Systems and cars always crash

"Well, it hardly counts as a breakdown, does it?" This was my brother's response when I informed him that the "car trouble" that was making me late for an important appointment was actually a case of me locking the keys in the boot. I fought back the urge to respond -- "Well, in that case I'm not late then, am I?" Fortunately the RAC took the same view as me: My car won't go; that's a breakdown. It doesn't matter why.

But sometimes it does matter why. I've been trawling through the recent reports on the implementation of the NHS national IT programme. "Crash!" scream the papers. "Teething troubles," murmur the officials.

The negative impression will remain and for the general public, who must by now be merely skim-reading these things, it's probably just a case of "computer problems at the NHS. Yada yada yada. Can't these people get anything right?" They won't have noticed, for example, a recent piece in The Evening Standard, under the headline London's health bosses were accused today of endangering thousands of patients by relying on faulty computers, that made a completely spurious link between a hardware failure at the London Ambulance Centre and problems at the Royal Free Hampstead NHS Trust caused by the introduction of the new patient care records system. The paper described these as "two major computer crashes" which, to go back to the car analogy, is a bit like expecting the same amount of sympathy for reversing into a lamppost as for having your brakes fail while doing 70 on the motorway. Cars, eh? Always "crashing".

It's clear that in the second case we're not talking about "crashes" so much as people getting to grips with a system which they are not familiar with, and possibly don't like very much. The list of problems experienced by one Trust starts with a technical-sounding bang -- "bed availability not displaying correctly ... reports not printing" -- but ends with a whimper -- "passwords being forgotten". In other words, a lot of the problems are with what IT bods used to charmingly call the "wetware". But let's not be too hard on NHS staff. As I understand it, while the care records system itself is basically free -- and therefore attractive, albeit in a purely cynical way -- a lot of the costs associated with implementation will actually fall on Trusts. And as we all know, no budget is more vulnerable than the training budget. A telling phrase from the British Computer Society's response to the Department of Health Informatics Review from July 2008 cited a "lack of commitment from NHS management at all levels" in the implementation of IT systems for patient care. It's not surprising then that the staff, who have to use these systems, aren't exactly throwing themselves into it.

There's a point in any system's lifecycle when it starts experiencing real problems and that's when people start using it. And it's in the nature of the media, and the NHS, that ugly messes will make better copy than millions of successes. It only takes one acorn to persuade a chicken that the sky is falling, and in an implementation of this size there are going to be plenty of acorns. In the fullness of time I suspect the system will sort itself out, but who will be interested by then? I suspect the NHS won't have the dosh to follow BAA's lead, which is currently running ads on the Tube stating "Terminal 5 is now working".

There's another little-documented point in the IT lifecycle, that one where the system becomes to blame for everyth