Last week, E-Health Insider published a round-up of comments from readers on the apparent new hard line on suppliers being adopted by NHS IT Tsar Richard Granger –The NHS and the IT Industry: Over to You. Since then your emails have continued to roll in.

One reader emailed to ask about our readership: "Has anyone thought to drop the web address into Mr Granger’s email so he can read what everyone thinks? E-Health Insider’s web stretches wide and appropriate emails have been sent.

Investigations strongly suggest that the Mr Granger is indeed aware of our coverage and readers feedback – whether he can be counted a fan remains unclear.

The comments we published last week also inspired a follow-up email from a commentator describing themselves as ‘a senior NHS clinical informatics consultant’, who said they were reassured that others had expressed similar reservations.

"It was reassuring to see so much anonymous consensus – and from a range of stakeholder perspectives. Many comments go a long way towards explaining why the "Information for Health" strategy of the last four years has now so obviously failed.

"From the coal-face, one major problem seems to have been the failure of the NHSIA and/or IPU (division of responsibilities has always been unclear us on the outside) to consult and work with all the stakeholder communities, including my own. And this in spite of an NHSIA Directorate evidently dedicated to this activity!"

‘Senior NHS clinical informatics consultant’, urged that lessons be learned from the past fast. "Before embarking in earnest on yet another, even more costly, NHS IT programme isn’t it time for the National Audit Office to ask why IfH has run aground?

Another anonymous commentator with an inside track expressed mounting exasperation at the delays and lack of decision-making from the centre, and questioned whether the whole NHS modernisation programme was now at risk

"The historic problems of delivering IT in the NHS are well documented:

  • Lack of investment

  • lack of standards

  • Lack of strategy and direction

"Last March Sir John Pattison and Lord Hunt raised hopes with news of extra cash, a vision that hinted at ‘ruthless application of standards’ and a strategy and direction to move the agenda forward. We have already seen in July, a Procurement strategy that at least gave further hope by cutting through the procurement nightmare that currently exists. Although imperfect, these developments had much to recommend them as major steps into the light.

"The appointment of Mr Granger, however, has slowed the process almost to standstill. Firstly there was the prevarication in the lead up to his eventual appointment (Clearly, not his fault). Now there has been the almost inevitable announcement of yet further delays in the process as the new Director decides how to do things his way. Unfortunately, it would seem that his first actions have been less than constructive and one has to wonder if we have the right man for the ‘biggest IT job this century’. How much more delay must we endure?"

‘Anonymous health IT commentator’ concluded, with a note of foreboding: "If, as Derek Wanless suggests, IT improvements are a key dependency for wider health service reforms, then one has to wonder, if these reforms are now at severe risk."

Another correspondent, an NHS IT veteran, spoke from experience of the barriers to "ruthless standardisation" within the NHS, particularly resistance from the "not invented here brigade":

"For many years I was a supporter of National Standards Systems… In the past this approach failed not because the systems were necessarily no good but because they were "not invented here". People want to be in charge and want to think they control their work environment. In particular Managers need to feel they own their IT systems as more and more they are measured against the information held in them.

"In the past NHS standard systems had so many local variations built in that they became no longer standard and were difficult and expensive to maintain."

To overcome these problems this time round NHS IT veteran recommended the following course:

"The strategy that the NHS should now be adopting, and I think the top level management in the IA understand this (but I am afraid the senior and middle managers don’t, they still want to develop and control national systems) is to;

  • Define the data standards

  • Set National Coding standards

  • Define reporting structures which provide local flexibility and meet central information needs.

  • Define technical infrastructure

  • Provide through PFI contracts a National Infrastructure backbone

  • Work with Suppliers to develop an achievable evolving IT strategy for the NHS

"The centre can then allow local choice of local systems from an approved list of suppliers, giving managers at the sharp end the opportunity to own their systems. I don’t believe that local senior management wish to develop or necessarily run system but they want choice and supplier relationship.

"Suppliers must ensure that their systems conform to national standards, enabling networked integration as we move to the goal of patient records being available wherever they, the Patient, present themselves for treatment (this might then be a realistic objective). We need co-operation as well as healthy competition between suppliers and I am sure this was the message Richard was trying to convey."

Finally, one NHSIA member of staff contacted us to say. "I have to say I do find your mailing extremely informative, I actually work for the NHSIA yet I still find out most of the strategic info from you first."

Many thanks to all our readers who have taken the time to email and share their thoughts and comments with us – please keep your messages coming in. Early in the New Year we will be launching new interactive online forums, if you would like to suggest a topic for debate email

The NHS and the IT Industry: Over to You (part 1)