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Policy decisions drafted in the luxury of opposition don't always become real measures when that party is in government. However this week's ministerial statement on the future of the NHS National Programme for IT in England seems to indicate that in office, the Conservatives are implementing the findings of the independent review of healthcare IT published by the Hayes committee last year (PDF link, news article from August 2009).
While health minister Simon Burns' announcement was widely trailed and assumed by some to announce the end of the programme, in reality it follows the Hayes committee's recommendations to maintain the general thrust of the programme while putting the squeeze on major contractors and granting more local control.
Burns' statement said that an (unpublished) DH review had concluded "a centralized national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured".
The new policy looks very much like the Hayes committee's recommendation to "halt or renegotiate" the local service provider contracts that were the hallmark of the programme set up by Richard Granger in 2003.
The statement also echoes the review's recommendations that centrally operated systems for handling electronic appointment booking and prescribing remain in place - along with, by implication, the ambition to computerise almost all patient records first set out in the Information for Health strategy in 1998. But this will be achieved by connecting existing systems rather than replacing them, the statement says.
Some organisations that were previously highly critical have now found some aspects to be worth defending. Doctors' representatives broadly supported the new policy. Dr Chaand Nagpaul of the BMA's GPs committee, said giving NHS organisations choices "makes sense". However he warned that devolving responsibility for IT could lead to problems. "There still needs to be some central accountability to ensure consistent and equitable delivery, manage local implementation, avoid wasteful duplication of effort, and support local decision-making. For example, a nationally accredited list of systems would be helpful."
The Royal College of Physicians also gave a qualified welcome. Professor Iain Carpenter, co-director of the RCP's Health Informatics Unit, described the decision as "a good idea in theory". He called for a renewed effort to improve the quality of patient records though IT.
"One of dirty secrets of the NHS is the regrettable state of medical record keeping," he said. "Earlier reports have been shown that this compromises patient safety and clinical care. If IT in the health service is going to regain the confidence of the medical profession then more emphasis has to be placed by the DH on making sure that the new systems accurately capture the dialogue between doctor and patient. Everything else flows from getting that right."
The NHS Confederation warned that the change could lead to NHS trusts being forced to divert local resources to systems that had previously been centrally funded. "It is important to remember that removing some elements from the national programme is likely to shift cost to local providers," said Frances Blunden, its senior policy manager. "Good information systems are essential to running a modern health service, they improve patient safety and reduce cost, it is vital that every effort continues to be made to get this issue right."
The main uncertainty raised by the announcement is where the expected £700m savings will come from. Officials said that around £500m would be saved from local costs and a further £200m from a 2003 contract with IT services firm Computer Sciences Corporation (CSC), which is responsible for implementing systems in the north, Midlands and east regions of England – although the latter has yet to be contractually agreed.
But the previous government had already shaved £300m from those contracts, roughly 10% of their overall value, and has indicated that it will challenge further cut-backs. The Department of Health will be anxious to avoid the legal wrangles that followed the departure of Fujitsu, its main IT contractor in southern England, from the programme in 2008. It is understood that the case has gone to arbitration.
More details on the future of NHS IT will emerge over the next few weeks, including on the specific future of summary care records. However, those who had been waiting for the death of the National Programme have been disappointed – instead, the new government appears to have been put it on a different, stricter diet.
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