Why NHS IT spend may actually rise over the next few years

MIchael Cross has written a typically well informed and thoughful piece for Kable on the convergence of the Conservative and LibDem plans for NHS IT but I suspect his core conclusion may be wrong. The roll-out of NPfIT has been stalled for several years, leaving the previous local systems preserved in aspic, with the NHSIA strategy of linking and building incrementally on the best of breed, replaced by a grandiose centrally mandated, silo structured, target driven, big-bang approach.

Cash spend, as opposed to announced spend, on NHS IT has in consequence fallen.

There is therefore a good case for believing that cash spend will actually rise, not fall, if clinicians are set free to build on those surviving systems which locally integrate hospital and home care including, for example, health management programmes for those with chronic conditions. If these can be linked to reform of practical implementation of the “working time” and “health and safety” requirements as they apply to hospitals, care homes and home visits, the result could well be significant improvments in patient care leading to more active lives and reduced costs all round.

The “big” difference is that the decisions would be taken locally by clinicians whose priority is the patient not the target.

The “big” question is whether the Conservatives and LibDems are really serious about devolving power from the centre – given that, within months of it beginning to deliver results, the Today Programme and the Daily Mail will be complaining about “Post Code  lotteries”.

Where would such a development leave the Microsoft and Google health record services?

Answer: where they belong – as one among many such services competing for the business of those who are allowed a choice – including the choice to leave the records where they are – under the control of clinicians who care about the patient not the system.

Such a change is likely to be strongly resisted by suppliers used to selling technology, centrally, to ministers and officials as opposed to service delivery, locally, to clinicians and petient care groups.