Why the NHS National Programme for IT didn’t work

The National Programme for IT (NPfIT) is to be dismantled. The concept of the NPfIT was devised during Tony Blair’s first term in office.

It was one of a number of ambitious policies around government reform and one that Blair himself was a key part of pushing through. It has, however failed to meet its aspirations, not even close.

Fundamentally, the NPfIT failed to meet the needs of the NHS, with each care setting requiring different, yet interoperable systems.

As health secretary, Andrew Lansley put it “Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.”

From the outset the programme lacked clinical engagement, with the focus placed upon technology and not service change. There was no comprehensive sell programme to clinicians or NHS Executives to ensure they understood the concept and had bought into it.

The programme architects and the appointed suppliers underestimated the complexity of the NHS and the power of its clinical community.

In addition to this, the very controlled, top-down approach was always going to cause issues, including Connecting for Health (the NHS IT delivery function) developing requirements that no product existed to deliver, little financial support for Trusts to implement national systems and poorly crafted commercial agreements with key suppliers.

When two of the four Local Service Providers, Accenture and Fujitsui decided to cut their losses and leave the programme it was a clear indicator that the programme was never going to fulfill its original aims.

Throughout there has also been the fundamental issue of politics. It was planned NPfIT would take 10 years to implement, an ambitious and completely unrealistic target.

The demise of the NPfIT has been a slow one and no one involved was the least bit surprised when the recent announcement came through.

It carried no confidence within the NHS community and was clearly never going to be supported by the coalition government.

As expected the new government are introducing reform to the NHS, much of which is underpinned by local decision making – not exactly what a national programme set out to deliver.

It would however be unfair to label NPfIT as an all out failure, for all of the negative press, a number of significant successes have been achieved.

ost notably, the BT N3 Network which connects all NHS organisations via a single network, underpinning national applications such as Choose and Book and Electronic Prescription Service (EPS).

EPS has made prescribing safer and more convenient for patients.

Choose and Book ( the real time referral system for GPs) has been reasonably successful. The Spine did manage to be delivered successfully and NHSmail is now fully operational, providing a secure, centralised service.

The big-bang centralist was never likely to work in an organisation such as the NHS . It is essential that NPfIT’s mistakes are learnt from and not repeated.

In reality, the localisation of NHS IT systems has been underway for a couple of years but it is hoped that the government’s push for local-decision making will embrace innovative ways of working, allowing Trusts to procure IT systems which meet their needs and those of new, transformed NHS.

This does nonetheless reveal a pressing issue, as NPfIT grinds to a halt individual NHS CIOs have a serious issue to deal with; formerly centrally procured contracts are to be procured and managed at Trust level.

While this presents an opportunity for grass-roots innovation to thrive there are also a number of significant risks should it not be carried out in the correct manner.

The NHS does not in most cases have the necessary commercial skills to match their private sector customers and therefore if they are not careful run the risk of making poor procurements.

Rhys Hefford is CEO of Channel 3 Consulting and Digitech Resourcing