The Government's ambitious plan to overhaul NHS IT may be the
largest technology project ever seen in the UK but the question of
who will control it is a controversial one. James Rogers found NHS
IT managers wary of the risk of repeating past mistakes but focused
upon the potential benefits.
The response from NHS IT managers to the service's new IT strategy,
Delivering 21st Century Support for the NHS, has been mostly
positive.
Under the terms of the plan, which was unveiled by health minister
Lord Hunt last month, health service IT is likely to receive £5bn
of much-needed government funding.
Primary projects include a national patient booking system,
electronic health records and electronic reporting of laboratory
results.
Crucially, however, key elements of the strategy, which is
scheduled to start in April 2003, include setting stringent
national standards for data and IT, and establishing a centralised
procurement strategy. A national IT programme director, or IT tsar,
will also be appointed to implement what has been described as "the
IT challenge of the decade".
The main problem that the Government faces is how to implement a
strategy so dependent on central control across an organisation as
complex and devolved as the NHS. With more than a million employees
and encompassing about 600 trusts, the UK's health service is a
sprawling behemoth, with nothing comparable anywhere in the world.
This is at the heart of the worries raised by many of the IT
managers interviewed. It appears that the sheer scale of the UK's
health service is both its strength and its weakness.
Exploiting the colossal buying power of the NHS clearly makes sense
but there is concern that local needs could be overwhelmed by the
overall strategy.
For example, one head of IT in a medium-sized acute trust
acknowledged that centralised procurement is the way forward but
warned against disenfranchising local IT staff as a result of
national strategies.
The NHS is no stranger to problems with centralised IT projects. In
the early 1990s a centralised approach to IT delivery failed - the
Hospital Information Systems initiative losing up to £103m and
prompting criticism from the House of Commons Public Accounts
Committee.
Experts, however, have warned that NHS IT managers should not get
bogged down in a debate about centralisation. Terry Young, a
professor at Brunel University's Department of Information Systems
and Computing, said, "Instead of focusing on whether a system is
centralised or decentralised the IT community needs to stand back
and examine the role of information and communication in delivering
better care."
Young believes that new datawarehousing and application service
provider models are among the technologies that need to be
researched.
This would improve the flow of information within the health
service and support the development of new operational procedures
and better service delivery, he said.
There can be little doubt that effective information and up-to-date
IT are key to a 21st century health service but it appears that
there are still long-term issues to be resolved among IT users.
The NHS IT managers who spoke to Computer Weekly asked not to be
named because of the politically sensitive nature of NHS spending.
They expressed views both for and against the issue of central
control of the new IT strategy, which shows that issue will
continue to be debated during the next few years.
Economies of scale could save millions
A straw poll of
NHS IT managers revealed that the potential to use the NHS'
purchasing muscle was the main plus-point in the argument for
centralising IT delivery across the service.
- "I think that this is probably a good thing because it may
speed the procurement process up - and it may place an added
emphasis on suppliers to provide solutions that the NHS requires,
as opposed to other industry solutions that are then applied to
health." An NHS IT performance director in a southern trust
- "In some ways the idea of centralisation is right. What NHS IT
has been lacking is any form of architectural overview." An
information management and technology director in an NHS acute
trust
- "There are clear advantages in doing some procurement
nationally - such as electronic health records - because there
needs to be a common national system for cradle-to-grave records."
A head of IT in a medium-sized acute trust
- "The problem with claiming that we need local control over IT
is that this strategy has not delivered in the past. Centralisation
has already delivered the likes of NHSNet. Clinical managers and
those managers directly responsible for patient services in the
trust will benefit from centralisation. They just want services
such as electronic health records and bookings systems - it doesn't
matter where they come from." A head of IT in a north of England
NHS trust
- "The principle of increased centralisation and standardisation
is long overdue and has to be welcomed. Centralisation is a way of
avoiding funds being diverted to other, non-IT requirements, such
as reducing waiting times." An NHS trust IT director
- "Central procurement will help in terms of driving down cost
but there needs to be some serious thought given to what types of
deals you can get. For example, there is a lot of local interaction
between software and hardware companies and trusts. Many smaller
companies will have a lot to offer but may not be considered for
national procurement strategies. This applies to both software and
hardware." An IT systems designer in a specialist NHS
trust
Local flexibility could be limited
According to IT
managers the main problem with centralised control is that it may
lack the flexibility required by local health systems that vary
radically around the country - healthcare in Edale is hardly the
same as in Elephant and Castle.
- "Centralised procurement takes away trusts' flexibility but if
the Government does this then clear standards need to be given and
people need to receive some flexibility in terms of the packages
offered. These packages will need to be clearly defined, with
interfaces that work across the whole NHS. The Government also
needs to take collaborative working across hospital groups into
account." An NHS IT manager in a southern NHS trust
- "The new NHS IT strategy critically lacks detail on how to
deliver the vision. For example, there is a national programme
director being appointed but there is no national ICT architect
being appointed." An NHS information management and technology
director in an acute trust
- "There will be a number of instances where local needs and
requirements must be satisfied. There must be leeway in the system
to allow for that." An NHS trust IT director
- "With regard to procurement, there needs to be a broad enough
cadre of systems out there to cover the whole spectrum of
healthcare so that the smaller clinical specialisms such as
dermatology do not need to compromise." An NHS IT performance
director in a southern trust