I S THE National Programme for IT in the National Health Service, the largest civil IT initiative in the world, a bold and innovative move that will push both the NHS and the British IT industry to the forefront of healthcare technology and practice? Or is it just a disaster in the making?
This pounds 6 billion question - the price tag on the 10-year NPFIT programme - is so far hard to answer. The draconian vow of omerta imposed by programme head Richard Granger (basically, any company talking to the press is putting its contract at risk), has done a good job of suppressing leaks of bad news. But it has also made it impossible to talk about the good. In this context, the National Audit Office's recent finding that by December last year only 63 hospital appointments had been booked electronically instead of the anticipated 205,000, plus a decidedly downbeat opinion survey of doctors last week, seemed to confirm the worst.
Not everyone is depressed, or silent, however. 'Everyone concentrates on the "go-live",' says Markus Bolton, founder of System C Healthcare, a specialist UK software company that is involved in three of the programme's five regional 'clusters' or consortia. 'But there's a huge infrastructure that has to go in first which no one sees, and that takes time.'
To put the effort in perspective, the north west-West Midlands cluster Bolton is authorised to talk about is in itself a pounds 1bn programme embracing six strategic health authorities, 140 trusts, 2,500 general practices and 281,600 staff. All these entities have to agree how to share information and learn the new systems - a process, incidentally, that has not been helped by the tight-lipped communications policies decreed so far.
'This is a big, big project,' points out Bolton, an entrepreneur with a record of plain speaking about NHS IT. 'It's an extraordinary challenge. Very few people have worked on anything this size. It's evolving as we go along, but we're genuinely making enormous progress.'
NPFIT's effects are not confined to the NHS. As intended, it is already transforming the healthcare IT market. Before the programme, computerisation in the NHS was so cumbersome and fraught with political difficulty that few companies deemed the effort worthwhile. So the supplier base was small and fragmented. System C, with six electronic patient record systems delivered to hospitals in the past few years, was one of the more substantial yet it was still a small company, with a workforce of 70 and turnover of about pounds 5 million.
Overnight, NPFIT changed the rules of the game. Unable or unwilling to respond to the demands of the national programme, a number of companies have withdrawn from the business, while new international companies - such as the US firm CSC - have come in. In the middle, companies such as System C, with replicable experience but without national reach - there are 50 hospital trusts in the north west cluster alone - have had to find a new niche.
Anticipating some (though not all) of the changes, System C took the gamble of expanding fast when the programme was announced in early 2003, consolidating a lot of the highly skilled, and increasingly scarce, manpower released by others. In two years it has trebled in size - but it no longer majors on its own products. Instead, it is working across the board as a 'general domain adviser', using its experience of working with clinicians on the design, development and installation of working systems to help speed the implementation.
Working in a big group is new territory and has required changes in System C's small-company management style. 'A show as important as this has to be run by the rules,' notes Bolton. 'One of the big changes for us has been the emphasis on process, and in many ways it's been very good for us.'
Used to working at hospital level, the company has developed a healthy respect for the industrial-strength project-management disciplines and the experience of colossal technical infrastruc- tures brought to bear by CSC. Bolton believes that the learning developed between the alliance members is in itself an important gain for the future. So is the ability to plan forward: with multi-year contracts to run, System C, like other companies, can start working on other elements of the programme - such as electronic prescribing - which are not due until later.
Working for the national programme, Bolton reflects, has changed the company's focus. It still believes in its own products and will continue to develop them for possible international and private sales. But the programme has subtly changed participants' ambition. 'We're fully committed to helping iSoft [a much bigger rival] put in the best possible systems,' he says. 'As an organisation, we're doing everything in our power to make this whole project work. That goes for all of us.'
Digitisation of the NHS's antiquated and unjoined-up systems has to come, he reasons. 'It's essential for better patient care and helping staff to do their jobs as effectively as possible.' It could have been done a number of ways, but they all have pros and cons, so there is no use fighting those battles any more.
Is he more confident about the outcome than a year ago? 'Yes,' he says, without hesitation. Some over-ambitious target dates may be missed, and not every contract will deliver at the same speed. But that does not mean the project is a failure. On the contrary, 'With the infrastructure going in, we think people will see things in action soon. Yes, it will work - we're going to make it work.'
The Observer, 13 February 2005