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Commentary from Westminster

An Unhappy Computer Programme

FROM A CORRESPONDENT

WHAT is it worth to save 5 minutes per patient perappointment at a big hospital? That was a questionwhich tt.P.s on the Commons Committee of PublicAccounts faced recently when they examined theNational Health Service experimental computer projectaimed at exploring ways of improving patient care andclinical and administrative efficiency in Britain’s hospi-tals. The committee’s sixth report, published last week,tells the story of what has happened to that scheme, andit is not a happy story. Indeed, it led the committee toissue a general rebuke to the Department of Health andSocial Security for defects in its financial control overhospital expenditure.Four times last summer, stretching over several

hours, Sir Patrick Nairne, Permanent Secretary at theD.H.S.S., appeared before the committee and under-went some intensive cross-examination by Nt.P.s abouthospital costs. The main investigation centred on thecomputer plans first approved by the then Ministry ofHealth in 1967. There was to be a five-year research andexperimental phase, involving fifteen projects and cos-ting 13 million, followed by a five-year developmentphase, the whole affair to cost £ 55 million. But the best-laid plans of Ministry officials went sorely wrong andin 1971 seven of the original projects were wound up.The eight schemes which remained, originally estimatedto cost 6-8 million, are now expected to cost nearly C20million by March, 1978, or, after allowing for inflation,double the original estimate.To find out how this could happen, the committee ex-

amined three of the eight projects in detail and theywere not impressed by what they found. The most dis-turbing example was at King’s College Hospital wherea pilot scheme was started in 1970 to establish whetherpatients’ clinical notes could be held on a computer withaccess by doctors and nurses. The estimated cost was;572 000. After a feasibility study in the late 1960s, theproject began on two wards. A computer was bought, aproject liaison officer was appointed, and a project com-mittee, on which the D.H.S.S. was represented, was setup. In September, 1972, the hospital suspended thescheme. Yet the D.H.S.S. was not informed until Aug-ust, 1973, and by the time the Department closed downthe experiment in February, 1974, it had cost £ 14 mil-lion. Sir Patrick admitted that the D.H.S.S. were

"shocked at the way that this event has turned out" andthe M.p.s expressed concern that the hospital had appar-ently concealed for a time its suspension of the scheme.The experiment failed because junior doctors found ittoo much of a strain to feed data into the computer atthe same time as they were having to do their normalnotes. But to the committee this simply raised doubtsabout the value of the feasibility study.The second case examined was at North Staffordshire

Hospital Centre, Stoke, where an experimental project

approved in 1968 was designed to improve outpace:appointments, the flow of inpatients through two hospi-tals, and the admission of non-emergency patients, andto establish links with outlying hospitals about admis-sions and discharges. The original estimate ofO 00(jhas now risen to £ 2 25 million and initial hopes that theproject would be operational by March, 1973, provedhopelessly wrong. The first stage alone is not expectedto be complete until this year. Delays over staffing wereone of the main reasons put forward by the D.H.S,S, forthese increased costs. But evidence again revealed a fall-ure in liaison between the hospital and the D.H.S.S. AsSir Patrick explained to the committee, however, this is

regarded as a successful experiment and one that is

likely to be the basis for further applications. But hisdisclosure that the experiment had saved 5 minutes perpatient did not impress one M.p., who said that aftera 75-minute wait for an appointment 5 minutes saved wasbarely progress.The third scheme to come under the microscope was

at the London Hospital. There the project was to pro-vide a communications system covering inpatients, allo-cation of nurses, and operating-theatres, and then out-patients and other activities. But the later stages havehad to be dropped, and again costs and time scalesextended well beyond original estimates. But theD.H.S.S. believes this scheme also to have been success-ful. The better planning of patients’ time has releasedthe equivalent of 15 nurses and saved 38 hours a week.But in relation to the money spent on all eight projects,the committee has not been impressed by the results andis concerned at the Department’s own guarded view ofthe benefits emerging.The Department itself admits that it probably tried to

move too fast and too ambitiously in the early stages andthat the pace at which major changes could be intro-duced into complex organisations such as hospitals hadbeen overestimated. The committee accepts that this

experimental area is necessarily complex and difficult,but its report stresses the need to determine at the outsetthe exact objectives of each experiment and to ensurethey are sufficiently limited to enable evaluations of theresults to be carried out within a reasonable time. It

must also be established from the first that the objectivesare clinically acceptable and that they are likely to becost-effective and to be of general application to otherhospitals. If more attention had been paid to these prin-ciples, the report declares, there would have been fewerfailures and modifications and a greater prospect of ben-efits to the N.H.S. commensurate with the total costs.

The impact on the D.H.S.S. of the committee’s sharpstrictures about its general lack of financial control wasimmediate. The day after the vt.P.s reported, Mr DavidEnnals, Secretary of State for Social Services, said thatat a time when N.H.S. spending was being rigorouslv ’%pruned it was more than ever necessary to have carefulaccounting and scrupulous economies. Control over

public spending must be ruthless.

No further major experiments at hospitals are

expected for the time being. But the main responsiblefor carrying forward computer applications now falls or.the health authorities. It remains to be seen whether

regional control will prove to be any more enective th.,-.central control.