Published: 09/12/2004, Volume II4, No. 5935 Page 2

I didn't listen to File on 4's investigation into NHS IT at the end of October. I heard the trailers and decided it would be a trot over familiar ground; billions of pounds spent, clinicians not consulted, the National Audit Office investigating - all adding up to a potential disaster in the making.

Which it was, to judge from the BBC website. But lots of people in the NHS will have read newspaper stories picking up File on 4's claim that the costs of the national programme for IT could spiral to£31bn (even though it was quoting Computer Weekly, a long-standing thorn in the national programme's flesh).

And many will have concluded that the programme is failing. So it is understandable that director general Richard Granger and co are cross.

The national programme has gone out and placed contracts for a broadband network for the NHS, electronic records and other goodies to the value of£6.2bn over 10 years.

It was always clear that getting this stuff installed, training people to use it and driving changes in working practices would cost more than£6.2bn. In line with most industry analysts, the Department of Health seems to think it will cost between three and five times the cost of procuring the kit. Multiply£6.2bn by five and you get£31bn.

So There is no evidence that the costs of the programme are 'spiralling'. In fact the general view seems to be that it did a good job of getting the prices it did - but all that installation etc will have to be paid for.

The programme's line is that the money will be there, because the NHS is already spending more than£1bn on IT, and some of this 'baseline' spend will be available for the programme. And the NHS is committed to raising spending on IT to 4-5 per cent of its total budget, in line with the recommendations of the Wanless report.

However, there are several problems with that. First, the continual emphasis on maintaining baseline spend suggests this core NHS funding is under pressure, at least in some areas. Second, it seems many NHS organisations are still unclear about exactly what is and is not in the contracts, and when they will be expected to release funding.

And third, it is one thing to say that the NHS is getting massively above headline inflation increases to take account of spending on things like the national programme, and quite another to say that money will naturally flow into frontline budgets.

Foundation trust regulator Monitor recently announced an investigation into the finances of Bradford Teaching Hospitals foundation trust, which is projecting a£4m deficit. One problem it says it has run into is that while the new consultant contract, the European working-time directive and the national programme are supposed to be covered by the extra money, they are costing more than expected.

Bradford is unlikely to be alone, given that financial pressures are cropping up all over the NHS. So when the programme or ministers say the programme is fully funded, they are either being naive or somewhat disingenuous.

One of the many reasons that the 1998 IT strategy Information for Health ultimately failed was that the money that was supposedly earmarked (and then ringfenced) for it went on other things.

Getting the money earmarked for the national programme spent on it may be no less difficult, especially as trusts become more independent from the centre and are given more incentive to play up funding pressures by a harder-edged financial regime.

Meanwhile, it is also hard to feel sorry for the national programme because it has brought a lot of the ill feeling reflected in the File on 4 report upon itself. Putting aside GP self-interest, survey after survey has shown that clinicians do not feel involved.

And I would quite like to write about Choose and Book, but the national programme will not allow that until the scheme has been launched officially, and that seems to have been delayed by the recent bad publicity about the programme.

I repeat: the programme feels it has been unfairly accused of being off course and has therefore decided not to talk about one of its putative, albeit small scale, success stories.

Work that one out.