NHS: Will the Microsoft deal and extra funds for IT mark a
step-change in attitudes? Lindsay Clark reports
Last week health secretary Alan Milburn said IT is essential to
modernising the NHS so that it can provide a better service to the
public.
In front of a select group of NHS chief executives he announced
£85m in new funding for the service and set out a strategy which,
he said, would promote the importance of IT in the health
service.
Following a presentation by Microsoft's chief software architect
Bill Gates, Milburn said, "We just have not done enough in IT and
we need to do more. We have to begin to talk about patient choice
and self-service. None of that would be possible without IT.
Investment in IT is no longer an optional extra - it has got to be
part of a modern service."
For NHS IT managers, Milburn's announcement promises a change in
culture towards computer departments in the NHS. For a start, he
has ring-fenced the extra cash to prevent IT project money being
raided by trust chief executives to pay for more politically
pressing waiting list targets. "On reflection, I should have
earmarked the money last year," he said, adding that future NHS IT
investment would also be protected in this way.
Nigel Crisp, chief executive of the NHS, also indicated that IT
managers would get a better reception from senior NHS managers when
lobbying for the needs of IT. The new strategic health authorities
will be responsible for promoting co-ordinated IT projects across
GPs' surgeries, acute hospitals and community trusts to ensure that
patient information is accessible to all health
professionals.
Crisp's vision is one in which health professionals from different
NHS organisations are able to work together more closely. "We
cannot run a network of NHS people unless we have the IT to support
it," he said.
But one of these groups, the medical profession, gave the latest
NHS IT push a mixed response.
Grant Kelly, chairman of the British Medical Association's (BMA) IT
committee, said, "The new money is good and it is important that it
is ring-fenced, but you have to remember that there are more than
1,000 acute trusts, each with about 30 support teams, so £85m is
not a vast amount of money."
Last week Computer Weekly predicted that Milburn would announce
more NHS IT money. Insiders had suggested that the figure would be
closer to £200m. The shortfall could be explained by the health
secretary's enthusiasm for public private partnerships (PPPs) in
health service IT projects.
Milburn said the Department of Health (DoH) was already talking to
a number of large outsourcing and technology suppliers and that PPP
could provide a means of achieving the ambition of lifelong
electronic health records for UK citizens.
Although Kelly applauded PPP as a means of raising capital for
investment in the health service, he was more sceptical about its
practicalities.
"The reality is that unless you completely tie down the contract,
the supplier has every chance to fudge its targets and the project
falls behind," he said. "The NHS takes on more of the risk but the
supplier ends up being paid more. When the NHS has a mature
approach to contract procurement PPP would be good, but that is
some way off."
Throughout last week's event there seemed to be evidence of a
genuine change in attitude towards IT. The chief executives were
effectively told by their superiors that the political centre of
the service must take IT more seriously.
Crisp said that IT had not been given a high enough priority and
the DoH was determined to change that.
"NHS information systems are simply not able to support our staff.
This is a real leadership role for us," he said.
Richard Gibbs, chief executive of Kingston & Richmond Health
Authority, also encouraged his peers to take IT more seriously, but
in doing so also gave way to some of the dated stereotypes that
remain about IT professionals. "You must get involved, you cannot
leave it to the anoraks," he said.
Only if these attitudes change will IT find a voice in the NHS that
is not lost in the constant battle between the money men and the
medics.
Milburn's plans for NHS IT
Leadership
The new strategic health authorities will
play an important role in championing IT across all NHS
organisations.
"Mainstreaming" IT
Only effective IT support can
enable change in clinical practice. The implementation of the NHS
plan will depend on improving IT.
Sustained investment
An extra £85m ring-fenced funding
on top of the £800m already being invested up to 2005. Future
investment in IT will also be earmarked to prevent it being
diverted into clinical practice.
Access to new technology
There is a growing aptitude
for IT among health professionals and this must be matched by
improved access to technology. The health secretary announced a
target of providing all hospital consultants with PCs on their
desks by September next year.
Making better use of massive NHS purchasing
power
Following the £50m deal for NHS-wide subscription
licences for Microsoft software, Milburn wants to see improvements
in the way the NHS uses its considerable purchasing muscle. It is
Microsoft's fifth largest customer worldwide. The Department of
Health (DoH) is also negotiating NHS-wide deals with Novell and
Lotus.
More innovative use of public private partnership
deals
The NHS needs "industrial strength" PPP deals to
achieve ambitious plans for national electronic health records.The
DoH is already in discussions with Microsoft, Cisco, BT and
Lockheed Martin for a project in the Midlands, dubbed "Lightbulb".