At HC2003 NHS IT director-general Richard Granger said that he wanted a debate about whether there were viable alternatives to the direction of travel set out by the National Programme. Though he made clear that he believed the route set out was the best way to ensure delivery, he added it was not too late to change direction, even at the eleventh hour, if a better option could be found.

E-Health Insider asked readers for their views, and here are some of the messages we received.

There was a suspicion that any debate on direction of travel is by now largely academic. One head of IT at a leading NHS trust confessed to having been surprised at the call: “Given the advanced stage of planning for a nationally driven programme why would Richard now want to engage ‘stakeholders’ in a discussion about whether this is the best way ahead? The time for this debate surely was before the planning and implementation of any ‘preferred option’ commenced?”

There was a clear feeling that being seen to "rock the boat" would prove either a bad career move or potentially damage business – even though most commentators were supportive of the main tenets of the National Programme. This was a cause of regret and frustration for several readers.

An individual who has worked at senior levels within the NHS and industry noted, “There are people who whinge for the sake of whinging, but there are people who have something useful to contribute and feel they can’t at the moment.”

He added that this was a problem because of the consistent “failure to learn from experience and past failures”. His particular concern was limited engagement with clinicians so far. “Lack of clinician involvement has been a consistent theme in past failures.”

The commentator concluded, “There is a culture here that means you just can’t force solutions on clinicians, they have to be cajoled and persuaded.”

The CEO of a systems supplier, meanwhile, offered one alternative to national procurements, “We all accepted that the procurement process was a nightmare, but if there had been a national EPR (electronic patient record) specification then all suppliers would have had far less bureaucracy to go through.”

He went on to point out that the GSM standard in the mobile phone industry and the vision for health IT interoperability set out by Mr Granger at HC2003, had not emerged from government diktat but from within the market itself.

The same commentator also questioned whether the model of Local Service Providers (LSPs) could actually be made to stick, pointing to a mixed experience in NHS Scotland. “In Scotland many people have chosen to opt out of the LSP contract awarded for health IT services when it doesn’t suit them,” he claimed.

Another concern voiced was that a national procurement appeared to risk dumbing systems down to the lowest common denominator. One trust IM&T modernisation manager cited the data spine concept for phase one ICRS. “This isn’t the clinically-functional service we were expecting (is it?). In fact isn’t this pretty much EHR as envisaged post-IfH?”

The hospital trust IT manager noted: “It seems to me (a relative newcomer to the health service) that the current one size fits all approach is the highest risk method, is not based on precedent and needs not only cash to fix but the right people with the right skills, expertise and experience in place to have any reasonable chance of delivering potential benefits to patients and staff alike.

“Remember, we are where we are because of the present players (health service and suppliers alike) so how do we achieve (probably) the most ambitious health aspirations ever with these ingredients?”

His favoured level of implementation was regional rather than national.. “Health successes around the world tend to be based on a regional approach to health care that I think could be more appropriate here in the UK.”

He went on to stress the need to involve stakeholders and make change management not technology the priority. “Who is to manage this process? Well it all seems a bit half-hearted to me – the Modernisation Agency seems to be responsible but hey, are they working hand in glove with technologists? Do they have appropriate change management skills? Do they have the motivation?

“I believe that significant progress can be made though the deep involvement of health service staff, suppliers and patients but if the focus remains on technology and not the people then a real opportunity will go begging."

So what do you think of the National Programme so far? By the way all our respondents this time have been male – we would welcome views from the female readers too! Contact us at: