DOWN TO THE WIRE

Published: 15/08/2002, Volume III, No. 5818 Page 18

The government is changing the rules about NHS IT procurement - not for the first time, and no doubt not for the last. But whenever the rules change, the danger is that all work on new NHS IT systems grinds to a shuddering halt. That is bad for the NHS IT industry. It is bad for the patient, because the benefits of new systems are lost or delayed.And it is also bad for the government, because promised benefits to patients - the justification for higher taxes - cannot be delivered.

That is why in June, NHS IT minister Lord Hunt issued a clear instruction: 'We cannot afford months of planning blight, ' he said. 'Where activity is already underway, my clear message is:

do not stop.'And at a recent supplier forum held by the NHS Information Authority, Sir John Pattison repeated the message.

'We do not want sensible current procurements to stop, ' he pleaded.

With so much urgency around, how could there be a problem?

Yet there is. Speaker after speaker at the forum, including Sir John himself, stated that the new initiatives had already caused serious planning blight.

Those IT projects that are already well down the procurement route seem to be pressing ahead. Those that have yet to get to the Official Journal of the European Communities stage seem mostly to have shelved their plans.

How did this happen? The NHS IT policy statement produced by the new government in 1988 put decisions firmly in the hands of the organisations which would be using systems. Chief executives were made personally responsible for the successful introduction of IT in their organisations. This took a year to have an impact, but eventually resulted in a surge of procurement activity, with scores of trusts replacing systems.

Now, the plan is for the NHS to appoint between two and five prime service providers (PSPs) which will supply all IT for the NHS. As part of its tender process, each prospective PSP will create an aligned consortium of vendors that will be its bidding partners in future procurements.

The NHS is going to develop system standards and every vendor wishing to join a PSP consortium will need to have its systems accredited by the Information Authority first. This will mean that existing systems may need to be redeveloped to meet the standards when they are published.Only accredited products will be eligible for supply to the NHS, but accreditation does not guarantee contracts.

The power to purchase systems will be transferred from trusts to the 28 strategic health authorities, and these will be expected to join together into consortiums, further reducing the number of contracts to be let (this may induce a slight sense of déjà vu for anyone who has been around the NHS IT market for 12 years or more). Each SHA will face a simple choice between the PSPs, avoiding the need for procurements and European tendering.

As this policy has begun to emerge over the last three months, many trusts seem to have decided that IT is no longer their problem and have therefore moved their attention to more pressing matters.A colleague of mine was recently working with some potential users, designing clinical data collection forms.

Between two meetings just two months apart, attitudes swung from 'let's do this now' to 'we do not need to bother any more, there will be national standards and systems for this sort of thing'.

Starting the drive towards new systems at trust level took a mighty push. It is remarkable how quickly that momentum seems to have been lost.

The problem, of course, is that planning blight is alarmingly easy to cause and much harder to cure.

Central command is beavering away trying to sort out the problems of the new purchasing policy.They are setting and validating accreditation standards, defining the role of PSPs, sorting out European procurement law, drawing up contracts for this single massive procurement, appointing PSPs, finding the extra budget to pay for the PSP tier, and so on.All these tasks must be completed before planning blight can be lifted fully.

The potential benefits of NHS IT systems delivered to high national standards are enormous, but the consequences of blight and delay could be serious. Blight is bad news for suppliers, of course, but also bad news for NHS patients, and perhaps politically it will be bad news for the government too. l Markus Bolton is chief executive of a healthcare computer systems supplier.