Category Archives: Choose and Book

What do Ben Bradshaw, Caroline Flint and Andy Burnham have in common?

Posted on 18/06/2015 | 1 comment

By Tony Collins

Ben Bradshaw, Caroline Flint and Andy Burnham have in common in their political past something they probably wouldn’t care to draw attention to as they battle for roles in the Labour leadership.

Few people will remember that Bradshaw, Flint and Burnham were advocates – indeed staunch defenders – of what’s arguably the biggest IT-related failure of all time – the £10bn National Programme for IT [NPfIT.

Perhaps it’s unfair to mention their support for such a massive failure at the time of the leadership election.

A counter argument is that politicians should be held to account at some point for public statements they have made in Parliament in defence of a major project – in this case the largest non-military IT-related programme in the world – that many inside and outside the NHS recognised was fundamentally flawed from its outset in 2003.

Bradshaw, Flint and Burnham did concede in their NPfIT-related statements to the House of Commons that the national programme for IT had its flaws, but still they gave it their strong support and continued to attack the programme’s critics.

The following are examples of statements made by Bradshaw, Flint and Burnham in the House of Commons in support of the NPfIT, which was later abandoned.

Bradshaw, then health minister in charge of the NPfIT,  told the House of Commons in February 2008:

“We accept that there have been delays, not only in the roll-out of summary care records, but in the whole NHS IT programme.

“It is important to put on record that those delays were not because of problems with supply, delivery or systems, but pretty much entirely because we took extra time to consult on and try to address record safety and patient confidentiality, and we were absolutely right to do so…

“The health service is moving from being an organisation with fragmented or incomplete information systems to a position where national systems are integrated, record keeping is digital, patients have unprecedented access to their personal health records and health professionals will have the right information at the right time about the right patient.

“As the Health Committee has recognised in its report, the roll-out of new IT systems will save time and money for the NHS and staff, save lives and improve patient care.”

[Even today, 12 years after the launch of the National Programme for IT, the NHS does not have integrated digital records.]

Caroline Flint, then health minister in charge of the NPfIT,  told the House of Commons on 6 June 2007:

“… it is lamentable that a programme that is focused on the delivery of safer and more efficient health care in the NHS in England has been politicised and attacked for short-term partisan gain when, in fact, it is to the benefit of everyone using the NHS in England that the programme is provided with the necessary resources and support to achieve the aims that Conservative Members have acknowledged that they agree with…

“Owing to delays in some areas of the programme, far from it being overspent, there is an underspend, which is perhaps unique for a large IT programme.

“The contracts that were ably put in place in 2003 mean that committed payments are not made to suppliers until delivery has been accepted 45 days after “go live” by end-users.

“We have made advance payments to a number of suppliers to provide efficient financing mechanisms for their work in progress. However, it should be noted that the financing risk has remained with the suppliers and that guarantees for any advance payments have been made by the suppliers to the Government…

“The national programme for IT in the NHS has successfully transferred the financing and completion risk to its suppliers…”

Andy Burnham, then Health Secretary, told the House of Commons on 7 December 2009:

“He [Andrew Lansley] seems to reject the benefits of a national system across the NHS, but we do not. We believe that there are significant benefits from a national health service having a programme of IT that can link up clinicians across the system. We further believe that it is safer for patients if their records can be accessed across the system…” [which hasn’t happened].

Abandoned NHS IT plan has cost £10bn so far

1 Comment

Posted in BT, Campaign4Change, Cerner, change management, Choose and Book, CSC, Department of Health, e-health, Fujitsu, Government IT, health, health records, IT-related failures, LPfIT, npfit, procurement, project management, SPfIT

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Why was NHS e-Referral service launched with 9 pages of known problems?

Posted on 17/06/2015 | 2 comments

By Tony Collins

Were GPs guinea pigs for live testing of the new national NHS e-Referral Service?

Between 2004 and 2010 the Department of Health marked as confidential its lists of problems with national NPfIT systems, in particular Choose and Book.

