Department of Health threatens hospitals bypassing NPfIT

The National Programme for IT in the NHS was launched with the best of intentions - to use technology to help doctors, nurses and other health professionals...

The National Programme for IT in the NHS was launched with the best of intentions - to use technology to help doctors, nurses and other health professionals make better decisions in the interests of patients.

The NPfIT is also aimed at helping patients make better decisions in their own interests.

But good intentions have taken some hospitals on the road to hell.

Conservative MP David Davis - the former shadow secretary - says that there are too few in government who understand IT enough to realise that it doesn't have magical properties.

This could explain why, when New Labour launched the NPfIT in 2002 ministers and their enthusiastic advisers - particularly potential suppliers - delighted in the potential rewards and consigned the risks to a list on an A4 page in documents about policy, objectives and methodologies.

It is the materialising risks which now dominate the programme. Patients at hospitals have had their care and treatment disrupted, cancelled or deferred as a result of installations of the NPfIT Care Records Service at hospitals such as Nuffield Orthopaedic Centre, Barnet and Chase Farm, Weston, Barts and the Royal Free.

Now another risk is coming to the fore - that of trusts buying their hospital systems outside of the NPfIT. This raises questions about the point of a national programme for IT.

The Department of Health has given suppliers billions of pounds worth of contracts, largely to install systems at trusts. But if trusts do not buy their main systems from the NPfIT suppliers is there much point in colossal national contracts?

This is a political problem: if the national programme was badly cracked at the outset, and there is every sign of this, that is a matter for politicians.

It is more than a political problem, however: health officials are now threatening to penalise some hospital boards, particularly semi-autonomous foundation trusts, if they buy outside the NPfIT.

This could have a bizarre effect: trusts paying millions of pounds in penalties so they can forfeit the right to have "free" systems under the NPfIT.

The NPfIT contracts have guarantees to the programme's local service providers CSC and BT. The idea is that these companies use their money to build systems which comply with Whitehall's output-based specifications in return the Department of Health guarantees to the suppliers a minimum amount of annual business. This guarantee puts the onus on trusts to buy their patient administration and central clinical systems from CSC or BT.

But when foundation trusts bypass CSC or BT, the Department of Health is left with a liability to the supplier for "non-deployment" compensation. Some health officials want to pass this liability to trusts which buy their main hospital IT outside the NPfIT.

This is why health officials have threatened Rotherham NHS Foundation Trust with charging its board for the Lorenzo system from CSC when trust has decided to go to open tender and install alternative technologies.

The threat was revealed by Brian James, chief executive of the Rotherham trust, in an interview with Computer Weekly.

If the threat were carried out, it would mean that Rotherham installed one hospital e-records system and paid for two. The supplier CSC would be paid in effect for not deploying Lorenzo at Rotherham and the taxpayer would pay for nothing which would benefit patients or the NHS.

We understand that threats of penalties for non-deployment have been made against various NHS trusts but have not been pressed home, as far as we know. It may happen. Last year John Yates, a lawyer with Beechcroft, said in an article that there was tension between the Department of Health and trusts over "non-deployment" charges for trusts opting out of the NPfIT.

He said: "This is becoming a bone of contention between trusts and the department.The department's legal right to penalise Trusts buying outside NPfIT is unclear, but anecdotal evidence suggests that the department is using its political and financial muscle to force trusts to follow NPfIT, and so perhaps Monitor [the regulator of foundation trusts] needs to look into this urgently."

The Labour government was dismissive of, and even oblivious to, the seriousness of the risks when it launched the massive NHS IT programme. From its outset the programme was defective in its one-size-fits-all approach. But the materialising serious risks should remain a problem for ministers and perhaps even for voters at the next general election. The programme's defects should not continue to haunt NHS trusts - or taxpayers.

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