A matter of trust

Jon Hoeksma

NHS IT boss Richard Granger is pushing for the adoption of new IT services and systems to be mandated as part of the performance management framework for trusts and their board members.

In an exclusive interview with E-Health Insider at this month’s NHS Confederation conference, Granger said: "I would likely to see the timely adoption of products as they become available, become part of the performance management framework."

He revealed that he had been pushing the DH for such a move for almost three years. "I’ve had discussions that go back to the summer of 2002 with Nigel Crisp and more recently with John Bacon about how we ensure an alignment of trust boards’ priorities around their current performance objectives and modernisation objectives."

The purpose of these performance management goals would be to ensure that as IT services and products became available through the NHS National programme for IT, boards would give "proper prioritisation" to their deployment.

Local obstacles

Granger said the DH is now aiming to identify bottlenecks and remove local obstacles to deployments. "I’m working with (Department of Health delivery director) John Bacon now on an increased level of transparency around the successful adoption and, where it occurs, reasons for delay in adoption."

Granger believes that the NHS IT modernisation programme unfairly gets flak for delivery delays that he says are partly down to trusts dragging their heels on taking and implementing new systems. "We’ve got examples of where we’ve got product ready and people decide they don’t want it because they’ve now got an ‘expanded requirement’, for example."

One trust "ordered up a PAS originally and decided subsequently that they would like it integrated with an A&E system. Well, maybe they should just take the PAS system that has better reporting functionality, rather than wait for the thing they’ve decided subsequently they want."

He told EHI that he has ordered an investigation into how widespread this problem is. "I’m having some analysis done at the moment. I want to know the root cause for a number of installations not occurring as scheduled — whether it’s a technological deficit or organisational prioritisation.”

Making a business case

Responding to audience questions from trust board members at the NHS Confederation, Granger also called for trusts to be more “honest” and “imaginative” in developing their business cases. "I offer services but you say you need more money to implement them. For putting PACS (Picture Archiving and Communications Systems) in, people say it’s quite difficult to get budgets in, but don’t include costs like film transportation."

"Quite often business cases on total costs are not honest,” said the NHS IT boss. "There needs to be a bit more honesty and imagination in business cases."

Another part of the problem, Granger told EHI, is that not enough senior trust board members have the necessary skills or experience: "One of the questions I ask an audience like the one here today is: how many of you have people on your boards who have been involved in IT-enabled transformation of services?"

While some boards may have members with expertise in implementing transactional systems, Granger believes there is a chronic shortage of "the people able to deal with the complexities caused by presenting consumers with alternative channels to interact with services". He questions how to find the leadership in the NHS that can enable organisations to respond to the new demands technology will create on services, such as patients accessing their own electronic records.

The situation now

Granger acknowledges that none of this will be easy. "I know it’s very hard for people who work in real-time health services to take a step out, train and have the disruption of new things being introduced, and this is a disruptive technology. If you introduce this, it causes disruption before you get to a position of improvement."

Summarising progress to date, the NHS IT director general said the programme was "pretty much" where he hoped it would be by now. "We’ve established a reputation for delivery, and we estimate 350,000 people are using products we’ve shipped. The NHS is benefiting from what we are doing and couldn’t operate without it." Early successes he points to include the new NHS network, QMAS and "dozens of local implementations".

Despite the replacement of IDX as the clinical systems provider for the south of England, Granger also says he is happy with the way suppliers are responding. "I think the supplier community is in parts really getting into its stride now, and in other parts is understanding the unique complexities of the NHS and the task they’ve taken on. And again we expected to see that, that’s why we didn’t place all our bets in one organisation."

Summarising the current position, he said: "So we’re not at all complacent, we’re not at all happy about things that have not gone as we’d have wished them to, but I think we’ve got a good solid delivery track record.

"Over the current year we will see very large scale deployment going on," he added. "Most large scale public sector programmes would not even be beginning any deployment activity in their first three years."