The national programme for IT in the NHS has so far been
promised £2.3bn. The government anticipates success, but clinicians
are questioning whether this is enough
IT manager Philip Jones compares himself to a mushroom. “I am
fed mulch and am expected to grow,” he said.
Jones was referring to the way officials in the Department of
Health expect him to prepare with enthusiasm for his trust to link
into new systems that are being developed for the NHS’s £2.3bn
national programme for IT, without giving him the information he
needs.
Under the programme, local or national service providers will
provide an integrated care records service, including electronic
patient records, hospital appointments system, a new national
infrastructure and e-prescriptions.
Jones needs, but cannot get, answers to his questions about how
much his trust will receive to help make the national programme a
success. He said that he and most other IT staff in the NHS are
still waiting for answers to questions they have been asking for
months. He wants to know:
- How much he will receive to provide quality assurance on
patient data for a new national data repository known as the
spine?
- How much will he receive to replace antiquated but working
systems with standardised equipment from new local service
providers?
- How much will his chief executive make available from the
Department of Health for interfaces to national systems?
Jones is the pseudonym of an IT manager in a London trust who
believes his career would be damaged if he were named.
Last month, his strategic health authority arranged meetings to see
how its trusts were preparing their IT systems to link to new
national systems. But the meetings were cancelled at short notice.
Officials at his strategic health authority realised that IT
specialists could not give details of how prepared they were to
provide data feeds into national systems, when there were no
answers to their questions about the national programme.
Yet trusts still have to meet tight deadlines. By 2005 Tony
Blair wants every patient in England to have an electronic record
and to be able to book hospital appointments at their
convenience.
One reason the systems have a high priority in the NHS and a
short timetable for delivery is that, in the run-up to a general
election, Blair wants to cite the successful introduction of the
systems as evidence of the government’s commitment to modernise the
health service and give patients a choice over where they are
treated and when.
But, to the frustration of NHS IT managers, there is an absence
of qualitative information about funding, which contrasts sharply
with the quantity of information on the programme’s benefits.
As part of a communications programme to enlist the support of
clinicians, officials at the Department of Health regularly brief
newspaper and magazine journalists about how the national programme
will transform the NHS, and the billions of pounds of extra money
that the government is providing to fund an IT-led
modernisation.
Indeed, various national newspapers over the past 10 days have
given the impression that the NHS is flush with money for new
IT.
“The health service’s IT spending is set to rise from about £850m a
year – less in percentage terms than in almost any other modern
Western health system – to more than £3bn annually by 2007,” said
one broadsheet newspaper.
“Richard Granger, head of the project to modernise the NHS, is
to ask the Treasury for a further £1.5bn to fund the scheme through
its fourth and fifth years,” said another national broadsheet.
It went on to quote a Department of Health official as comparing
the national programme to the historic engineering feats in the
19th century, which immortalised such men as Isambard Kingdom
Brunel.
But for those faced with implementing the new IT systems at
trust level, one of the basic issues is this: is the £1.5bn of
extra money – on top of the £2.3bn allocated to the national
programme for the three years from 2003 to 2006 – a hope or a
guaranteed sum?
Believing this to be a straightforward question, Computer Weekly
put it to a spokeswoman for the programme. The answer was not
straightforward.
“The NHS received a five-year funding envelope and it is
anticipated that in years four and five of that envelope,
comparable funding to that allocated to the national programme for
IT in year three will be achieved,” said the spokeswoman.
When asked if it were possible to establish whether the
“anticipated” funding is definite, she tried but could not obtain
any further authorised response.
Even if the national programme receives a further £1.5bn or £2bn
on top of the £2.3bn, will this be enough? Richard Granger,
director of IT for the NHS, has not been bashful about mentioning
the size of the programme. He told the Financial Times there was
“no other project of the same scale on the planet.”
With enormity of scale comes cost. A position paper, More
Radical Steps, from the British Computer Society’s Health
Informatics Committee, said that between four to eight times the
£2.3bn may be needed for the non-IT elements that are critical to
the programme’s success.
Jean Roberts, lead for the BCS health committee’s policy group,
suggested last week that £10bn may be needed if doctors and nurses
are to use new systems to their best advantage.
The money is needed, said the BCS, for “professional training,
organisational systems redesign and realignment to support a
successful national programme for IT”. It added, “Until any other
figure is ratified, the potential for the national programme to
have a substantial impact on care remains at serious risk”.
Mark Outhwaite, lead for the national programme at the
Modernisation Agency, part of the Department of Health, was unable
to give Computer Weekly any assurances that enough money would be
made available for the business change that will accompany the IT
systems. He did not deny that the costs could be of the order that
Roberts mentioned.
Outhwaite said last week that doctors and nurses are changing
their working practices as part of a successful change management
exercise. But, he added, these improvements were planned before the
national programme was conceived. These changes will need to be
“repositioned” to fit in with the programme’s requirements, said
Outhwaite.
As yet the specific changes in business practices that will
enable doctors to take advantage of electronic booking and the data
spine have yet to be costed. Trials will take place next year to
assess what changes are needed and how much they will cost.
