The British Computer Society (BCS) has warned that unless urgent action is taken 40 years accumulated experience of health informatics may be swept away either by the promise of the "new" or by attrition and inertia caused by the current IT planning blight, placing the NHS IT strategy at risk.

In a briefing paper, called ‘Radical Steps in Health Informatics’, the BCS Health Informatics Committee (HIC) welcomes the direction of the new strategy for informatics for the NHS, but urges a "serious review of the target dates and the interaction with the wider e-government agenda."

Jean Roberts, BCIS HIC communications task force lead, told E-Health Insider that the report was the product of think tank workshop sessions involving over 100 delegates from the industry, academia and the NHS.

Radical Steps says that health informatics is currently characterised by "an environment of confusion, blight, demotivation," and a lack of appropriate skills. It adds that past successes have not always been widely disseminated and built on.

The report says that the role of complexity has so far been "very seriously under-estimated" in the national IT programme. It also stresses that the functional requirements of systems solutions must be specified and tested for fitness of purpose by potential clinical end users before final acceptance.

"Strategic health authorities are a long way from the coal face and the IT decision makers in them will not have a lot of operational experience," Ms Roberts told EHI.

Radical Steps adds that the NHS is "far too large and complex to be run on a centrist command/control basis", and calls for a major structural revision to deploy decision making and decision support to operational level – though the value of national frameworks is acknowledged.

Serious concerns are also identified about the introduction of new players into delivery of informatics in support of health. In particular it questions how local implementations of national systems will be relevant and appropriate, based on a model for delivering the the NHS IT strategy based on big Prime Service Providers (PSPs).

The BCS paper calls for initiatives to generate a greater understanding, and says the best solutions will need: "protected funding, meticulous planning, dedicated implementation, empowered users and an informed commitment to informatics use".

Radical Steps adds "This can only be achieved in a climate of positive partnership between new and existing stakeholders." It calls for action to remove the ‘blame’ culture of the past, and engage the commercial sector in partnership rather than customer-supplier relationships.

The paper also stresses that all healthcare professionals require further informatics education and awareness training to reduce current images of ‘big brother’ tools used only to evaluate practice and performance.

The BCS paper concludes that while the NHS has no responsibility to sustain health informatics companies, "it is in its best interest" to maintain a competitive, financially sound industry in order to ensure choice, innovation.

"Given the structure of a PSP and its stable of application providers, how does innovation get into the loop?" questioned Ms Roberts.

She also highlighted the potentially disastrous impact on clinical application providers as the market freezes over while StHAs wait for the National Programme to take shape. "We think that StHAs will feel that they cannot put in place interim contracts before PSPs are in place."

The BCS paper calls on the centre to look again at ongoing developments with a critical eye with regard to value for money, effectiveness; lessons learnt, and where necessary terminate existing contracts.

It stresses that ‘strenuous efforts’ are required so all those health professionals affected by informatics understand the implications of new systems, arguing "This may counter any previous perception of systems ‘infliction’."