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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.<ref> http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2004/08/31/nhs31.xml</ref>

The cost and scope of the programme, together with its ongoing problems of management, have placed it at the centre of ongoing controversy.

Contents

[edit] Structure and Scope of the Programme

Following several Department of Health reports on IT Strategies for the NHS, the NPfIT was formally established in October 2002.<ref>http://www.connectingforhealth.nhs.uk/aboutus/history</ref>

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:

[edit] The Spine (including PDS & PSIS)

The creation of a core data storage and messaging system, known as the Spine which also contains two data stores - the PDS (Patient Demographic Service) and the PSIS (Personal Spine Information Service). The Spine is key to providing electronic NHS Care Records for every patient. The PDS will store personal characteristics of patients such as demographic information against a patient's NHS Number. The PSIS will store summarised clinical information which may be important for the patient’s future treatment and care. All Spine systems (including PDS and PSIS):

  • Provide the security systems required to restrict access to the national and local systems
  • Bind together all the local IT systems within the programme.

Also included within the Spine is a secondary uses service, using data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery

[edit] Exceptions

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.

NPfIT has no links, planned or actual, to the equivalent system in Wales and there is no similar system yet proposed for Scotland. Scotland and Wales are responsible for their own systems complying with the continuing trend of devolution of government reponsibilities.<ref>http://www.connectingforhealth.nhs.uk/faq/hottopic/hottopic_05-002</ref>

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 (many of whom have opted out of the NHS), and some other medical areas are not included in the plans at all.

[edit] 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 2006, four different industry consortia were LSPs:

[edit] 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:

[edit] Changes to Service Providers

In March 2004, EDS had their 10-year contract to supply the NHSMail service terminated.<ref>http://www.e-health-insider.com/news/item.cfm?ID=676</ref> <ref>http://www.e-health-insider.com/news/item.cfm?ID=677</ref> On 1st July 2004, Cable and Wireless were contracted to provide this service, which was initially renamed Contact.<ref>http://www.cw.com/uk/public_sector/nhs_solution_centre/secure_email.html</ref>

IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005. They were replaced in September 2005 by Cerner Corporation.

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 Healthcare.

In July 2006, the London region replaced IDX (which had been bought out by GE Healthcare in January 2006) as its supplier. Systems for secondary care, primary care and community and mental health services will be provided by Cerner, INPS (formerly In Practice Systems) and CSE Servelecrespectively.<ref>http://www.e-health-insider.com/news/item.cfm?ID=2037</ref>

In September 2006, the CSC Alliance, Accenture and Connecting for Health signed a tripartite agreement that as of January 2007, the CSC Alliance would take over the responsibility for the majority of care systems the North East and Eastern clusters from Accenture, with the exception of PACS.

[edit] 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.<ref> http://www.privacyinternational.org/bigbrother/uk2000/</ref> 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.<ref> http://news.bbc.co.uk/1/hi/technology/3933679.stm</ref>

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. It is the view of many impartial observers that such criticisms are the result of media-hype and misinformation amongst the broader clinical community. The measures put in place by the NPfIT are generally considered by most authorative commentators to be among the most stringent in the world.[citation needed]

More worryingly, a January 2005 survey among doctors indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year.<ref>http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=2414</ref> 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.

