NHS IT juggernaut rumbles on
Coalition's conservative cuts
Analysis The major casualty of an overhaul of NHS IT has been revealed. The National Programme for IT (NPfIT) is no more - up to a point.
The death of an unwieldy acronym is hard to mourn, but otherwise the coalition's changes to the scheme are marginal. Indeed, if anyone is to suffer as a result of the decision to trim £700m from the scheme, it's unlikely to be BT or CSC, the last contractors standing.
Christine Connelly, the Department of Health's director general of informatics since 2007, insisted yesterday their multibillion pound contracts will be honoured by taxpayers.
"The best way to deliver value is to honour the contracts," she said.
That means despite the localist rhetoric that accompanied minister Simon Burns' announcement yesterday that NHS trusts would proceed "in a way that best fits their own circumstances", a guaranteed, undisclosed number will be compelled to buy services the two firms. In CSC regions that means more deployments of iSoft's troubled Lorenzo patient records software.
Elsewhere "a more locally-led plural system of procurement should operate", Connelly said.
The detailed sources of the new £700m saving are currently unclear. Some £200m will be taken from CSC's £3bn total deal, Connelly said, but negotiations to determine how are ongoing. One likely cut is a national procurement of software for running GP surgeries, she suggested.
The remaining £500m will come from unspecified cuts to the budget for local services. Given the BT and CSC local contracts will remain largely unchanged, that means those trusts which are not forced to buy from them will have to find cheaper solutions by that "plural system of procurement".
The announcement yesterday contrasts with Tory calls for a radical overhaul, or even scrapping, of the NPfIT before the election. Instead, the coalition plans tweaks that will save less than six per cent of budget, weeks before the Comprehensive Spending Review is expected to herald cuts of 30 per cent across the rest of the public sector.
So far the Department of Health has spent more than £5bn on the NPfIT and is still intends to spend at least that again. "The money that has been spent so far I believe has been value for money," Connelly said.
In fact the changes announced yesterday are mostly bureaucratic, and conservative with a small "c". Connelly explained that two complete areas of work - infrastructure such as the Spine, and successful network applications such as the digital imaging system - will no longer be considered "projects" but be moved out of the NPfIT and run by the NHS as IT services.
No doubt it's a significant change for those working on them, but to taxpayers it means nothing.
Indeed, Connecting for Health, the 1,200-strong central quango created to deliver the world's largest civilian IT project, will remain unchanged, for now at least. "Our intention is to dismantle the central bureaucracy," Connelly said, unable to provide specifics.
This week's announcement also has no impact on Summary Care Records, the most controversial aspect of the entire scheme. A separate review of the related questions of what they should contain and how public consent for them to be shared should be obtained is ongoing. ®
NHS needs a systematic overhaul first
Unfortunately NHS working methods are embedded in 1940's - 1950's UK.
Static populations, preferences given to service providers and contracted partners, ... with little consideration of the great unwashed (a term belonging to the time).
Yet in 21st C UK populations are more dynamic with greater movement and the NHS is still embedded in historical working practices. Any NHS IT procurement will have to uphold those old and out of date practices hence should be delayed until a 21st C NHS takes form.
If the NHS cannot adapt then there is no point in NHS IT procurement going forward with an alternative NHS going forward as a matter of priority. Some things an alternative NHS should/would need to work with (maybe VNHS 21C? = Virgin National Health Service 21st Century?)
+ fee earners forming the operating structure rather than end users
+ income imbalance of fee earners over other staff (say nurses) (Rumour has it that UK doctors earn twice or more than equivalent European nations doctors and nursing staff earn half as much as European equivalents)
+ why be tied to one GP practice (OK in the 1940's - 1950's, not ok in 2010's)
+ why permit administrative boundaries to become effective barriers on continued care? (after all, it is a nationally resourced health service reasonably following a distribution administration model but that admin model has somehow perversely perverted into executive management)
+ I could go on but can't really be bothered...
Conclude: no further non-end user spend in NHS should be authorised until NHS working practices are brought up to date and cater for modern needs OR an alternative national provider is identified with far superior working practices)
regarding---Christine Connelly, the Department of Health's director general of informatics since 2007, insisted yesterday their multibillion pound contracts will be honoured by taxpayers.
is there no such thing as controlling One's costs?
Or will halifax shareholders take care of my mortgage for me?
I was laid off 3 months ago due to the recession by barclays bank
Look into the history a bit more
People who are ignorant of the NHS IT history are unaware of what already existed. Much of the national programme is about renewing the old slow and snail mail based systems. Data being sent via snail mail instead of the N3 network which is a private Internet system for the NHS.
Also, some of the systems were re-written due to some service suppliers demanding too much money when changes were required. So existing systems were re-written.
How can you measure improvements without gathering information?