The perils of ambition

First published Sep 22nd 2011

The Department of Health has today issued a press release headed “Dismantling the NHS National Programme for IT”, and I am wondering how that core message will be conveyed across the media in the coming days.  There is clearly a headline waiting about the dreadful waste of money.  Or another one bewailing another Government IT failure.  Perhaps a triumphallist roar of “about time too!”

But underneath the surface of the report are some facts worthy of a moment’s consideration.  The programme’s total outlay has been much less than the agreed budget at “only” £6.4bn.  Big numbers?  Well, no actually!  Around 0.8% of the NHS’ operating budget over its 9 year life, and Wanless demanded at least a 2% growth in IT spending to around 4% of budget, to modernise the NHS’ ability to deliver world class care.  Comparable customer service industries spend maybe 10-15% of their turnover annually in the tools of understanding and supporting their customers.

And whatever sensational stories you read about this programme, the Cabinet Office report from the Major Projects Authority notes that around two thirds of this £6.4bn has delivered important contributions – some on technical infrastructure including connectivity, some on the tools and information to enable better planning and management, and some on hugely important clinical tools such as the PACS technology which all hospitals have adopted to bring diagnostic imaging out of the dark ages of ordinary films.  But I doubt if you will read elsewhere that the UK is the only health system in the world where our primary care physicians – our beloved GPs – have received specific payments for the last 7 years based on quality.  And the National Programme delivered the support for that without a fuss, so that some of our population health data is now the envy of the world!

So, with all the hype, there is a little more than £2bn which the programme has wasted over 8 years.  A few bankers’ bonuses misplaced perhaps!  Around a quarter of a percent of the total NHS budget which has failed to deliver the expected improvements.  Contrast that with maybe as many as 30% of interventions which are unnecessary, inappropriate or unsuccessful, and contribute to wasted budget.

So, the travesty is not in the money, valuable though that could have been.  The travesty is in the lost opportunity!  The dashed ambitions!  The desperate need for real, valuable information by which care outcomes will be improved and efficiencies achieved.  More than any other area of healthcare, it will be better information which will drive this quality. Better information helps ensure the right treatment, at the right time.  Better information prevents errors.  Better information allows clinicians and managers to plan their resource needs more effectively.  Better information helps the doctor-patient dialogue.  Without better information it will be impossible to respond to the challenges constantly battering at our health and care system.

What matters now, is that the nail in the coffin of the NPfIT marks the beginning of renewed confidence throughout the care system that it is worth investing in systems that do work.  Those which present the clinicians with the best possible information to direct them to the most effective interventions.  It is worth investing in the sort of management information systems which will allow good leaders to transform organisations and teams from being burdened by administrative problems, to being at the heart of well oiled intelligent systems.  No more grand scheme heroics trying to solve the world, but real, local health intelligence systems that pool information, agile technologies that can respond in a matter of days to innovative ideas, and above all, a workforce confident in using the very best information and tools available.