Health chiefs work to limit risks as trusts worry about funding

Department denies trusts will have to cut jobs to pay for later stages of national programme.

Department denies trusts will have to cut jobs to pay for later stages of national programme.

Top officials in the Department of Health are seeking to mitigate a series of funding and other risks to the NHS' national programme for IT, only weeks before the scheduled signing of outsourcing contracts worth billions of pounds.

A leaked letter, dated this month, from health officials to strategic health authorities, trusts and chief information officers in London, said, "A number of risks to the programme have been identified, including revenue funding and recruitment.

"The Top Team, which includes senior NPfIT [national programme for IT] and Department of Health officials and all strategic health authority chief executives, is aware of these issues and is currently working towards resolving them."

The Department of Health has confirmed that it is undertaking a comprehensive analysis of the risks of the programme with a view to mitigating them.

The review, which was welcomed by NHS IT professionals, comes 18 months after the national programme was announced and only a few weeks before the department is due to sign contracts with five local service providers to install and run national systems across England.

Last year ministers announced that they would allocate an extra £2.3bn between 2003 and 2006 to fund the NPfIT, which comprises e-prescriptions, a new infrastructure, electronic patient records and online booking of hospital appointments. But it has become apparent that the £2.3bn will not cover all the local costs of introducing new standardised systems.

Tony Eardley, national chairman of the Association of ICT Professionals in Health and Social Care, said trusts would have to gradually increase their spend on IT from about 2% of the total budget to 4% or more to ensure successful implementation.

"It is unclear how trusts will find the money to increase their spend on information management and communications and how some of the existing IT spend can be freed up to help fund local implementations that are part of the national programme," he said.

Philip Firth, strategy implementation manager at Wrightington, Wigan & Leigh NHS Trust, made a similar point in a paper presented in June. He said that the £2.3bn would be needed to fund infrastructure and applications, such as a national data spine and the electronic booking of hospital appointments, at regional and national levels.

Firth warned that extra staff would be needed to take on new administrative tasks, such as maintaining registers of patient consent, and addressing clinical data quality. Local integrated care records service implementation projects will also need people with specialist IT skills, such as systems integration and XML.

"At a time when NHS budgets are stretched to the limit, and many trusts have huge budget deficits, it is not entirely clear where the funding needed to address these local issues will come from," he said.

Mark Ogden, director of finance at Greater Manchester Strategic Health Authority, commenting on the NPfIT, said the costs associated with supporting care professionals and others to fully exploit the opportunities of technology "may, in some instances, be as much as 70% of the overall costs of introducing new systems".

Paul Cundy, who chairs the IT subcommittee of the British Medical Association's GPs committee, said last week,"The national programme is not the great freebie that some people thought at first."

The Department of Health has a range of options to meet the local costs of the national programme that cannot be funded from the £2.3bn allocation. It could seek new money from the Treasury; it could claw back some of the £850m spent every year on existing IT systems in the NHS, although trusts say this could lead to a threat to jobs; or it could redirect money that would otherwise go to hospitals more directly for the care of patients.

A spokesman for the national programme said, "As with any large-scale public sector procurement, good practice and the specific checklist requirement for gateway reviews, we are undertaking and managing a comprehensive risk analysis of the programme. This is a perfectly normal process to ensure continual attention is given to the mitigation of overall and specific risk in order to deliver value for money."

He declined to say how much the national programme for IT is expected to cost in total, above the £2.3bn allocated over the next three years, describing the figures as commercially confidential.

No threat to jobs

A spokesman for the national programme for IT denied that trusts may have to make people fully redundant to fully  fund the local costs of implementing and running national systems. "Ongoing funding for core NPfIT projects and the connection of existing systems... to national applications will come from NPfIT central budgets," he said. "The balance will be used to fund local trust strategic health authority systems and services."

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