Stretching the length of Britain, an ultra-high-speed broadband data highway designed to link every hospital and doctor in the country at the click of a mouse has been built by BT at a cost of some £600 million. But will it ever be used? This is the key question to be asked about the colossal drive to computerise the NHS that ministers insist will transform the service offered to its patients. It is a question that the National Audit Office’s latest survey fails to answer.
The National Programme for IT in the NHS, also known as Connecting for Health (CFH), is a laudable effort. It was conceived to make a reality of patient choice by allowing GPs to refer patients anywhere in the country as easily as buying a book on amazon.com. It is meant to hold 50 million continually updated sets of personal medical records ready to follow patients wherever they might need them, with case histories, X-rays and ultrasound scans also instantly available as digital attachments. And it is supposed to do away with paper prescriptions.
Given that some updating of existing NHS computer systems is inevitable, a bold approach is better than overcaution. But the scale of CFH is unprecedented. With a total cost put yesterday at £12.4 billion, double the Government’s estimate in 2002, this is the biggest civilian IT project in the Western world. Comparable schemes have proved worthwhile only when the cultural as well as technical hurdles they throw up are surmounted, and in this case they have not been. Until they are, CFH risks wasting much of what it spends.
Four serious flaws in the planned system have yet to be properly addressed. First, its broadband “spine” cannot serve its purpose unless connected seamlessly to hundreds of regional and local NHS networks. While many of these were primitive before the national programme was announced, some were sophisticated and popular with their users. Yet all are to be replaced with standardised software platforms whose benefits cannot be proven until they are plugged into the national network — so far, none are. In these circumstan-ces, institutional resistance is not just understandable, but inevitable.
Secondly, crucial questions concerning patient confidentiality and consent have to be resolved before a single set of personal medical records can be uploaded on to the new system — a process that the Government admits has already been delayed by more than two years. Thirdly, the Choose and Book system intended as the engine of patient choice is already showing signs of strain because of a shortage of time in GP surgeries. Many bookings that it was hoped would be made instantaneously on screen are being made by patients, at home, armed only with a reference number handed to them in haste by their doctor.
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The failure to win broad backing from NHS staff is the project’s final, and potentially fatal, flaw. Doctors and nurses remain not only unconvinced by CHP. Three in ten of them, according to the audit office report, remain unaware of it. The report’s main recommendations — that the NHS ensure its contractors deliver what it needs, and that it wins the support of its own organisations and staff — are deceptively gently worded. But the implied criticism is damning. At least £12 billion of taxpayers’ money is at stake, and yet the health of that investment is not guaranteed.