Tony Blair's plans for an £1.1bn IT-led reform of London's
health service must meet a series of "critical" challenges before
contracts are awarded, although deals were due to be signed
yesterday (24 November), according to a leaked NHS
document.
The paper, which set out a formal business case for an Integrated
Care Records Service in London under the £2.3bn national programme
for IT, revealed that uncertainties existed over the full cost of
its implementation.
It referred to an "affordability gap", with anticipated spending on
IT reforms exceeding funding by £345m until 2009. The paper also
revealed that the national programme will not cover the funding of
system implementations in hospital trusts, change management, some
training, data migration or local infrastructure.
Nor will the programme meet more than 25% of the costs of replacing
systems to meet new national requirements - 75% will have to be
locally funded.
The paper highlighted a "national versus local funding issue" which
has led to the need to "prioritise local functionality in
accordance with the availability of funds".
It also disclosed that the national programme may be under pressure
to award bidders more than one contract. If a bidder wins more than
one deal, extra discounts can be negotiated to help bridge the
affordability gap, the paper said.
It added that the gap may also be bridged by obtaining improved
prices from suppliers when they submit best and final offers and,
possibly, "increased contribution from local funds".
Information managers in trusts who were shown a copy of the paper
by Computer Weekly said they were surprised the Department of
Health was pressing ahead with contracting out services and systems
in London while such uncertainties existed.
They said they did not know how their trusts would pay for
implementations and costs such as replacing clinicians while
training takes place on new systems.
Contracts with firms that will supply new systems and help provide
the Integrated Care Records Service were due to be signed on 24
November, according to the paper. The Treasury was due to approve
the business case for the London element of the national programme
on 21 November.
The national programme comprises four main elements: online
appointment booking, national IT infrastructure, Integrated Care
Records Service and electronic prescriptions. The programme has
central funding of £2.3bn until 2006.
The plan is to appoint a local service provider in each of five
"clusters" across England. Officials who represent the London
cluster wrote the leaked paper.
It disclosed that the health service in London initially plans to
proceed with those projects that are paid for centrally and which
will require no additional local funding. This will allow for local
interfaces to national systems, including the Integrated Care
Records Service and an online service for booking hospital
appointments.
In theory, this will enable officials to deliver Tony Blair's aim
of setting up a system of electronic patient records by 2005, but
trusts say that standardised IT will be of little use to clinicians
without comprehensive implementations along with data migration and
other critical elements for which funding is uncertain.
A Gateway Review of the London plans by the Office of Government
Commerce gave the programme an "amber" warning, according to the
leaked paper.
The Gateway Reviews in general were introduced in 2001 and gave IT
projects a green, amber or red light at each of six stages.
Recommendations are made to departments which have the power to
implement or reject the project. The London plans have reached
stage three, which examines whether the plans are sound enough for
contracts to be signed.
"We are pursuing all Gateway recommendations deemed 'critical
before award of contract', including those for governance and
resources," said the leaked paper.
Health officials will be pleased the programme did not get a red
light, but an amber light is not a guarantee of success. The OGC
gave Inland Revenue plans for IT systems to support new tax credits
a green light. Last week, public spending watchdog the National
Audit Office published a report which strongly criticised the way
the systems were introduced.
The Department of Health aims to exploit IT to provide patients
with access to their own records by 2005 and by 2007 eliminate lost
results of clinical investigations.
A spokesman for the national programme said, "As with any public
sector procurement, when the national programme for IT awards its
contracts, negotiations will have been completed, issues resolved
and relevant approvals secured."
Leaked problems
The leaked paper revealed "certain problems" had developed in the
national plan for IT in London. At a late stage in the procurement
it was realised that a planning review was needed to:
- Update information on current systems
- Identify current costs and contract issues
- Determine dependencies between systems.