Department denies trusts will have to cut jobs to pay for later
stages of national programme.
Top officials in the Department of Health are seeking to mitigate a
series of funding and other risks to the NHS' national programme
for IT, only weeks before the scheduled signing of outsourcing
contracts worth billions of pounds.
A leaked letter, dated this month, from health officials to
strategic health authorities, trusts and chief information officers
in London, said, "A number of risks to the programme have been
identified, including revenue funding and recruitment.
"The Top Team, which includes senior NPfIT [national programme for
IT] and Department of Health officials and all strategic health
authority chief executives, is aware of these issues and is
currently working towards resolving them."
The Department of Health has confirmed that it is undertaking a
comprehensive analysis of the risks of the programme with a view to
mitigating them.
The review, which was welcomed by NHS IT professionals, comes 18
months after the national programme was announced and only a few
weeks before the department is due to sign contracts with five
local service providers to install and run national systems across
England.
Last year ministers announced that they would allocate an extra
£2.3bn between 2003 and 2006 to fund the NPfIT, which comprises
e-prescriptions, a new infrastructure, electronic patient records
and online booking of hospital appointments. But it has become
apparent that the £2.3bn will not cover all the local costs of
introducing new standardised systems.
Tony Eardley, national chairman of the Association of ICT
Professionals in Health and Social Care, said trusts would have to
gradually increase their spend on IT from about 2% of the total
budget to 4% or more to ensure successful implementation.
"It is unclear how trusts will find the money to increase their
spend on information management and communications and how some of
the existing IT spend can be freed up to help fund local
implementations that are part of the national programme," he
said.
Philip Firth, strategy implementation manager at Wrightington,
Wigan & Leigh NHS Trust, made a similar point in a paper
presented in June. He said that the £2.3bn would be needed to fund
infrastructure and applications, such as a national data spine and
the electronic booking of hospital appointments, at regional and
national levels.
Firth warned that extra staff would be needed to take on new
administrative tasks, such as maintaining registers of patient
consent, and addressing clinical data quality. Local integrated
care records service implementation projects will also need people
with specialist IT skills, such as systems integration and
XML.
"At a time when NHS budgets are stretched to the limit, and many
trusts have huge budget deficits, it is not entirely clear where
the funding needed to address these local issues will come from,"
he said.
Mark Ogden, director of finance at Greater Manchester Strategic
Health Authority, commenting on the NPfIT, said the costs
associated with supporting care professionals and others to fully
exploit the opportunities of technology "may, in some instances, be
as much as 70% of the overall costs of introducing new
systems".
Paul Cundy, who chairs the IT subcommittee of the British Medical
Association's GPs committee, said last week,"The national programme
is not the great freebie that some people thought at first."
The Department of Health has a range of options to meet the local
costs of the national programme that cannot be funded from the
£2.3bn allocation. It could seek new money from the Treasury; it
could claw back some of the £850m spent every year on existing IT
systems in the NHS, although trusts say this could lead to a threat
to jobs; or it could redirect money that would otherwise go to
hospitals more directly for the care of patients.
A spokesman for the national programme said, "As with any
large-scale public sector procurement, good practice and the
specific checklist requirement for gateway reviews, we are
undertaking and managing a comprehensive risk analysis of the
programme. This is a perfectly normal process to ensure continual
attention is given to the mitigation of overall and specific risk
in order to deliver value for money."
He declined to say how much the national programme for IT is
expected to cost in total, above the £2.3bn allocated over the next
three years, describing the figures as commercially
confidential.
No threat to jobs
A spokesman for the national programme for IT denied that trusts
may have to make people fully redundant to fully fund the local
costs of implementing and running national systems. "Ongoing
funding for core NPfIT projects and the connection of existing
systems... to national applications will come from NPfIT central
budgets," he said. "The balance will be used to fund local trust
strategic health authority systems and services."