Third time lucky? The latest NHS IT strategy will be enforced by 'some very tough cookies'.So might this one actually work? Michael Cross reports

Published: 20/06/2002, Volume II2, No.5810 Page 14 15

This time it is really going to happen. Junior health minister Lord Hunt unveiled the third IT strategy in a decade for the NHS in England with a call to 'move up a gear and significantly accelerate the pace of IT development across the NHS'.

Like its predecessors of 1992 and 1998, The National Strategic Programme: delivering 21st century IT support for the NHS sets target deadlines for installing new NHS information systems (see box). The big three 'deliverables', as widely predicted ('The same game', page 13, 7 June) are:

a national e-bookings service, to be implemented by December 2005;

a national e-prescriptions service; to be 50 per cent implemented by December 2005;

an electronic health records service available everywhere by December 2005.

Underpinning these new NHSwide services will be a broadband network carrying encrypted secure messages to all NHS staff. This infrastructure layer is also due to be in place by the end of 2005, though in practice some parts will have to be ready much sooner.

Further targets for telemedicine, electronic images, telemonitoring and combined electronic records run to 2007 and 2010. These are labelled 'tentative'.

Lord Hunt's announcement, at the annual conference of the NHS IT staff association ASSIST (itself a child of the 1992 strategy) trod a delicate balance.While talking up the new programme and the government's commitment to deliver it, the minister had to claim it represented no great departure from its predecessor, 1998's Information for Health. The fear is that timid chief executives will use the announcement as an excuse to put IT plans on hold until new arrangements become available.

Lord Hunt stressed that 'in essence' Information for Health remains 'sound... and the last thing we want to do is introduce planning blight for the next two years'.

However, the new programme is more than a tweak on the existing strategy. It is wider ranging, technically more ambitious and sets more immediate deadlines than either of its predecessors.

Its preliminary stage alone, 'phase 0', running from now until March 2003, blithely tackles three sets of problems: data standards, system specifications for electronic patient records, and procurement delays that have plagued the NHS IT community for years.

Unlike the previous strategies, there is a specific role for industry, with 'strategic partnerships' delivering services through private finance initiative-type projects.

These will have to be put in place in record time - but the procurements will be bitterly contested by the giants of IT services.

The national health record service also raises huge technical, professional and political issues, especially if it is to be run by a private contractor.

The strategy document does not mince words: 'This programme of work is very substantial and it is quite clear that significant risk will be involved.'

Hence the strategy's emphasis on delivery mechanisms. Lord Hunt was unapologetic about imposing central control on IT, a contrast to the government's devolutionary sentiment elsewhere. 'I can't think of any other national or corporate organisation that would approach IT in the fragmented and piecemeal manner that we have over the past four years, ' Lord Hunt said.

In place of frontline freedom will come firm, top-down national management, delivered by the new IT programme director reporting to a ministerial committee, with the authority to crack whips.

In the programme director, the Department of Health is looking for 'a person of the highest calibre with a depth of expertise in delivering national IT projects'.

The director will have a commissar in each strategic health authority in the shape of a chief information officer. Lord Hunt said that these individuals - 'my preference at director level' - should have enough clout to enforce progress. 'What I am not going to have is a small number of trusts in each SHA holding up progress because they can't come to decisions.

'The people who are going to be chief information officer are going to be very tough cookies indeed.We will work very closely with these 28 people.'

ASSIST chair Tony Eardley welcomed the minister's announcement of It is central role. 'The day of the enthusiastic amateur is gone.'

But he warned that top-level commitment to IT was a fickle thing, needing constant encouragement.

Others at the conference wondered if the minister was biting off more than he can chew. Dr Paul Johnson, head of the pioneering telecare unit at the John Radcliffe Hospital, Oxford, said SHAs were too large a unit through which to manage IT. He argued for organising on a smaller scale. 'Primary care trusts are the natural demonstrators, ' he said.

Of course, the strategy is still vulnerable to the old enemy, the Treasury. The strategy document admits that the whole plan is based on the assumption that the 2002 spending review 'provides a significant level of increased funding'.

Lord Hunt could make no promises, saying only that an announcement would be made within weeks. He also warned that the new money 'ain't going to go in as a substitute for local expenditure'.

'We are going to use central money to leverage in investment at local level.'

Just because IT is being run from the top, it doesn't mean that chief executives will be able to ignore it. l Great expectations: the first deadlines

Phase 0 (to March 2003)

Define technical standards; ensure all consultants have PCs.

Create first stage of the national health record service; agree a specification for electronic patient records.

Streamline the procurement process; increase NHS IT capacity and capability.

Phase 1 (April 2003-December 2005)

Connect all staff to a broadband network; with secure access and messages.

Implement the national bookings service; 50 per cent implement the national prescriptions service; all trusts to have some elements of electronic patient record; full national health record service implemented and accessible; patient record analysis service established; e-learning materials available through the NHS University.

Establish a faculty of health informatics at the NHS University; new project management procedures for IT.

Phase 2 (January 2006-December 2007)

Smartcards for all NHS staff; national prescriptions service fully implemented; EPRs, including electronic radiology images, in all hospitals; telemedicine available for all GP surgeries.

Phase 3 (January 2008-December 2010)

Telemonitoring in all ambulances and in all homes needing it.Unified electronic records for health and social care.