Talk:NHS National Programme for IT

Old discussions
There are some niggling inaccuracies in this piece that really could do with correcting.


 * 1) NPfIT is not an initiative of the "British" NHS, such an organisation does not exist. It is the NHS in England - quite distinct from NHS's in other parts of the UK: NI, Wales, Scotland. May sound like a small point, but England comes under the DoH, other UK NHS's come under their respective national executives. If there was a "British NHS" then NPfIT would cover the entire country. However, passports not withstanding, "Britain" is not a country, UK is.
 * 2) CfH did not replace the NHSIA. CfH was a renaming of the National Programme Office. At the same time, it  absorbed about half the NHSIA, which was disbanded. CfH(NPfIT) and NHSIA had been separate (and relatively antagonistic) agencies which embodied very different approaches to healthcare informatisation: NHSIA was a product of the NHS - originally the Information Management Group (IMG) based at Quarry House, Leeds, later based in Birmingham.
 * 3) NPfIT/CfH did not receive a Big Brother award in 2000 - it couldn't, it didn't exist then. The NHS as a whole received a Big Brother Award because of what was considered a poor attitude to data security and encryption - the result of long campaign mainly driven by Cambridge lecturer Ross Anderson.
 * 4) The financial figures given in this piece are highly misleading - and really should be corrected. The £2.6 billion was always described as the first tranche of funding. This was then increased to approx £6 billion. This is for capital spending.

However, the government also acknowledged that there would be extra spending involved at the trust level. From my rather hazy memory, I think they put this figure at between £500 to £1 billion a year. This they said would be funded from two sources - increases in NHS IT budget to trusts in line with Wanless recommendations, and savings in trust IT from the benefits brought by NPfIT. Last point much disputed by trusts and various others. Also it has been loudly pointed out - by the BCS amongst others - that all these figures only deal with the capital elements, and do not include the cost of re-engineering, staff training, consultants, time lost, etc etc. A figure of £15 to £30 billion then became accepted as real cost of NPfIT: DoH acknowleges possibility of £15 billion as top line figure - all journalists, critics etc claim £30 billion+. I think I've even seen figure of £50 billion bandied about. I think the statement that "Government estimates put figure at between £20 to £30 billion" is wrong - I'm pretty certain that Government does not accept the £30 billion figure. That was first pushed by Computer Weekly(?).

The Exclusions section is also misleading.

The Programme is "National" because England is a nation, just as Scotland and Wales are (I'll leave NI out of discussion for obvious reasons). England has separate legal system, separate national insignia (the English Royal Arms), separate monarch (yes, it's the same person, but she's actually legally a separate "person" in England from in Scotland), separate Parliament etc. The Parliament at Westminster is both the English Parliament, the UK Parliament, and the Imperial Parliament (I kid you not): three for the price of one. Always has been, since the Act of Union. While the Scots lost their parliament, the English never lost theirs, they just gained two more - one after Act of Union, second with the Canada Dominion Act in the 1880s.

Secondly, the point about opticians and dentists - these are not fully part of the NHS. However, there are NSFs, and related information strategies, that cover diabetes, cancer, etc that do affect opticians and dentists. CfH is increasingly involved in these NHS information strategies, viz pathology, RIS, and PACS. There is also a Dental Health Information Strategy that envisages the creation of a separate Electronic Dental Record (EDR) that will then connect with the nCRS. The analogy is with GPs moving from spine compliance to running the full Web services-based LSP core service.

The piece seems to suggest that NPfIT is not involved in surgery. This is not true.

What is important is that NPfIT does not currently touch on medical systems - ie Intensive Care, etc. It is clear that they have ambitions in this area, but are currently struggling with what they're committed to do.

Piece does not mention fiasco of IDX in Southern cluster, nor the problems facing Lorenzo in three northern clusters, nor problems around PACS delivery in NWWM and Eastern, etc. Doesn't mention either appointment of Cerner and Millennium to South.

Nor is there any discussion of software behind system, and why it seems to suffering so many glitches - ie use of obsolescent s-cobol system in London, and the problems the Programme seems to be having with .Net Framework 2.0 in rolling out core services. Nor why the Nat Prog went initially for cheap software solutions, that it then has had to buy itself out of expensively via heavy duty hardware (eg NonStop). --Prokopios 19:40, 12 January 2006 (UTC)

Some new criticisms of the project have come out in the press today:


 * http://www.guardian.co.uk/uk_news/story/0,3604,1682859,00.html
 * http://www.computerweekly.com/Articles/Article.aspx?liArticleID=213589&liFlavourID=1&ebref=3203

Maybe someone could write some of these up into the article?

-- TomRobinson 17:34, 10 January 2006 (UTC)

I have no particular opinion about this topic, but it would be good to balance out the criticisms with some of the stated benefits.

