Data day

Published: 03/04/2003, Volume II3, No. 5849 Page 15

It is all change again for NHS IT. Lord Hunt has gone and Sir John Pattison's departure is imminent, leaving Richard Granger to steer a new strategy.

But managers want to know how the national programme will secure the support of clinicians, as Lyn Whitfield reports

For the past two years, parliamentary business has kept Lord Hunt from the big healthcare IT conference of the year and Department of Health director of research, analysis and information Sir John Pattison has had to read his speech for him.

This year, the junior health minister resigned over the war on Iraq just before suppliers and NHS IT managers made their annual trek to Healthcare Computing, so Sir John delivered his own address.

Lord Hunt had been a 'great champion and leader for NHS IT', he told the Harrogate audience. But not to worry - 'interim arrangements' have been put in place until a new minister can be assigned to the job.

Sir John then announced that he is going as well.He will hand over his IT duties to the new director general of NHS IT, Richard Granger, because of the latest DoH reshuffle - and because he is retiring next year.

The sight of Sir John extolling the importance of leadership and then benignly waving farewell, newly acquired European computer driving licence in hand, caused some amusement among delegates.

However, it did not cause any obvious dismay. This may suggest that the NHS IT community realises that it will not lack the firm smack of leadership while Mr Granger is around.

Mr Granger is in charge of the national programme for NHS IT, which has been set up to deliver the latest IT strategy, Delivering 21st Century IT for the NHS.

It will do this through a new system of procurement, based on the creation of consortia led by major firms. The most visible of these will be the local service providers (LSPs), which will upgrade trust and primary care systems and get them working together.

An OJEC advert asking for expressions of interest in being an LSP was issued at the start of the year. By the closing date in mid-March, the national programme office had received 99 responses.

It is not yet clear how many LSPs there will be, although five looks likely, covering London and four geographical areas.

However, most of the companies that responded to the advertisement do not want to be LSPs; they want to contract with them to provide electronic record systems and the like.

A long shortlist of potential LSPs should be available by the end of the month, with the first contracts placed in October.

The main topic of debate at Healthcare Computing conferences past has been the degree to which 'the centre' should direct NHS IT. The momentum achieved by the national programme has rendered this redundant.

Instead, attention is shifting to potential pitfalls ahead.One issue, raised by a London IT manager, is whether trusts, and other healthcare organisations, will have the staff and resources to implement the programme locally. Another is manager buyin (see box). But the most pressing issue, raised time and again, was whether the national programme can secure the support of clinicians.

Paul Cundy, a GP, told a debate that it couldn't - 'you just know in your bones that anything distributed nationally will not work'.

'You need the input of those who actually clip the toenails and change the bandages.'

Markus Bolton, an acute sector supplier, also argued that hospitals are so different, and change so painful, that 'local choice' of IT systems is essential for successful implementation.

However, the optimistic view is that clinicians will welcome new systems as long as they are intuitive to use and deliver obvious benefits, although neither has always been the case.

Mr Granger used his address at the end of the conference to appeal to the NHS IT community to rally behind the national programme.Using far more conciliatory language than he has become known for, he stressed his personal commitment to improving the NHS. 'I do not have somewhere else to go. I will make this successful, ' he said.

He also admitted that communications had so far been poor, but said this would change now the programme had been 'mobilised.'

'I am asking for your support to do this because if we work together we will deliver together.

This is about what we do collectively to serve the society we are part of, ' he said. l First-degree Burns: 'I have to recognise that success was limited Wirral Hospital trust chief executive Frank Burns was co-author of the first NHS IT strategy, Information for Health, which established a clinical focus but relied on local implementation.And, as Mr Burns told a conference session, 'I have to recognise that success was limited'.

Delivery of 'real-life clinical information systems was slow', he says, because the 1998 strategy was not backed by enough cash, the money that was 'earmarked' for it was diverted to other priorities and chief executives never really supported local implementation.While welcoming the new strategy, and its national approach, Mr Burns warns that a potential pitfall was that 'chief executives may just have succeeded in passing this poisoned chalice back to the DoH'.

'Chief executives must be responsible locally for delivering 21st century IT because if [not] you create the opportunity for people to fudge their responsibility, especially when the going gets tough.'