Things can only get better

The Liberal Democrats, whose surge in support looks set to be the big story of the 2010 general election, would like to abolish England's National Programme for IT. In the words of Norman Lamb, the party's health spokesperson writing for SmartHealthcare.com in March, the next government should "admit that we've been sold a turkey, salvage what we can and adapt our approach so that our focus is on local connectivity". ( Link to Lamb's article ) The Lib Dems will need to get a move on, however: the programme's managers have spent the weeks before the election abolishing large chunks of its former purpose. The idea that every trust in a region would use the same software to handle patient administration and records has been abandoned – explicitly in London, and implicitly in the 60% of the country covered by the North, Midlands & East (NME) region – and the brakes have been applied to the Summary Care Record's accelerated roll out. The abandonment of single software packages has been the likely outcome for months, or even years. The idea that every trust could adopt standardised software was proven wrong by episodes such as the painful introduction of Cerner Millennium at the Royal Free in Hampstead in 2008. And if software is going to be adjusted for each trust anyway, why not allow more than one kind and adapt those that are already in place? The government had already conceded this choice for the South following Fujitsu's departure as the local service provider. Trusts in the region are somewhat behind schedule in choosing from the Additional Supply Capability and Capacity (ASCC) list ( link ). But at the start of April, BT's reduced cost deal for London meant that some acute trusts will continue with their existing IT systems ( link ). Later in the month, the government said it had agreed a deal with McKesson to maintain its patient administration systems at 26 trusts. The Department of Health press office would not say where, but a Freedom of Information request revealed that the majority are in NME territory ( link ). CSC commented that this is only a four year deal, and it "remains confident that trusts will continue to view Lorenzo Regional Care as the best long term solution". But with several other trusts, including Newcastle Hospitals and Blackpool, Fylde and Wyre Hospitals, already having opted for alternatives, even as a stop gap, it looks likely that iSoft will eventually have to compete for Lorenzo deals in the North. (Perhaps against McKesson, which yesterday announced its intention to introduce its Paragon suite to the UK - link ). iSoft seems ready to do so, given it is already doing so in the South, such as at Sussex Partnership ( link ). So all three regions look like they are open, or about to open, for business. Meanwhile, the other great bone of contention of the national programme – the dash to form Summary Care Records in five regions in England – was put on ice by the government on 16 April, following pressure from the British Medical Association ( link ). Parts of it are excellent Some see the National Programme as a complete failure. This isn't fair. It has succeeded in introducing a number of national systems, including N3, NHSmail, Choose and Book, and picture archiving and communication systems (Pacs). But those running it had two major failures of judgement. The first was that the idea that the highly varied group of organisations that make up the NHS could use standardised software. The second was that a centralised patient record system, to which a large number of professionals would have access, would not raise serious security and privacy issues with patients and professionals. Both mistakes can be pinned on former prime minister Tony Blair, who took a significant role in the programme's design, and his government. In setting up the programme, they seemed to rely more on advice from management consultants rather than those within the NHS, which helped lead to the software standardisation mistake. Furthermore, as Blair's 'surveillance state' projects such as the probably-doomed identity card show, he also had cloth ears for privacy. Did this make Blair the right person to establish of the largest civil IT project in the world, dealing with hundreds of varied organisations and perhaps the most sensitive set of personal data held by the state? No – it made him pretty much the opposite. NPfIT and NHS Connecting for Health, quite possibly under different names, will continue in some form after this election: the national infrastructure and standards they have established are an asset to the NHS. However, the wrong-headed aspects of the programme look likely to fall away along with Labour's single-handed grip on government. The alternatives – NHS trust choice over core software and informed patient choice over electronic records – look, basically, better.