Pulling the plug

The NHS’s failed attempt to go digital.

Data has the potential to be the lifeblood of the UK’s National Health Service. “One of the most important resources held by the UK health system is the data generated by the 65 million people within it,” wrote Bell, regius professor of medicine at Oxford University, in the Government’s Life Sciences Industrial Strategy. However, effectively collecting and securely distributing patient information remains one of the sector’s biggest challenges.

The UK Government attempted to tackle the problem back in 2002 when it launched the National Programme for Information Technology (NPfIT) NHS Care Records Service – the biggest civilian IT scheme ever attempted. The vision of the programme was to link up the entire NHS for the digital age, allowing patient records to be available electronically to all clinicians, while appointments admissions would be booked online and drugs prescribed electronically.

$12.7bn

The scheme was originally costed up to be around £5bn, but by 2011 that price tag had more than doubled to £12.7bn and was dubbed ‘the world’s biggest IT disaster’ by Edward Leigh, chairman of the Public Accounts Committee who reviewed the project.

So where did it go wrong? While there was a clear vision and huge political commitment, the implementation was flawed from the beginning.

The initial strategy was that national standards for NHS IT would be laid down but that local NHS trusts would be left free to commission their own suppliers and choose their own software. However, the programme became a centralized one managed by the agency, Connecting For Health (CFH). CFH was responsible for estimating and procurement, selecting contractors such as Accenture and CSC, with little apparent oversight from the Government.

Enormous, £1bn contracts were signed before talking to clinicians and finding out what they actually wanted. Hospital trust executives felt that such a centralised project was at odds with the federal structure of the NHS in England, where trusts are used to making decisions for themselves. After nearly a decade of pumping money into the project with very little yield, the NPfIT was officially dismantled in 2011. As a result, many hospitals still lack a comprehensive electronic patient record system. In The blunders of our governments, a survey of government disasters including numerous IT projects, authors Anthony King and Ivor Crewe describe NPfIT as ‘the veritable RMS Titanic of IT disasters . . . doomed from the beginning’.