- Smart Healthcare, Wednesday 2 September 2009 09.00 BST
Home with a view: national IT procurement can provide economies of scale to small health boards such as Orkney, site of the Neolithic Skara Brae village. Photo: jiunlimited.com
It's a perennial political dilemma: local or national? In the post-war era national policies reigned supreme; from the late 1970s Thatcherism emphasised the local and, of course, the virtues of greater choice.
In the early 21st century the dilemma remains in flux, not least in terms of health service IT. In England, the NHS is moving from a centralised national system under the National Programme for IT towards more local control; in Scotland, the direction of travel since 2007 has been in the opposite direction.
Within the last few months, for example, National Services Scotland (NSS, also known as the Common Services Agency) has awarded Lumension a lucrative contract to protect patient data against loss and theft, while Sun Microsystems was awarded a £9.5m deal to provide an identity and access management service throughout NHS Scotland.
Recent reports also suggest that NSS is close to making a decision on the contract for a national patient management system. NSS basically acts as the middleman, procuring IT on behalf of Scotland's 14 health boards and eight special health boards, although only when the required contract needs to operate on a pan-Scottish basis.
Andy Robertson, director of the National Information Systems Group, part of NSS, says that Scotland's health boards are "incentivised" to collaborate on contracts rather than being compelled to from the centre. The benefit for health boards is mainly financial: if a consortium has a consumer base of more than half of the Scottish population, then the Scottish Government will help in terms of funding.
"They're not forced to do that," says Robertson, "but incentivised to do so. There are financial benefits in (health boards) getting together through consortiums to consolidate their financial power. The patient management system, for example, qualified as a national system because it covered more than 50% the population.
"Another example is our plan to replace GP IT systems: a framework will be put in place and again there's a consortium of boards. NSS will help manage the procurement, core contracts and the legal side of things on behalf of boards because it's a large purchase. It's encouraging people to go down a path of consolidation without forcing them to; if they can all agree on one solution then it should reduce costs, as well as build an enterprising architecture which all hangs together."
Bringing the nation together
Dr Alan McDevitt, a general practitioner in Glasgow and chairman of the British Medical Association's National GP Committee in Scotland, has been following the procurement of the new GP IT system with interest. "Because so much of the NHS is now joined up, maintaining several different IT systems in each health board area meant that the national system started to break down," he says.
"But the market has shrunk quite a bit over the past few years and there are only two or three contractors who could realistically handle a national GP IT system. That said, I think the most likely outcome is that GPs within health board areas will end up choosing from two, or maybe three, different systems instead of the five or six, including GPASS, we have at the moment."
But this national approach – or rather national consolidation – does not apply in every case. Different health boards are in different positions, ranging from relatively small boards like those in Orkney and Shetland, to huge authorities such as the Greater Glasgow and Clyde Health Board, which covers 25% of Scotland's population.
"Relatively small purchases for board-specific purchases are still handled by individual health boards," says NSS's Robertson. "In those cases the same economies of scale associated with national contracts simply do not apply; there aren't the same benefits. Smaller purchases would usually be for laboratory systems, more niche systems where one board is ahead of the others.
"But certainly for things like GP IT, identification, patient management etc – for the core components in our national architecture – the emphasis is on Scotland-wide contracts. Almost by definition on those things health boards will collaborate, but for smaller scale and more niche systems those would be handled locally. Our strategy is to look for a middle ground."
There is, of course, another "national" dimension when it comes to NHS IT systems: the United Kingdom. On certain contracts the NHS in Scotland collaborates with its English and Welsh counterparts. But rather than becoming completely "national" or "local", Scotland is pursuing a pragmatic compromise, or what New Labour once dubbed "the middle way".
