Following sustained criticism of the National Programme for IT, the government is absorbing NHS computing into the state sector mainstream
Amid the embarrassment and recrimination following the latest damning report into the English NHS's National Programme for IT (NPfIT), one outcome is certain. No longer will the NHS be able to set its own IT policy, distinct from the rest of the public sector.
Even before Parliament's public accounts committee (PAC) reported on the dismal progress of care records systems in secondary care, the Cabinet Office had already taken the NHS under its wing. Katie Davis, an executive of the Cabinet Office efficiency and reform group, was parachuted in to take over from informatics director general Christine Connelly, who announced her resignation from her £205,000 post in June.
The Cabinet Office had also announced that the national programme was being scrutinised by its Major Projects Authority following the National Audit Office's scathing report into care records in May. This review has now been completed.
Hands-on direction from central government's IT team is a humiliating novelty for the programme. It was set up in 2002 with its own prime ministerial mandate and was able to proceed independently of the rest of the public sector in such matters as wide-area networks, patient ID numbers – and IT service contracts. It was even permitted to steam past critical Gateway reviews, introduced by the Office of Government Commerce in response to previous public sector IT failings.
Under the new management there will be no such latitude. The NHS in England will have to comply with policies set by the efficiency and reform group as well as the overall Government IT strategy, published in March. Its measures include a presumption against projects costing more than £100m, mandatory use of open standards and sharing existing systems rather than procuring anew. There will also be no NHS exemption from the government-wide strategy of making public services "digital by default".
Mike Farrar, chief executive of the NHS Confederation, said the report "presents the opportunity for a much-needed review of NPfIT and the how the NHS can best spend tighter finances on a workable solution."
The new NHS information and IT strategies, due to appear in the autumn, will have to tackle more immediate problems. Top of the list is what to do with the outstanding local service provider contracts criticised by the PAC's report.
The £4.3bn question
The parliamentarians found that the department and the NHS expect to spend a further £4.3bn on care records systems by 2015-16, when the current contracts expire. This assumes that deals with contractor CSC can be negotiated down by £500m. Despite the NHS's claim that it would cost more to terminate the CSC deal than to continue, the likelihood of outright cancellation is now growing.
Another prime candidate for the chop is the NHS in England's central IT infrastructure, especially the agency NHS Connecting for Health. The PAC reported that this body had 1,300 staff and has spent £820m on central programme management – yet was still unable to provide "basic management information".
However politically attractive, simply shutting down Connecting for Health would create further problems. Whether or not the NPfIT contracts remain in place, some central coordination will be needed to ensure that the NHS can share information across what the PAC called "a patchwork system".
NHS chief executive David Nicholson warned the PAC that a new interim body would be needed to manage the transition from central to locally managed care records contracts.
In the longer term, there is the need for an organisation to set interoperability standards. The NHS Information Revolution strategy, published for consultation last October, proposed that the job of setting and maintaining national information standards be given to the NHS Commissioning Board.
However in the post-NPfIT regime, central government will be looking hard for ways to shift elements of NHS IT into the "common ICT infrastructure" envisaged for the whole public sector. This envisages the use of a "government cloud", running from shared data centres, delivering computing power and software online wherever it is needed. Enthusiasts say that the common infrastructure, shared with Whitehall agencies, police and local government, will not only be cheaper but also allow organisations and small companies to develop innovative solutions to local problems.
Yet efforts to force the NHS down this route are fraught with problems. The NHS's distinctive IT infrastructure, with its own networks, standards and code of connection, grew up largely in response to concerns about the need for special measures to safeguard health data. Any move to the cloud, especially one shared by private providers, will be controversial. Abandoning the now discredited NPfIT may mark only the beginning of the NHS in England's ICT worries.
This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.
Read the complete post at http://www.guardian.co.uk/healthcare-network/2011/aug/09/nhs-losing-control-it-destiny
Aug 09 2011, 04:00 AM
Healthcare Network | guardian.co.uk