--212.159.18.8 22:33, 25 Apr 2005 (UTC)

Agreed this page is a vast over reaction to a poorly misunderstood concept. The NHS in my region alone has 4 Hospitals and 60 GPs, but every single computer system in this area (50sq miles) has a non-compliant, non communicating computer system; of which three of the primary patient information systems (PAS) were written 30 years ago on UNIX machines and are no longer supported or able to cope with the mass of new data.

What did the author expect the NHS to do?

Privacy assurances have always been utmost in the design of the system, and the concept has been built into the core of the data structure. Indeed the protection is so high staff have problems accessing it from authorised stations using Smartcard (Chip enabled) cards as the dummy testing is carried out.

As a Healthcare Scientist and Clinical Computer Systems expert I must object to this unbalanced knee jerk reaction. CjW

Connecting for Health
I think the name of this project/initiative/whatever has been changed to Connecting for Health - can someone confirm this is the case, and if so, the article needs to be moved. I'll do it if someone else has confirmed it and it hasn't been done next time I check. Proto t c 13:42, 29 September 2005 (UTC)

Name changes
The NPfIT is still called the NPfIT. However the agency responsible for delivering it is now known as NHS Connecting for Health.


 * Oh, OK. Thanks. Proto t c 12:20, 25 November 2005 (UTC)

Italic in NPfIT
Is the f in NPfIT supposed to be in italics? It doesn't seem to be on the connecting for health website --VinceBowdren 10:05, 20 July 2006 (UTC)

No, it's not supposed to be italicised. The NHS CFH website is the authoritative source for "official" information about the NPfIT.


 * NPfIT is written both with an italic f and without, ther eis some inconsistency between the new Connecting for Heatlh and old NHSIA websites as well as foundation and Primary Care trusts. Captain Scarlet and the Mysterons 11:29, 8 August 2006 (UTC)

National Identity Register
Inclusion of this reference to identity cards is misleading as it implies a relationship between NPfIT & ID cards which doesn't exist. Delete? Pimdip 13:46, 2 September 2006 (UTC)
 * I can't see what reference you are referring to. I actually think it would be valid to have a reference in the criticism section, as the criticism is inherently related to the government's insistence on placing everyone's personal details on national databases without adequate privacy safeguards, however I will not be insisting on such a reference. The only reference I can see is a 'see also' link, which I think is perfectly appropriate. -- zzuuzz (talk) 20:17, 2 September 2006 (UTC)

True Costs
Setting aside the 'waffle' comment, why would one need to 'cite' that a systems procurement incurrs off-contract costs? It's an accepted fact. The "£12Bn" figure relates to the activities I described. Feel free to 'unDilbertize' ttiotsw, but if the £12Bn is referred to, it needs context. That's what the NAO report stated. PS. Love the "against Censorship" logo on your page ;-) Pimdip 18:33, 18 April 2007 (UTC)

Rewrite 2008-05-29
I've just reorganised the article slightly. Going straight into the nuts and bolts of what the project deliverables are was to my mind less relevant and less interesting than the major concerns over the project, which I've accordingly moved up behind the section on scope. I've moved a little of the serious stuff from the criticisms section up to support the relevant higher sections, too - the open letters from a large group of leading IT academics in the UK deserved better than to be tucked away at the end of the article as it's extraordinarily trenchant stuff.

Similarly, I've divided the criticism section into subsections: if readers have to endure a section on "Clusters and Local Service Providers", I think it's reasonable that we also offer them one explaining what security risks the project carries. Nmg20 (talk) 10:39, 29 May 2008 (UTC)
 * As one who usually challenges unsubstantiated criticism or 'rumours passd off as facts', this edit seems a very balanced and impartial perspective. Pimdip (talk) 16:28, 29 May 2008 (UTC)

Google Health
An anonymous user posted about Google Health and claimed that it "offers what appears to be an identical service". At best, it offers a shareable care record, but with no interface to any of the other architecture of a healthcare IT system (Diagnostics, clinical noting, results reporting, booking etc.) I deleted the reference.

If it does deserve a mention here (I don't believe it does), someone who can be arsed (I can't) needs to explain and contextualise it accurately. Oh, and perhaps mention that as Google is US Based, all data are subject to the US Patriot Act, and may make interesting reading for any bored officer in Homeland Security. Pimdip (talk) 17:54, 31 May 2008 (UTC)

Observer Article
I've added a couple of words to compensate for sloppy journalism in The Observer. They transpose problems with Cerner Millennium in South & London (horrendous) to the whole of England.

I'm not implying that Lorenzo/iPM has been a cakewalk north of Watford, but the imbalance needed to be addressed. Any similar article about criticisms of CSC's offering would add balance, but I'm not aware of relevant equivalents to this Observer piece that relate to the rest of England.