By Tony Collins
“The National Programme for IT embodies the type of unpopular top-down programme that has been imposed on front-line NHS staff in the past,” said Maude.
Not quite in accord with these sentiments is a letter that has been sent out by the Department of Health’s top civil servant Sir David Nicholson the Chief Executive of the NHS. Nicholson is the Senior Responsible Owner of the NPfIT. The letter sums up the current state of the NPfIT without a word of criticism of the scheme.
“The National Programme has provided us with a foundation, but we now need to move to more local decision making if we are going to truly unlock the potential of information to drive improvements for patients and achieve the efficiency and effectiveness required in today’s health service,” says Nicholson.
Having taken on the job in 2006, Nicholson was not responsible for the NPfIT – which was founded in 2002 – but he was appointed by Labour in part to promote the scheme within the NHS.
His positive view of the NPfIT remains a little out of step with the coalition’s criticisms. But Nicholson is part of the permanent civil service and ministers hold office temporarily. It’s easy to get the impression that senior officials see their ministers this way.
Nicholson’s stance reflects the view of senior civil servants that the NPfIT has been a success. Nicholson was party to a briefing in February 2007 of the then Prime Minister Tony Blair on the state of the NPfIT. The briefing paper was entitled “NPfIT Programme Stocktake and said “ … much of the programme is complete with software delivered to time and to budget.”
In fact much of the National Programme is incomplete, late and the costs far exceed the original budgets, according to the Public Accounts Committee. Nicholson was knighted in 2009.
This is his letter last week to NHS chief executives on the “National Programme for IT and the latest steps to no longer run it as a centralised programme” …
In September 2010, we announced that the National Programme for IT (NPfIT) would no longer be run as a centralised programme and today I am writing to update you about the renewed steps being taken to achieve that change.
A modernised NHS needs information systems that are driven by what patients and clinicians want. Restoring local control over decision-making and enabling greater choice for NHS organisations is key as we continue to use the secure exchange of information to drive up quality and safety.
We are undertaking a review, led by Katie Davis, Managing Director for Informatics, of the full portfolio of Department of Health informatics applications and services to determine how we will take this work forward. I expect this to conclude and report in the Autumn. Alongside this, we are introducing new governance arrangements to support local decision-making, which we expect to be in place in the Autumn.
It is important to be clear that this review will build on the substantial achievements that have now been firmly established and are delivering real benefits to patients. Applications and services such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service will all carry on providing vital support to the NHS. Similarly, key national applications such as the Summary Care Record and the Electronic Prescription Service will continue to develop in line with our commitment to give patients real information and choice about their care.
We are working in partnership with Intellect, the Technology Trade Association, to develop proposals for how we can stimulate the healthcare IT and technology marketplace in future, to offer greater choice of supplier to local NHS organisations, while still achieving value for money across the service.
The National Programme has provided us with a foundation, but we now need to move to more local decision making if we are going to truly unlock the potential of information to drive improvements for patients and achieve the efficiency and effectiveness required in today’s health service.
There is no doubt that Nicholson’s actions are guided by sincerity and integrity. But his letter is a reminder that it is the civil servants that are in charge of Whitehall, not the ministers. The National Audit Office has exposed the blight on NHS IT of the National Programme for IT, as has the Public Accounts Committee and many others including academics.
Nicholson’s voice is the only one that really counts, though.
His views are in line with the institutional resistance in Whitehall to admit mistakes when anything undertaken by the civil service goes wrong. Senior civil servants who preside over failures and defend them in the face of outside criticism – particularly criticism from MPs and the media – are much more likely to be knighted than those that share the concerns of outsiders.
Andrew Lansley should take control of his civil servants, which may set a precedent for a secretary of state, Department of Health. If this is beyond Lansley, Francis Maude and Cameron should seek to exercise more control of the department.
Until ministers run the civil service, not vice-versa, reforms of central government IT, or indeed any major change in the machinery of government will not happen. All the signs are that senior civil servants are biding their time until after the next election when, they hope, reforms of government will have run out of steam. If the reforms fizzle out a great opportunity will have been lost.