An insider’s view of the NPfIT

By Tony Collins

Joe McDonald was national clinical lead for IT at NHS Connecting for Health. He has written an important account of life at Connecting for Health, admittedly at the tail end of the NPfIT.

 “The only acceptable news to be fed up the chain of command was good news. Good news kept the show on the road and the longer we could keep the show on the road the greater our chance of success.

“Messengers with bad news were routinely shot pour encourager les autres. We all had to become “good lieutenants” to survive and keep paying the mortgage. Doubly true if you were on a short term contract…”

Some of the comments on McDonald’s eHealth Insider article also show an important insight.

“… Let us not forget the number of commercial consultancies and consultants, that swore “black was white” as regards product quality and availability. Hired by poor senior PCT/SHA managers to influence our Board members that we (local IT leads) were so wrong…”

Another comment:

“It galls me that so many well respected senior persons, right down to SHA and PCT level, “bullied” us Acute IT Directors to accept NPFIT …

“When we asked the questions of how, when and why, we were told we were off message. Yet many of these people are still in positions of authority and power.”

And another:

“Some [senior people] have been downright obstructive when a trust has grown tired of waiting and made proposals to do something outside of NPfIT rather than watch NHS IT wither and clinicians’ faith in ever getting anything worthwhile die completely.

“…we’re soon going to see these same [senior] people popping up somewhere else in the NHS and having fingers in the IT pie again…”

Comment:

It’s fascinating to see how Connecting for Health operated within a democratic structure and yet operated independently with its own sometimes dictatorial power structures, a control on thought and what was said about it, and an ability to spend seemingly limitless sums on everything from hotels, travel and publicity films to consultancy with companies that shared the NPfIT vision.

All of this was made possible because CfH had the consent of [Labour] prime ministers and ministers who were happy to be fed – and accept willingly – a  diet that was confined to 95% good news. The other 5% was somebody else’s fault, usually the media and the NHS.

What made the NPfIT ideology particularly irresistible for a long line of ministers was that it was a good idea. That it was an impractical one is something they weren’t told.

It makes sense for a private company to be ruthless in imposing standard systems. You cannot do that in the NHS. The DH cannot always impose its will on an NHS that comprises a disparate set of semi-autonomous businesses.

Every hospital is different. Sometimes every ward within one hospital is different.

Radio 4’s Today programme this morning had an item on a group of doctors and nurses that are calling for all hospitals in the NHS to use the same type of chart at a patient’s bedside to monitor their vital signs. Even different wards within the same hospital use different charts.

Wards in large hospitals still use hundreds of different forms. If it’s hard enough to standardise processes and systems in a single acute hospital, how could IT within the whole of England be standardised, as the NPfIT envisaged?

At a more practical level, an exchange of information on the basis of technical standards is feasible – but unfortunately for ministers it doesn’t involve a politically- aggrandizing masterplan.

There is something wrong with a political system that allowed NPfIT to launch, and for NHS Connecting for Health to have had the control and spend it had.

It could happen again.

Joe McDonald’s article.

Joe McDonald on Twitter:  @CompareSoftware