The fortnightly newsletter that unpacks system leaders’ priorities for digital technology and what impact they are having on delivering health services. Contact Ben Heather in confidence here.
New tech fund?
Our new health and social care secretary, Matt Hancock, has named technology his number two priority (measured purely by Mr Hancock’s enthusiasm, an argument could be made that it is number one).
Both NHS England and the Department of Health and Social Care have made no secret that the system did get enough tech money from government last time round (£4bn or so short seems the rough consensus).
And there will be, by November, a new long term plan (and funding) for the NHS.
All this suggests that some sort of technology funding boost is a fair bet in the near term.
However, before everyone gets too excited, HSJ has some words of warning based on a highly technical back of napkin analysis of NHS tech funds that have come before.
New money, just like the old money
Announcing the same money multiple times has been a popular trick for NHS tech funds for many years.
Money can be announced when it’s agreed in principle, again when it’s allocated to a specific project, yet again when Treasury agrees to release it, and anywhere in between.
The most recent round of pretending existing funding was sort of new kicked off in early 2016, when the then health secretary Jeremy Hunt announced a £4bn “personalised health and care 2020” fund.
On closer inspection, only £1.3bn of this money was for new stuff, like electronic patient records or whizz bang apps, while the rest was for existing spending commitments, like keeping emails and networks running.
Chunks of this £1.3bn has been reannounced many times since, sometimes to mark a new programme, other times just for something to say.
As recently as July, Matt Hancock announced nearly half a billion of this money again, in a move that was widely reported as another tech funding “boost” for the NHS.
However, a DHSC spokesman confirmed this was the same money that was announced back in 2016, specifically a chunk finally approved by Treasury.
In short, any new tech funding should be examined closely for traces of old money.
New money, but your money
An occasional variant on the above new money/old money fudge is to bundle local spending (money trusts need to find in their existing income) with national spending (new money the centre hands out), thereby generating a larger headline sum.
DHSC tried this in September 2017 when it announced £160m central funding for 17 hospital trusts picked to be digital “fast followers”.
The next day, the department had to clarify that actually the trusts would only, collectively, receive £80m and, by accepting this money, would be expected to find a matching sum from their own bottom line.
Money here, money there
Speaking to The Download, senior NHS IT folk have described a process for accessing central digital funding that often borders on arcane.
The Download has been told that some funds, such as “exemplar” money, come with so many strings that it’s almost more trouble than it’s worth. At least one trust was invited to bid for one of these exemplar projects but declined.
On the other hand, some central tech funding is handed out relatively freely, with little apparent logic to distribution or controls on spending.
Sources have identified both the post-WannaCry boost in cyber security funding and the estates and technology transformation fund as sometimes falling into this latter category.
One source told The Download a smaller clinical commissioning group in their region had received millions in ETTF money while its larger neighbour had attracted only a few hundred thousand pounds, with no obvious reason for discrepancy.
If the past is any guide, the mechanics of accessing a new fund will likely not be immediately, or perhaps subsequently, clear.
Old money, new name
Another variant on new money/old money fudge, it to rename a fund, or the strategy attached to it.
References to a “personalised health and care 2020” or “paperless 2020” strategy and/or fund have now been surreptitiously replaced. The 2020 target was the first to go, like the 2018 goal before it, and now the whole thing has been renamed “digital transformation” (sans any year).
However, subject to a few tweaks, it is the same approach first mooted back in 2014.
Beware of investing too much in any new labels.
New money, less money
And lastly, and most importantly, ever since NHS England become a thing, every new technology fund has been cut, delayed or raided, sometimes by hundreds of millions of pounds.
A full reckoning of central tech spending in 2017-18 has not yet been published, but HSJ revealed in July that at least areas, such as the digital exemplar programme, have continued to see big cuts (although to be fair others, such as cyber security, saw a jump in spending).
So, whatever new headline figure is quoted for the next tech fund, it will be prudent to assume the actual sum will be smaller.