Milburn stresses importance of IT to the future of the NHS

NHS: Will the Microsoft deal and extra funds for IT mark a step-change in attitudes? Lindsay Clark reports

NHS: Will the Microsoft deal and extra funds for IT mark a step-change in attitudes? Lindsay Clark reports

Last week health secretary Alan Milburn said IT is essential to modernising the NHS so that it can provide a better service to the public.

In front of a select group of NHS chief executives he announced £85m in new funding for the service and set out a strategy which, he said, would promote the importance of IT in the health service.

Following a presentation by Microsoft's chief software architect Bill Gates, Milburn said, "We just have not done enough in IT and we need to do more. We have to begin to talk about patient choice and self-service. None of that would be possible without IT. Investment in IT is no longer an optional extra - it has got to be part of a modern service."

For NHS IT managers, Milburn's announcement promises a change in culture towards computer departments in the NHS. For a start, he has ring-fenced the extra cash to prevent IT project money being raided by trust chief executives to pay for more politically pressing waiting list targets. "On reflection, I should have earmarked the money last year," he said, adding that future NHS IT investment would also be protected in this way.

Nigel Crisp, chief executive of the NHS, also indicated that IT managers would get a better reception from senior NHS managers when lobbying for the needs of IT. The new strategic health authorities will be responsible for promoting co-ordinated IT projects across GPs' surgeries, acute hospitals and community trusts to ensure that patient information is accessible to all health professionals.

Crisp's vision is one in which health professionals from different NHS organisations are able to work together more closely. "We cannot run a network of NHS people unless we have the IT to support it," he said.

But one of these groups, the medical profession, gave the latest NHS IT push a mixed response.

Grant Kelly, chairman of the British Medical Association's (BMA) IT committee, said, "The new money is good and it is important that it is ring-fenced, but you have to remember that there are more than 1,000 acute trusts, each with about 30 support teams, so £85m is not a vast amount of money."

Last week Computer Weekly predicted that Milburn would announce more NHS IT money. Insiders had suggested that the figure would be closer to £200m. The shortfall could be explained by the health secretary's enthusiasm for public private partnerships (PPPs) in health service IT projects.

Milburn said the Department of Health (DoH) was already talking to a number of large outsourcing and technology suppliers and that PPP could provide a means of achieving the ambition of lifelong electronic health records for UK citizens.

Although Kelly applauded PPP as a means of raising capital for investment in the health service, he was more sceptical about its practicalities.

"The reality is that unless you completely tie down the contract, the supplier has every chance to fudge its targets and the project falls behind," he said. "The NHS takes on more of the risk but the supplier ends up being paid more. When the NHS has a mature approach to contract procurement PPP would be good, but that is some way off."

Throughout last week's event there seemed to be evidence of a genuine change in attitude towards IT. The chief executives were effectively told by their superiors that the political centre of the service must take IT more seriously.

Crisp said that IT had not been given a high enough priority and the DoH was determined to change that.

"NHS information systems are simply not able to support our staff. This is a real leadership role for us," he said.

Richard Gibbs, chief executive of Kingston & Richmond Health Authority, also encouraged his peers to take IT more seriously, but in doing so also gave way to some of the dated stereotypes that remain about IT professionals. "You must get involved, you cannot leave it to the anoraks," he said.

Only if these attitudes change will IT find a voice in the NHS that is not lost in the constant battle between the money men and the medics.

Milburn's plans for NHS IT

The new strategic health authorities will play an important role in championing IT across all NHS organisations.

"Mainstreaming" IT
Only effective IT support can enable change in clinical practice. The implementation of the NHS plan will depend on improving IT.

Sustained investment
An extra £85m ring-fenced funding on top of the £800m already being invested up to 2005. Future investment in IT will also be earmarked to prevent it being diverted into clinical practice.

Access to new technology
There is a growing aptitude for IT among health professionals and this must be matched by improved access to technology. The health secretary announced a target of providing all hospital consultants with PCs on their desks by September next year.

Making better use of massive NHS purchasing power
Following the £50m deal for NHS-wide subscription licences for Microsoft software, Milburn wants to see improvements in the way the NHS uses its considerable purchasing muscle. It is Microsoft's fifth largest customer worldwide. The Department of Health (DoH) is also negotiating NHS-wide deals with Novell and Lotus.

More innovative use of public private partnership deals
The NHS needs "industrial strength" PPP deals to achieve ambitious plans for national electronic health records.The DoH is already in discussions with Microsoft, Cisco, BT and Lockheed Martin for a project in the Midlands, dubbed "Lightbulb".

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