The National Programme for IT in the NHS seems
to be destined to be dissipated, in part, into general health IT in
England. There are signs the programme is in flight from ruthless
standardisation; Whitehall has dropped plans to give
NHS Connecting for Health, the agency set up to run the
programme, the status and independence of an executive agency;
officials are struggling to find money for plans to localise the
scheme; and a more diffuse leadership may be poised to subsume the
departing Richard Granger's role as director general of NHS
IT.
At a government IT summit in May in London, a senior health
official gave an assurance - of sorts - about the future of the
NHS's £12.4bn National Programme for IT (NPfIT). "It has three
wheels still on, and it is still moving. But things are in hand to
a certain degree. They are not in other respects but we are going
to get there," said Andy Burn, head of IM&T planning at NHS
Connecting for Health, which runs much of the NPfIT.
Not all trust IT directors share Burn's confidence about the
future of the programme. A comprehensive assessment of the
programme by Birmingham and Solihull NHS Trust raised a question
about whether the NPfIT would achieve its objectives.
It said, "The NPfIT is an ambitious programme that has
experienced delays, with current system migrations running two
years late, and there are concerns over its achievability."
The paper was referring in part to a plan to give 50 million
people in England a reliable and useful medical record - called the
NHS
Care Records Service - which is running at least two years
late. Some trusts are now buying essential systems outside of the
NPfIT.
The paper said, "In priority situations, full EU procurements
are being undertaken for systems outside the local or national
product portfolio.
"The financial impact on national contracts has yet to be
resolved, but some trusts may need to pay financial penalties for
operating systems outside of the national contracts."
Birmingham and Solihull NHS Trust is not the only trust to make
such an assessment of the NPfIT.
Given the problems with the programme, including concerns in the
NHS over the quality and reliability of some NPfIT products
installed so far, what is the
government of Gordon Brown to do about its future?
Several developments indicate that the government, advised by
Whitehall officials, has decided to blend the NPfIT more into NHS
IT in general. Thus the scheme may not have such a distinctive -
and controversial - character.
This would make it more difficult for observers of the programme
in the NHS, parliament and the media to delineate what is and what
is not a success. In the run-up to a possible early general
election, ministers would welcome a reduction in the number of
articles that cast the NPfIT in a grim light.
Recent developments
● Local service provider
Fujitsu has issued a statement to Computer Weekly that concedes
that some parts of the NHS dislike standardised solutions, and it
will adopt a more flexible approach to local requirements. This
could indicate a u-turn for the NPfIT - the Department of Health's
motif for the NPfIT has always been "ruthless
standardisation".
● Ministers and senior officials have made a u-turn over plans
to turn NHS Connecting for Health into an arm's-length agency. It
will no longer publish an annual report on the programme's
successes and challenges, and will not have all of the autonomy of
an executive agency.
● There are signs that the budgets for organising a
devolution of the NPfIT to NHS trusts and strategic health
authorities - a plan called the NPfIT Local Ownership Programme -
are being squeezed. Although more than £2bn has been spent on the
programme so far, there are signs of shortages of a few million
pounds over the Local Ownership Programme.
● New top appointments at the Department of Health include
people whose skills could replace some of those lost when Richard
Granger, director general of NHS IT, leaves this autumn. This could
make leadership of the programme more diffuse.
Some observers of the NPfIT are likely to see the programme as
becoming more indefinable, and accountability more obscure.
NHS Connecting for Health is expected to continue refusing calls
by Computer Weekly, academics and other independent voices for a
new high-level, published, independent review of the programme.
So there will continue to be no independent verification of the
government's claims for the success of the scheme.
Meanwhile, at the front line, NHS trusts will face penalties if
they do not place a minimum amount of orders with the NPfIT's local
service providers - whether the trusts are enthusiastic about the
NPfIT products on offer or not.
Heading towards obscurity?
NHS Connecting for Health's lack of a separate existence could
be part of the political plan to blend the NPfIT with NHS IT in
general. And the move away from ruthless standardisation would
remove from the programme its distinctive character, a loss that
would be compounded by the departure of the charismatic head of NHS
Connecting for Health Richard Granger.
All of which may help to explain why the NPfIT - after a series
of ministerial announcements about the programme during its early
years of the programme - is hardly mentioned in the latest annual
report of David Nicholson, the chief executive of the NHS.
But if, as seems the case, some politicians and officials want
the programme to head slowly towards obscurity - at least until the
next general election - they may be disappointed, especially if
suppliers start levying fines on NHS trusts over a lack of NPfIT
orders.
Tony Collins' blog on NPfIT developments >>
www.computerweekly.com/npfit
>>
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