So the Health and Social Care Information Centre deserves praise for publishing a list of problems when it launched the national “e-Referrals” system on Monday. But that list was 9 pages long.

The launch brought unsurprised groans from GPs who are used to new national systems going live with dozens of known problems.

The e-Referral Service, built on agile “techniques” and based on open source technology, went live early on Monday to replace “Choose and Book” for referring GP patients to hospitals and to other parts of the NHS.

Some GPs found they could not log on.

“As expected – cannot refer anything electronically this morning. Surprise surprise,” said one GP in a comment to “Pulse” on its article headlined “Patient referrals being delayed as GPs unable to access e-Referrals system on launch day.”

A GP practice manager said: “Cannot access in south London. HSCIC debacle…GPs pick up the pieces. Changing something that wasn’t broken.”

Another GP said: “I was proud never to have used Choose and Book once. Looks like this is even better!”

Other GPs said they avoided using technology to refer patients.

“Why delay referral? Just send a letter. (Some of us never stopped).”

Another commented: “I still send paper referrals – no messing, you know it has gone, no time wasted.”

Dr Faisal Bhutta, a GP partner in Manchester, said his practice regularly used Choose and Book but on Monday morning he couldn’t log in. “You can’t make a referral,” he said.

The Health and Social Care Information Centre has apologised for the disruption. A statement on its website says:

“There are a number of known issues, which are currently being resolved. It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks. We have published the list of known issues on our website along with details of how to provide feedback .”

But why did the Centre launch the e-Referral Service with 9 pages of known problems? Was it using GPs as guinea pigs to test the new system?

Comment

The Health and Social Care Information Centre is far more open, less defensive and a better communicator than the Department of Health ever was when its officials were implementing the NPfIT.

But is the HSCIC’s openness a good thing if it’s accompanied by a brazen and arrogant acceptance that IT can be introduced into the NHS without a care whether it works properly or not?

In parts of the NHS, IT works extraordinarily well. Those who design, test, implement and support such systems care deeply about patients. In many hospitals the IT reduces risks and helps to improve the chances of successful outcomes.

But in other parts of the NHS are some technology enthusiasts – at the most senior board level – who seem to believe that all major IT implementations will be flawed and will be improved by user feedback.

The result is that IT that’s inadequately designed, tested and implemented is foisted on doctors and nurses who are expected to get used to “teething” troubles.

This is dangerous thinking and it’s becoming more and more prevalent.

Many poorly-considered implementations of the Cerner Millennium electronic patient record system have gone live in hospitals across England with known problems.

In some cases, poor implementations – rather than any faults with the system itself – have affected the care of patients and might have contributed to unnecessary deaths when records needed urgently were not available, or hospitals lost track of urgent appointments.

A CQC report in March 2015 said IT was a possible factor in the death of a patient because NHS staff were unable to access electronically-held information.

In another incident a coroner criticised a patient administration system for being a factor in the death of three year-old Samuel Starr whose appointment for a vital scan got lost in the system.

Within NHS officialdom is a growing cultural acceptance that somehow a poor IT implementation is different to a faulty x-ray machine that delivers too high a dose of radiation.

NHS officials will always brush off IT problems as teething and irrelevant to the care and safety of patients. Just apologise and say no patient has come to any harm.

So little do IT-related problems matter in the NHS that unaccountable officials at the HSCIC have this week felt sufficiently detached from personal accountability to launch a national system knowing there are dozens of problems with the use of it.

Their attitude seems to be: “We can’t know everything wrong with the system until it’s live. So let’s launch the system and fix the problems as GPs give us their feedback.”

This is a little like the NHS having a template letter of regret to send to relatives and families of patients who die unexpectedly in the care of the NHS. Officials simply fill in the appropriate name and address. The NHS can then fix the problems as and when patients die.

