NHS IT: Are there better ways of measuring IT?

The success of the £6.2bn NHS IT modernisation programme should be better linked to the quality of the service delivered to patients, according to the director general of NHS IT Richard Granger.

Speaking at a silicon.com public sector briefing, Granger ran through a number of alternative measurements that could be taken to chart the progress of the NHS technology programme and criticised some of the existing measures.

Tens of thousands of people every year have adverse clinical effects as a consequence of keystroke error... We have this target about electronic prescriptions. Maybe we should have a target about how many people didn't get killed.

-- Richard Granger, director general of NHS IT

"We don't have metrics about quality of service," he said. "We have these very blunt 'Let's have 100 per cent of this done electronically [targets]'."

One thing the public sector could look at is how long it takes to procure and implement large-scale systems. "I bet over half the money we spend on IT systems is buying systems that have gone at least half way through their product cycle by the time we start to install them," he said.

This is compounded by the scale of the NHS. Granger added: "When you look at the massive challenge we have in terms of scale - we are talking about national scale organisations - when we deliver change across the whole of the public sector your rollout activity necessarily takes a long time.

"Especially if you have the kinds of challenges you have with the NHS - I have 600 end-user organisations each of which has a unique configuration."

Granger also responded to criticism of the progress of the 'choose and book' electronic appointment system. So far only 9,000 appointments have been made using the system.

He said: "We've got a target that this has to be 100 per cent electronic and 100 per cent booked. It's a stupid target and I'm sure many people in this room are burdened by stupid targets.

"What we are focused on at the moment is making sure the outcome the public want in terms of choice is supported as efficiently as possible."

He said the NHS is working through the detail of how this patient choice will be delivered and said that many patients don't actually want to make the commitment about appointments with their GP "there and then" and would prefer to go away and think about it before booking an appointment.

He added: "The NHS is going through an experience that organisations that are more mature in terms of their use of technology went through 10 to 15 years ago - the reality of IT programmes meeting business processes and fitting the two things together."

The NHS is working on a project to put prescriptions online and get rid of 330 million pieces of paper every year. But Granger said the real measure of success with this is saving lives: "Tens of thousands of people every year have adverse clinical effects as a consequence of keystroke error.

"This is killing thousands of people every year in this country. We have this target about electronic prescriptions. Maybe we should have a target about how many people didn't get killed."

He added: "Wouldn't it be interesting to have a target on paper consumption because we know paper is dangerous. That would be an interesting measure of the move to an electronic NHS."

But Granger also pointed to some of the successes of Connecting for Health: "We've just delivered the largest VPN that BT runs anywhere in the last six months - 11,000 connections, knocking out over a 1,000 a month. Almost all primary care in England have new minimum 2Mbps connections with backup."