The level of uncertainty is of concern to NHS IT professionals
who have a strong wish for modern, effective IT systems, but not if
the national programme carries with it a high risk of failure.
Roberts said the Department of Health should question whether it
should, even now, commit taxpayers to £2.3bn on the national
programme when it does not know the whole cost.
Despite the uncertainties over funding, Sir John Pattison,
senior responsible owner of the national programme, told Computer
Weekly that there will be enough money for trusts to “do what they
want to do in IT terms”. He added that the government is putting
extra money into the NHS “in the most spectacular fashion – about
£90bn by 2006/2007 or 2007/2008.”
So the success of the national programme rests on some financial
certainty: that trusts will receive more money to support the
modern equivalent of the 19th century’s Great Western Railway. But
executives are still uncertain there will be enough money for the
changes to business and technology.
Brunel was revered in his lifetime, but some may have forgotten
another 19th century genius, Charles Babbage, who sought to build a
difference engine, the forerunner to the computer. The project was
so ambitious and dragged on for so long that government funds dried
up. It was not completed until more than a century later.
Pattison: it is my belief that once trusts see the power
of good IT they will invest
Sir John Pattison, senior responsible owner of the national
programme for IT in the NHS, has sought to allay concerns over
whether £2.3bn is enough to make the initiative a success.
In an impromptu interview with Computer Weekly, Pattison said
the £2.3bn, together with other government money, would be enough
to allow trusts to link into new national systems and replace a
jumble of incompatible hardware and software with standardised
equipment.
He said, however, that the £2.3bn allocated to the national
programme over three years from 2003 to 2006 would not be
sufficient without the existing £850m a year “baseline” spend by
health organisations on IT systems and staff.
“The spending from the baseline continues,” he said, “We
estimate this is approximately £850m a year and this has to be
maintained. £2.3bn will not cover it [delivery of the national
programme] if this is not maintained.”
Many IT managers doubt they will have enough money to fund their
trust’s responsibilities under the national programme. So Computer
Weekly asked Pattison how the £850m baseline spend could be
diverted into part-funding new projects when most of it is already
committed.
Much of the baseline money, according to trust IT managers, is
spent on the salaries of technologists and other staff, for
example, the specialists who code information that is entered into
systems.
Pattison suggested in his replies that the costs of IT staff
might become the responsibility of other health service managers or
possibly new local and national service providers, as employees
switch jobs or roles.
Pattison was asked in particular about a trust whose largest
capital IT programme cost £300,000 a year. If, to meet the
government’s plans for standardised systems, that trust had to
replace its antiquated hardware and software with top-specification
equipment costing £1m from a local service provider, how would the
IT manager find the extra £700,000?
“People may have to do different things in the future,” replied
Pattison. “You will have local service providers operating. You
will have national contracts operating. Richard Granger, [director
general of IT in the NHS], is very clear that he thinks we will
need as many staff. They will not be doing the same things in the
future as they have been doing in the past.
“IT staff may be taken over by local service providers or the
requirement for the staff to do what they were doing will
disappear. So there will be a change programme.”
When asked if the release of money allocated to salaries under
existing IT budgets would pay for new systems to help meet the
targets set by the national programme, Pattison said, “I do not
want to give the impression it will free up staff costs. It might
free up the staff. It is then a judgement for trusts on how best to
deploy those staff.”
When pressed about how the IT manager, whose budget mainly
comprises staff costs, would find the extra £700,000 to buy a
new system from a local service provider, Pattison said, “The
Wanless report [an independent report to the government] said
that by about 2010 the NHS should be spending about 3% to 4% on
IT”.
His reply appeared to suggest that the chief executives of
trusts should at least double the IT spend from the existing 1% or
2% of the total budget to meet commitments.
When asked if the money would come from general hospital
budgets, Pattison told Computer Weekly, “The NHS as a whole will
have to find and will have to deploy a greater percentage of its
expenditure on IT. It is the only sensible way to do things.”
He said the general level of funding available to hospitals was
increasing substantially, “The pot is up in the most spectacular
fashion," said Pattison, implying that trusts will have enough
money for the extra IT spend.
“We cannot take every decision away from trusts," he added. "We
will have to leave some decisions to them. But it is my belief that
once they see the power of good IT they will invest in it. Once you
have invested in it and your business is running with a dependency
on IT you have got to keep investing in IT. You cannot stand
still.”
When asked if the IT manager faced with finding an extra
£700,000 should stop worrying because his trust chief executive
will decide to more than double the IT budget, Pattison said, “You
put it rather bluntly. It is not quite as simple as that but
yes.”
It seems from Pattison’s replies that there will be enough money
for trusts to finance their IT commitments under the national
programme, but only if the boards of trusts allocate extra funds
from the general hospital budgets.
The question is, therefore, will NHS trust boards allocate extra
money to IT, rather than meeting other government targets on, for
example, reducing waiting times for operations, or improving the
care of patients who are being treated for cancer or heart
disease.
This could be another uncertainty which compounds the risks to the
success of the national programme.