Stuart Threlfall, ICT director at King's Lynn and Wisbech NHS Trust, has reduced a funding requirement of £1.2m to £498,000. But his board, which is in the red, has politely refused to fund the remaining sum. It said it wanted to convey its "enthusiasm for the implications/innovations implicit in the programme" but given its current financial position it had "no funds to meet the shortfall".
Hertfordshire Partnership NHS Trust, although enthusiastic about the national programme, warns of the risk of diverting cash from healthcare projects into its IT programme. It said in a strategy paper in September that if the local IT funding plan proves inadequate it may have to divert capital earmarked for improving mental health and meeting government health targets.
"Our primary care trusts have still to identify funding in what remains a difficult financial climate in Hertfordshire. This puts a major question mark on the deliverability of the programme [locally]," said the trust paper.
Asked whether the NPfIT is confident that trusts will find the money to implement national systems, its spokesperson said, "Implementation of the national programme is a core part of local NHS modernisation and therefore implementation activities will form an integral part of local development plans."
One of the most notorious IT failures in the health service came in the early 1990s when local hospitals refused to continue funding an IT initiative that was based regionally.
Accenture (then Andersen Consulting), one of the main suppliers to Wessex's Regional Information Systems Plan, said it had delivered systems that were satisfactory. But when local NHS authorities' funding stopped, the plan had to be abandoned at a cost to taxpayers of £20m-£43m.
Success in the national programme would give the government a world-leading reputation for achieving an IT-led business transformation in an organisation with more than one million staff. The likelihood of success is boosted by the almost universal support in the NHS for the objectives of the NPfIT.
David Hinchcliffe, Labour chairman of the Commons' health committee, believes the national programme has a strong chance of success. He has met senior officials from the national programme and said he believes that lessons from past IT-related failures have been learned.
"I am astonished that we are light years behind [other countries] in the use of healthcare systems," he said.