2007 in review

The biggest health story involving IT had nothing to do with the NHS IT programme, but was the debacle of Medical Training Application Service which resulted in personal details – including religious beliefs and sexual orientation – of junior doctors being openly viewable.

The theme of breaches in data security, and the perception that government is far too often cavalier with citizen’s personal data, came back with a vengeance by year end with the HM Revenue Customs’ loss of 25 million personal records, and now risks undermining public confidence in electronic patient records.

With the National Programme for IT’s (NPfIT) Summary Care Record and HealthSpace programmes beginning to gather some momentum it would be a real shame if the NHS was stymied by failures elsewhere in government.

It was the year in which politicians and the Department of Health (DH) lost patience with the heavily centralised Connecting for Health (CfH) approach to delivering the NHS IT modernisation, and belatedly decided that local ownership was the way ahead. The NHS Local Ownership Programme was born, quickly labelled by beleagured NPfIT veterans as ‘No Longer Our Problem’.

Following NLOP there are big questions about what, if any, the future role of CfH is. Is it now about providing core infrastructure and services – similar to the NHS Information Authority it replaced? There also remain huge questions about how the local service provider (LSP) contracts can be squared with local ownership. Contract ‘re-negotiations’ with LSP continued at the end of the year. That these are happening in secrecy does not bode well, suggesting local ownership still has some way to go.

It’s worth remembering, though, that it was the historic lack of interest in IT from NHS trust and health authority chief executives, and their desire for someone else to deal with it, that led to the creation of the national programme in the first place. It remains to be seen whether they have all been reborn as apostates of IT-supported health service modernisation.

Out in the health service the year began with Accenture finally being replaced by CSC as the LSP for the North East and East of England, for everything apart from PACS. After getting off to a brisk start in the North West, the pace of CSC’s acute PAS implementations has tapered off.

Another long-running saga finally resolved after many twists and turns was the future of iSoft, eventually bought by Australia’s IBA Health. The latest promised delivery of Lorenzo is 2008, though trusts say they have been told not to expect the full electronic record product until 2010-11.

BT delivered a total of two acute implementations in London, one of those at Queen Mary’s Sidcup, which had previously recieved an IDX system. Progress was better on community and child health systems, but remained limited in primary care.

In the South of England the picture was also mixed. After delays, five further sites took the Cerner Millennium system, less than half the number Fujitsu had promised. Some sites appeared to go fairly smoothly. But at Milton Keynes in April there was a storm of protest from 79 disgruntled clinicians, resulting in a visit by by NHS chief executive David Nicholson and CfH boss Richard Granger.

In retrospect Milton Keynes proved something of a watershed, forcing the DH to take notice of the problems many acute trusts were reporting of late and limited delivery. While maintaining a concerted public front, wheels were in motion behind the scenes.

In July Richard Granger, boss of NHS CfH, finally had enough and, after telling a magazine he was “ashamed” of some of the systems delivered, announced he would depart by year end. In recent months EHI has become concerned at his disappearance as reported sightings of the man who for five years led NpfIT, became increasingly rare. The official line is that he remains at the helm until the end of December.

Its also been a year of reviews. First in April the Commons Public Accounts Committee published its report, saying the aims of NPfIT were commendable but delivery of central clinical aims badly awry: it pointed out that the project was two years late and had doubled in cost. It also questioned the ability of suppliers to deliver. The PAC called for an independent review, a call subsequently rejected by the government.

In September it was the Commons Health Select Committee’s turn. It concluded electronic patient record systems are vital to the future of healthcare in England, but said there remain big questions and concerns over how and when they will be delivered by the NHS National Programme for IT.

Quietly the DH launched the Gibbs review of informatics, and spent much of the year trying to cut through the Gordian knot of CfH’s byzantine contracts with LSPs. The change of Prime Minister in July accelerated the review process with Patricia Hewitt replaced by Alan Johnson as health secretary. An interim report from Lord Darzi called for NPfIT to focus on delivering clinical benefits and NHS chief executive commissioned DH insider Matthew Swindells to carry out a root and branch review of information in the health services.

The year ends with Swindells now titled DH director-general for information and policy, and the indications are that big announcements are due on the future structure of CfH.