Reinventing the wheel – a private internet for medical records wastes 10 billon – stakeholder case study

By Geoff Reiss
This case study reviews a failed IT project to digitise medical records at a loss of 10 billion. Lack of Stakeholder Management played a large part in making this such an expensive fiasco.
Stakeholder case study digital medical records - laptop and stethoscope
To my mind The National Programme for IT, NPfIT, is the worst example of a total lack of stakeholder management and a total waste of public funds. Certainly, nothing competes with its vast waste of money.

In a nutshell NPfIT was conceived as a central database of every UK resident’s medical records in a secure system available to all suitably authorised medical professionals. Like many projects this started life as an idea that seems great at the time.

This was an idea from the then new Blair Labour government. They did of course consult assorted management consultants all of whom rubbed their hands in glee at the vast fees on offer for a vast programme such as this.

A key benefit of this system was based on access to your health care records. If you were away on holiday, perhaps skiing in Scotland or surfing in Cornwall, and became ill or injured, the local medical people would have access to your medical records.

When the programme started, I happened to chair the Programme Management Special Interest Group within the Association for Project Management. As programme managers we were especially interested in benefits so, yes, we could see the lifesaving potential of this new idea. To understand the benefit better we asked the NHS how big a problem lack of medical records at the point of delivery currently was.

We expected to hear that a certain number of people was treated inappropriately, or their treatment was delayed due to this lack of data access. After some while we did get a response.

“We have no idea,” came the answer, “we do not store this data.”

So, we were off to a bad start committing something in the order of fifteen billion pounds to resolve a problem of unknown size. It might have been a problem for one person each year. It is important and rather shocking to know that the ‘b’ word is accurate. The sum involved was £15bn – the then cost of four or five sparkling new hospitals.

The then Parliamentary Under-Secretary of State for Health, Lord Hunt, announced the proposed major IT reform to the NHS on 12 June 2002, along with the publication of the Department of Health’s ‘Delivering 21st Century IT support for the NHS – National Strategic Programme’ (the NSP Plan).

The NSP Plan initiated what would subsequently become known as NPfIT, with its vision of “connect[ing] delivery of the NHS Plan with the capabilities of modern information technologies” (DH, 2002, p.1), through delivering the four key elements discussed at the 18 February 2002 seminar:
  1. an integrated electronic health records system;
  2. electronic prescriptions;
  3. an electronic appointment booking system;
  4. an underpinning IT infrastructure with sufficient capacity to support the national applications and local systems
Gung-ho as only a public sector programme can be, work began on element four – the private internet infrastructure.

It was decided that the internet was not sufficiently secure for our medical records, so BT was awarded a half a billion quid to create a private, NHS-only, internet to be known as the Spine. A large chunk of this cash went on fibre optic cables laid beside railways lines from city centre to city centre and technological infrastructure to support it.
Very considerable expert stakeholder comment arose at this time saying that this private NHS internet would be at best no better, and probably worse than the already existing internet.
Government spokeswoman Caroline Flint failed to dispel concerns regarding access to patients' data by persons not involved in their care when she commented in March 2007 that "in general only those staff who are working as part of a team that is providing a patient with care, that is, those having a legitimate relationship with the patient, will be able to see a patient's health record.’

In June 2006, the Local Medical Committees’ Conference passed a proposal to advise GPs to consider withdrawing from the Spine on privacy and security grounds (E-Health Insider, 2006). Several data risks with NPfIT around patient awareness, confidentiality, accuracy and security were also acknowledged by the Information Commissioner, Richard Thomas (Thomas, 2007).

A little while later serious stakeholder issues began to emerge chief of which was that common stakeholder cry; “Why were we not consulted earlier?

The next group of stakeholders to raise concerns were the many UK GPs themselves. GPs asked two key questions:
  1. If the electronic appointments system, to be known as ‘choose and book’ was to allow a patient to choose which consultant to see, in which hospital and when, how would this fit with the seven and a half minute appointment time GPs were supposed to allocate to each patient.

  2. How would all the medical records currently held in GP surgery systems, some on IT systems and much on paper, plus records from many other health care organizations including hospital, be transferred onto the new nation-wide system.
It began to become clear that here we had a solution looking for a problem.

Somewhere around this point one should ask if there was another way of solving the problem. Perhaps a look at a few other countries might have helped. Australia and Germany both had systems built around the patient and not a central IT system.

It also became clear that the mass of data simply could not sensibly be held in a single system. 65 million people’s medical records, test results, X-rays and so on would be a massive amount of data.

It is hard to work out what was spent as the whole programme became such a hot potato. It was clearly somewhere between the Guardian’s estimate of £10bn but it might have been as much as £15 billion.

Richard Bacon, a Conservative member of the Public Accounts Committee, said the report was further evidence of a "systemic failure" in the government's ability to draw up and manage large IT contracts.
"This saga is one of the worst and most expensive contracting fiascos in the history of the public sector”.
What did we get for all that cash?

Some would argue that we did get electronic prescriptions. Some others would argue this was on the cards already and that NPfIT actually slowed down the creation of the e-prescriptions systems in some areas of the country..

We do share X-rays. Your GP will have access to the X-ray taken at your local hospital in a matter of moments. Some local health authorities were developing this at that time.

Sadly, what the NHS could have had with that level of investment casts a long shadow over the few minor improvements we got.

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National Audit Office (NAO), 2011, The National Programme for IT in the NHS: an update on the delivery of detailed care records systems. REPORT BY THE COMPTROLLER AND AUDITOR GENERAL. Available at: