Does the NHS have an IT infrastructure?

The NHS spent something like £1bn plus per year on IT even before the advent of NPfIT. But for all that expenditure it is questionable whether or not it has an IT infrastructure in the sense described by Susan Leigh Star and Karen Ruhleder (reference here , criteria set out below). Why is this important? Because until there is an infrastructure the NHS won't be in a position to benefit from IT, and expenditure will be fragmented and of uncertain purpose.

Infrastructure includes the following, and I've scored the NHS on each

• Embedded (3/10 - computers and computing seem to be an anathema to many NHS staff)
• Transparent ie does not need to be reinvented for each new task (2/10 much of the NHS computing estate consists of point solutions which need to be significantly modified as each new need arises - including BI systems)
• Reach or scope beyond local practice (2/10 . This is an area where NPfIT has signally failed to make a case or implement change)
• Learned as part of membership (1/10 . There are some steps are being taken to embed IT in professional life but little impact yet)
• Links with conventions of practice (2/10 - a few honourable exceptions in primary care. Maybe PACS is on the way to becoming infrastructure)
• Embodiment of standards (2/10 the keyword here being embodiment. And no, the use of TCP/IP doesn't count)
• Built on an installed base (4/10 - once upon a time there was an installed base, for example regional computing centres. Nowadays there are a few elements of an installed base, such as N3 and NHSmail, NHS Choices, NHS Evidence)
• Becomes visible upon breakdown (Comments about the breakdown of IT systems having no impact on patient care suggest 1/10 for this criteria, but in some situations a failure of an IT system would be significant, so 6/10)

A reasonable conclusion is that, with a few exceptions, despite huge expenditure the NHS lacks a an IT infrastructure.

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