Richard Granger, director general of NHS IT and chief executive of NHS Connecting for Health, has delivered another stern warning to suppliers lagging behind on delivery.
Speaking at the Health and Social Care Exchange conference in London, he said: "There is a problem with some suppliers. The strategy of not giving the whole of the contract to one supplier with one solution is borne out by this.
"We will get very soon to a point where they will either come good with what they’ve got, or they will get a bullet in the head."
Granger gave mixed reviews to contractors. CSC, local service provider for the North West and West Midlands cluster, were praised for delivery of 20 PAS systems since Easter. However, he went on to criticise BT’s service provision in the London cluster and their management of IDX.
He hinted that the landscape might change: "There’s going to be a number of major players consolidating."
Granger also revealed the latest working plan of the care record, which will feature the ability for a patient to opt in and opt out of the service. The BMA had helped to generate debate about the subject, and he was thankful for that.
However, he acknowledged that it was a work in progress. "I don’t know if this is the whole answer," he said.
Granger highlighted some of the achievements in NHS IT over the past few years. However, implementations have not been without their hitches. "In some places BT have drilled the wrong wall, and some innocent member of the public has had a free broadband connection."
He praised Cable & Wireless’s NHS webmail system, which he said had been a quiet success and proved that the exchange of clinical information over e-mail was necessary and in demand. "Until very recently [it] had almost total service availability," said Granger. "It’s now struggling with its own success."
Speaking about the changing features of the National Programme for IT, he commented: "It might be a policy disaster, but it isn’t an IT disaster. The system was delivered to spec. If some of my colleagues do not think sufficiently through as to what was wanted then it’s a specification error."
One example Granger gave of this was the introduction of the electronic staff record, which didn’t exist at the time that NPfIT was conceived: "It wasn’t in the scope and was a necessary prerequisite for an electronic health record."
Another was that a directory of NHS services was needed in order to offer patients choice. It seemed strange to have to do this, said Granger, added: "It’s difficult to explain to the general public that the NHS doesn’t know what it does."
He also put an end to one line of speculation about his next career move. "I am not going to go off to deliver the ID card," he said.
Granger stressed the insecurity and unreliability of paper records, although he did say he recognised that some organisations might drift back to paper after implementing electronic records because it still suited their needs.
Nevertheless, NPfIT will result in the NHS seeing "the death of paper, rather than patients."