The biggest challenge - by Lord Hunt, minister in charge of the NHS's £12.4bn National Programme

Lord Hunt, the health minister responsible for the NHS’s National Programme for IT [NPfIT] says the biggest challenge is getting “local ownership of the programme.”

He was referring to an initiative of David Nicholson, the Chief Executive of the NHS, who has helped to put in place the National Programme for IT Local Ownership Programme. This aims to devolve responsibility for the NPfIT to the heads of strategic health authorities, and the chief executives of NHS trusts.

Speaking at the HC2007 Healthcare IT conference at Harrogate on 19 March 2007, Lord Hunt said: “The biggest challenge is this question of local ownership of the programme. I have no doubt about that whatsoever. I see that as a minister that is one of my major areas of work in engagement with local NHS organisations.

“David Nicholson [Chief Executive of the NHS] feels very strongly too that this is where we need to put our energy. It’s clear that up to now people locally, NHS staff, boards of NHS organisations, have not felt as fully involved as they ought to have done.

“That’s why we have created NHS local ownership programme [my comment: there seems no agreement yet on whether it should be called the National Programme for IT Local Ownership Programme which oddly brings together the words “national local”, or the NHS Local Ownership Programme] and I am very hopeful this will be the way forward to getting that local ownership to getting that local support and getting across to NHS boards the critical importance of their support and leadership for the IT programme.”

From the audience Jane Hendy, a researcher at Imperial College, London, told Lord Hunt that chief executives of NHS trusts are ready and willing to engage with the NPfIT but there is little in the way of new software or services to become enthusiastic about.

She was referring to the uncertainty among trust boards over what to do about the delay in the deliver of core software from the NPfIT’s local service providers. Trust boards are uncertain whether to buy outside the NPfIT, make do with interim software that may be costly to replace when the core software eventually arrives, or extend contracts on existing systems that are perhaps becoming increasingly unreliable and unable to meet the needs of the organisation.

“I have been looking at the implementation of the NPFIT for the last three years,” Hendy told Lord Hunt. “I agree with a lot of what you said particularly about the ‘too much too quickly’ comment.

“I also think it’s not just a question of local ownership; it’s a question of local guidance for chief executives in acute trusts. There has been a lot of delay and my concern has been the uncertainty about what to do in terms of that delay. People do need timetables and people do need to know exactly where they are going with this particularly in relation to patient administration systems and also clinical systems as well. That really was not on your slides very much. The lack of implementation of new clinical systems does represent a real risk to patient safety as we sit here now and the lack of guidance on what to do about that.”

Lord Hunt’s reply did not address Hendy’s point on what trust boards should do in the light of the delays in the delivery of new national systems.

“I think that’s a very helpful point,” Lord Hunt told Hendy. “The key issue I take from [your comments] is closing any gap, if there is a gap, between people who are having to make these big decisions locally and the national programme. That’s the work that David Nicholson is now leading. He’s meeting chief executives of acute trusts in april to talk through the programme and I am sure those are issues which he and they will be prepared to tackle.

“Why did we take such a national direction approach? Frankly, and I suppose I have to put my hand on heart and I have to perhaps bear responsiblity for this, frankly I think it’s the only way that we could have achieved change in any scale of time at all within such a huge system.

“At the time I always knew that there would be issues about engagement at local level. There would always be an issue about the thousands of systems that are being run locally and how you got the integration that was required and the challenge that that would present to so many people locally, to companies, to IT specialists to the organisations themselves. We have to accept that, I don’t think that if we had been carrying on the way we had been carrying on we would have made progress. But we have now made sufficient progress in order to change the thrust towards local ownership. What of course that then requires is the capability of people at the local level to accept the responsibility that is being given to them.”

He said the boards of NHS bodies must recognise that their buy-in to the NPfIT “has got to be an absolute priority for them”.

Lord Hunt and Nicholson will be meeting chief executives and the chairs of NHS trusts and Strategic Health Authorities to “get their buy-in and their commitment”. “It’s one thing saying local ownership is important but the other side of the coin is that organisations locally then have to accept their responsibilities.”

To this Hendy said: “My personal experience having talked to chief executives in the trusts over the last three years is a great readiness and willingness to engage but unfortunately there has not been much to engage with. What people have wanted is something concrete to engage with, and that is something that has not been forthcoming.”

Lord Hunt again bypassed this particular concern. “That a fair point,” replied Lord Hunt. “I accept that. What I am saying is that we are in a position to have a grown up conversation with those people who will be absolutely critical to success in the next stage. All I am saying is that it is a two-way thing. I agree with you. If I compare where the NHS is now to where it was five, six seven years ago I think there has been a huge change in attitude among senior managers and clinicians but we have now got to make it work.”