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Whoever forms our next government, the NHS IT 'baby must not be thrown out with the bathwater'. IT-enabled new ways of working are essential to help the NHS to meet ever-growing health demands whilst also achieving the NHS productivity and improved outcome goals.
I recently led a significant research project on NHS IT for the health and technology think tank, 2020health.org. This culminated in a report published in March, Fixing NHS IT – an action plan for a new government (link to report).
The aim of our work was to bring some dispassionate clarity to the future of the £12bn National Programme for IT (NPfIT). Both Conservative and Liberal Democrat politicians have talked about localising NHS IT and cancelling elements of NPfIT. In response, our report set out a detailed rescue plan for NPfIT, looking at what has worked, what needs stopping and what needs doing next.
Our analysis started from the view that a new government must work IT planning intrinsically into its policy, treating IT as an asset not a cost. Moreover, a national approach to IT should only be taken when one or more of three principles apply:
- to avoid redundant variation for infrastructure and back-office solutions on a once and once only basis;
- to provide economies of scale, associated with using NHS purchasing power;
- to provide essential central coordination or regulation, e.g. standards, security.
We expect a new government would wish to do an urgent stock-take of NHS IT projects, assets and organisation against these principles. Our report set out 30 detailed recommendations for action, all to be executed within the first 12 months of a new administration. Outside this, trusts should be free to set their own IT direction to meet local clinical priorities, provided nationally agreed standards are met.
Our key recommendations cover the following:
- those elements of NPfIT which are a valuable platform for the future should be developed (including N3, Pacs and the Electronic Prescription Service);
- a course of national action and investment is needed in areas where IT is currently underexploited, notably telemedicine and collaborative technology;
- the roll-out of the controversial Summary Care Records project should be halted and subjected to review;
- in combination with a consolidation and strengthening of IT provision at the local level, a radical reorientation and downsizing of the central IT organisation is needed, making it more transparent and accountable to the NHS.
Finally, we considered what action is needed with the care records service in acute hospitals where the failings are greatest. Here we set out a series of tests that a new government should apply in its first three months on the local service provider (LSP) model and the follow-up steps needed.
Since our report was published, the need for this has become even more stark. The Department of Health has just announced that while 'contract reset' agreement has been reached between NHS London and BT, this has not been achieved in the North, Midlands and East cluster with CSC, apparently due to its failure to deploy its solution to Morecambe Bay hospitals on time.
Here, the absence of a worked-up NHS contingency plan is worrying, given the fall-out from the Fujitsu exit in the South cluster two years ago. Our report sets out how the existing LSP arrangements could be safely deconstructed – keeping the parts that work well, in primary and community care – and how hospitals can be offered choice through a new nationally coordinated approach.
Overall, our new government must emphasise technology-enabled service transformation to improve patient outcomes. Technology for its own sake is for the past.
John Cruickshank works for 2020health.org, a think tank specialising in healthcare and technology. He has been involved in NHS IT development continuously over the last 25 years, through leading roles in the healthcare practices of major systems integrators and consultancies in the UK and in Europe
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