Foundations of an IT headache

As this page went to press, health secretary Alan Milburn was busy defending his plans for foundation hospitals in a Commons...

As this page went to press, health secretary Alan Milburn was busy defending his plans for foundation hospitals in a Commons debate, ahead of a crunch vote. Milburn faces widespread disquiet at the spectre of a two-tier health service being introduced.

More specifically for IT professionals within the sector, his vision of a new breed of locally run and partially financially autonomous hospitals casts fresh doubt over the government's national programme to reform health service IT systems.

Foundation trusts, should they materialise, would be controlled and run locally, not nationally; and the communities they serve would elect their boards of governors. On the Department of Health's website, Milburn states that these trusts would have "the freedom to improve services for NHS patients without interference from Whitehall". Moreover, government sources have confirmed that it would not seek to mandate foundation trusts' adoption of the shared services initiatives, set in place in 2001, that are intended to introduce common financial IT services across the NHS in the coming years.

These shared services projects are already well advanced. Contracts have been signed that will result in massive IT systems intended to centralise and simplify NHS payroll and human resources systems. Yet centralised IT can clearly never achieve its predicted cost savings if trusts have autonomy in deciding whether or not to opt into systems.

If these foundation hospitals cannot be persuaded to accept centrally driven IT projects, how can we expect other hospitals to jettison their locally developed solutions and comply readily? Without universal buy-in, these projects will surely founder, leaving us with another public sector IT debacle to bemoan.

This brings us to the national IT programme. If the government cannot mandate shared financial systems across the health sector, how will it be able to mandate other new electronic systems universally?

If the national IT programme is to secure buy-in across the board, it is crucial that IT professionals and key stakeholder groups at the local level are consulted. But buy-in will never materialise if people think there is one rule for them and another for foundation trusts.

Are foundation hospitals to be given free rein to adopt or reject national IT systems as they see fit? If so, we can kiss goodbye to NHS IT tsar Richard Granger's vision for centrally driven and procured national appointment booking systems, electronic patient records, IT infrastructure and electronic prescribing.

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