How an IT programme became a licence to print money

Connecting for Health, the £12 billion national IT programme for the NHS launched in 2002, is in serious trouble according to the National Audit Office, and mighty have to be scrapped.

Billed as the world’s largest civilian IT infrastructure project, its primary objective was to provide an electronic care record for every patient. Since patients could find themselves being treated in a wide variety of different settings, by a growing number of clinical specialists, it was becoming increasingly important to ensure that they all had access to the record of care.

This would reduce the costs of repetitive examinations, and enable a much more effective collaboration between generalists and specialists. To those involved in population medicine, and public health specialists dealing with epidemics, access to an entire population’s health records promised a rich seam for research. Drug companies were hovering like vultures, awaiting new data on prescribing patterns and disease trends.

But now comes the NAO’s a stark conclusion: "The original vision for the national programme for IT in the NHS will not be realised. The NHS is now getting far fewer systems than planned despite the Department [of Health] paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme.”

But there’s a lot more to it than that. Before the programme was launched, hundreds of people across Europe and the USA, including clinicians and information specialists - those close enough to unravel the complexity of the project - had been working on the project for years. They were developing the standards needed to provide the development path that would ensure information could be shared across the multiplicity of systems that had been already installed in health care and those yet to be developed.

What the NAO doesn’t do is to judge the consequences of the decision by the New Labour government to hand the entire programme over to the private sector. Decades of work on standards were thrown away.

In 2003-04, the health department awarded five 10-year contracts totalling some £5 billion to four suppliers for the delivery of local care records systems: Accenture in the East and in the North East; BT in London; Computer Sciences Corporation (CSC) in the North West, and West Midlands; and Fujitsu in the South. The aim was for detailed care records systems to be delivered to all NHS trusts and GP practices (excluding GP practices in the south) by the end of 2007, with increased functionality and integration added until full implementation was complete in 2010.

The naïve expectation from the new project leaders was that the competing suppliers, with little or no knowledge of health care systems, would talk amongst themselves to develop the standards needed to enable records to be shared across all systems.

Now only BT and CSC remain in the game. Whilst the broadband communications infrastructure is up and working, and x-ray and other images are routinely transmitted, and many patients are offered a choice of where they go for hospital treatment, as the NAO says, the care record is unachievable.

After years of missed deadlines, incomplete and inadequate systems and adjustments to the specifications and contracts, the outcome is an indictment of both New Labour’s cosy relationship with the business sector and the failure of market-led solutions.

New Labour effectively gave IT contractors a licence to print money as part of the introduction of the market into health care. Next came foundation hospitals that were run like commercial organisations. You don’t have to be a genius to see where the ConDem government got its inspiration for NHS competition from.

Gerry Gold

Economics editor