Coffee House

Will Hunt’s paperless NHS reform dream ever come true?

16 January 2013

Jeremy Hunt has announced new plans to shift the NHS into the twenty first century by removing all vestiges of paper by 2018. While computerising health records sounds mundane and complicated, the Health Secretary has done his best to make the plans appear logical and advantageous. In his announcement, Hunt says:

‘The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution. It is crazy that ambulance drivers cannot access a full medical history of someone they are picking up in an emergency – and that GPs and hospitals still struggle to share digital records.’

The interim stages to Hunt’s ultimate goal sound realistic. Records held online by March 2015 if you so choose, paperless referrals, followed by the secure linking of health records that can be passed around different parts of the NHS. There’s economic logic behind the plans too. The Department of Health have brought in PricewaterhouseCoopers, who concluded £4.4 billion can be saved by modernising their administrative operations; money that could be used to treat patients.


Alas, to quote Shirley Bassey, ‘the joke is rather sad, that it’s all just a little bit of history repeating’.  Pretty much everything Hunt announced today was part of the £12 billion stupendous disaster known as the National Programme for IT. The project was due to include a similar electronic linking of records, scrapping paper as well an NHS-wide email system. Although the latter half was brought to life, the rest was scrapped and the final bill to the taxpayer was double the original budget. When finally axed, then-Health Secretary Andrew Lansley said:

‘Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs’

Hunt is thankfully aware of the dangers  and has promised to do things differently. Instead of a huge central database, local NHS groups will build their own databases that will be magically linked together. It’s localism in action (hopefully), according to Hunt:

‘Previous attempts to crack this became a top down project akin to building an aircraft carrier. We need to learn those lessons – and in particular avoid the pitfalls of a hugely complex, centrally specified approach. Only with world class information systems will the NHS deliver world class care.’

Much like Iain Duncan Smith’s Universal Credit system for welfare, the success or failure of this project will rest on good cooperation between private contractors and the government to ensure the individual systems can speak to each other. If they get it wrong, it will be another public sector IT disaster, another failed attempt to reform the NHS and more ammunition for Labour. The stakes couldn’t be much higher.

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  • John McClane

    I don’t want to be on an NHS database. I don’t want to end on up on the Liverpool Care Pathway on the basis of what a nurse sees on her computer screen.

  • williamblakesghost

    The idea that these databases are somehow going to magically link to each other if they are not identicial is risible. What happens if a few groups decide they cannot afford these databases and prefer to spend the money on patient care? What if the database designs differ significantly? What happens if some use Access, others use Oracle and others use Informix? What happens if some use MS Windows others use Apple and others use Linux. Whilst there are ways to interface different products the cost is immense.

    Its one thing to create a centrally designed distributed system which might be feasible eventually at great cost. However such a design is not localism by any sense of the term. Its one great big centralised IT project still just using a different technology design and has all the inherent risks that a centralised database plus a whole lot more associated with distributed computing and whole lot more cost as well.

    The idea that various groups autonomously build their own databases is even worse. Then you don’t even have a commonality of design and the development, implementation and integration costs will be immense. So either its a lunacy of localism in IT terms or Hunt is a bare faced liar!

    This is going to be the greatest disaster in Government IT history and probably the biggest waste of money on technology there has been. Someone should send Hunt to the funny farm!

  • alexsandr

    i hear of governement doing IT and I think – here we go again. Why is government so crap at IT?

  • Jonathan Munday

    As a GP in London a localised IT system is our number one priority. When the CCG takes over from the PCT this is something we plan to push hard on. We already have a link up with the local physios and are expecting to expand this.
    So many consultations are wasted because I do not have access to notes and investigations and treatment plans devised elsewhere and vice versa
    The local hospitals are well behind in using IT and all have a different system. We have created an IT hub that will allow every computer to see a patients health record elsewhere in the NHS community. Patients have the right to opt out but will then continue to have their consultations subject to the Royal Mail’s permission.

    This is totally different from Labour’s IT disaster which was set up purely for the convenience of epidemiologists and was far too complex to ever work. It was also a snooper’s charter. With our system the only people who will be able to see your record are people who you are consulting

    • MirthaTidville

      `With our system the only people who will be able to see your record are people who you are consulting`……you cant be that naive surely??..that sort of info must never be trusted to governments/agencies etc. They WILL find a way to snoop. Individuals must also be given a cast iron opt out from this database as well…

    • williamblakesghost

      The local hospitals are well behind in using IT and all have a different system

      And there it is localism in IT at work.

  • In2minds

    Another giant database to go wrong!

  • Andrew Paul Shakespeare

    Oh please! Paperless offices? How very 1990’s. The idea was so impractical, that everybody else has given up on it. Whoever talks of paperless offices these days (outside the government, evidently, which has yet to catch up with the rest of the world) And they haven’t been able to make that NHS computer programme work for years.

  • telemachus

    Lest we forget

    The Culture Secretary, Jeremy Hunt, was battling to save his political career last night after it was revealed that his office was secretly passing information to the Murdochs during their £7.5 billion bid to take over BSkyB.

    Mr Hunt faced demands for his resignation after hundreds of pages of explosive emails, released by News Corp to the Leveson Inquiry, showed that his political advisers engaged in intimate and frequent briefing of the Murdochs’ chief lobbyist to help get the deal through – despite Mr Hunt’s claim to have acted impartially in his exercise of quasi-judicial powers.

  • 2trueblue

    The answer to your question is NO. All government IT programs end in disaster, overruns, both in terms of delivery and keeping to the budget. I have worked with 2 areas in the public sector their computer projects, and they were a disaster. Those ‘gifted’ with the responsibility had not got enough experience in dealing with such complex systems.

    Being aware of the difficulties does not make one capable of doing the job.

    The idea that local areas will have their own databases, and probably have a different system, and magically link up is worrying.

    There are currently a number of different Patient Admission Systems in operation which are not compatible. It all sounds messy and expensive. A paperless system does not exist when you have details that need continual referencing by a vast number of people on patients condition. As it is doctors do not even open letters that arrive by email, or read through all the pages of test results on screen.

  • Tom Tom

    It has to become reality to conform with the EU Database requirement for medical records to be interfaced across the EU. The Single Market requires that patient data be fungible and accessible throughout the EU and it will be easier for medical researchers and pharma companies if it is not paper based.

    • Tom Tom…………….A large-scale European programme, Smart Open Services European Patient (epSOS) network, came online in May 2012………………..(02/07/2008) The European Commission today launched two initiatives to improve the safety and quality of care to people who require medical assistance while travelling or living abroad: a Recommendation on cross-border interoperability of electronic health record (EHR) systems and the european patient Smart Open Services (epSOS) project.

      • John McClane

        Doesn’t work. Won’t work.

        Multiple alphabets operate across the EU. How is the EU going to make that work? If the doctor can access your records does he have the technology & expertise to deal with it? I’ve been offered kidney transplants on the results of a blood test.

        Even the EHIC doesn’t work in some countries in the EU.

        • Tom Tom

          Don’t ask me . I opt out and do not trust the NHS or anyone else with data I do not have access to

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