Frustrated with previous IT strategy failures, the government is planning a major rethink and some of the world's biggest IT firms are being called in. Jon Hoeksma reports

Published: 07/06/2002, Volume II2, No. 5808 Page 13

Sustained new investment in IT is now seen as an imperative for NHS modernisation, but the government is determined to avoid bear traps that have dogged past attempts to achieve a great leap forward.

As HSJ exclusively reported last week, a new implementation strategy, Delivering 21st Century IT Support for the NHS, due to be published at the end of June, makes clear that while devolution is the refrain across the NHS, for IT the new clarion call is 'ruthless standardisation'.

If the massive new investment being sought - up to£5bn extra to 2009 - is secured, the centre is determined to control tightly how the money is spent and ensure investment delivers rapid, marked improvements in patient care.

The determination to adopt a new corporate approach is born out of the NHS's perceived longterm failure to use IT as a strategic asset in delivering and managing healthcare, resulting in patchy local progress and key targets missed. The draft strategy says insufficient priority has been given to IT at all levels of the NHS.

'As far as IT is concerned, we urgently need to reverse almost two decades of failed attempts to modernise the NHS core infrastructure, ' health secretary Alan Milburn told the NHS Confederation conference in Harrogate on 24 May.

The most significant recent failure has been to meet the target for 35 per cent of acute trusts to have level-3 electronic patient record systems in place by April 2002.

A central plank of the 1998 IT strategy Information for Health, the target was achieved by only five trusts - barely 3 per cent of the total.

As a result, the ability of NHS organisations to deliver on IT has increasingly come under question - a view that has been re-inforced by local raids on funds earmarked for IT investment to help address imperatives such as waiting-list targets.

'Attempts to ring-fence IT money in successive financial years have failed, ' Dr Richard Gibbs, chair of the NHS chief executive's IT forum, says.

He believes that national standards, specifications, shortlisting of suppliers and centrally held funds will be welcomed. 'Our surveys show chief executives do want to be told what to do on IT, and are horrified at the idea of all doing their own thing.'

Unlike a bank or supermarket group, which mandates common IT systems, local NHS organisations have been left to select and procure systems locally, resulting in protracted, expensive procurements and fragmented systems.

The Gordian knot the draft implementation strategy seeks to cut is how to rapidly achieve a step change in adoption and use of IT across the entire NHS.

Given past performance, how can the government ensure that fresh IT investment will deliver the transformational change required?

Part of the solution set out is to streamline procurements, set national standards and draw up lists of accredited suppliers, while a new NHS IT programme director would provide central programme management and only release investment funds for approved systems.

But the most far-reaching change envisaged is the introduction of 'development partnerships', with consortia of suppliers, led by very large IT and integration firms. This would produce a limited number of compliant systems that can be called off at regional and local levels.

The government is understood to be engaged in discussions with leading firms, including EDS, Logica, Lockheed Martin, IBM, BT, KPMG and SchlumbergerSema to potentially lead consortia.

These top-tier firms would provide programme management and sub-contract with secondtier specialist suppliers of health systems. Strategic outsourcing to consortia would effectively ringfence future investments in NHS IT and shift risk and responsibility for delivery onto the private sector.

As one anonymous chief executive says: 'The NHS has no demonstrable track record of delivering large-scale IT projects.'

NHSIA, meanwhile, will continue to support national IT services and systems, work on defining data standards and provide project management for the new national IT programme director.

But even with heavyweight consortia, effectively spending an extra£5bn on IT will prove a challenge. 'The overwhelming issue here will be about capacity, ' says Kingsley Manning, chief executive of Newchurch Ltd.

Others question the need for a new national programme.

'Information for Health generated explosive growth in NHS IT and this was about to become apparent, ' says Markus Bolton, managing director of System C Healthcare, who stresses that these projects have long lead times.

For others, the most immediate challenge will be to maintain the momentum of existing developments. But that will have to happen against the backdrop of an emerging national strategy and no new money available until April 2003.