Building a huge database of patient records is a titanic task that takes a huge investment. But the NHS has come unstuck with Health Minister Andy Burnham pulling the plug on £600 million for the project. Out of £12 billion planned. How has it come to this? Was there a better way? Probably.
I think any large scale IT system is best grown organically. Take the internet. It started with a few interconnected US military computers, went on to encompass academia then the public and then all of us with the web. But when you’ve got a huge legacy paper system to convert that’s already in disparate formats, what do you do?
What you don’t do is rope in an enormous inefficient old school tech company and manage it with mandarins who don’t know how to control function creep. Things move creakingly slowly. Too many jobsworths get involved. Too many people who know too little get in the way and the whole thing grinds to a halt with spiralling budgets and spiralling scope.
It’s something that isn’t unique to a national health service. Even in the advertising business, I’ve twice seen over-ambitious software plans go to waste because too many were involved in producing software without the talent to manage it properly.
Far better to let each trust develop the systems they need quickly and cheaply
Thankfully, Andy Burnham has said it would now be up to local NHS trusts to decide how to be a part of a national system. And the Tories also feel that local development is better. Shadow Health Secretary Andrew Lansley supports decentralisation and local procurement. Great. Both Labour and Conservatives agree, and it’s a point of view I fully support. Far better to let each trust develop the systems they need quickly and cheaply. If trusts talk to each other on a regional basis, the best systems will catch on and soon get adopted organically. In the end, it saves everyone a lot of money and time and patients get a better product. A competitive internal market.
Burnham said:
“Our aim is to give trusts more flexibility and choice of IT systems … enabling local innovation by linking national systems with those provided by local service providers; allowing the NHS to design IT systems to fit their local needs.”
Sometimes centralisation can be a good idea, giving huge economies of scale. But sometimes it saddles you with uncompetitive, inflexible processes. Let smaller projects compete for attention on their own merits, awarding performance and value for money points using local and regional innovation competitions. Then let them get adopted organically. Ring fence the organic growth. Don’t let anyone take charge and demand it tomorrow, nationally. That’s the tricky bit. But that’s also the way to get leading edge good value software.
