NHS hospitals will spend£2.7bn on new computers over the next six years. This is an industry estimate of the cost of upgrading systems to meet targets set in the health service's national information technology strategy, Information for Health.
Under present rules, a large slice of that money will go to lawyers. Any trust wishing to buy a new system has to hold its own open procurement under international free-trade rules and persuade at least four levels of officials in the NHS and the Treasury that its business case is sound. The process can take more than two years and cost upwards of£50,000.
Everyone agrees this is daft. A year ago, the IT strategy admitted: 'This process is no longer tenable and must be simplified.' The result, the so called national procurement review, is about to be unveiled.
The review seeks to streamline both business cases and procurement contracts. Although details are still under wraps, the keyword - conveniently in tune with Blairite philosophy - is 'collaboration'.
Groups of trusts will work together to plan business cases and pick suppliers. This will avoid duplicated costs and effort. It will also whittle down the number of IT companies competing in the market to a handful of accredited suppliers who will have an incentive to spend money on research and development rather than wining and dining prospective customers.
The new rules have been a long time in the making - the NHS Executive first promised a 'root and branch' review in 1996 - and will be launched on a grand scale.
Their test-bed will be the largest IT project ever run in NHS hospitals, covering 23 trusts in the old South and West region. Over the next two years they are supposed to market-test their IT supplier, the giant computing services company EDS.
Over the next few weeks, South West regional office plans to advertise in the Official Journal of the European Community for bids to supply these hospitals. It will attract widespread interest as fewer than 20 trusts have bought new computer systems in the past five years.
The idea is to pick two or three suppliers from the bidders, creating a shopping list of systems that trusts can choose without holding their own procurements. If the scheme works, it is likely to be applied throughout England and Wales.
Good news all round? IT managers and suppliers are not celebrating yet.
Alan Spours, head of informatics at Salford Royal Hospitals trust, who is about to launch a procurement he expects to take two years, says: 'Anything that streamlines procurement, I'd support. But I don't think it will be the panacea.'
Large IT suppliers are noticeably more enthusiastic than small ones.
Jim Cassidy, UK and Ireland managing director of SMS, one of the top three hospital systems suppliers, described himself as 'very optimistic' about the review. 'It could be the first step to getting it right.'
But smaller suppliers say the new rules could restrict innovation. 'The current draft proposals are highly dangerous, ' argues Markus Bolton, managing director of System C, a UK-based firm. 'The NHS is far too bureaucratic an organisation to make decisions on a national level. IT moves too quickly, and by the time they get anything done it is out of date.'
Other sceptics point out that the idea of collaborative procurements has been tried before - and failed. In the early 1990s, the old HISS Information Management Group spent years organising competitive bids for two major 'framework' contracts to upgrade the NHS's most widely used hospital systems.
The idea was that trusts would be able to buy systems from the winning bidder without having to repeat the procurement process. In the event, only one such 'call-off ' contract was signed. The winning bidder, Hoskyns, later became one of many IT firms to abandon the NHS market.
Officials say that they have learned the lessons of the framework contracts. But Phil Sissons, chair of the Computing Services and Software Association's healthcare group, is not convinced. 'Nothing's changed. My worry is that we can see no evidence that a joint procurement will be done any better than in the past.'
The CSSA will tell the NHS that the scheme will work only if trusts are compelled to accept jointly negotiated terms and conditions. But at the moment, regional offices do not have the power to do so.
Even if they did, it would be difficult to set identical terms for trusts which over the past 10 years have moved at different speeds in adopting IT.
One recent attempt to set up a region-wide collaboration in an IT market test has already failed. Some 14 hospitals in the North West are holding procurements to test their IT contracts with SMS.
An early attempt to hold a joint procurement foundered because different trusts wanted to work at different speeds. Bolton, for example, picked an entirely new system, from iSoft. Salford is taking a more cautious approach, piloting new technology on top of its existing system.
Whether the West Country's diverse mixture of trusts can be held together remains to be seen. As one insider says: 'It only takes one hospital to say that its system must be able to handle the Cornish language for the whole project to fall apart.'
And there is a final irony. The procurement review is coming into force just as the NHS is learning how to make the current regime work.
There is evidence that, when trusts really want to update their IT, they can dramatically shorten the two year cycle while sticking to the rules.
Bournewood Community and Mental Health trust in Chertsey, Surrey, recently pushed an IT contract with Servelec through the process in eight months.
The NHS might be better occupied learning from that lesson, rather than in digesting and implementing yet another set of rules.
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