It’s surely time that bad practice in NHS IT was eradicated.  Board members need to question more. When necessary directors must challenge the blind positivism of the chief executive.

Some managers can learn much about the culture of care at the hospitals that implement IT successfully.

Patients, nurses and doctors do not exist to tell hospital managers and IT suppliers when electronic records are wrong, incomplete, not available or are somebody else’s record with a similar name.

And GPs do not exist to be guinea pigs for testing and providing feedback on new national systems such as the e-Referral Service.

e-Referral Service “unavailable until further notice”

Hundreds of patients lost in NPfIT systems

Hospital has long-term NPfIT problems

An NPfIT success at Croydon? – Really?

Physicians’ views on electronic patient records

Patient record systems raise some concerns, says report

Electronic health records and safety concerns

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Posted in Agile, Campaign4Change, change management, Choose and Book, Department of Health, e-health, e-Referral Service, Government IT, health, health records, HSCIC, IT successes, IT-related failures, LPfIT, NHS, npfit, open source, open standards, operational issues, procurement, project management

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Is Choose and Book failing?

Posted on 30/03/2012 | 2 comments

By Tony Collins

Choose and Book, which is one of the limited successes of the NHS National Programme for IT, may be “withering on the vine” says Pulse.

It reports that the Department of Health is investigating a fall in the proportion of GP referrals made through Choose and Book. Several PCTs have described Choose and Book as “failing”.

Pulse says that the Government’s notional target is for 90% of GP referrals to be made through Choose and Book, but the latest figures indicate usage has fallen from a high two years ago of 57%, to around 50% in January 2012

Initiated in 2004, Choose and Book is now in use in every PCT and provider organisation across the NHS in England, including many independent sector organisations that deliver services to the NHS under a standard, national contract.

Choose and Book provides patients with the offer of choice of hospital and clinic and a booked appointment.

The Department of Health told Pulse that there have been falls in use in some areas but it was committed to ‘embed Choose and Book into daily clinical practice’.

Choose and Book was classified as ‘failing and worsening’ in February board papers from Bristol, North Somerset and South Gloucestershire PCTs, says Pulse.

DH press release in 2003

A Department of Health press release on the award of a contract for an electronic booking system to Atos said in October 2003 said

“By the end of 2005, every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs.”

Pulse suggests the drop in interest may be because GP practices are no longer paid to use Choose and Book.

Through “local enhanced service” payments to GPs, primary care trusts have given family doctors a strong reason to use Choose and Book. The payments to GPs have ranged from about 50p to about £4 for every patient booked through Choose and Book. That funding is drying up.

A locum GP who commented on Pulse’s website suggests that Choose and Book will fall into disuse without financial incentives: “I couldn’t fit it [a Choose and Book appointment] into a ten minute consult what with QOF [quality and outcomes framework, part of the GP contract] the patient’s list etc – had to do referrals at the end of the day, so never used it.”

Comment

The failure of Choose and Book to reach anything like the original target of 100% use throughout the NHS shows the fallacy of paying people, in this case GPs, to use national IT systems.

New IT should be so needed that its use doesn’t depend on special payments to the end-users. Choose and Book was trumpeted by some major suppliers as a simple and obvious solution – rather like an airline reservation system; and after years of bedding down the technology works. But GPs cannot be forced to use it.

The Department of Health had considered the NPfIT  to be the centre of universe, and that doctors would want to use it for the common good.

The fact is that GPs  care only about their patients – which is as it should be – and if they consider the system detracts from the time spent with their patients the common good becomes an abstract, indeed meaningless, concept.

Choose and Book was always a good idea, a fun thing to work on. But does a 50% take-up after nine years justify the hundreds of millions spent on it? The Department of Health is hopeful the scheme will eventually succeed. But then the DH has always been confident the NPfIT would succeed.

DH to investigate fall in the use of Choose and Book – Pulse.

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Posted in Choose and Book, Government IT, IT projects, IT-related failures, managing change, NHS, npfit, operational issues, public services

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