Fact: no organisation in the world has as much potential as the National Health Service to improve people's lives with IT.
Fact: a national health service needs a national IT strategy and, in some cases, should buy IT systems nationally.
Fact: automating the collection and processing of data from the frontline of healthcare will bring about one of the biggest revolutions in the practice of medicine for centuries. No one can yet predict its outcome.
It was spine-tingling facts such as these that led in 2002 to the creation of the world's biggest and most exciting centrally directed IT effort, the NHS National Programme for IT. Unfortunately, the £6bn programme was founded on fallacy, too.
The fallacy was the more damaging because it came out of the prime minister's mouth. Setting out his vision of the NHS in 1998, Tony Blair said: "If I live in Bradford and fall ill in Birmingham, then I want the doctor treating me to have access to the information he needs to treat me."
No one knows where this idea sprang from, but the finger must point at IT companies with little knowledge of the NHS peddling their "death of distance" philosophy at anyone who would listen. In the 1990s, we sat through countless PowerPoint scenarios featuring an NHS patient being run over far from home and her life being saved because the emergency crews were able to call up the fact that she was allergic to penicillin.
In principle, there is nothing wrong with this concept. That's why it is so appealing. In practice, the idea that the whole point of computerising the NHS is to make patients' records available anywhere across England (devolved Scotland and Wales have their own IT programmes) has been the source of all sorts of problems - one of which now threatens to derail the whole programme's credibility.
In the real NHS, outside the world of IT consultants' PowerPoint presentations, most information flows take place within local communities of GPs, a district general hospital, the nearest facilities for mental health care and specialist treatments, and local pharmacies. These are the flows of information in which automation would pay dividends; fewer operations cancelled because the notes were not available, fewer patients blocking beds and at risk of hospital infections because their discharge prescriptions have not reached the pharmacy.
When people are run over by buses out of town, accident and emergency medicine has evolved relatively effective ways of coping without information. When that information could save a life - that famous penicillin allergy, for example - the data is better conveyed in a piece of medical alert jewellery worn next to a pulse point.
Trying to do this with computers has added serious complications to what was already the world's most ambitious IT programme. First, it restricts progress to the rate at which the national architecture, the care records "spine", goes live. If it is late (and it is), everyone's credibility suffers. Second, making health records available across the country, whatever the safeguards, is a red rag to those who believe that the electronic accumulation of medical data is a threat.
Finally - and this is the "derail" point - it gives politicians ideas. In a classic case of function creep, central government in 2003 landed the IT programme with responsibility for enabling patients to choose where they could go for hospital appointments.
As a result, the IT bods found themselves landed with a host of out-of-scope activities, such as creating the first NHS electronic directory of services. "Like counting animals into the fucking ark," one senior executive said. Worse, the programme has become the fall-guy in a profound and impassioned argument about the NHS's future.
None of this means that the world's most exciting IT programme has ended in tears - though we may see some significant "re-scoping" soon. But there are lessons here for all.
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