Published: 07/02/2002, Volume II2, No 5791. Page 18
Like a great oil tanker moving on a mighty sea, the NHS changes direction only slowly and with effort.
Yet sometimes, often to everyone's slight surprise, it finds itself heading in the right direction.
After many years of neglect and under-investment, spending on NHS IT will exceed£1bn for the first time ever this year. Trusts are discovering the benefits that can follow from successful electronic patient records. Those that do not have such systems in place are learning from those that do. A growing number of trusts have placed contracts, and many more are deep into procurements.
Unfortunately, government targets are not going to be met.
As the NHS Modernisation Agency has pointed out: 'Nearly all health economies are reporting doubts over whether they can meet the targets for electronic patient records.'Only a handful of acute trusts - perhaps half a dozen - have functioning EPR systems in place. The original target of a third of acute trusts reaching level-3 EPR by April this year now seems absurdly optimistic. This does not look good for a 'modernising' government, and health ministers are presumably worried that they will be left with highly visible egg on their faces.
Two broad conclusions can be drawn from failure to meet a target. Either action is needed to speed things up, or the target was over-optimistic in the first place and should simply be changed.
For political reasons, governments are generally reluctant to accept that their targets could never be met.
Instead there is often a search for scapegoats and a vague but insistent demand for 'Action'.
Enter junior health minister Lord Hunt.He is evidently in danger of following the politician's syllogism, 'Something must be done. This is something.
Therefore we must do this.'He says the problem is that large suppliers are reluctant to deal with the NHS because it is too fragmented. 'The issue is whether the NHS is a good customer for the type of companies that invest in research and development, ' he suggests.
'Suppliers tell me, 'We can't invest time and money when we have to sell to 500 different customers', and I've really taken that to heart.'
He must mean very large suppliers indeed, because for most IT companies a£5m-£30m contract with an acute trust is a significant contract, not a small one. If the minister is serious, he will be introducing the sort of large-scale centralised procurements prevalent on the front pages of our national newspapers. Either IT companies would deal with the whole NHS or they would deal at least with whole NHS regions. A higherrisk project I could not imagine.
The sort of changes being mooted will be detrimental to trusts, and before bright new plans are imposed I hope the following will be considered.
First, hospital systems are deceptively complex when compared to other applications such as issuing passports. Any player coming into the market today will take at least five years to develop a suitable product.
Even if Lord Hunt attracts his favoured suppliers, they will not help him meet the government's next big target - that all acute trusts should have level-3 EPR systems by 2005. Even for seasoned suppliers, EPRs take two years to install, so for any trust to meet the 2005 target, it will need to start its procurement within the next few months.
Second, introducing framework or central procurements will simply lead to yet more planning blight.Chief executives will simply find other things to worry about and will lose interest in the messy business of introducing effective IT systems.
The rate of procurement, now just picking up, will slow once again to the barely perceptible crawl that Labour inherited.
The work of years will be undone in moments.
Third, already over a dozen suppliers sell hospital IT systems, and at least half of these have the capability to implement them successfully.These companies have been investing hundreds of millions into NHS computing.
Substantial companies like Torex, iSoft, Siemens and Sema will be as delighted as my own to hear that the government has lost interest in the current batch of suppliers and is now looking for a new set to play about with.
The government turned the wheel on the great ship of the NHS.There was no rapid movement, but a slow, clear change in the right direction.
Now politicians, in a rush of impatience, propose to spin the wheel and reverse course. If they succeed, once again there will be no immediate change. But in two or three years' time, the ship will come to a sudden and shuddering halt.
Steady as she goes, milord.There is no need to change course now.
Markus Bolton is chief executive of a healthcare computer systems supplier
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