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.
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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.
● 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.