Go-ahead for standalone systems in response to problems developing integrated technology
Whitehall officials are altering course over their plans to deploy fully integrated health systems under the multi-billion pound National Programme for IT in the NHS (NPfIT).
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They are drawing up proposals to deploy some standalone technologies, negotiating nationally with suppliers to extend legacy contracts, and installing older but proven software at new sites.
The shift in strategy is being welcomed by some trusts given delays in the delivery of joined-up or "core" systems from the four Local Service Providers (LSPs) that are due to be deployed across England.
The stop-gap measures will allow trusts to urgently replace systems that suppliers are no longer supporting or that have become so old they are unreliable. The measures will also provide established technology to trusts that have few advanced systems.
But extending the contracts of legacy suppliers, deploying standalone software or installing proven systems that cannot be easily integrated with others without significant enhancement or replacement, has a price.
Some NHS trust IT directors are advising their boards that the move could increase the costs and time taken to achieve a fully joined-up NHS.
A paper presented last week to the board of North Central London Strategic Health Authority, for example, said the delivery of the first main release of a core NHS Care Records Service - including electronic patient records - for acute trusts has been put back from 2006 to 2008-9. This is six years after the NPfIT was launched.
The authority said the LSP for London, the BT-led consortium Capital Care Alliance, was "being more flexible in its approach," and offering "scaled down interim products" including standalone systems as a stop gap.
The interim "tactical" solution, available from 2006 would enable trusts to meet their business requirements until a strategic solution is available in 2008 or 2009.
It would not allow the same degree of joined up working as the strategic solution, said the paper.
Despite the delays, there will be some early integration successes. Systems will be integrated to meet government requirements for Choose and Book, which will allow a hospital appointment to be booked when a patient wants it.
But some IT directors in the NHS believe that full and effective integration of systems will take much longer than 2009, or may never be achieved. This is in part of because of complexity and the disjointed working of the health service. They say the plans should be reviewed to make them less complex and ambitious.
There are signs around the country of a more pragmatic approach to NHS IT modernisation.
In the South of England the main patient administration system adopted by Fujitsu, the LSP is a Cerner product used at Homerton foundation trust and Newham University Hospital Trust as part of on an investment plan approved before the NPfIT contracts were awarded.
In London, IDX's "Carecast" system is expected to be deployed, as used by University College London Hospitals. The system was also delivered under a deal agreed before the NPfIT's contracts were signed.
West Suffolk NHS Hospital Trust reports that its Local Service provider Accenture couldoffer a mixture of partially integrated and standalone systems.
A paper to the board of North Bristol NHS Trust this summer reported on positive developments over the NPfIT. It also said the switch in Southern England from IDX to Cerner as a key contractor may be an improvement but "raises questions of credibility about the programme and its ability to deliver."
It noted the switch to Cerner marked a "strategic shift on NPfIT's goals and will not necessarily require a single 'instance' (of data) across the Cluster, nor will it be compliant with the national spine for some time."
The data spine will hold summary patient records.
The government agency Connecting for Health, which is delivering the NPfIT, said it was not relaxing its rules and specifications for joined up systems.
Looking ahead, a spokesman said, "Systems will be of industrial strength, have excellent service availability, solutions will be spine compliant and local service providers will deliver a fully integrated NHS Care Records Service as originally specifiedÉ An independent study confirmed the central purchasing of core systems and services will save the NHS in England some £4bn over 10 years."