The Cost of Doing Nothing
Paul Taylor · Computers and the NHS
There are no good news stories about computers and the NHS. The reporting of Friday’s malware attack may, however, be usefully different from the typical bad news story, in which hubristic politicians or nameless bureaucrats waste millions, if not billions, of public funds on projects which go over budget, fail to deliver, prove to be unusable or collapse under pressure. In this instance it seems that, for once, inaction and underinvestment have led to something sufficiently focused to be newsworthy, showing that there can be a political as well as a human cost to doing nothing.
For most of the 21st century, the story of NHS IT has been the slow unravelling of New Labour’s ambitions for the transformation of public services. In February 2002, Tony Blair committed his government to a programme that was supposed to take the NHS, in two years, from being largely paper-based to having a seamless IT architecture, enabling a new generation of consumer-friendly digital health services. The mistakes that were made in the pursuit of this vision, which became known as the National Programme for IT, have had devastating consequences for those whose care was supported by NHS IT systems over the last 15 years.
The government entered into huge contracts with large corporations that promised to supply systems they couldn’t engineer, and for which the NHS couldn’t specify the requirements, under a set of hugely prescriptive constraints determined by the politicians who had initiated the process. It wasn’t an unmitigated disaster: radiology departments moved quickly from analogue to digital; it became straightforward to transfer records between GP practices; email and directory services were transformed. But it was, undeniably, a disaster. For all the billions that were spent, the central aim, to transform hospital IT services, was never achieved.
After the 2010 election, the coalition government dismantled the programme and busied itself creating other difficulties for the service, its employees and their patients – until 2013, when Jeremy Hunt promised to spend £4 billion making the NHS paper-free within five years. Last year a US doctor, Robert Wachter, was invited to review progress and produced an unusually lucid and helpful report. One of its sensible conclusions was that the 2018 target should be scrapped. Wachter argued that the lessons of New Labour’s National Programme should be learned but not overlearned. He suggested that the available funds should be spent carefully, and would be best focused on trusts that were already some way to achieving ‘digital excellence’. The report was accepted and a premier league of ‘global digital exemplars’ identified, along with a second tier of ‘fast followers’. To the staff in less fortunate trusts, and to those staring at frozen screens this weekend, this must look a lot like trickle-down economics.
In the hospital over the road from where I work, IT staff try to maintain and support something like 350 different computer systems, navigating a variety of different contracts with a diverse range of suppliers. It isn’t sustainable. The rational thing to do would be to procure a single integrated system that supports most of the hospital’s essential functions. Only a handful of US companies can meet the requirements of the tendering process for such a system. It isn’t clear that any can do so on terms that the trust can afford. But look what happens if nothing is done.
Comments
This makes sense for the majority of businesses, who are neither large enough nor specialised enough to justify a bespoke system or inhouse development, but it makes little sense for a complex organisation like the NHS. What the advocates had failed to appreciate was that the NHS's traditional difficulties with IT and data management arose from the divisions within the organisation. Not for the first time, IT was erroneously held up as a solution for organisational and process deficiencies, and one that could be imposed from without.
The marketisation of the NHS, begun by the Tories but perpetuated by New Labour, has simply amplified the inappropriate application of private sector "solutions", while the politically-driven fragmentation of the service since 2010 has exacerbated the organisational and process deficiencies. IT is just one dimension of this, so the current problems should be seen as symptomatic of a wider malaise, not as a tech failure.