The Download: The £13bn wish list and what it means

£12.9bn.

It’s a big number.

Not since the heady days of the National Programme for IT has this level of investment in digital technology even been whispered.

Behind it lies a long list of projects on everything from electronic rostering to cyber security.

With a self-professed digitally enthused health and social care secretary Matt Hancock at the helm, those advocating for greater investment in NHS tech can be forgiven for becoming a little excitable.

But it is worth dissecting exactly what this estimate, and it is an estimate, might mean and what it probably doesn’t.

Maybe not quite £12.9bn

The NHS will almost certainly not, when the dust settles, get £12.9bn for tech for the next five years.

The figure of £10.9bn to £12.9bn is an estimate put together by officials as part of digital and tech workstream of the long term plan.

Firstly, the estimate includes £2.8bn in tech funds already committed through to 2020-21 (in theory, but read more about the vagaries of NHS tech funds here).

So, the extra ask on the new funding settlement is more like £10.1bn to £8.1bn, backloaded to 2021-24.

Broken down that’s between £2.06bn and £2.75bn a year or roughly £1.5bn to £500m more a year than the government is already planning to spend on technology for the next two years (no commitment has been made beyond 2020-21).

Secondly, it covers the cost of technology to support pretty much every project in one of the long term plan workstreams.

Each workstream has submitted a long list which will then be whittled down by Simon Stevens and Ian Dalton until it can be stuffed into the available financial envelope (£20bn extra in real terms by 2023-24).

As the overall list shrinks to the absolutely-can’t-avoid-doing and a few extras, the tech ask required to support it will also diminish.

NHS England also downplayed the figure. It noted that “sectors will lobby their own agendas” but realism was needed from all involved in the plan.

Given NHS England’s central oversight of the plan that does not bode well for a £13bn tech bonanza.

But….

The estimates also make it clear that a substantial core of the tech funding ask beyond 2020-21 is not about the long term plan at all but keeping the current IT commitments running.

About a billion pounds a year will be needed to keep current IT infrastructure running and finishing digitalising hospitals (The Paperless 2018 and then 2020 and now 2023 commitment).

Securing that money seems a safe bet as it would be politically difficult to abandon these programmes, particularly after Mr Hancock has given technology such prominence in his first few months in the job.

And, assuming there is some transformation money left over after meeting the many more immediate financial demands of the system, some new technology will be required to supporting these projects.

That means there is likely to be at least a little more than a billion a year (subject, as always, to Treasury approval) for NHS tech over the five years.

There’s a digital solution for that

In his first speech in July, Mr Hancock described the long term plan as being “contingent” on the adoption of modern technology.

At first inspection, this could come across as a veiled threat that NHS organisations with poor IT systems might miss out.

But it could be taken to mean that if there is a problem the NHS is trying to solve through the plan, technology should be part of the solution.

More than the wrangling over money for a new NHS tech fund, it is the proposals for how technology can support NHS transformation that matter more long term.

Taken collectively they set out a vision of NHS care underpinned by minutely detailed digital records of every patient down to their genome, available wherever it is needed.

Collectively and individually, these records will be crawled over by software that will automate clinical and patient alerts, care planning at an individual and population level and extract data for research.

For patients, there will be digital tools to care for themselves and connect quickly to clinical support when needed.

For clinicians, mundane procedural tasks will be automated, clinical judgement better informed and, where required, easily dispensed remotely or in virtual collaboration with colleagues.

For system planners, there will be a vastly improved real time, and at times predictive, view of exactly what is happening across health and care (and more importantly how that information should be used) nationally and regionally.

But achieving even half of this utopian vision in 10, let alone five, years won’t be cheap.

The National Programme for IT largely failed to deliver on a similar digital promise, with billions of pounds of public money wasted.

Decisions over the next few months will reveal how much risk NHS leaders (and Treasury) are willing to tolerate in a second attempt.