Will patients suffer to pay for new NHS IT?

If £2.3bn is not enough for new IT, will money intended for doctors and medical equipment be diverted into the coffers of...

If £2.3bn is not enough for new IT, will money intended for doctors and medical equipment be diverted into the coffers of computer suppliers? Tony Collins reports.

When government officials announced details of a national programme for IT in the NHS earlier this year, they said it would be centrally funded over three years with £2.3bn of new money.

In March 2003, for example, the Department of Health said, “The [£2.3bn] budget is to meet deliverables of the document, Delivering 21st Century IT, into the NHS.”

That document referred, among other targets, to four national projects: electronic patient records, called the Integrated Care Records Service (ICRS); e-booking appointments with GPs and hospital doctors; e-prescriptions; and a new IT infrastructure. 

Only last month, Nigel Crisp, chief executive of the Department of Health, emphasised the role of central funding. In a letter to NHS trusts, he said the national programme would have “no impact on the immediate financial position” of NHS organisations.

But Computer Weekly has obtained formal letters to chief executives of trusts in London which show that £2.3bn will not be enough to implement the national programme. The letters, and accompanying documents, are from two senior health officials: David Kwo, chief information officer for London, and Duncan Selbie, chairman of the ICT Board for London.

The questions-and-answers briefing documents that accompanied the letters from Kwo and Selbie said that only some of the cost of the national programme will be met from the £2.3bn central fund. Much of the balance will need to come from trusts, although IT executives in hospitals and GP organisations say they are already struggling to cope with shortfalls in their budgets.

Kwo and Selbie’s letters ask chief executives of NHS trusts to give a written commitment to the programme, and particularly to phase one of ICRS, which will provide a national data spine containing some details of  patients’ medical records. Phases two and three will yield the main benefits for patients and trusts, according to the Department of Health’s business case.

But the briefing papers seen by Computer Weekly stated that phases two and three of ICRS “will require a mix of local and national funding for their delivery”.

“The precise details of these stages, together with supporting planning and approvals processes are still being determined,” the papers said. This means chief executives of trusts are being asked to commit in principle to supporting the national programme without knowing how much it will cost to participate.

There are also uncertainties about whether clinicians will want to use systems that have been imposed centrally; and any lack of commitment on their part may be exacerbated by an admission in the questions-and-answers document that phase one of ICRS will contain only “limited” features.

Shortages in funding for the national programme were hinted at in July in the carefully chosen words of John Pattison, director of research at the Department of Health (to whom the director general of IT, Richard Granger, reports).

“Whether £2.3bn will be adequate [for the national programme] for the next three years is still an interesting question,” he told an e-healthcare conference.

NHS IT executives believe that that a few trusts with large allocations from the NHS will receive sufficient funds to play a strong role in the national programme for IT, at least in the implementation of phase one of ICRS.

But they said that many others are so short of funds that their trusts may not be able to afford to finance phases two and three
unless IT or clinical jobs are cut, or spending on equipment or the doctors’ and nurses’ salaries is reduced.

“We have no access to further funds unless we take money from hospital revenues,” said a senior NHS IT executive. 

The national programme for IT expects trusts to make savings through relationships with local service providers. But trust IT executives said contracts with them could prove far more expensive because national systems, when fully implemented, will have a far higher specification than equipment that exists locally.

Even so, with the national programme enjoying the personal support of prime minister Tony Blair, NHS trust chief executives are, despite their questions, likely to face intense pressure to sign up to the programme.

Few if any IT executives in trusts and supplier organisations reject the aims of the national programme. But many see it
as noble idea soured by being over ambitious, over-centralised, rushed and poorly thought through. Others said the risks,
uncertainties and funding shortages must be overcome because the government may never again find an extra £2.3bn to spend on NHS IT.

Where will the money come from?

Computer Weekly asked the national programme for NHS IT whether it would be risky to proceed with phase one of the programme without authority from trusts or guaranteed funds from the NHS or the government for further phases.

It replied, “There is no such risk. The national programme for IT will provide a national patient record spine; electronic booking; electronic transmission of prescriptions; and supporting infrastructure. These initially will be funded from the £2.3bn of additional funds being invested in NHS IT. Local health communities can add further products, services or systems to complement the core functions in accordance with their local needs and priorities and over time by redeploying their existing spend on IT.”

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