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In the NHS, one size rarely fits all

August 22, 2011

The other day I visited my local GP surgery and got into a conversation with one of the practice nurses. When I told her that I designed software for a living, she asked if I’d heard about the troubled NHS IT project to create centralized patient care records.
“I don’t understand why it’s so hard to put a patient’s information into one central system, so if they go to a hospital at the other end of the country, all their medical records are there waiting for them. Why is that so difficult?”
It’s a good question - why is that so difficult? The technology is available, so what’s the problem?
This month the Public Accounts Committee published a report into the project’s failings. The Committee chairman Margaret Hodge said “The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable.”
Reading the report, there are various factors which contributed to the project’s difficulties including weak management, a lack of accountability, and poor risk management. There have also been questions about patient confidentiality. But there is one key phrase which I suspect hides a multitude of issues and that’s one-size-fits-all.
In an organization as large as the NHS, one size rarely fits all. Each part of the organization will have their own individual ways of working, and thus their own requirements for what an IT system should deliver. When the requirements of a system cannot accurately be pinned down, any software project will founder, and the report recognizes that the system would have been easier to deliver if there had been more clinical engagement at the outset to help define specifications.
The full report can be read here.


by Michelle Timmons, Technical Architect

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