already signed a renewal agreement, but any changes to the programme could have a significant impact on it.

CSC's rethink proposes a more modular, standardised deployment of systems, as well as better engagement of clinicians in development and planning.

The BMA welcomed the idea of better engagement, saying this had long been lacking. "One of the problems has been the implementation without adequately consulting doctors and patients," Nagpaul said.

Prominent IT industry analysts also supported the ideas, agreeing that this was overdue. Tola Sargeant, a director at TechMarketView, said CSC's plans were "sensible" but "really should have been in place sooner".

With CSC's suggestion that clinicians would be involved more in the "requirements, refinement and capture stage" of the project, Sargeant said, it served to highlight slow progress. It was "telling", she said, "that this stage is still ongoing more than eight years into the contract".

"We have long singled out a lack of proper engagement with clinicians as one of the reasons the National Programme for IT in the NHS has struggled across the board," she said.

Silvia Piai, research manager at analyst firm IDC Health Insights, said a lack of engagement "must be reversed".

"One of the reasons that clinical engagement has not happened, or has not happened enough [on the current programme], is that the original contracts left investments in change management to individual trusts," she said.

Sargeant said the more incremental approach to deployment, proposed by CSC, was wise, adding that it "ought to make the deployments smoother".

But she warned that the idea of standardisation would be difficult. "I think this will be the hardest thing for CSC to deliver on," she said. "There is no such thing as a standard NHS trust and the backlash against 'ruthless standardisation' is another key reason the service providers have struggled to deliver on NPfIT's promise.

"Even trusts that apparently have a lot in common often do things differently and persuading clinicians to accept less tailoring of the systems is not going to be easy."


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