In April 2006, 23 academics<ref name=Signatories>Signatories of the open letter to the Health Select Committee: Ross Anderson, Professor of Security Engineering, Cambridge University ; James Backhouse, Director, Information System Integrity Group, London School of Economics ; David Bustard, Professor and Head of Computing and Information Engineering, University of Ulster ; Ewart Carson, Professor of Systems Science, Centre for Health Informatics, City University; Patrik O’Brian Holt, Professor, School of Computing, The Robert Gordon University ; Roland Ibbett, Professor, School of Informatics, University of Edinburgh ; Ray Ison, Professor of Systems, The Open University ; Achim Jung, Professor, School of Computer Science, University of Birmingham ; Frank Land, Emeritus Professor, Information Systems Department, London School of Economics ; Bev Littlewood, Professor of Software Engineering, City University ; John A McDermid, Professor of Software Engineering, University of York ; Julian Newman, Professor of Computing, Glasgow Caledonian University ; Brian Randell, Professor, School of Computing Science, University of Newcastle ; Uday Reddy, Professor, School of Computer Science, University of Birmingham ; Peter Ryan, Professor of Computing Science, University of Newcastle ; Geoffrey Sampson, Professor, Department of Informatics, University of Sussex ; Martin Shepperd, Professor of Software Technologies, Brunel University ; Michael Smith, Visiting Professor, Department of Computer Science, University College London ; Tony Solomonides, Reader in Computer Science and Medical Informatics, University of the West of England ; Ian Sommerville, Professor, Computing Department, Lancaster University ; Harold Thimbleby, Professor of Computer Science, Swansea University ; Martyn Thomas, Visiting Professor of Software Engineering, Computing Laboratory, Oxford University ; Colin Tully, Professor of Software Practice, School of Computing Science, Middlesex University </ref> in computer-related fields raised concerns about the programme and wrote an open letter to the Health Select Committee.<ref name="CW20060412a"> Collins, Tony. "NHS Focus: Open Letter: Questions that need to be answered", ComputerWeekly.com, Reed Business Information Limited, 2006-04-12. Retrieved on [[2006-11-01]]. </ref> <ref name="CW20060411b"> Collins, Tony. "Signatories to health committee letter", ComputerWeekly.com, Reed Business Information Limited, 2006-04-11. Retrieved on [[2006-11-01]]. </ref> 2006-10-06 the same signatories wrote a second open letter <ref name="CW20061010a"> Collins, Tony. "Experts strike new NHS warning note", ComputerWeekly.com, Reed Business Information Limited, 2006-10-10. Retrieved on [[2006-11-01]]. </ref> and created a wiki <ref name=Wiki23> [Wiki Documentation of academics' concerns] </ref> documenting their concerns.

However by July 2006, over 75 trusts were live in the NWWM cluster alone. 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.

Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition from civil liberties campaigners such as the anti-database state pressure group NO2ID.

[edit] 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 some of this will be recovered in "savings and other benefits" [1].

Calculating the true cost of any significant IT programme is notoriously difficult. The £2.3Bn figure related to the obvious costs (procurement, development and deployment) and is only part of the equation . Additional costs are incurred through a number of other dependent activities ouitside of the core contracts, such as hardware upgrades (to accommodate new software), business and clinical process redesign, training, stakeholder engagement, marketing and evaluation. It is these areas that make it almost impossible to know the true, final cost, but raise it to the higher forecast.

[edit] Impact on IT providers

The size of the programme means that it has become a substantial element in the UK activities of many IT providers. The onerous contract terms which have been an element in the process have therefore placed significant organisational and financial strain on some providers. According to the Daily Telegraph, the head of NPfIT, Richard Granger, 'shifted a vast amount of the risk associated with the project to service providers, which have to demonstrate that their systems work before being paid.' The programme's largest software provider iSoft has been seriously affected by this process and is under investigation by the UK Financial Services Authority for irregular accounting.<ref>Daily Telegraph, 28 September 2006, 'IT providers left in the debris of NHS's 'Big Bang'</ref> On 28th September 2006, the consultancy Accenture announced its intention to withdraw from £2bn of 10 year contracts with NPfIT, which will be taken over by CSC - both Accenture and CSC laid blame with iSoft, although CSC has said it will be retaining the company as software provider. <ref>Daily Telegraph, 29 September 2006, 'Accenture pulls out of NHS deal'</ref> Earlier in the year Accenture had written off $450m from its accounts because of 'significant delays' in the programme.

[edit] Management team

The NHS has appointed a management team, responsible for the delivery of the system <ref>http://www.connectingforhealth.nhs.uk/about/whoswho/topteam</ref>:

[edit] References

<references/>

[edit] See also

[edit] External links

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