The fortnightly newsletter that unpacks system leaders’ priorities for digital technology and the impact they are having on delivering health services. Contact Ben Heather in confidence here.

As recently as June, NHS Digital’s figures showed there was about £700m left to spend over this year and next on improving IT in NHS trusts

While the overall figure has skewed and shifted, NHS England has consistently talked about the hundreds of millions it has to spend on NHS tech through to April 2021, most of it capital. 

When HSJ reported that the centre had spent drastically less than planned on trust IT for the past three years, NHS England insisted these were delays, not cuts, with a spending bonanza to come this year and next. Now, the new central tech unit, NHSX, has told HSJ the capital element of this funding is up in the air.

The tech unit said the amount of capital for NHS IT through to April 2021 will now be subject to review. To be clear, this is not new money, but part of the tech fund agreed between Jeremy Hunt and the Treasury back in 2016.

HSJ has also been told by multiple senior NHS IT providers that there is growing uncertainty about funding under NHSX, with multiyear IT contracts at risk and a growing gap between the centre’s rhetoric and actions.

Resetting the clock

Central funding for NHS IT in recent years has mostly drawn from a five-year settlement agreed with the Treasury in 2016. This provided an additional £1bn to £1.8bn (depending on how you count it) through to April 2021 to improve NHS IT.

Money was initially slow to flow and has been less than promised. But, for the past two years, hundreds of millions of pounds extra have been given to NHS trusts to pay for everything from cybersecurity to new electronic patient record systems.

When the long-term plan was published, NHS England told HSJ the tech fund would continue through until April 2021 as planned, with some rejigging of spending priorities but no major changes until that date. As delays mounted and spending increasingly backloaded, NHS trusts were due hundreds of millions in additional IT funding this year and next. About £700m, according to NHS Digital figures.

However, when the long-term plan implementation framework was published in June, it included a new five-year revenue commitment for technology, specifically covering trust IT and regional electronic records (the so called-LCHREs), beginning this year through to April 2024. In other words, the framework reset the clock for a new five-year tech fund, but only for revenue.

In response to HSJ’s questions, NHSX has confirmed technology revenue funding for this year and next (£264m total) detailed in the framework is not new money. It is from the same tech fund agreed back in 2016.

But what about capital? 

When HSJ asked NHSX about capital funding, a spokesman said the unit was “reviewing capital priorities in the current year and expects to be able to confirm them in due course. Next year and future years won’t be available until after the spending review.”

The spokesman would not commit to honouring any previously published allocations for capital spending on NHS IT. 

Discontent among the ranks

So where does that leave funding for NHS trust IT?

In the void of clear information about where the money for NHS IT is going, or whether the money already promised is still coming, rumours and confusion are blossoming.

One senior NHS IT provider described the current approach from the centre as “chaos”. They said: “Capital issues are a joke; I fear for schemes we’ve put three-year plans in for as they just keep robbing Peter to pay Paul and pretending they aren’t.”

While the NHS England’s “global digital exemplar” approach to NHS IT of recent years has had plenty of critics, primarily its reliance of big American suppliers and exclusion of most trusts, it did mean a real funding boost for some NHS providers. NHSX’s shift in focus to bringing all trusts up to the basic standard of IT has been generally welcomed. But less welcome is uncertainty about what this means for the amount of IT funding and who gets it.

Some trusts involved in GDE programme, likely to be wound down under NHSX, are concerned about what will happen to progress they made thus far once the programme, and funding, runs its course in April 2021. Others are worried, despite official assurances to the contrary, that money they have already committed to spending will be clawed back by the centre.

Last week, Digital Health reported funding for the Local Health and Care Record Exemplar programme, a core IT commitment in the long-term plan and one that NHSX has said it will continue to support, may be cut. Despite NHS chief clinical officer Simon Eccles insistence on Twitter that nothing had changed, both an NHS and industry source has since told HSJ they too have been told not to expect LCHRE money previously promised.

Add to this NHSX’s refusal to confirm previous capital funding commitments and the discontent deepens.

All roads led to number 10

Much of this uncertainty is because NHSX, and its overlords NHS England and health secretary Matt Hancock, now has little real control over NHS policy, tech or otherwise.

HSJ has been told Number 10 has essentially taken over policymaking at the Department of Health and Social Care in the run up to the Brexit deadline. Anything that doesn’t need to happen before 31 October, such as most NHS IT funding decisions, has been put on hold.

Given the views of the prime minister’s new senior health policy adviser on NHS funding and tech, further changes in NHS IT strategy, and where the money is spent, seem likely.

This doesn’t mean there won’t be more NHS tech announcements, like the £250m for artificial intelligence, in the next few months. But such announcements should be treated with deep caution. Two of Mr Hancock’s biggest NHS IT funding announcements in the job have either been quietly shelved (remember the £200m second wave of “exemplar” trusts?) or delayed ( the £412m health system led investment fund). 

Now more than ever, the government’s NHS IT funding commitments should be treated as vague aspirations to the point money starts flowing.