Hospitals and GP organisation will have to pay for delivery of substantial parts of the Department of Health’s national programme for IT, despite the government’s earlier announcement that it would be funded by £2.3bn of extra money from the Treasury.
Computer Weekly has obtained letters sent by health officials in London to the capital’s chief executives of NHS trusts and GP organisations which call on them to commit to backing the national programme, although the level of their financial support is unspecified.
Accompanying documents from David Kwo, chief information officer for London, and Duncan Selbie, chairman of the London ICT board, disclosed the need for local funding.
Phases two and three of the Integrated Care Records Service (ICRS) for electronic patient records – a project at the heart of national programme – “are likely to require a mix of local and national funding for their delivery”, one document said. Some trusts may also have to fund parts of phase one ICRS implementation.
A commitment by chief executives is part of a formal “approval to proceed” process which will let the Treasury see that the programme has local support.
Once all NHS organisations in London make the formal commitment, contracts for new systems will be signed by Christmas,
said a questions-and-answers document which accompanied Kwo’s letter to chief executives.
Health officials have given trust board members little discretion. “Understanding and owning the national programme and its relevance at local level is not discretionary,” the questions-and-answers document said.
However, the standard letter that trust chief executives have been asked to sign does give their boards the right to reconsider once costs are known or if funding does not materialise.
Jean Roberts, lead for the BCS health committee policy group, said, “There is a very significant requirement for local funding, which will come as a great surprise to people.”
A separate document sent to NHS trusts and GP organisations, signed by Selbie, said that if trusts have any concerns about the programme these should be “about detail and not principle”.
Selbie’s letter said, “Sir Nigel Crisp [chief executive of the NHS] has made clear his expectation that the whole NHS, without exception, work within this national framework for ICT and commit to local implementation, albeit sensibly planned and phased over time.”
Trusts are universally supportive of the aims of the national programme, which will provide electronic patient records, electronic prescriptions, e-bookings and a new infrastructure. But there is concern across England about their contributions to the costs of implementation and whether their spending commitments will be open-ended.
Bill McCarthy, director of strategic development at West Yorkshire Strategic Health Authority, said in a briefing paper about the national programme published in July, “The greatest uncertainties at present are about affordability and the structure of financial flows.
“There is inevitably a risk involved in a project of this size and complexity being driven at unprecedented speed.”
A similar briefing paper for trusts in the Southern area listed among the challenges facing specialists “the pace of the national programme for IT”, funding and obtaining clinicians’ support.
In 1999, public spending watchdog the National Audit Office criticised the Department of Health for not setting out overall expected expenditure on its 1992 and 1998 IT strategies, saying that this made it difficult to monitor spending. However, the department said at that time that it did not believe there was any purpose in setting such plans.
Computer Weekly put a series of questions on the letters to the national programme but it did not respond.