By Erika Wright
BBC Radio 4's Wiring the NHS
The NHS National Programme for IT is the largest non-military project in the world and aims to revolutionise healthcare.
The NHS IT project is costing over £12bn
But the budget for the massive project was never properly explained and it was given a "ludicrously tight" time-frame a new BBC Radio 4 investigation reveals.
In 2002, Sir John Pattison at the Department of Health and colleagues were invited to a seminar on IT at Downing Street.
They were given 10 minutes to explain their vision for a computerised NHS.
The initial plan was for a dependable electronic network connecting all parts of the NHS containing three elements - electronic patient records, booking of appointments and prescriptions.
"I suggested it would take three years," says Sir John, but admits: "We did not get across that the initial time-frame of three years and budget of £2.4bn was just the first phase, and this is possibly where the concern for delayed implementation has come from".
This initial timescale was "ludicrously tight" according to Dr Paul Cundy, chairman of the BMA's IT committee. "If you'd asked anyone with any sort of feet on the ground anywhere near any sort of IT project, they'd have said no it's not possible."
Now the project has a 10-year plan with an estimated budget of £12.4bn.
The director of the project, Richard Granger, resigned in June this year.
During his tenure, he had coped with accusations of delays, problems with contractors, including one of its software suppliers - iSoft - being investigated for alleged accounting irregularities.
Executives at the Department of Health refrained from giving an interview to the Radio 4 investigation as did most of the software contractors although BT agreed to take part.
"I think the whole thing got off to a slow start because most major programmes do," says managing director for BT Health, Patrick O'Connell.
"There is a certain amount of coming together of ideas with practicalities. Some capabilities turn out to be less important.
"Some capabilities turn out to be more important and get brought forward in time. And some things people decide they really want to have like PACS, the picture archiving system that puts everything online - that wasn't there on day one - but it came in later.
"We will probably finish not quite the same system that people thought they were going to buy on day one but a much richer, much fuller system and probably much more relevant."
In April 2006 Martyn Thomas was one of 23 computer science academics who wrote an open letter to the government, expressing concerns about the project and calling for an independent review.
Professor Thomas has his own views on how big IT projects tend to go wrong.
"Politicians like to do big things whereas introducing new computer systems is best done in the small. Deadlines are then set which are typically political deadlines.
GPs have concerns about some parts of the new system
"Things have got to be in place for example before the next election - rather than having the timescales worked out for the project on the basis of proper engineering analysis."
Thomas and his fellows were invited to a meeting with the then director of the IT project, Richard Granger.
"We explained what our concerns were that we believed that an independent technical review of the programme if it was constructive could help them to minimise the risk and move more quickly towards a successful outcome."
"My feeling was that Richard Granger and his team were genuinely open to having independent people come and help them but it appears that the Department of Health felt a review would be very damaging."
The independent review never happened but a few months later, in June 2006, the National Audit Office published a report assessing the NHS IT programme, which had allegedly been completed in draft form a year earlier.
The editor of trade magazine Computer Weekly, Tony Collins, saw a draft version of the report which he alleges was radically different to the final one and believes it was exploited by the Department of Health and turned into "the most gushing report".
He says the tone of sentences were changed from criticism to praise and about 20 pages were added which were in praise of the national programme.
"There has been a suppression of dissent and a degree of control of information never seen before on an IT project," he says.
Despite the optimistic tone of the National Audit Office report, within three months two more suppliers - IDX and Accenture - withdrew from the project and there was also a new NHS chief executive, David Nicholson, to oversee the National Programme for IT.
Earlier this year he rejected fresh calls by the 23 academics for an independent review but he later announced the National Local Ownership Programme - a move away from Granger's original vision of a centralised IT delivery - to the regions - something many critics have called for in the past.
The change of direction followed consultation with health professionals and trusts about their needs and has been welcomed by Dr Paul Cundy at the BMA who was so critical of the project's initial timescale and vision.
For instance as a GP, he says he needs completely different records to those needed by psychiatrists, anaesthetists or radiologists.
He believes the whole vision for the project should have been based on local implementation and developing systems for different specialists before joining them up.
"All the interested organisations are saying the way we should have done it was to connect up the electronic islands, develop the electronic islands to suit the specialists in those areas."
Five years after the Downing Street meeting, a ten year plan is in place and Sir John Pattison is confident it will bear fruit.
"The only question of any relevance is to look at the cost and benefit and say whether it is worth it. To my mind there will actually be no question about that. I cannot imagine a national health care system in the future that isn't well and properly enabled by IT."
Wiring the NHS was broadcast on Thursday 25 October and will be available for 7 days at Radio 4's Listen again page.