The Government's confirmation last week that its £6bn investment to overhaul public sector technology is earmarked specifically for IT projects was given a cautious welcome by IT managers in the NHS, an area where lack of ring-fenced IT investment has been a long-running source of controversy.
In his first speech on e-government for two years last week, Tony Blair identified the health service and education as two areas where there is still room for improvement. Warning that too many of the UK's public services live in a technological dark age, he used examples from these sectors, pointing to "an NHS without a single electronic network" and "too few teachers without their own e-mail".
A Downing Street official later confirmed that the money, which was already allocated to public services in this year's spending review, is destined specifically for IT projects. For example, one sixth of the promised £6bn will be invested in networking the UK's public services, a strategy that aims to link every school to broadband technology by 2006, and link GP surgeries to hospitals and NHS Trusts.
It is the NHS, however, where the broader IT funding issues become particularly complex. The need to ring-fence IT cash across the NHS is a source of long-standing tension in the service, where it has often been diverted to alleviate pressures on frontline services.
It is still not clear how much of the £6bn will be allocated to NHS IT, although a spokesperson for the Department of Health said that this announcement would be made "in a short while".
One thing seems certain, however: the Government must boost current IT spending levels if it is to underpin its high-profile NHS modernisation agenda.
In April, the Wanless Report urged the Government to double NHS IT spending to £2.2bn a year in 2003-2004. This is a long-term strategy. The Government-commissioned review was set up in March last year to identify the resources that will be needed by the NHS over the next two decades.
Notably the, report by former NatWest group chief executive Derek Wanless, also urged the Government to ring-fence NHS IT funding. "Central standards must be set and rigorously applied and the budgets agreed should be ring-fenced and the achievements audited," it said. It appears that the Government intends to heed this advice.
The issue of protecting funds has dogged NHS IT managers for many years. Richard Gibbs, the former chief executive of Kingston & Richmond Health Authority, recently told the Intellect conference of IT suppliers that he diverted half of the money set aside for IT into meeting other priorities. "The problem is that we were under so much pressure to deliver lots of other targets, like waiting list targets, which quite clearly carried a higher political imperative," he said.
Gibbs, however, said that Kingston & Richmond had been relatively lucky - in many other authorities 75% of the IT allocation had been re-directed.
Perhaps not surprisingly, then, health service IT managers initially welcomed the fact that the £6bn public sector IT investment, allocated in this summer's spending review, is being specifically earmarked for IT. One NHS trust IT director, who asked not be named, said, "The fact that money is going to be made available is very positive - you can't do anything without money."
While welcoming the targeted cash senior IT professionals labouring at the NHS coalface have cautioned that it must be spent correctly.
Ted Woodhouse, director of IT at the Leeds Teaching Hospitals NHS Trust, which is the largest NHS trust in the UK, said, "Yes, it is positive that it is going to IT but it needs to be properly managed and carefully allocated so that it is spent on the most important IT areas."
The good news for Woodhouse is that the prime minister's speech at last week's e-summit confirmed that that this is likely to be the case. Blair said, "In the NHS we will be investing to create a national integrated care records service, an electronic prescriptions service and an electronic bookings service."
These initiatives are integral parts of the health service's ambitious National Strategic Programme, which was launched earlier this year, and will be funded by a substantial chunk of the £6bn cash injection for public service IT.
The strategy, which will form the basis of the UK's largest ever IT project, is being overseen by the newly-appointed NHS IT tsar, Richard Grainger, a job that has been described as "the IT challenge of the decade".
Long-term objectives of the strategy include providing broadband access to all NHS clinicians and support staff by December 2005, as well as implementation of domain-to-domain encryption. A national appointment bookings service is also expected to be implemented by December 2007, as will electronic patient records in all primary care trusts and hospitals.
However, the trust IT director who asked not to be named did express concern about how the additional NHS IT funding would work in conjunction with the National Strategic Programme. "The money and the National Strategic Programme are driving the NHS to wholesale change on its IT systems. that is a very high risk exercise that many IT managers are very fearful of." There must be some mechanism for incremental change, he added.
Woodhouse also urged the Government to use the money in addition to existing NHS IT funding, as opposed to employing it as a substitute. "It must be ring-fenced so that it is used in addition to existing expenditure, not as a substitute for it," he said.
While precise details on the new levels are funding for NHS IT are hard to come by, the Government's decision to earmark the investment for technology is a clear statement of intent. It suggests that it is willing to live up to pledges in its last two election manifestoes and overhaul the IT infrastructure that underpins one of the cornerstones of the welfare state.
How the money will make a difference
Tony Blair said the Government's £6bn public sector IT investment will play its part in overhauling the technology infrastructure of the NHS through:
- The creation of a national integrated care records service
- Development of an electronic prescriptions service
- The creation of an electronic appointment booking service
- New technologies that will replace cumbersome and inefficient paper-based approaches - eliminating up to 600 million paper documents a year. According to the prime minister this could make GPs' handwriting legible "for the first time in history"
- Making it possible for ambulance crews arriving at the scene of an accident to check a patient's electronic health record through a handheld mobile device
- Enabling GPs to e-mail a prescription directly to a pharmacist who in turn will e-mail the patient to let them know when it is ready for collection.
Blair said the Government is allocating £1bn to networking the UK's public services. In addition to connecting every school to broadband by 2006, it also intends to link GP surgeries, hospitals and primary care trusts.