It has not been a great few days for NHS IT's political profile. On Sunday, days before his pre-budget report, chancellor Alistair Darling said "isn't essential to the frontline"; but the net damage, following a announcement by health minister Andy Burnham to Parliament on Monday, appears to be very little.
Darling, under pressure from Andrew Marr on his BBC1 show to offer an example of a spending cut, said: "For example, the NHS had a quite expensive IT system that, frankly, isn't essential to the frontline. It's something that I don't think we need to go ahead with just now."
It appears the chancellor, who is trying to cut public sector debt and nurture a very fragile recovery, "misspoke," according to an anonymous Department of Health official quoted by The Financial Times.
On Monday afternoon, health secretary of state Andy Burnham made a detailed statement to the House of Commons – the usual approach taken when a mistake needs to be corrected urgently. He made it abundantly clear that the National Programme for IT was not being cancelled – rather difficult, given significant elements are already live and paid for – but that £600m will be cut from its lifetime costs.
"We will now pare back the programme to the core elements that have been identified as critical by clinicians," Burnham said. "Specifically, that could include the IT systems that clinicians have told us are most important to them, such as electronic prescribing; enabling local innovation to take place by linking national systems with those provided by local service providers; and allowing the NHS to design IT systems to fit its local needs."
Explaining how this will work, a Department of Health spokesperson said: "By reducing internal activities such as back office services and payments to suppliers, through looking to reduce the scope of what they are delivering, we'll be discussing and agreeing with the NHS our delivery priorities and areas for reduction in future scope."
This may include reducing the range of functions provided within trust-wide systems such as those provided by Cerner and iSoft, and making greater use of software functionality already within the NHS, such as GP systems. "GPs are happy with them and they are internationally recognised," Burnham told Parliament. "Recognising that, we have agreed that we will not now go ahead with the replacement of further enhancements to that system, because people are happy with it."
In the swim
Negotiations between the Department of Health and suppliers are already under way. In an interview with SmartHealthcare.com, the chief executive of iSoft Gary Cohen confirms that his firm is involved in discussions, and welcomes the adjustments to the programme, which he thinks may mean trusts get improved IT in a shorter time.
But he does not sound impressed by the last few days, which have led the Australian firm to issue an audio recording of Cohen's views on NPfIT to the firm's investors. "It's good to see that the government has clarified the statement that was made by the chancellor over the weekend, and brought some clarity to what was blown up out of all proportion," he says.
"You can talk about closing the programme in a theoretical sense," says Cohen, adding: "It's like swimming across the English Channel, getting two thirds of the way across and changing your mind. It doesn't help you – the alternative is far worse."
If the government has not covered itself in glory over the past few days, neither has the opposition. Alistair Darling's talk of a "system" was reminiscent of David Cameron's talk of an "NHS supercomputer" early last year – since replaced by more informed comments from the Conservative leader about the potential for personal health records, and detailed engagement by shadow health minister Stephen O'Brien.
Andrew Lansley, the Conservative shadow health secretary, chose in interviews with the the media and in Parliament to go for the knockabout option. "The secretary of state is clearly not in charge. The government got it wrong and the Treasury is now belatedly putting a stop to the continuing disaster," he told Burnham, allowing the health minister to point out the backing the programme had received earlier in the day from the British Medical Association.
Victor Almeida, Kable's senior health analyst, is cynical that the cuts will make much difference, given the way the programme has been developing towards local control and the murkiness of its finances. "The impact of this 'cut' is doubtful," he says. "It will not be difficult to reshuffle a 'meagre' £600m in this myriad of 10-digit figures, creative maths, highly secretive negotiations and government spin."
What does seem clear that the changes that have been underway in the National Programme for some time, including greater local control, are continuing, with evolution rather than revolution as the continuing watchword. Sometimes, it seems, politicians just misspeak.
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