NHS boss says NPfIT ‘was not in right place’

NHS chief executive David Nicholson says the NHS IT programme had become too centralised to support the move to a health service based on plurality and far more locally-based decision making by clinicians and patients.

Speaking at the World Healthcare Congress in Berlin on Monday Nicholson explained why the introuduction of the NHS National Programme for IT (NPfIT) Local Ownership Programme had become necessary to support the future structure and achieve a far more integrated and devolved health service, in which services are “wrapped around patients”.

Nicholson said: “It felt we’d reached a position where the balance was not in the right place”. The challenge he said was extremely difficult, “How does a very central system adapt to becoming a very local one.”

The NHS chief executive said that as a result of listening to the views of clinicians and patients the NHS IT programme was being reviewed and reshaped. “We are working through that now.”

Nicholson concluded by stressing the CfH programme was a critical part of wider NHS system reforms, now underway. “It is a programme that gives us the potential to make that extra leap to have a world class healthcare service.”

He stressed that systems changes on the scale being attempted by the NHS – including NHS IT – were difficult and often painful, but said benefits were being delivered, from reduced waiting lists, to increased patient choice, significant reductions in hospital acquired infections and the NHS set to achieve a £1.5bn surplus.

Nicholson spoke of the large amount of work that has had to happen in the background in the early years of the NHS IT programme, not always apparent to clinicians or politicians. “You have to put a lot of investment and time into things that don’t have an immediate payback.”

He said that politicians have been remarkably steady in their support of the programme, taking a long term view of its strategic importance to the future of the health service, despite a lot of negative press coverage. “Credit to politicians who have taken a large amount of criticism for little obvious benefit.”

But he acknowledged that such support could not be taken for granted and said that recent “losses of data”, such as the HMRC loss of data, had led to a “loss of public confidence” in government IT and information governance that created a potential risk to the aims of the NHS IT programme.

Turning to difficulties experienced with implementing systems, he said one of the problems is that users often bridle at efforts to standardise. “If you are doing a system implementation you should go for rapid standardisation, but the people who operate the health service hate that.”

Nicholson said the NHS IT programme he said it had proved difficult “We have to make sure we have the IT processes absolutely right”, but added benefits were already being delivered, thanks to new IT systems.

Despite difficulties and changes to the programme now underway, Nicholson said the health service’s IT programme had achieved significant benefit, already saved 400 lives. It also highlighted efficiency savings saying a quarter of a million paper prescriptions had so far been eliminated. “We are already seeing real benefits and real problems as well.”

Jon Hoeksma