- Smart Healthcare, Wednesday 6 January 2010 09.00 GMT
It's all cloudy: the future is far from clear for NPfIT. Photo: jiunlimited.com
Last year saw shockingly disparate reports on the National Programme for IT (NPfIT). Some declared that the programme had been slashed, after chancellor Alistair Darling's budget cut announcement in December. Others hailed 2009 as great year for the programme, as the Care Record Service (CRS) was finally rolled out in a few sites – after years of delay – and usage of the already-established Choose & Book and picture archiving and communication system (Pacs) continued to increase.
In reality, 2009 did not see any major changes to NPfIT. Several elements of the programme, such as Pacs, radiology information systems (Ris), the N3 broadband network, Choose & Book and the NHSmail email system, had been rolled out in the years before, while CRS progress was very modest.
But there is much suspense over what will happen next.
In April, the Department of Health's chief information officer Christine Donnelly stated that CRS suppliers should make "significant progress" by the end of November 2009 or she would seek "an alternative approach", but she failed to provide an outline of what this would be. It's now New Year, but there have been few indications of what will happen next.
The department published a new strategy paper entitled Informatics Planning 2010/11 last month, but it hardly elucidates the future of the CRS and the NPfIT.
The document does not even allude to the CRS. It just refers to the summary care record, a minor element of the project. It also hardly touches on the NPfIT, simply stating that "a new direction for has been agreed", but once again stopping short of the details.
Abhorrent acronyms
The DoH and the NHS have the habit of avoiding terms which have become associated with failure in the minds of health professionals. The NPfIT and the CRS – as well as other abhorrent acronyms such as NLOP (NPfIT local ownership programme), LSP (local service provider) and NASP (national application service providers) – fall neatly into this description. But this is not to say that the initiatives have been scrapped.
There are signs that the CRS landscape could become more competitive, with a number of new suppliers joining the initiative. The strategy document advocates "process redesign using existing technology" and does not refer to existing suppliers Cerner and iSoft. This presents a contrast to the previous NPfIT rip-and-replace approach, where organisations were encouraged to substitute their existing systems in favour of the two selected suppliers.
Connelly has already opened doors to trusts in the South, which were left without a supplier after Fujitsu left the programme in 2008. She has promised these trusts central funding as long as they buy from any of the various technology vendors in the Additional Supply Capability and Capacity (ASCC) framework before April.
It would make perfect sense to follow this strategy in other regions of England and expand the pool of CRS suppliers for the entire nation. I believe that Connelly will indeed do so before the general elections.
But I wouldn't hold my breath. Unpredictability is one of the few consistent features of the programme. The NPfIT has taken so many unexpected turns during its existence – the departure of two key suppliers, the creation of NLOP, the scaling down of information held on the Spine, and so on – that it is now hardly even a shadow of its former self.
Unfortunately, decisions within Whitehall departments including the Department of Health are normally short-sighted and short-lived. Landmark announcements are sometimes innocuous rhetoric, government spin and politicking. It's very difficult to read between the lines and distinguish between action and talk, especially in pre-election times.
Staff
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