Small Firms And Open-Source Software Put Spine Back Into NHS After IT Fiasco

Without the fuss and delays that have plagued so many large government IT projects, a key part of the NHS digital infrastructure was recently migrated and updated in a single weekend.  The collection of applications and directory services known as the Spine connects clinicians, patients and local services to core NHS services such as the GP2GP patient record transfer, the Electronic Prescription Service, patients' Summary Care Records, and the Choose and Book service. More than 250,000 health service staff connect to it every day, sending more than 400m messages each month.

After the original contract with BT expired, the NHS Health and Social Care Information Centre (HSCIC) decided to move from a proprietary system to one based on open-source software, using Leeds-based company BJSS.  This is a major departure from the approach taken during the ill-fated NHS National Programme for IT (NPfIT), of which the Spine was a part. Seven years late, this was largely cancelled in 2011 as costs spiralled from £3 billion to more than £12 billion. Major parts of the programme had never been completed, and the parliamentary Public Accounts Committee described it as: “One of the worst and most expensive contracting fiascos in the history of the public sector.”

The prescriptive, top-down design of the NPfIT was left to the contracting companies to implement, with little oversight from above and even less input from NHS staff. This proved to be a recipe for disaster – incompatible software, massive delays, poor adoption and legal wranglings. It is a poor reflection on a project when its contracts prove to be more robust than the software delivered...