NHSmail take-up minimal so far

One year on from award of a £90m contract with Electronic Data Systems (EDS), and six months after its launch just 2.3% of NHS staff have signed up to use NHSmail, the new web-based email system for the NHS.

According to an internal NHSIA report seen by E-Health Insider 25,074 NHS staff had activated a personal NHSmail account by 25 August. This is despite the service going ‘live’ in February and a national advertising campaign underway to promote the service.

The figures mean that one year on from the signing of what was billed as one of the largest corporate email system deals ever, just 25,000 out of the 1.2 million NHS staff have signed up for the service. If progress continued at the current rate it would take another 47 years to roll the system out to the whole of the NHS.

NHSmail is intended to provide every NHS staff member in England with an email address for life and enable secure electronic clinical communications across NHSnet. The service includes a national directory service containing details of all NHS staff. Staff must first be on the directory before they can activate their account.

According to the NHSIA report though some trusts reported significant numbers of staff signed up in many more instances just a handful, or none, had. In the NHSIA barely a quarter of staff had activated an account.

In addition, up to 10,000 of the 25,074 accounts activated by 25 August actually came from ‘early adopter’ sites, established during testing of the system between September 2002 and February 2003, suggesting that just 15,000 new NHS staff have signed up since NHSmail went live in February 2003.

The NHSIA announced the launch of NHSmail from 19 February 2003, having awarded a £90m contract to EDS in September 2002. Launched on a ‘self-service’ basis, is described as ‘critical’ to meeting the government target for all NHS staff to have access to email by March 2004.

Other than the target for access to email there are no formal targets for the adoption and use of the service, though the Government has said the directory service will contain details of all NHS staff by March 2004.

In July responsibility for NHSmail passed from the NHSIA to the National Programme for IT (NPfIT). The NPfIT, however, now claims that despite an announcement by the Department of Health on 25 March 2003 about NHSmail’s ‘live’ status, and heavy promotion of the availability of the service at the Healthcare Computing 2003 conference in the same month, that NHSmail has not actually been launched.

A national programme spokesman told E-Health Insider: "The NHSmail service is currently in its development phase prior to being fully launched. A limited service went technically live in February 2003 to early adopters." The spokesperson added that a full version of the service is due to be launched ‘soon’ but declined to provide details.

But in the 25 March 2003 press release the DH was unequivocal that the service had been launched: "NHSmail the new secure email and directory service is now live." The release was e-mailed to E-Health Insider but is no longer traceable in the DH archive.

The release neither described the service as ‘limited’, nor a precursor to a full launch later in the year, though it made clear that further features would be added later.

The NPfIT spokesman also said the ‘limited’ service was not being actively marketed; a position at odds with the fact that it is the subject of a current advertising campaign in publications including the Health Service Journal.

NHSmail users contacted were mostly satisfied with the service, with several describing it as like hotmail with encryption. One early adopter was Dr Grant Ingrams, a Coventry-based GP, and member of the NHSIA’s NHSnet Service Management Board. He commented: "It’s a major improvement on what we had, but the most important thing is to get it used."

Dr Ingrams stressed it was vital to build a critical mass of users, particularly among hospital clinicians and GPs, before features such as the ability to securely send patient identifiable data really became useful. "I expect it to become the de facto standard within two years."

He added that the slow pace of adoption was because many NHS organisations, particularly primary care trusts, have only just finished upgrading their email from the redundant X400 messaging standard to SMTP. "And now they don’t want to have to go through the change process again."

Dr John Zakrzewski, GP and IM&T lead at Hyndburn and Ribble Valley PCT, said he was happy with the service but concerned that the switch-off of X400 in mid-November, could leave NHSmail as the only option: "To revert to a pure web mail based service would be unacceptable."

Another user found it "fairly useful" but admitted to being unclear about the purpose of the service: "I am confused about whether in the long term it will be a conduit for confidential NHS data flows, or just stays as a glorified hotmail service!"

One anonymous NHS IT director was more critical though: "The early version of the system is slow, buggy and very limited in what it can do. Adverts are appearing that encourage NHS users to sign up – they sign on and are extremely disappointed in the quality of the service."

The same source said he was concerned if NHSmail, procured by the NHSIA, provided a glimpse of the usability of national systems on the way from the NPfIT. "Is this going to be typical of centrally procured products such as those for Integrated Care Records Service? It does not instil confidence in the central procurement process."