HOWZAT

A project that began with high hopes of giving the NHS a world-leading “e-health” infrastructure is rapidly descending into acrimony.

The ambition was to create a national patient-records service that would allow doctors to call up anyone’s medical history, irrespective of the hospital or surgery they were attending. It would make it easier for GPs to book hospital appointments (“Choose and Book”), to prescribe drugs electronically, and to store and distribute x-ray and other medical images.

Granger compared the scheme — reckoned to be the world’s largest civilian IT deployment — to great Victorian public works such as Bazalgette’s sewage system for London, and Brunel’s construction of the Great Western Railway.

However, parts of the NHS scheme, notably Choose and Book, are already many months behind schedule.

Many GPs, consultants and other healthcare providers appear alienated by Connecting for Health and Granger’s dirigiste approach. There have been complaints about the system’s slow operation and about the risk of unauthorised disclosure of sensitive medical information. Doctors, many of them already sophisticated users of technology, are demanding greater freedom to make their own IT choices.

Sir John Bourn, head of the National Audit Office (NAO), last month warned the House of Commons’ public accounts committee that the IT programme had become “a focus of dissension” within the NHS.

One of the scheme’s “failures” — to be spelt out in an eagerly awaited NAO report — was that it “has not won the hearts and minds of those who are being required to use it”.

All of this is undermining the economic rationale of the original contracts, all negotiated through a highly pressurised tendering process during 2003. For example, under pressure from the medical profession, the Department of Health has recently proposed giving GPs more choice over the systems they can use in conjunction with the national IT infrastructure.

Accenture planned to offer a choice of only two systems. Under the proposals, GPs will be able to choose from a list of a dozen eligible suppliers, and will also have the option of upgrading the clinical systems they already have in place.

The British Medical Association said that previously some GPs were being required to junk their existing systems for something “vastly inferior”. The new approach would allow doctors to continue using their existing applications, and resist the “dictatorial” approach of Connecting for Health and its lead suppliers.

This and other initiatives to increase flexibility and choice have seriously damaged Accenture’s hopes of generating revenue from the project. More choice means fewer sales for Accenture. “We were going to (supply) this for everyone,” it said. “Now we are looking at dramatically less demand.”

Some experts believe it is only a matter of time before the other lead contractors, including CSC and BT Group, encounter similar problems.

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