The megalomaniac strategy has backfired. The "largest civil IT initiative in the world" – as the National Programme for IT (NPfIT) was often called – began disintegrating from the day it started. It will continue to do so until the decentralisation process has been finalised.
There were at least two major problems with the Programme, and both are in evidence in its name. Firstly, the focus should not be on "IT". Health organisations are looking for innovative applications and solutions to their problems, and not for complex IT technologies, with complicated systems integration, implementation and protocol requirements. Trusts would be probably more enthusiastic if the initiative was called something like "National Programme for Health Modernisation".
Secondly, it is not a "national" programme. It is now clear that different regions have different requirements. The NPfIT Local Ownership Programme (known as NLOP – an acronym of an acronym!), which was created two years ago, once CfH recognised this. It moved many processes to the regional level, such as service implementation and stakeholder management.
The departure of Fujitsu from the Southern Programme for IT, which is what NPfIT is called in the South, last year and the failure to reallocate a vendor for the entire region demonstrates that requirements differ even between different trusts in the same region.
It would have probably been better if NPfIT had never existed. There would have been no massive implementation delays, no exorbitant contracts, no extensive product failures, no continuous finger pointing, no perfidious media fuss and widespread negativity. In a nutshell: no superlatives.
I am not saying that the NHS does not require modernisation and that NPfIT will not eventually deliver benefits. But I believe that it should have been up to the different regions of England to run their own programmes.
Connecting for Health's (CfH) existence not is redundant, but its role should have been confined to delivery support and protocol compliance. It should not have selected the major suppliers and defined product and service scope on its own, with such limited consultation with the local trusts and the clinical community.
Recognising the inevitable
Christine Connelly, the Department of Health's director general for informatics, and Martin Bellamy, the head of CfH, are now beginning to recognise that Programme disintegration is inevitable, although their vocabulary is a bit more subtle.
Connelly argues that if there is no "significant progress by the end of November 2009", then they will "move to a new plan delivering informatics to healthcare". But she stops short of explaining what this will be.
Bellamy now compares the initiative to a "jigsaw puzzle", insisting that the pieces will eventually come together. These words mark a major shift away from "largest civil IT initiative in the world" mentality.
A large chunk of the NPfIT has already been paid out – £3.55bn by March 2008, CfH has not published 2008-09 figures yet – and so it would make little sense to scrap the initiative as a whole, as tempting as it may seem.
It is possible that Care Records Service (CRS) will drive the Programme past the £12.7bn mark. The early adopters – some of the best performing trusts in the country – have experienced major difficulties and absorbed large unforeseen costs implementing the first version of Cerner CRS software. It is likely that the least sophisticated trusts will experience an even more problematic process.
NPfIT will continue to run until the whole spectrum of CRS applications has been fully rolled out and the programme benefits can be fully realised. But it is impossible to establish when this will happen and therefore pointless to stick to the 2015 deadline.
By the time of completion, the Programme will have experienced so many changes that it will be hardly recognisable. It may even be called something else. It will have mutated from nation saviour into big hairy beast into hot potato into jigsaw puzzle into – hopefully – small bits of happiness.
