Evaluating "Connecting for Health": Policy implications of a UK mega-programme

Around the world the implementation of information and communication technology (ICT) is proposed as a way of transforming healthcare, making it " better " (e.g., safer, more accessible, and patient-centred) and more efficient by facilitating the management of healthcare organisations and processes. The implementation of ICT has been a vital component of UK government strategy for the National Health Service (NHS) for at least a decade, most recently expressed in the National Programme for IT (NPfIT) for England, considered to be the biggest non-military initiative of IT implementation in the world and now subsumed in the wider institutional structure of " Connecting for Health " [2]. The National Programme is a 10-year change initiative dating from 2002, which was originally estimated at a procurement cost of £6.2 billion, although recent projections suggest it may cost £20 billion in the end [4]. The aim of the programme is to deliver a " system of systems " supported by a nationwide IT infrastructure and network covering all of the strategic health authorities in England. The critical applications will provide electronic facilities for sharing patient records, booking appointments, transmitting prescriptions, and transferring digital images (e.g., X-rays and scans) and will be supported by ancillary services such as email, online directories, and websites.