Dealing with the aftermath of the National Programme for IT in the NHS has been identified as one of the risks to the government’s latest reforms of the NHS, in a leaked draft of the risk register for the changes.
The undated draft, which was leaked to former NHS chair and health writer Roy Lilley, opens by noting that “the policy design for some aspects of the future organisation is incomplete” which means the Health and Social Care Bill will proceed “on the basis of incomplete / flawed design.”
The register specifically mentions the “future design of informatics” as one of the aspects of the new set-up that “comes too late to feed into the overall system definition / architecture.”
Although the government has twice said that it will “dismantle” the national programme, it has yet to publish an information strategy, outline the split between the roles of the NHS Commissioning Board and a new IT delivery agency, or finalise how IT support will be delivered to local organisations.
It also needs to complete some contractual business, with a new deal with CSC for the North, Midlands and East of England due to be signed by the end of this month, and new procurements for systems in the South due to start shortly.
The risk register puts the risk of design of key parts of the system running behind decisions being made on the Bill as ‘4’ on a five point scale running from 1 (rare) to 5 (almost certain), and assigns it an impact of ‘4’ on a similar five point scale, running from 1 (very low) to 5 (very high).
The government has fought a campaign against releasing the register for more than six months.
The Information Commissioner’s Office ruled last November that it should publish transition risks register, and the Department of Health recently lost its appeal against publication at an information tribunal.
The government argued that publishing the document could impact on the quality of advice given to ministers in the future and that it could be misunderstood by the public.
Many of the risks identified mirror criticisms of the reforms and the potential dangers of imposing them at a time of “unprecedented” financial challenge in the NHS.
Several of the risks deal with the danger of managers taking their eye off the need to make financial savings through quality, innovation, productivity and prevention programmes, of new organisations starting work before their roles and budgets are clear, and of new organisations making costly decisions.
“One example of an area where the system could be more costly is if GP consortia make use of private sector organisations / staff [that] adds costs to the overall system,” the register says, adding that “unfavourable media coverage” is already focusing on “privatisation” and “financial cuts”.
On the other hand, some of the risks discuss worries that the new system may not be different enough – that clinical commissioners will adopt management habits, and that “excessive risk aversion” among existing players will leave commissioning support and reconfiguration policy looking “much like it does now.”
The risk register suggests that senior figures at the DH and NHS CB are acutely aware of the impact on informatics on these outcomes.
The register lists three risks related to informatics, two of which relate to transitioning contracts and failing to secure basic IT infrastructure and tools, and one of which returns to the question of how IT will support the new system.
Its over-arching concern is that the reformed will be seen as a new set of organisations, rather than as a fluid, dynamic system, and that IT will be set to support these new organisations, instead of transactions between them.
It says this means there is a risk that “the enormous potential of informatics (the knowledge, skills, processes and technology which enable information to be collected, managed, used and shared to support the delivery of health and care and to promote health and well-being) is not sufficiently taken into account in the system design."
© 2012 EHealth Media.
Pre-emptive leaking and lack of strategy?Mary Hawking 156 weeks ago
Is this leak suspiciously well timed?
*too late to have any effect or inform debate by MPs* - and in the middle of so many other problems - such as the Conservative party promise of not only private dinners with the PM and Chancellor but also feeding party donors' concerns into the policy committee - so unlikely to have the impact it would at other times?
The concerns expressed in the comments seem to be about IT within individual Trusts rather than the lack of an overall strategy: if the nNHS is to work and benefit patients, IT needs to be part of an overall strategy for information and communication: has anyone spotted such a strategy at any level yet?
As for the Information Strategy - it looks as though it, too, will be released - if it too isn't regarded as too sensitive for the proletariate to read - far too late to be of any use in shaping the nNHS: remember Frank Burns' daffodils?
Learn lessons or be doomed to repeat the mistakes of the pastInfoman 156 weeks ago
Shooooosh....don't tell everyone but I have a copy of a secret document (on a thing called a CD??) setting out all the lessons from a forgotted period in NHS history. Its yours for a fair price.....btw its entitled: "Electronic Records: Lessons from the Electronic Record Development and Implementation Programme; November 2002.
Shame that NPfiT didn't bother to read it.
I despairmrtablet 156 weeks ago
The NHS reforms IMO do not carry an IT risk. The reforms rather manifest an acute-on-chronic political failure.
A successful enterprise IT system requires the pre-existence of coherent, implementable and relatively stable management structures and business models.
The NHS has not had these since the early 1980's (or possibly ever). One cannot computerise a mess. End of.
Meanwhile here is a functional specification for a post-commissioning IT system in the NHS ....
"We don't understand how this fits together at all. Please Mr Management Consultant supply an IT system which counts enough beans to keep the Minister and DoH off our backs".
This will not end well.
Forgetting SantayanaJacquesOuze 156 weeks ago
Yes, but that has been tried before. In '98 we ended up with a few islands of excellence in a sea of dross. Obviously the landscape has changed enormously, but can anyone pursuade me that letting 'organisations chose to spned their budget on their priorities' will not lead to a similar pattern of behaviour as it did before?
Islands of excellenceDaniel Defoe 156 weeks ago
Yep Jaques; except that those with the dross were fast realising that if they moved to the excellence which others were achieving, they'd improve healthcare enormously. The trouble was that just as they'd completed their planning to acquire some worthwhile IT relevant to them, along came NPfIT to put the tin lid on things, and set us all back ten years. When I see the proper joined-up public healthcare IT that they now have in mainland Europe - even in the less prosperous countries - and compare it with what we have in England, I fell ashamed to be associated with it. It's ludicrous, for instance, that we're still writing radiology images to CDs and sending them to other hospitals when required, or faxing medical records... etc.
From islands to archipelago?JacquesOuze 156 weeks ago
Well I hope you're right. I couldn't see any evidence of that view emerging at the Trust I worked at at the time, although it was a complete basket case in so many ways.
And I don't see what incentives there are to make systems work on a health economy level or higher, even if you're correct and Trusts recognise the value of planning and joining up systems within their organisation, rather than adopting the kind of laissez-faire approach that was my experience. At the HE scale, I think MrTablet is correct and the state of permanent revolution will prevent any level of coherence from being established.
Not so contraryCanUseeTheLight 156 weeks ago
This issue now will be that so many of the smart / innovative suppliers have, as Elvis, left the building.
Those that remain are unable to compete on a level playing field because of the procurement rules and related SFIs . Consequently they end up having to sub contract to larger SI%u219s who ramp up the cost and shed the risk.
The status quo is maintained even though there is good intention for it not to be. There is the odd maverick FT which does its own thing and succeeds at doing so but I fear they are few and far between.
Central government is a large SI addict, it cant help it as the SI is very good at being the supplier to that engendered need. We need some revolutionary thinking, we need an agile (small a) approach, we need to stop thinking we know it all and actually ask questions of the people who do the work. We also need to ensure that elements within DOH and its subsidiaries actually communicate within and without their boundaries.
Only then could devolved funding make its way into provisioning systems of note and utility.
Now that's a surpriseContrarian 156 weeks ago
The biggest risk is letting CfH continue as was. I believe there is much to be said for allocating money directly to organisations for them to set and manage their own IT needs, steered by National policy. The sooner we get out of these legacy contracts that have delivered little at significant cost with questionable benefit and let front line organisations choose to spend their budget on their priorities the better.