by Derek Morrison, originally posted 10 July 2009, updated 14 August 2009
It may sound like the name of a trendy gym but NPfIT is the acronym for the somewhat beleaguered multibillion NHS National Programme for IT, the biggest programme of its type anywhere in the world. As such it makes a fine ongoing case study of the pitfalls, tragedies and sometimes triumphs of major centralised IT initiatives. The latest polemics are focusing on the impact of viruses/trojans et al on what is expected to be, and needs to be seen to be, an absolute bastion of security and confidentiality.
The UK’s Channel 4 broacaster transmitted a piece last night that will cause much concern. A recording of the transmission can be viewed online via NHS hit by a different sort of virus (More 4 News, 9 July 2009). The Guardian’s article System failure? (Guardian, 9 July 2009) also provides useful further background material based on interviews with stakeholders.
What I find interesting is why such viruses/trojans have infested what is supposed to be in the main a closed NHS system. It would be interesting to establish what proportion of infections and infestations were of Windows based clients and servers.
The record of major government and quango IT projects is not good; a factor not helped by the relatively small number of major league global IT contractors which is why the same names tend to feature in major public sector contracts and sometimes several Parliamentary reports. More recent Parliamentary records also comment on the loss of NPfIT contractors .
There is, however, a lot of very good work taking place within NPfIT, for example the Picture Archiving and Communications System (PACS) is generally perceived to be a triumph. PACS, however, also illustrates that technology works when it makes life easier and better for those expected to use it on a daily basis. There are many other aspects of NPfIT that appear to have done the opposite for staff on the ground; if they don’t perceive this benefit then patients certainly won’t be. As I have so often highlighted in other Auricle postings, people can so easily be expected to adapt to what the technology will allow them to do rather than what it needs to do. So rather than providing an improved experience we end up serving technologies rather than it serving us.
The Guardian piece highlights the point that the NHS is not a homegenous static entity. It is instead a heterogenous dynamic entity so drafting even exemplary technical specifications may only capture one perhaps transient aspect of its complex and ever changing workings and developments. In such circumstances embracing and leveraging the affordances of disseminated and distributed systems can sometimes be for the best. But time will tell, the NPfIT case study is still a work-in-progress vulnerable not just to the criticisms of NHS users but also the vagaries of changes in political ethos and control.
Further Reading
House of Commons Public Accounts Committee (14 January 2009),The National Programme for IT in the NHS: Progress since 2006, Second Report of Session 2008–09 (PDF).
“Delivering the clinical functionality will be key to convincing NHS staff of the benefits of the Programme because what has been provided to date has not met their expectations.” (pp3-4)
Update 14 August 2009
The print edition of the Guardian (13 August 2009) offered an excellent piece by Michael Cross titled The NHS IT Project should be engineering not politics. The same article in the Guardian technology website is called NHS computerisation: lessons from what the bosses never learned (Guardian Online, 12 August 2009). The Cross’ article refers to (but does not provide the links to) The challenges of complex IT projects a report published in April 2004 by The Royal Academy of Engineering and The British Computer Society and the follow-up report Engineering Values in IT published by the same organisations in July 2009.
