The Government has staked its reputation on reforming a health service struggling to meet public expectations. Downing Street has acknowledged that a modern NHS cannot survive without effective information and up-to-date IT.
Last week the health minister Lord Hunt unveiled a new strategy - Delivering 21st Century IT Support for the NHS - outlining the latest attempt to build a modern technology infrastructure across an organisation that has been dogged by IT failure.
Key elements of the ambitious plan, which is scheduled to start in April 2003, include stringent national standards for data and IT, and a new procurement strategy. A national IT programme director, or IT tsar, will also be appointed to implement what has been described as "the IT challenge of the decade".
However, it will not be cheap to overhaul the IT in an organisation with more than one million employees. One IT manager in an NHS trust said, "If [the Government] wants a standard NHS IT system it has got to put a lot of money into it."
NHS IT professionals have welcomed the strategy but are concerned that NHS IT projects have often been underfunded in the past.
In the influential Wanless Report, which was published on the same day as this year's budget, former NatWest chief executive Derek Wanless called on the Government to devote £2.2bn to NHS IT in 2002-2003. Current NHS IT spending is £1.1bn.
The new investment for IT will be ringfenced, although government officials have confirmed that it will be allocated to local projects that satisfy national standards.
There is still uncertainty about how much actual funding will be made available to deliver the strategy, although there has been speculation that it will be in the region of £5bn. However, government officials have been unable to confirm this.
A Department of Health spokesman said, "We won't know what the actual figure is until the summer." He confirmed that the money will come from the £40bn increase in NHS spending outlined in the budget earlier this year.
So it seems that the political will exists to fund a project of this size. The Government has already identified NHS reform as one of its top priorities, and the chancellor Gordon Brown predicted that health spending will equal 9.4% of gross domestic product by 2008.
One of the major challenges for the Government is overcoming the health service's legacy of inadequate IT. The Wanless Report described the UK's "particularly poor record on the use of information technologies in the health service". It also said Wanless had found that the health service's annual IT spend per employee was lower in 2000 than in any other sector of the economy he looked at.
However, the initial signs are that this could all be about to change. Analyst firm Kable recently predicted that IT spending in the NHS could reach £2.8bn by 2003-2004.
Despite the promise of additional funding, some NHS IT professionals have also urged the Government to bear the needs of local users in mind when it rolls out its strategy.
One NHS trust IT manager said, "A standard approach to [NHS] IT would be good but the data would have to be held locally, not nationally."
The NHS is no stranger to problems involving centralised IT projects. In the early 1990s a centralised approach to IT delivery hit the Hospital Information Systems initiative, losing up to £103m and prompting criticism from the House of Commons Public Accounts Committee.
The same trust IT manager also believes that it would be impossible to hold the masses of data contained in electronic patient records centrally, largely because of the amount of storage space that would be needed and the time that would then be required to retrieve the data.
But like it or not one of the cornerstones of the new NHS IT strategy is centralised procurement, although this has also prompted a mixed reaction. The NHS IT manager said, "I am not sure that centralised procurement for hardware really works. I am not sure that it allows you to get the best prices." This can lead to a limited number of suppliers, he added.
He acknowledged, however, that centralised procurement of software could prove beneficial to the NHS by making it easier to share critical patient information.
"If the Government states that software has to be compliant with a standardised technology then it could lead to a greater ability for the NHS to share information across standard interfaces." This could be used in areas such as patient administration systems and interfaces for coronary heart disease and cancer, he added.
Overall, NHS IT professionals have welcomed the new strategy. Ted Woodhouse, director of information services at the Leeds Teaching Hospitals NHS Trust, the UK's largest NHS trust, said, "This is a highly ambitious programme that is long overdue. I thoroughly support the promise of more investment in IT in the NHS."
This is even more overdue than the new NHS IT plan itself, he added.
Woodhouse also underlined the importance of ensuring that local needs are not swallowed up by the national IT agenda.
He said, "While I fully appreciate the need for central direction and standards, I hope that there is some leeway for local requirements to be appropriately satisfied."
NHS IT tsar faces "IT challenge of the decade"
A commercially savvy deal-broker with finely-honed political skills and an intimate knowledge of NHS IT - that, according to IT recruitment experts, is who the Department of Health is looking to recruit to take up "the IT challenge of the decade".
Experts have warned that the Government faces a tough task recruiting someone with the skills required to overhaul IT in the NHS, which, with more than one million employees, is one of the largest organisations in the world.
Andy Lord, director of specialist staffing and solutions company Best International, said, "For me the job is more than one person's job." Both a politician and someone who is a deal-broker from the services sector would be needed, he said.
The director general of the new NHS IT programme will need that rare combination of political know-how and commercial savvy, according to experts in the IT recruitment industry.
Martin Luise, divisional manager of Computer People Executive Search and Selection, explained, "The sort of individual that would be required to do this role would need both commercial acumen and political nous. That type of person will be difficult to find."
NHS IT professionals have also warned that the ideal candidate must have grassroots knowledge of health service IT.
An IT manager in an NHS trust said, "There is no point appointing a 'talking head' to spread the Government gospel, [the tsar] needs to be able to understand the problems from the shop-floor upward."
This was first published in June 2002