A decentralised future for NHS IT

2010 should see power moved from the National Programme for IT to trusts

Stephen O'Brien MP, Conservative shadow health minister
Smart Healthcare, Wednesday 20 January 2010 09.00 GMT

Given that the National Programme for IT is the largest civilian IT project in the world, it is remarkable how much the government have been able to get away with in 2009.

The programme's spending has crept up to £6.2bn despite the fact only six hospitals have deployed early versions of Lorenzo and Millennium to date – that's £1bn per NHS trust. London hospitals in particular continue to struggle under the burden of their £4m implementation bills which are not covered by the programme's central budget.

Health informatics does not naturally grab the headlines – and nor should it. The job of a robust health IT programme is to support and not usurp the work of frontline doctors and nurses seeking to provide better care to their patients.

But sadly, the National Programme for IT has been out of the headlines for the wrong reasons this year: little progress has been made in deploying electronic patient records in every UK hospital, as was intended by Tony Blair when he came up with the programme back in 2002. The programme continues to be plagued by delays and the burden of an ever-widening scope and the contractual wrangling of the main IT system suppliers.

But what is in store for 2010? It goes without saying that the election could make all the difference for the National Programme for IT. Either Labour continues to push the programme's problems under the rug for the sake of avoiding political embarrassment, or the Conservative Party earns the chance to implement its vision of locally deployed IT that fosters innovation, choice and competition in line with open interoperability standards.

There is of course one barrier that stands in the way regardless of the result of the election: the central NPfIT contracts with CSC and BT, which have for years gone unpublished and unscrutinised. Nobody outside of the government and their two suppliers has any idea what the scope for re-negotiation will be.

The ASCC framework and the interoperability toolkit have gone some way towards sidestepping the central contracts and localising the NPfIT via the backdoor, but until the government returns to the negotiating table to secure a more competitive and innovative deal for taxpayers, true local choice will never become low-hanging fruit.

I believe that voters have a right to know how the government is spending taxpayers' money on the programme. They have a right to both a full outline of the local costs of the programme and a right to know how the suppliers are being remunerated.

The fact that the government have been so evasive about what – at £12.7bn – must be one of their largest and most cumbersome contracts, is nothing short of a travesty.

My hope for 2010 is that the government will either see sense and opt for a more transparent and upfront approach to NHS IT – one which minimises wasteful top-down bureaucracy – or that, having gained a mandate to govern at the polling booth, the Conservatives successfully negotiate more choice for local NHS trusts over their IT systems and improve health and social care outcomes for patients.