Many questions remain for NHS IT programme

The government's decision to reorganise - and hence effectively scrap - the National Health Service's controversial £12.7bn National Programme for IT and save £1.3bn may come as a relief to many taxpayers, patients, health professionals and academics, but many people remain wary.

The government's decision to reorganise - and hence effectively scrap - the National Health Service's controversial £12.7bn National Programme for IT (NPfIT) and save £1.3bn may come as a relief to many taxpayers, patients, health professionals and academics, but many people remain wary.

On the face of it, little has changed. The new government thinks IT is important to healthcare. It thinks it has received value for the £5.8bn spent so far. The main contracts with BT and CSC remain in place, even though the government is trying to claw back £500m from CSC. A new management system is being developed. Local NHS trusts have now been given more autonomy over IT decisions rather than being forced to source from the two main suppliers, but they are likely to have little extra money to meet interoperability standards.

Until now the world's biggest public sector IT project has not been a towering success. Following its inception at a 10 minute sofa meeting in Downing Street, doctors complained they had not been consulted, academics slated the centralised medical record system as a potential threat to patient privacy, suppliers were so screwed down that two, Accenture and Fujitsu, walked away, and NHS trusts found their budgets being sucked away, such was the gravitational force of NPfIT.

The original sales pitch was that joined-up healthcare, thanks to networks and shared electronic patient records, would see patient waiting times shrink, supplier costs drop, the NHS become a model of bureaucratic efficiency, and the overall health of the nation would improve.

The plan was for NPfIT to connect more than 30,000 GPs in England to almost 300 hospitals. Patients and healthcare workers would have access, on a secure, need-to-know basis, to their personal health and care information stored as an electronic record. There would be a centralised summary care record that would be used in medical emergencies.

Operational systems

Some parts of NPfIT are now mature enough to become operational NHS IT systems, says Christine Connelly, director general for informatics at the Department of Health . These include infrastructure items such the BT-supplied Spine, a secure national database that drives key applications, and the N3 private broadband network.

Among the applications deemed mature are the Choose and Book appointment reservation system, the Electronic Prescription Service and PACS, the picture archiving and communications system that enables radiology images such as x-rays and scans to be stored, displayed and transmitted electronically.

Connelly says future development will concentrate on delivering electronic patient record systems to hospitals. These will be delivered by CSC, which she says is already late delivering v1.9 of its Lorenzo system, and BT, which says it is already rolling out its Cerner and Rio systems for acute trusts and psychiatric hospitals respectively in the south of England.

Splitting the mature parts means local healthcare trusts have more freedom of choice in their procurement plans for other parts of NPfIT, Connelly says. However, she says the government remains committed to buying a number of patient record systems from CSC and BT.

Dr Chaand Nagpaul of the British Medical Association's (BMA) GPs committee welcomes the move. He says giving NHS organisations more choice of IT systems makes sense, but he warns a more localised approach could raise problems.

"The provision and experience of IT for clinicians on the ground is likely to vary according to the level of support and resources available locally," he says. Nagpaul also says it is important not to lose successful national IT initiatives or to stifle innovation.

He wants central accountability to ensure consistent and equitable delivery, to manage local implementation, avoid duplication and support local decision making. A nationally accredited list of systems would be helpful, he says.

Commenting earlier on plans to cut back NPfIT, Dr Grant Ingrams, chairman of the BMA's GP IT committee, said it was "characterised by poor value for money in its early stages", but cutting back spending was not as simple as it seemed, given that contracts were in force.

"Good IT is central to efficient, effective, safe patient care," he said, adding that many of the errors in the NHS could be prevented through improved information systems.

Summary care record

Connelly says the government will persist with the controversial centralised summary patient care record (SCR). Groups representing clinicians and patients are discussing what details the SCR should contain and will report at the end of September, Connelly says.

Cambridge academic and SCR critic Ross Anderson remains sceptical, especially of the SCR. "Both the Conservatives and the Lib Dems announced in opposition that they were going to abolish the summary care record. It is still there. So is the unnecessary national childhood obesity database. If I see these two systems being shot, I will believe that [health secretary] Andrew Lansley and [health minister] Simon Burns have got a grip. If they survive, I will assume that this is just a rebranding exercise," he says.

Matthew Swindells, chair of BCS Health, says patients need a say in what personal information is available from the SCR. This is because they are best placed to judge the risks and rewards of having it online.

Welcoming the more flexible approach to the national programme, Swindells urges the Department of Health to set the standards for interoperable IT systems in a devolved NHS.

The Department of Health and the new commissioning board should use their purchasing muscle to get suppliers to deliver systems that let patients take control of their own health. "With this, the NHS can be free to make the right local decisions and the industry will be clear about what is required from them," he says.

Questions

Ovum analyst Cornelia Wels Maug says the change raises more questions than it answers. Worried that the new approach may lead to more delay, she asks who will lead the process, ensure the interoperability of systems, and manage deadlines.

Referring to a government ban on IT projects in excess of £1m, she asks if this will also apply to the healthcare sector.

Maug believes the new approach will result in less business for the larger suppliers, but it will open the market to smaller vendors, which have previously been excluded.

Software AG's senior vice-president Jim Close describes the move as an "epiphanic breakthrough" in the government's approach to IT investments. "It is refreshing when a government minister says it is better to connect systems together than rip out the old and replace them all," he says.

"That this modern approach to IT procurement is being adopted so quickly shows a decisiveness that augurs well for the current efficiency review. I trust that the NPfIT rethink is the first of many such moments for this government."

NPfIT largely remains an ambitious IT project. The main operational components are likely to be delivered, even if they are late. Attention should now shift to maximising the utility and value of the information they will deliver.

The government needs to convince the public that its data is secure, that its privacy is assured, that the benefits will outweigh the costs, and that good will result. That remains a tall order.


Podcasts

• In this podcast Christine Connelly, chief information officer for health explains why the management and organisation of the NHS National Programme for IT is being revamped. Download now >>

• Christine Connelly, chief information officer for health, responds to questions about what has actually changed, the future of Connecting for Health and value for money on the £5bn spent so far. Download now >>

• Christine Connelly, chief information officer for health, explains how much freedom NHS trusts will have to buy what they want, in terms of IT, and the future of the Summary Care Records system. Download now >>

• In this podcast, Christine Connelly, chief information officer for health, is quizzed on what the NHS will have to pay BT and CSC. Download now >>

• Christine Connelly, chief information officer for health, explains how the revised IT plan for the NHS will affect existing IT suppliers. Download now >>

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