By Tony Collins
On Monday 29 October the Chancellor will announce his 2018 budget. Taxes are expected to go up to provide extra funds for the NHS.
Health secretary Matt Hancock has already said that part of £20bn extra for the NHS will be spent on making “making the NHS an ecosystem for the best technology available”.
But a former Conservative minister George Freeman – who is an advocate for more NHS IT spending – has expressed his “horror” at the way money has been allocated to NHS IT.
His comments suggest that no lessons have been learned from NPfIT, the disastrous £10bn NHS IT programme.
Freeman is no stranger to the world of IT. Before entering politics he ran a predictive toxicology business that created an algorithm to look at existing drugs and side effects and how drugs could be more effective.
When in government in 2014 he was Life Sciences minister with a responsibility for digitising the NHS. In 2016 he moved to head up the upcoming Prime Minister Theresa May’s policy board. He resigned from that role last year.
Now the BBC reports a talk by Freeman to the Taxpayers’ Alliance in which he described his “horror”, when he was Life Sciences minister, at being handed £4.2bn to create a “paperless” NHS in England by 2020 without a plan how to do it.
Although Freeman’s ministerial role was digitising the NHS, he had not been involved in the 2016 public spending talks. He said his civil servants were ordered to set out how they would spend the money only after it was allocated.
This is how things are done in government, said Mr Freeman. This is why schemes go wrong, he suggested.
“The deal was done between Jeremy (Hunt) and George (Osborne) – it was a good thing, a big chunk of money to digitalise the NHS,” he said. His civil servants were delighted to have secured the money, he said, but when they were asked to produce a delivery plan, involving 26 different “work streams”, the “system” proved incapable of doing it.
When he visited the team charged with designing a new digital health care system, he found the designers were “nice people” who had based their work on academic literature rather than the experiences of patients and clinicians.
Freeman wanted to make his point that “top down” solutions never work. He said,
“The Treasury should have said you are not even having a penny until we have got your delivery plan and until we know that you are not just going to buy a system off the shelf from some big company.”
Freeman said it was scandalous that the health service still relied on “paper and cardboard” – and 20 year-old computers – when doctors, nurses and patients all had smart devices that could be used to access records and online communities.
He said the answer was “lots of local digital solutions” designed by doctors – and he claimed the IT industry would “quickly” work out how to get the different systems to talk to each other.
“Hiring an off-the-shelf big package from one of the big companies has been proven time and again to fail,” he said.
NPfIT – in which big IT companies were given contracts worth billions of pounds – was “dismantled” in 2011 as a failed £10bn scheme.
As in Freeman’s time as Life Sciences minister, the NPfiT began as a generalised scheme without any clear or precise plan as to how the new billions would be spent.
It’s astonishing that after 30 years of repeated and costly IT failures in the NHS, little or nothing in Whitehall seems to have changed in the way policy-makers allocate central funds to NHS IT.
All governments want to digitise the NHS without knowing what that involves and without getting the basics right.
Today ministers will talk at every opportunity about the benefits of artificial intelligence and “building an ecosystem for the best technology available” rather than listening to what clinicians and nursing staff want. Clinicians and nurses do not want to spend 20 minutes or more every day logging into a plethora of different systems that don’t talk to each other.
Clinicians and doctors do not want to hear from ministers about how much is going to be spent on a paperless NHS, or on making the NHS world-class, when their existing systems are, for various reasons, unavailable.
It’s true that, apart from all GP practises and a small number of hospitals where impressive systems are part of the culture of the organisation, the NHS is still largely reliant on paper. Still, that does not justify spending £4.2bn without a clear idea of what clinicians and nurses want and need.
How many more governments will over the next 30 years continue the apparently hard-wired trend in Whitehall of professing to have learned lessons from past failures while overtly displaying a contempt for those same lessons?
As Freeman suggests, the best way to spend money on NHS IT is to allocate it to groups of local clinicians and nurses (and especially not hospital boards) to decide how to spend it within a coherent national plan for systems to talk to each other, over secure internet links if necessary.
This isn’t to the taste of senior Whitehall officials who’d rather have central control and a grand strategy to announce in ministerial statements.
Will anything change? Probably not. The likelihood is that we’ll all be paying increased taxes – to be announced on 29 October – for more NHS IT disasters.
Thank you to openness campaigner David Orr for alerting me to Freeman’s comments.