NPfIT - what happens now in the south

As Fujitsu departs the NHS’s National Programme for IT [NPfIT] there will be three competitions for the supply of Care Records Service systems to most trusts in the south of England.

BT and CSC, as the two remaining local service providers under the National Programme for IT [NPfIT], will have to compete with other suppliers for orders from southern trusts.

NHS CIO Christine Connelly said at HC2009 at Harrogate that three strategic health authorities in the south will hold competitions under NHS Connecting for Health’s Additional Supply Capability and Capacity [ASCC] framework. 

Each SHA will choose a supplier from a list of about 10, which includes BT and CSC.

So large hospitals in the south are likely to end up with a mixture of Cerner’s Millennium patient administration system, Lorenzo and other products. Some foundation trusts are likely to buy systems direct from a small range of suppliers.

They may not use ASCC because this would commit them to three-way deals in which they, NHS Connecting for Health and the suppliers are all working under contracts which have been agreed centrally. Two’s company and three’s a crowd.

On the other hand any trust which chooses a patient administration system under the ASCC competition will have it funded centrally. This has been confirmed by NHS Connecting for Health.

A decision on the winners of the three competitions is likely to be announced in November.


The regionally-run competition in the south seems to be one means by which the central bureaucracy holds onto the vestiges of a national programme.

The idea of centralised procurements under the NPfIT was system integration – ruthless standardisation. But the constraints imposed by integration stop nationally-chosen systems getting installed in NHS trusts.

So integration has all but been abandoned in favour of tailoring national systems locally to get them to work acceptably.

The choice of different suppliers in the south is welcome. But it’s another nail in the coffin of integration. 

What hasn’t stopped is the spending. There’s the central bureaucracy, the lawyers, the hotel bills, the consultancies – and the tens of millions it will cost to sort out the Care Records Service problems at London Trusts.

About £5.1bn has been spent on the NPfIT so far.  

This is probably the most that has been spent on any Government IT project or programme. Yet the programme is still in a state of disorder, wracked by uncertainties which are as a deep as they were years ago.

This muddle is compounded by the shackles of the remaining local service provider contracts, which impose commitments on taxpayers, NHS IT professionals and Whitehall officials.

It’s true the NPfIT has replaced to some extent the fragmentation of the past few decades of NHS IT; and it has had some benefits:  PACS x-ray systems have probably been installed faster than would have happened without the NPfIT; Choose and Book if it ever works properly could aid patient choice; and there’s a national data spine and broadband to NHS trusts and GPs.  

But the programme has caused confusion, billions of central spending, wasted spending locally, damage to patient care and treatment in some areas, and future financial commitments to BT and CSC.

All hope it not lost, however. Carl Jung said that there’s a secret order in all chaos. Perhaps that explains the Department of Health’s original plans for the NPfIT.