Translating Health IT Policy into Practice in the UK National Health Service

The challenge to provide a nation-wide integrated health service is central to UK government policy. The National Program for Information Technology was launched in 2002 to transform healthcare using information and communications technology. As the largest, non-military, non-scientific government funded IT program worldwide, it was planned over a decade with an estimated total cost expected to exceed £20bn. This paper is a longitudinal study of the National Care Record Service, which was the largest part of the program, aimed to provide 50 million UK (English) citizens with an electronic health record. Using episodic interviewing techniques over ten years and secondary source material, the findings reveal a series of IT policy changes to the original Program. Delays to roll out electronic health records are linked to issues about procurement strategies with IT suppliers, benefits realisation, risk assessment and clinical engagement. This study extends academic work on the deployment of large scale, long-term publicly funded IT projects, which go beyond the technical imperative to transform healthcare. Findings suggest government agencies need to embed cultural, social and economic criteria into health IT policy-making. Tracking this Program for a decade, we observe how a centralised, top-down approach was replaced by localised IT procurement and implementation, giving NHS organisations more decision-making powers. However, the Program was beset by continuous policy changes affecting the structure, organisation and IT of the NHS, where attempts to achieve benefits finally resulted in the break-up of the Program.