Joe McDonald: NHS IT’s failed patient safety culture needs radical change

An approach by a BBC journalist has Joe McDonald wondering what it will take to end the NHS scandal of flawed computer systems wasting public money and harming patients

Mr Bates vs The Post Office has changed everything. Bad software is now mainstream. After the TV drama aired in January, people in my barbers were discussing remote access to Horizon by Fujitsu. Last month, the British public even tuned in to the Post Office inquiry to watch its former CEO Paula Vennells demonstrate how little knowledge or integrity counts in the running of big IT projects.

I can’t imagine I’m the only health IT veteran who has been thinking of calling Netflix and suggesting that if the Post Office was great drama for ITV, then NHS IT  could be a soap opera that would run for years. I was pondering who might play me in NPfIT – The Opera when I was contacted by Sharon Barbour, health correspondent at the BBC. She wanted to talk to me about recent reports that serious harm had come to patients because of clinical software; it’s an issue that had been referenced by coroners.

It quickly became clear that she wanted a deeper understanding of the tragic cases which originally drew her attention to NHS IT problems.

I know some people are wary of talking to journalists but when problems drag on for decades and become culturally embedded, and ludicrous positions are defended by senior leadership with little connection to reality, it can be the only way to move forward.

Management by slogan

So, I agreed to meet Sharon, who turned out to be a neighbour in Newcastle. We met in my kitchen and talked for four hours.

Sharon and colleagues’ freedom of information exercise revealed a significant number of trusts reporting harm from electronic patient records. Of course, television being what it is, my four-hour interview turned into 30 seconds on the TV news at 7.30am. It’s somewhat alarming to see yourself on the telly before breakfast. Two things struck me immediately: I have a great face for radio and how hard it is to convey the complexity of NHS IT in a format that the public can understand. On balance, I thought the BBC did an excellent job, but in the allotted time could only scratch the surface of the patient safety elephant in the NHS room.

We have had nearly 20 years of Vennells-style leadership in NHS IT, management by slogan and exhortation from people ignorant of the real requirements on the coalface. A new ‘strategy’ every 18 months which, with every turn, hands bigger and bigger chunks of money to a dwindling cartel of increasingly powerful suppliers who can call the shots because we have become so dependent on them.

A story that should be told

I hope the story of how we got into this state does get to be told. How we have spent billions developing IT systems without acquiring one red cent of intellectual property. How we paid Fujitsu and got nothing. We have worked hard for years building a house which we gifted to a handful of companies, and they are now renting it back to us at a price they decide.

The scandalous waste of money on systems that can’t talk to each other, with all that inherent risk, is a product of decades of poor planning and leadership which shows no sign of coming to an end.

I came into health IT from a clinical safety background having chaired over 100 serious untoward incident reviews including suicides and homicides. I still believe EPRs can be part of improving clinical safety but it will require a major rethink of how we are going to do NHS IT.

Daring to hope

Will we get such a rethink? Well, a general election may bring a sense of hope but as my late friend Ewan Davis once told me, there are only three possible outcomes when a new leader drops into a longstanding culture: the leader is absorbed by and adopts the existing culture; the leader comes into conflict with the existing culture and is expelled; the new leadership changes the culture. The third option is the least likely.

The current failed culture has survived many general elections so it’s going to take something radical to change NHS IT’s safety culture. As it happens, in a silo separate from NHS IT, the NHS is busy reforming its safety system with a new Patient Safety Incident Incident Response Framework (PSIRF). There is an opportunity to integrate incident reporting, EPR systems, and appraisal systems but that would require genuinely courageous leadership. Over to you Wes Streeting.

Professor Joe McDonald is a former NHS consultant psychiatrist, trust medical director, chairman of CCIO Network and founder of the Great North Care Record. He is currently working as peripatetic medical director for a number of SME health tech companies, including Sleepstation, SARDJV and Parsek.