The government's decision to accelerate the dismantling of the NHS National Project for IT (NPfIT) came as little surprise to those who have followed the terminally ill project since 2002. But what is the prognosis for the NHS's badly needed modernisation programme?
Few details have yet been released on how the end of the NPfIT will affect NHS trusts and existing contracts with BT and CSC, but there will be significant changes under the government's move to a local commissioning-based approach.
The previous framework contract under the NPfIT meant just a handful of suppliers dominated this market. There is optimism that the decision could stimulate a more vibrant healthcare market, including greater involvement from SMEs. This could also dovetail into the government's cloud strategy, with the likes of Google supplying records systems.
"This is about opening up and giving opportunities for suppliers to deliver solutions for the NHS and for the NHS to have a better understanding of what industry can offer, rather than going to frameworks and other procurement routes," said Jon Lindberg, head of trade body Intellect's healthcare and transport programmes.
But Tola Sargeant, analyst at Techmarketview, said initially there will be uncertainty among trusts. "Inevitably this means a hiatus in the delivery of electronic records, while trusts look at how they can link up what they already have, rather than ripping out and replacing. This will mean more opportunities for those not part of programme, but also a period of uncertainty and delay," she said.
Part of the cancellation of the NPfIT means the government is devolving commissioning responsibility to trusts. But as the market fragments into multiple suppliers and multiple procurements, there is a real danger that systems won't be able to communicate and share patient information - one of the fundamental reasons for electronic healthcare records. Intellect's Lindberg agrees that the challenges are around ensuring that systems can be joined up.
"With the move to local decision-making there is a danger that trusts won't look at how systems interoperate, which we will need to have if we are to give patients better value from the NHS. We are working with the Department of Health around the implementation of the interoperability toolkit [a system intended to create shared standards]," said Lindberg.
MPs had previously heard from the Department of Health (DoH) that cancelling the outstanding NPfIT projects could be more costly than completing them. Although Richard Bacon MP later claimed this was untrue, there will undoubtedly be expensive cancellation charges involved. The DoH has not yet said what these will amount to.
But Gayna Hart, managing director of software provider Quicksilva, has spoken to government ministers and believed it was an exaggeration to say the NHS's NPfIT is being canned. It would be too costly to scrap entirely. Instead, the programmes will each go forward under different names - a siloed approach to NHS IT, she said.
A spokesman from BT said the company will carry on delivering to the 17 acute hospitals under its remit, plus the other parts of the programme to which it is contractually obliged. CSC said it was not able to comment on contractual issues.
The cancellation of the project will likely mean that already cash-strapped trusts will have to dig deep in their pockets to find the cash to deliver their own electronic records systems.
But Chaand Nagpaul, a GP and member of the British Medical Association's working party on IT, said IT must remain a priority as it has the potential to deliver significant cost savings.
"The health service must learn lessons from the past, such as ensuring that healthcare professionals are central to determining the priority and implementation of IT policy. IT remains a fundamental element of administration and delivering healthcare services," said Nagpaul.
"It would be folly to look at IT as an unnecessary expense. When you look at IT in the wider context, such as the benefits of telemedicine, it has an important role and should be central to delivery," he said.
Lindberg agrees. Boards must recognise that electronic record systems will change the way they work and will end up saving money and improving healthcare delivery, he said. "The simple fact is there is no more money about. So it's about recognising [what technology] can do for trusts."
The move to a more local-based approach could have a negative impact on the direction of IT strategy across the NHS. "While we may not have the NPfIT, we would be concerned if the national responsibility for the provision of IT also moved locally," said Nagpaul.
"High-level IT for GPs needs to have national specifications and standards. We will be worried if IT moves too far down the local route. There needs to be a balance and dialogue to define a meaningful approach that combines national responsibility with local implementation," he said.
It is easy to overlook the elements of the NPfIT have been successful - such as the N3 network, PACS, the Spine, and Electronic Prescriptions - when criticising the other aspects of the project's failure. But even these pockets of success could be affected, with major NHS shake-ups underway to axe Primary Care Trusts, as it remains uncertain who will take responsibility for the running of these systems.
"We need to have a dialogue as to where functions will fit in context with NHS changes," said Nagpaul. Arguably, this could be the NHS's biggest challenge going forward.