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The National Programme for IT (NPfIT) which is being delivered by the new Department of Health agency NHS Connecting for Health, is an initiative in the British National Health Service to connect England's 30,000 GPs to 300 hospitals, allowing access to all patient records by health professionals and patients. It is said to be the world's biggest civil information technology program [1].
The programme has been criticised for its lack of security. In an interview in The Times newspaper of August 16, 2004 [2], the government's own Information Commissioner expressed concern over this and other national IT projects, indicating that there was a danger of the country "sleepwalking" into a surveillance society.
NPfIT has so far won two Big Brother Awards from the campaigning organisation Privacy International:
- 2000 - "Most Heinous Government Organisation", due to the lack of security and lack of protection to patient privacy.
- 2004 - "Most Appalling Project", for the continuation of the plans without adequately addressing the earlier concerns.
These concerns must be set alongside the necessity of care professionals having access to personal medical data if they are to deliver safe, high quality care. The balance between the right to privacy and the right to the best quality care is a sensitive one. However the stringent sanctions against those who access data inappropriately are instant dismissal and loss of professional registration. This means that not only will the perpetrator lose their job, but any chance of getting another.
More worryingly, a January 2005 survey among doctors [3] indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year. There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project.
Originally expected to cost £2.3 billion over three years, November 2004 Government estimates put the cost of the programme at between 20 and 30 billion pounds, although it is expected that this will be recovered in "savings and other benefits" [4].
On April 1 2005, the Programme became part of a new agency called NHS Connecting for Health (note - it did not change its name), which also absorbed both staff and workstreams from the abolished NHS Information Authority, the organisation it replaced.
The NHS in Wales is also running a national program for service improvement and development via the use of Information Technology - this project is called Informing Healthcare
As of August 5, 2005, research carried out across the NHS in England suggested that clinical staff felt that the programme was failing to engage the clinicians fully, and was in risk of becoming a white elephant.
The scope of the programme
The programme divides England into five super regions (London, South, Central, North-West, and North East) and has appointed five different industry consortia to act as Local Service Providers for these regions. The LSPs will take over provision of all IT services to both primary and secondary care providers in each region. (This information is 2 years out of date)
Above these five LSPs the programme has also appointed a National Service Provider (NASP) to provide a "data spine" to connect all the regions. (This information is 2 years out of date). The core of this data spine will consist of a national data base of summarised patient health care records and a service to identify an individual from a partial set of demographic data. This second service is needed to be able to find the right records for a given patient who may not know or be in a position to recite his or her NHS number.
The national data spine will also host services such as Choose and Book — the electronic appointment bookings service — the electronic transfer of prescriptions (ETP) and the National Care Record Service (CRS).
Important Exclusions
It is important to note that NPfIT is not really the all-encompassing medical system it claims to be. For instance, despite being called 'National' it has no links, planned or actual, to the equivalent system in Wales and there is no similar system yet proposed for Scotland; because Scotland and Wales are producing their own systems complying with the continuing trend of devolution of government reponsibilities. These systems will then be croos linked to the English programme.
NPfIT also currently only caters for GPs; Acute and Primary Hospitals, medical clinics and local hospitals and Surgeries. There are no immediate (certainly not before 2010) plans to include opticans or dentists and several key medical areas (e.g. neurosurgery) are not included in the plans at all. Stop Press: Neurosurgery is now included, there are now 8 choices for the patient in the Oxford and Buckinghamshire area alone.
Surgery where Cancer or where immediate treatment is required is not and never has been the remit of non-urgent booking schemes before of after the NPfIT programme. These patient needs have always and will always bypass any queuing system and be rushed to the forefront for urgent patient care.
The problem always has been making sure these urgent cases are correctly identified as such from diagnosis to treatment. The 2 week wait initiative will be strengthened - and never was intended to be incorporated.
See also
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