The director in charge of the £6.2 billion NHS National Programme for IT has warned that the project is in “grave danger” of being “derailed”, according to leaked Whitehall e-mails.
The claim was made by NHS IT director General Richard Granger, in an email to Margaret Edwards, director of access and patient choice, at the Department of Health. The e-mails were leaked to the Sunday Times.
A further report indicates that the leak has infuriated NHS chief executive, Sir Nigel Crisp. The Guardian said this morning (14 Nov) that Sir Nigel was preparing “a stiff note asking Mr Granger to explain his unconventional behaviour and lack of corporate discipline.”
According to the e-mail exchange reported in the Sunday Times, Choose and Book is unable to offer appointment bookings to any of the 32 foundation trusts in England because they are not on its “choice menu”.
Similarly, the 10 private sector treatment centres are also missing from the menu of treatment options. Neither foundation trusts or treatment centres are due to become available on Choose and Book until the middle of 2006 – six months after the system was due to be fully implemented.
In the e-mail exchanges in September, Granger blames Edwards, a senior DH director, for the fiasco, attributing delays to her repeated last-minute changes and failure to heed his advice.
According to the Sunday Times report Granger criticises Edwards, for allegedly adding numerous new specifications to the booking programme, known as Choose and Book.
Granger’s leaked email says: “Choose and Book’s £20m IT build contract is now in grave danger of derailing (not just destabilising) a £6.2 billion programme.”
He concludes: “Unfortunately, your consistently late requests will not enable us to rescue the missed opportunities and targets.”
The NHS IT boss has previously publicly criticised Edwards, blaming her for delays to Choose and Book. At June’s NHS Confederation conference and he attributed delays to Edwards, and in an interview with Computing magazine last week where he argued that the central technology had been successfully delivered, but that delays had been created by policy people and the failure of NHS organisations to implement locally – a contentious view challenged by many EHI readers.
Sir Nigel Crisp was forced to admit to the Commons health select committee two weeks ago that the booking system was at least a year behind schedule.
To date, including telephone booked appointments, the system has made only about 20,000 appointments for patients. It was supposed to have made 250,000 by December 2004. When it is fully operational the system is meant to be capable of making up to 9.5m first hospital appointments a year.
Granger’s comments were triggered by an e-mail on 9 September from Edwards which states: “We have a problem!” The e-mail is reported to state that patients and their GPs still cannot book treatment at any of the country’s 32 foundation trust hospitals by computer because they are not on its “choice menu”.
The 10 private sector treatment centres, set up by the government to reduce waiting lists, are also absent from the choice menu on Choose and Book. Edwards warns that treatment centres and foundation trusts will not be on the “choice menu” until next summer.
Edwards says in her e-mail to Granger: “We haven’t yet told ministers that there is a problem.” Despite Edwards’s original e-mail being encrypted and password protected, Granger sent it out with his reply and widened the distribution.
According to the Sunday Times, Granger complains that the project has been allowed to change beyond recognition from the original specification. “The original request from your predecessor and yourself was for an Electronic Booking System. The change of this to Choose and Book occurred in (the second quarter of) 2003. This was the first of what are now recurrent major changes in your requirements.”
The booking system has been dogged with difficulties since its inception. GPs have been reluctant to use it, the national spine it operates across has proved at times unreliable and early pilot schemes identified software design flaws.
Granger insists that the booking system works, and has publicly blamed civil service colleagues in the Department of Health for failing to get GPs to use the system. In an interview with Computing Magazine last week, he said: “Low usage is not something I can do anything about.”
The problems with Choose and Book raise serious concerns about the prospects for success of the far more complex systems set to follow – particularly the core NHS Care Records Service and local core clinical solutions – both of which are already running late.
A detailed National Audit Office report on the procurement and early implementation of the entire £6.2 billion NHS IT programme is due within the next two months.
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