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National Programme for IT

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The National Programme for IT (NPfIT) which is being delivered by the new Department of Health agency NHS Connecting for Health, is an initiative by the National Health Service in England to move towards an electronic care record for patients and to connect 30,000 GPs to 300 hospitals, providing secure and audited access to these records by authorised health professionals. In due course it is planned that patients will also have access to their records online through a service called [HealthSpace]. NPfIT is said to be the world's biggest civil information technology programme [link].

The NHS in Wales is also running a national programme for service improvement and development via the use of Information Technology - this project is called Informing Healthcare.

Contents

Structure and Scope of the Programme

Following several Department fo Health reports on IT Stragegies for the NHS, the (NPfIT) was formally established in October 2002.[link]

On April 1 2005 a new agency called NHS Connecting for Health (NHS CFH) was formed to deliver the programme. (The NHS CFH absorbed both staff and workstreams from the abolished NHS Information Authority, the organisation it replaced.)

The programme is divided into a number of key deliverables. These are:

The Spine

The creation of a core data storage and messaging system, known as the Spine, is key to providing electronic NHS Care Records for every patient. The Spine will:

Clusters and Local Service Providers

The programme divides England into five areas known as "clusters": Southern, London, Eastern, North West and West Midlands, and North East. For each cluster, a different Local Service Provider (LSP) was contracted to be responsible for delivering services at a local level. This structure was intended to avoid the risk of committing to one supplier which might not then deliver; by having a number of different suppliers implementing similar systems in parallel, a degree of competition would be present which would not be if a single national contract had been tendered. As of October 2005, four different industry consortia are LSPs:

National Application Service Providers

In addition to these LSPs the programme has appointed National Service Providers (NASPs) who are responsible for services that are common to all users e.g. Choose and Book and the national elements of the NHS Care Records Service that support the summary patient record and ensure patient confidentiality and information security. As of October 2005, the NASPs are:

Changes to Service Providers

In March 2004, [EDS] had their 10-year contract to supply the NHSMail service (later renamed Contact) terminated [link] [link]. On 1st July 2004, [Cable and Wireless] were contracted to provide this service.

IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005, due to inability to deliver a working product. In September 2005, [Cerner Corporation] was brought in to adapt their 'Millennium' product for the NHS. By October 2005, they had a working product and the first Hospital Trust to go live was Nuffield Orthopaedic in Oxford in December 2005.

In early 2006, ComMedica's contract for supply of PACS to the North-West/West-Midlands cluster was terminated, and they were replaced by GE.

Criticisms of the Programme

NPfIT has been criticised for inadequate attention to security and patient privacy. In 2000, the NHS Executive won the "Most Heinous Government Organisation" Big Brother Award from Privacy International for its plans to implement what would become the NPfIT [link]. In 2004 the NPfIT won the "Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards [link].

Advocates of the NPfIT note that these concerns must be set alongside the necessity of care professionals having access to personal medical data if they are to deliver safe, high quality care. The balance between the right to privacy and the right to the best quality care is a sensitive one. Also there are sanctions against those who access data inappropriately, specifically instant dismissal and loss of professional registration. This means that not only will the perpetrator lose their job, but any chance of getting another.

More worryingly, a January 2005 survey among doctors [link] indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year. There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project.

As of August 5, 2005, research carried out across the NHS in England suggested that clinical staff felt that the programme was failing to engage the clinicians fully, and was in risk of becoming a white elephant.

However by Christmas 2005, at least 20 Trusts had gone live and another 50 are due to go live by May 2006. Supporters of the scheme suggest the only other choice was to do nothing and this was unacceptable. Previously hospitals and GPs were expected to provide their own solutions and funding, with the end result that there was no standard interface or measurement of functionality.

Costs

Originally expected to cost £2.3 billion over three years, November 2004 Government estimates put the cost of the programme at between 20 and 30 billion pounds, although it is expected that this will be recovered in "savings and other benefits" [link].

Important Exclusions

It is important to note that NPfIT is not really the all-encompassing medical system it claims to be. For instance, it has no links, planned or actual, to the equivalent system in Wales and there is no similar system yet proposed for Scotland; because Scotland and Wales are producing their own systems complying with the continuing trend of devolution of government reponsibilities. [link]

NPfIT also currently only caters for GPs, Acute and Primary Hospitals, medical clinics and local hospitals and Surgeries. There are no immediate (certainly not before 2010) plans to include opticans or dentists (90% or whom have opted out of the NHS anyway) and several key medical areas are not included in the plans at all.

Surgery where cancer or where immediate treatment is required is not, and never has been, the remit of non-urgent booking schemes before or after the NPfIT programme. These patient's needs have always and will always bypass any queuing system and be rushed to the forefront for urgent patient care.

The problem has always been making sure these urgent cases are correctly identified as such from diagnosis to treatment. The 2 week wait initiative will be strengthened - and was never intended to be incorporated.

References

See also

External links

 

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