Informatics Review and NPfIT: an opportunity

Analysis and comment


Matthew Swindells, the health service’s affable former interim CIO, was leading the NHS’s Informatics Review – but his name is nowhere in the final report which was published last week (10 July 2008).


In April, at the HC 2008 Healthcare Computing conference at Harrogate, Swindells was introduced by the British Computer Society as the man “leading” the review. He gave a well-received keynote speech on what his review would say. 

Swindells has now left the Department of Health. He has joined a private company, Tribal, which provides consultancy to the public sector.


But it’s notable that the bullish speech by Swindells at Harrogate on his forthcoming review made no mention of giving the boards of NHS trusts a choice of “interim” systems while they wait for the joined-up “strategic” products, Cerner and Lorenzo, which are due to be delivered by the local service providers to the National Programme for IT [NPfIT]. 


Yet the main message from the Informatics Review is that NHS trusts will be allowed a choice of accredited systems – and not necessarily from the NPfIT’s two remaining local service providers BT and CSC.


Since Harrogate, however, Fujitsu has been put on notice to quit the NPfIT and the directors of NHS trusts [but perhaps not all trust chief executives] have realised, if they haven’t before, that they cannot continue to wait indefinitely to replace systems they should have replaced years ago.


So the Informatics Review, and Gordon Hextall of NHS Connecting for Health, have taken the pragmatic view that trusts can buy what they need subject to conditions and funding. If not buying from a local service provider trust boards must, for example, write a good business case, which should not be too difficult because systems from other suppliers may be cheaper overall, even if some products from LSPs are subsidised centrally.   


What the Review says on interim systems


The Review says:


“The NHS is already using a number of effective solutions that are in addition to the scope of current national contracts. Recognising the likely timescale for the delivery of the strategic solutions, NHS organisations should be able to consider the benefits of additional interim solutions where they offer the chance to deliver patient benefits sooner, provided that they are able to confirm a roadmap to converge with the strategic solutions within the timescales of the national contracts.

“Strategic health authority CIOs and NHS Connecting for Health should work together to develop and publish case studies of best practice IT systems that can be adopted as interim solutions by local organisations to deliver benefits earlier, subject to local approval and funding…These can be based on any solution currently in operation in an organisation providing care to NHS funded patients…

“It will be for strategic health authorities and primary care trusts to decide, in the context of local informatics plans, how the adoption of any interim solutions would be implemented locally…The adoption of any interim solution will need local and SHA sponsorship and will need to be locally funded. The possibility of ‘enterprise-wide’ procurements will be considered where appropriate.”


The qualified support in the review for secondary care systems-of-choice means that the Informatics Review has been generally welcomed. Executives working for the NHS say that officials at Connecting for Health now have a chance to kick-start an IT-based modernisation of the health service, as long as their new thinking does not become mired in the unworkable parts of the NPfIT.


In the 1990s family doctors were given subsidies for IT which led to GP practices in England becoming the most advanced users of technology anywhere in the world.


Now NHS Connecting for Health may have some spare money to do the same with hospital trusts. It no longer has to pay hundreds of millions of pounds to Fujitsu and could use this money to kick-start a modernisation in secondary care, at least in the south of England, allowing trusts to buy from a range of suppliers, with central subsidies.


It’s true that the government has contractual commitments to place a minimum value of orders annually with the local service providers. But some executives working on the NPfIT believe it would not be too difficult to recast the LSP contracts on the basis that local service providers have not delivered the strategic products they had promised, so it’s reasonable for the Department of Health to negotiate to remove from LSP contracts the commitment to place a minimum value of annual orders.


Trusts would then be able from LSPs if they wished, without being under duress to buy from them. Even with renegotiated contracts neither BT nor CSC are unlikely to quit the programme: the signs are that the government will do anything in its power to keep them.  


When the Shadow Health Minister, Conservative MP Stephen O’Brien asked the government to state the minimum number of suppliers that can be countenanced under the the terms of the NPfIT contracts, the Health minister Ben Bradshaw replied: “The original procurement strategy for the national programme was to avoid reliance on a single supplier to deliver the programme …” In short, the government cannot afford to lose another local service provider.


But to wait for the NPfIT is to wait indefinitely. So trusts are drawing up plans to buy “interim” systems from a choice of suppliers under a framework contract, the Additional Supply Capability and Capacity [ASCC], which was set up as a contingency and now looks like taking centre stage.


Is the NPfIT dead?


Some in the NHS are saying that the Informatics Review is the eulogy being read at the funeral of the NPfIT.


That’s a bit unfair. The Informatics Review says what NHS IT should be. But almost the same visionary words could have been written 10 or 20 years ago – and  many were, in the NHS IT strategies of 1992 and 1998.


Talking about a Utopian future for NHS IT will not disinter the NPfIT. It will, however, help to justify the edifice of a central bureaucracy to oversee NHS IT of the future.


That’s politics; and executives working for the NHS say it’s time to put politics to one side and do what’s best for patients, which is, within the ASCC, to give a subsidised choice of IT suppliers to the boards of NHS trusts. They can then buy products they know work, not vapourware.  


It’s one thing for the NHS to have invested, in decades past, in a multitude of systems that weren’t joined up, cost a small fortune and worked. It’s another thing to put faith in a visionary IT programme in which the investment is in a minimal number of systems that aren’t joined up, cost a bigger fortune and don’t work.  




There’s an excellent analysis of the Informatics Review on Informaticopia [July 14 Post].




Tribal welcomes Informatics Review report – BJHC


Informatics Review  – The Department of Health


Informatics Review – write-up in BJHC


Informatics Review –  BCS write-up