Last week, E-Health Insider asked for responses to the new NHS IT Director General, Richard Granger’s reported advice to suppliers that they should desist from rocking the boat or publicly questioning the national programme – or else.

Never before has a single topic generated such a lively response from our readers. Here are some extracts from the reportable messages that came winging into E-Health Insider’s inbox this week. All names are protected, and e-mails edited lightly to protect the innocent.

Responses came in from suppliers, NHS IT managers and clinicians alike. And, with some notable exceptions, they indicated a deep unease.

Despite warnings of dire consequences some suppliers felt no inclination to button up. One chief executive of a systems supplier asked: "Why is there not a vibrant, healthy healthcare IT supplier community in the UK?

"I would suggest that he [Mr Granger] needs to look inwards into the appalling procurement policies and bureaucracy that has ruled the NHS for the last 10 if not 20 years. They have stifled innovation, have not taken even minimal risks and have not encouraged organisations to progress. They have taken so long to procure systems that by the time they get installed they are legacy!!"

An IT consultant added: "This is no way for the NHS, as a public service to do business. It casts the integrity of the procurement process into doubt."

Clinicians were not shy of making their contribution either:

"Industry is surely our partner in this developing field and they have as much to contribute to the debate as anyone else. Indeed, since they must be integral to the implementation of these changes in practice, their voice of experience and technical know-how should be taken seriously. Treating them in this way will only breed cynicism," wrote a consultant radiologist.

A fellow radiologist joined in with the observation that a local PACS procurement had been completed in his area by a smaller supplier for a fraction of the cost quoted by the larger players. An argument for some local control, perhaps?

An NHS hospital doctor working in Wales, added, "I’m concerned that by the time it comes to implementing the recommendations of the many gurus who are being employed at enormous expense, the dosh will have run out, and it will be NHS thin gruel as usual. I wonder what startling recommendations will appear, since there appears to be quite a well informed body of opinion already in existence, and for many of us, decisions need to be made here and now."

Some comments were short and sweet; one positive, and one inscrutable.

"Refreshing!" – PCT IT Lead

"Interesting articles!!" – Senior NHS IT strategist.

One correspondent backed Mr Granger’s approach, but delivered a bit of a sting in the tail:

"I think that a constructive approach to debate has not served NHS IT very well over the past 15 years. It is now reasonable to adopt the attitude that new systems must be put in place quickly (even if they only partially satisfy people’s expressed needs).

"No doubt not only Mr Granger, but also Messrs Patterson, Hunt and Milburn will be happy to take responsibility for the results,” said the NHS informatics project manager.

A very interesting perspective came from a correspondent best described a very senior Whitehall veteran.

"For 20 years the government has denied the NHS the chance to modernise, using the technology readily available, by interfering centrally every time the process was about to get going. Reasons for this include:

  • Governments’ instinct to control

  • Civil servants’ need to stay in the process in order to hide the fact that they have nothing to add to the process and most of their jobs are effectively redundant

  • Ministers’ need for announcement of a "strategy", even if a thoroughly misguided one

  • Plain incompetence, and lack of understanding that implementing a modern system in a large hospital is a fragile and complex process, which has only ever been achieved successfully site by site, as demonstrated by halting of all trust level procurement in the South West in favour of a "big bang" solution (three years wasted, so far), and the plan to procure SHA by SHA in partnership with PSPs (one year of chaos and counting)

“The paranoid reaction to criticism on the part of the new NHS IT supremo you report is I hope a slight exaggeration. Nevertheless it bodes ill for this whole project. Those inheriting a record of scandalous waste and chronic failure need to demonstrate a little humility to be taken seriously!"

There were comments, too, from the frontline NHS IT people. One electronic records project manager said he found himself in the unexpected position of defending suppliers:

"I never thought I would stand up for the IT industry, but how can we criticise these companies for not delivering results? Our trust spent nearly four years battling through the tortuous PFI procurement process. Most trusts are now facing ‘procurement blight’ while we wait to see who the PSPs will be. On a technical level, the NHSIA seems incapable of developing sensible standards for the industry to adopt (until its ten years too late…).

"The problems we face on a day-to-day basis are mainly self-inflicted. Maybe we should be thanking these companies for their patience…"

A PACS project manager, meanwhile, asked whether there had been any consultation with IT users at the local level:

"Has the NHSIA actually consulted with a representative group of IT users across a range of modalities? This proposal seems to be geared to make life easier for those who have to implement it with no regard to the many and disparate needs of end users. Often it is the independent company that can supply a solution quickly and cost effectively to what is sometimes a niche area of practice or research. At some point (and soon) I believe ‘the powers that be’ need to be asked to reflect on this policy."

A senior clinical informatics specialist working in the NHS, meanwhile, told us: "Granger’s approach appears to lack both insight and managerial maturity. The national programme has neither a clear over-arching strategic framework, nor a visible set of underlying mechanisms for practical delivery, risk management and benefits realisation. Under these circumstances, he probably needs all the constructive criticism he can get. "

If any of the responses above strike a chord with you or leave you wanting to tap out an email response then please drop us a line, we’d like to hear what other readers think. E-mail .