Published: 30/05/2002, Volume II2, No. 5807 Page 4 5

The Department of Health is bidding for an extra£5bn from the Treasury for NHS IT, a confidential strategy document seen by HSJ has revealed.

The figure is revealed in a restricted draft implementation strategy document, Delivering 21st Century IT Support for the NHS. The final strategy is due to be published in June or July.

The bid for an extra£5bn from the comprehensive spending review - expected to be spread over six years from April 2003 - is broadly in line with the doubling of investment called for in the Wanless report in April.

If approved, the investment would represent the singlebiggest and most complex IT programme in the UK.

Immediate priorities defined in the strategy are to upgrade infrastructure (bandwidth), and deliver the core applications of electronic patient records, electronic booking and electronic prescribing. The document demonstrates how far the timetable has slipped.

It extends the deadlines for EPR, with the NHS to deliver elements of EPR to trusts by 2005, and all PCTs and hospitals to have EPR systems fully implemented by December 2007. The 1998 strategy, Information for Health, had originally called for 100 per cent implementation by April 2005.

By December 2005, a national booking service is to be completed, with 100 per cent implementation of a national prescription service by December 2007.

With past NHS IT investment seen to have delivered only piecemeal progress, the strategy sets out a very centralised implementation route designed to avoid past mistakes and missed targets.

'The core of our strategy is to take greater central control over specification, procurement, resource management, performance management and delivery of the information and IT agenda, ' the document says.

Crucially, new investment for IT will be ring-fenced and held in a central fund, only released locally for accredited systems compliant with new national standards.Much of the programme is to be delivered through 'strategic outsourcing', with key components contracted out to the private sector.

Significantly, the strategy acknowledges the scale of the challenge and potential risks:

'This programme of work is very substantial, and it is clear that significant risk will be involved.'

A ministerial taskforce will oversee the programme, and a new NHS IT programme director will be appointed to oversee delivery and co-ordinate local implementation. HSJ understands that candidates for the post of 'IT czar' are already being sought from the commercial sector.

Though the czar will be empowered to deal directly with strategic health authorities and manage the centrally held programme funds, it is not clear whether they will direct the NHS Information Authority and Information Policy Unit.

One potential area of difficulty will be achieving the 'ruthless standardisation' the strategy calls for.

An indication of the challenge is provided by the time taken to draw up specifications for integrated primary and community systems.

First promised in 2000, these standards have yet to be released.

The implementation strategy promises new national data standards and specifications for a whole range of systems, followed by accreditation of suppliers and streamlined procurements to enable rapid implementation to begin from April 2003.

A further area of uncertainty is around the 'development partnerships' envisaged with consortia of suppliers. The preferred implementation route identified is to selectively outsource major components of the programme, but the strategy does not specify which components would be outsourced or which procurement mechanisms would apply to consortia.

The favoured model for consortia appears to be a top-tier supplier, with specialist systems suppliers beneath them. The strategy makes clear that those leading consortia will be expected to shoulder risk.

While the document sets out a route map for implementation, much of the detail of what is to be implemented still remains to be defined.