Interviewing health minister John Hutton last week about
the national programme for IT in the NHS, Edward Stourton tried his
best to get clear answers.
A presenter of BBC Radio 4’s Today programme, Stourton remained
persistent and polite throughout. But the answers he received left
trust IT executives deeply mystified about how they are supposed to
fund millions of pounds’ worth of local implementations of new
national systems.
Most of them would dearly have wanted to do what Stourton was
doing: questioning Hutton, the minister responsible for the
national programme.
Many IT managers support the programme. They are excited about
being part of the world’s biggest civil IT scheme, one which they
hope will greatly increase the chance of patients having successful
treatments.
Already they have seen the programme achieve success in turning
the attention of chief executives of trusts, as never before, to
the importance of modernising and standardising the use of IT in
the health service.
But two-and-a-half years into the programme, IT directors are
still worried about how much it will cost in the long term to
implement new national systems locally, and whether trusts will be
able to afford the bill, especially as they have to continue to
cover the costs of non-core IT systems.
The more sceptical among them have a suspicion that the
Department of Health has embarked on the programme without any
clear idea of how much it will cost over its 10-year life or
whether there is certainty that the money will be found to fund
it.
Some trust boards have already found that they have a large gap
between the money they need to implement the national programme
locally and the money now available.
Stuart Threlfall, director of ICT at King’s Lynn and Wisbech NHS
Trust, has managed to reduce a funding gap of £1.2m to £498,000,
but his board, which is in the red, has politely refused to fund
the remaining sum.
The board said it wanted to convey its "enthusiasm for the
implications/innovations implicit in the [national IT] programme"
but "given the trust’s current financial position" it had "no funds
to meet the shortfall."
It was on this matter of the programme’s costs that Stourton was
interviewing Hutton early last Tuesday morning. The interview had
been prompted by Computer Weekly’s disclosure that day that the
actual cost of the programme could be £18.6bn to £31bn – three to
five times the announced figure of £6.2bn.
The new figures were based on estimates in the national
programme’s unpublished business case. The cost of procuring new
national systems and services from large IT suppliers was the
declared figure of £6.2bn.
But the larger figure was because of the costs of implementing
the new services locally, including training hundreds of thousands
of NHS staff in using the systems, paying for locums to replace
staff who are training and upgrading the technical infrastructures
of trusts.
Asked for his response to Computer Weekly’s disclosure, the
minister told Stourton that the publication’s figures were
speculative and that trusts would be able to pay for local
implementations from the current trust "baseline" spend on IT of
about £1bn a year.
This suggested that trusts need not find any more money to
implement the national programme than they now spend on IT. But
trusts IT executives know this is incorrect.
Hutton remained steadfast in his insistence that trusts would
not need extra money from their existing IT budgets to implement
the national programme.
The minister went on to explain that trusts will save money as a
result of the programme’s centrally-negotiated contracts. He also
said that the better care and treatment of patients could so
improve the accuracy of medication and diagnoses that it would have
an impact on budgets for paying compensation in cases of medical
negligence.
But he did not appear to have been briefed on the fact that
Computer Weekly’s figures are based on statements made by the
national programme. It has confirmed that the total costs are
expected to be three to five times the procurement costs of
£6.2bn.
In a written statement, the national programme told Computer
Weekly two weeks ago, "It is generally accepted in the IT industry
that implementation costs are some three to five times the cost of
procurements. That is reflected in the business case that was made
for the national programme."
After Stourton's interview, NHS IT directors criticised Hutton’s
claim that the local implementation of the national programme is
going to cost the same as the health service is currently spending
– about £1bn a year.
They pointed out that more than half of the IT budget is for
staff, including computer and medical coding professionals, whose
work helps to keep hospitals running.
In an open letter to the minister, Terry Walton, head of IT at
Lewisham Hospital in South London, wrote, "In response to your
comments on the Today programme on Tuesday morning, you may think
that the NHS spends £1bn a year implementing systems and that this
money can be diverted to implementing the national programme for
IT, but I am afraid you have been badly briefed.
"Much of the £1bn you believe can be diverted is actually
committed to running IT services which the national programme for
IT, focused as it is on clinical systems, is not going to
replace."
This was pointed out in another e-mail to Computer Weekly, which
listed some of the important systems that the national programme
will not replace. These included finance, payroll, manpower, staff
rostering and other systems such as procurement and stock control
of medical and surgical equipment, food and services.
In addition, the £1bn budget covers pharmaceutical systems and
specialist equipment such as immunisation and cervical cytology
recall.
After Hutton made his comments, the Department of Health issued
statements to national newspapers that appeared to contradict the
minister’s comments. These statements said that trusts would
dedicate 4% of their total budgets to IT – which in some trusts
would mean an increase of more than double the existing IT
spend.
But it remains unclear how this official statement will
translate into extra cash for trust IT directors. They are also
entitled to wonder if the minister has been adequately briefed
about the full cost implications of the national programme. Yet it
will be ministers – not necessarily their officials – who will be
responsible for obtaining more money from the Treasury for the
national programme.
Since the programme was launched in early 2002, it has been
beset by uncertainty, although few doctors, nurses or NHS staff
would deny that its ultimate objectives, if achieved, would greatly
benefit patients.
Hutton’s comments were intended to be reassuring, but they have
not had this effect. At a time when trust IT directors want more
than anything else to have direct answers to their direct
questions, some have never been more uncertain about the future of
the world’s biggest civil IT programme.
Systems that will not be replaced by the
NPfIT
- Finance
- Payroll
- Manpower
- Staff rostering
- Procurement (clinical, food and services)
- Specialist equipment for immunisation programmes.
Open letter – the sums don’t add up
Dear minister,
In response to your comments on the Today programme on Tuesday
morning, you may think that the NHS spends £1bn a year implementing
systems and that this money can be diverted to implementing the
national programme for IT, but I am afraid you have been badly
briefed.
Much of the £1bn you believe can be diverted is actually
committed to running IT services which the national programme for
IT, focused as it is on clinical systems, is not going to
replace.
It is true that where systems are replaced by the national plan,
then once the replacements are working, trusts will be able to
spend the money released from having to pay annual support charges
on the implementation of the more advanced systems. This, however,
depends on whether or not the promises about the trusts being able
to retain the revenue are kept (a very big "if").
Even if the revenue is retained, it is much less than the £1bn a
year you think is available, and an even longer way short of the
money needed to introduce the more advanced clinical systems, which
the majority of trusts do not have at the moment.
These will be very costly to implement and it will be a long
time before the benefits really start to materialise. Moreover, the
benefits from implementing these more advanced systems tend, in NHS
parlance, to be "non-cash releasing".
You only have to look at the e-booking service to see what I
mean. To implement this system, we are going to have to train all
GPs and consultants to work in a new way, to set up and run
registration authorities, to purchase and install card readers and
software and to set up and run a telephone bureau to answer calls
from patients.
This is in addition to the cost of running the IT part of the
service. All of this is new. There may be savings downstream, which
may pay back the investment, but it has to be paid for up
front.
I am afraid the NHS is going to have to find a lot more money
from somewhere to prime the pump and get these systems up and
running successfully. Thinking that it will be possible to fund
this from trusts’ current IT budgets is not realistic.
Terry Walton, head of IT, Lewisham
Hospital
John Hutton: "We think it is goin to cost the same"
Trusts highlight local challenge of IT plan
To hear the full interview, go to the audio archive for 12
October atListen
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