Britain’s Tories say they will cancel
LONDON, U.K. – Britain’s
Conservative Party is threatening to scrap the country’s $12 billion
healthcare IT system if it wins the next general election. The Tories
have been critical of the massive electronic health record program,
which has been plagued with difficulties and is running four years late.
In August, Stephen O’Brien, the Conservative party shadow health
minister, published an independent review of NHS IT systems. Promising
an end to the Labour government’s centralized approach to information
management, he said the Tories would give patients more control over
their own medical records.
In particular, he said that electronic records could even be held on
internet-based systems run by companies such as Google and Microsoft.
As well as renegotiating “local service provider” contracts between
contractors and the regions of the NHS, Mr O’Brien signalled that some
parts of the current system will be abandoned outright.
The central “spine” connecting all parts of the NHS and allowing patient
records to be accessed from anywhere in the service would be scrapped,
Mr O’Brien said, saying that his review had identified little demand for
universal access to health records among NHS workers.
When the British healthcare IT programme was first bruited about in
2002, under the Labour government of Tony Blair, the idea of a full
patient record, available anywhere in an emergency, was the principal
political selling point for what was called “the biggest civilian
computer project in the world.”
The aim was to give all 50 million or so patients in England (the rest
of the U.K. is working out its own strategy) an all-encompassing
electronic record. Roll-out was meant to start in 2005 and be completed
Under a Conservative government, development of the local record –
exchangeable between primary care physicians and their local hospitals –
would continue. Nationally, clinicians would still be able to seek
access to it when needed from the doctors who would hold it locally.
But the idea of a national database of patients’ records, instantly
available in an emergency from anywhere in the country, would disappear.
According to a report published in the Financial Times, for many
clinicians, the idea of an instantly available national record was never
seen as a necessity. It is access to a comprehensive record locally that
is crucial for day-to-day care.
Nonetheless, the Conservatives’ decision to scrap the central database
is a symbolic moment for a £12billion (US$20 billion) programme that has
struggled to deliver from day one. It is currently running at least four
years late – and there looks to be no chance in the foreseeable future
of its delivering quite what was promised.
So what went wrong? Too much ambition, too much speed, too much
centralisation, too little local ownership and not enough choice have
been just some of the
“It is more difficult than people think. But I do think that by now,
seven years on, we would have been further forward,” said Dr. Glyn
Hayes, former chairman of the British Computer Society’s health section.
Running a huge, centralized project is seen as a major problem. In IT,
the bigger the project, the higher the chances of failure – that is,
running late or over-budget. Or worse still, not being used, after all
the time, effort and money has been expended.
“The arguments for centralization were first that all these systems had
to be able to talk to each other,” says someone who was closely involved
in the government’s original decision to launch the programme. “Second,
there were powerful arguments for economies of scale if the system was
bought centrally. And, third, the NHS had a long history at local level
of taking money earmarked for IT or other projects, and finding ways of
spending it on something else.
“Looking back, it was the wrong thing to do. It was right to centralize
standards for communication and for what should be in the record. It was
right to use centralized purchasing power. But the next step, that the
whole programme had to be centralized, did not have to flow from that.
It proved to be a mistake.”
With a staggeringly ambitious goal to get the first electronic records
running just three years down the line – when what was to be in them had
yet to be fully defined – Richard Granger, the then director, decided
that the fragmented and small providers of IT still in the NHS hospital
market did not have the scale or industrial muscle to deliver.
But there were problems with large companies that won contracts to
supply solutions. The US company Cerner had good clinical systems. But
software designed for hospital billing systems in the US needed a big
rewrite to run all the administration and reporting functions of the NHS.
Conversely, iSoft, which at the time was a British company, knew how to
run the administrative side of the health service but lacked a clinical
record. It has taken years for the often troubled company to come up
with one. The first deployments of early versions of it are only just
Moreover, while there was a £6billion budget for the 10-year central
contracts, no money was dedicated to training, in spite of the lesson,
from the relatively few successful installations of electronic records
in US hospitals, that at least as much has to be spent on changing the
way staff work as is spent on the systems themselves.
Furthermore, there was no local ownership of the programme. Local
developments of electronic records that were under way were halted. The
national programme became something that was delivered from on high to
hospitals and clinicians, not something that they chose or voted for.
They also had to fund their own training and other costs.
So where does the programme go now? BT and CSC, the two remaining
systems installers, have been given deadlines of November 2009 and March
2010 respectively to achieve a smooth implementation in a big acute
hospital. Failing that, the department of health says it will “look at
Quite what plan B is, however, remains a mystery. Any decision to cancel
the contracts is likely to result in mighty litigation. The hundreds of
millions of pounds set aside to achieve an electronic record could go up
in smoke in claim and counter-claim as each side blames the other.