NHS IT: A critical case for treatment

With £30bn at stake, the grand NHS IT project is already showing signs of delay and underperformance. Chronic problems need fundamental treatment

The prognosis is not good. Throughout the National Health Service MRSA (Ministerial Responsibility Shockingly Absent) is rife. The patient is confused, the doctors squabbling, the relatives increasingly angry.

Recent results on tests of the NHS IT central nervous system are bleak. Richard Granger, director general for IT in the health service, has publicly complained about the poor state of essential projects. In leaked emails, he goes further — diagnosing rapid changes in specifications which are arresting essential development. Cash is bleeding away, time is running out.

When civil servants break patient confidentiality like that while simultaneously straining professional mores — he named names — those of us clustered outside the intensive care ward can only assume things are bad indeed. We're glad he's talking, but there should be no need for such career-threatening strategies.

This is our health service, which is to say our health, at stake. The ministers don't know what's happening: they're only told that key projects are years behind when special committees investigate. The civil service is in open disarray. The contractors are not delivering — and as usual are probably well protected from the blame game.

We cannot expect the politicians to understand the technicalities of major IT projects, although we can expect them to make fine-sounding promises. Likewise, we can't expect contractors to turn down large contracts even though they suspect them to be badly conceived and unlikely to be deliverable. What we can expect is for the civil service to effectively mediate, telling the politicians what is and is not possible while keeping a firm grip on contract management.

This isn't happening, because the civil service has insufficient authority. In medical terms, it's as if clinicians have to obey diagnoses from part-time amateur professors while using untested drugs. No wonder the NHS is so poorly served.

To gain the authority required, the civil service must establish a centre of excellence for IT, a place of effectiveness and prestige capable of attracting the brightest and best. It must offer a proper career path, to keep those people in and the consultants out. It should aim for the impartiality and focus of the judiciary, and the technical savvy of the better academic institutions.

It will require cultural change, vision and expenditure — but nobody said good treatment has to be cheap. It just has to be effective and capable of long-term results, and on the current evidence nothing weaker can be prescribed.