What to do with a white elephant

Instead of imposing the National Programme for IT, the NHS should provide local connectivity

- Norman Lamb MP, Liberal Democrat health spokesperson
- Smart Healthcare, Wednesday 31 March 2010 09.00 BST

Elephant and baby in wild — Baby elephant talk: centralised systems should be replaced by local innovation, according to the Liberal Democrats. Photo: Tom Brakefield/Stockbyte

If you go and look up the term white elephant in a dictionary or on the internet you'll probably find that the best definition is on Wikipedia: a "valuable possession of which its owner cannot dispose and whose cost (particularly cost of upkeep) is out of proportion to its usefulness". While Wikipedia may not be the most reliable source of information on some occasions, it seems to have hit the nail on the head here.

The £12.7bn question over the next few years is going to be what to do about this particular white elephant. Nobody disputes that computers and IT systems can transform healthcare beyond anything that the developers of the computer ever dreamed of. Nobody who has ever seen a 3D body scan or watched doctors providing real time consultations based on MRI scans from a stroke patient on the other side of the world can deny the massive potential that IT systems offer an organisation like the NHS.

While these technologies are mind-blowing, other aspects are infuriating. If you've ever seen your GP shouting at their computer it is probably because the 'confuse and book' system has broken down again.

So far we have spent about £6bn on a system which has failed to match the high expectations that come with that sort of price tag. We are going to be faced with a major challenge: do we try and move forward, throwing good money after bad in the hope that one day we'll get the all-singing, all-dancing panacea we saw in the brochure; or do we admit that we've been sold a turkey, salvage what we can and adapt our approach so that our focus is on local connectivity.

My preference is for the latter. We never should have been trying to create a NHS IT system. Innovation from the centre and monopolies on ideas and implementation have a lousy record of delivering results. Instead, we would focus on how we can encourage the development and use of IT to help improve the system and to proactively manage patient care. We need to accept that a single giant database is neither feasible nor desirable. We should be looking at how individual developments can transform the NHS for patients and staff.

Permanente solution

There are some great examples out there. At Kaiser Permanente in California patients can email their GP for simple advice about their condition, medication or other issues. Their computer systems also identify patients who are at risk from a range of conditions to highlight the need for screening visits, medicine reviews or more regular check ups. The results are very encouraging – their screening rates for breast cancer for example are way above average and their smoking cessation programmes are incredibly successful.

At the US Veterans Health Administration, they use telehealth monitoring equipment to measure the weight of cardiac patients or to remind patients to take their medication. Relatively simple steps such as these have reduced hospital admissions and improved the long-term care of a group of patients with often serious health problems. I am interested in exploring how we can learn from these examples and drive the development of more efficient services.

We need an approach which fosters creativity and supports innovation. Instead of creating monopolies, we should be encouraging cooperation and competition. In a sector like IT where the initial capital costs of innovation are so low compared to other industries, it is madness to hand power to a small group of mega-contractors. Instead, we should be bringing doctors, patients and managers together with IT specialists to see how they can help each other. We would cancel development of the national database and would end the current use of Choose and Book. Instead, we would focus on local connectivity, engaging with clinicians in designing systems which put patient care first.

We need to recognise that up to this point the NHS IT system has been rudderless. This obsession with scale has left us with solutions which don't match up to the challenges in the NHS. Labour has presided over a shambles. They ignored the advice they were offered and addressed none of the concerns that were raised. Instead of responding to the people who count, the government was seduced by the smooth sales pitches of lobbyists.

The result is a system whose objectives have constantly changed and whose goals seem unobtainable. Instead of being part of the NHS, the IT system has been imposed on the NHS with disastrous – and phenomenally expensive – consequences. Remarkably, it has actually held back the development of IT at the local level.

The time has come to pull the plug on centralised systems and accept that the giant leap forward they promised will not lead to a practical solution to such a complicated problem. The NHS is a vast and complex organisation. It is full of remarkable people who do incredible work and achieve amazing things against all odds.

We need to recognise that the key to using IT effectively in the NHS can't be found in central diktats, it lies in empowering the people who work on the frontlines of both fields. Imagine how much they could achieve if clinicians could harness the talents of the IT industry without having to battle against a system which doesn't understand.