The Download: Trusts defy Hancock’s tech vision

It is a truth universally acknowledged that every NHS trust, in the 21^st century, must be in want of an electronic patient record system.

But despite repeated government pledges to end the reliance on paper records, there are still an abundance of trusts whose systems of storing patient records would not look out of place in Jane Austen’s era.

Not for the faint-hearted

While EPRs are not necessarily the main indicator of a trust’s digital maturity, they are a very significant part of a trust’s quest to unlock the many benefits that technology can offer healthcare providers. Other IT systems such as electronic document management, electronic prescribing and patient administration are all important transformations. 

However, EPRs remain high on policymakers’ priority list. Indeed, such was the desire for leaders of the notorious National Programme for IT (2005-16) to provide trusts with EPRs that the Department of Health and Social Care “offered bribes” to persuade reluctant trusts.

The results were far from ideal.

Buying and installing an EPR is not for the faint-hearted. It can cause problems which affect patient care, and ultimately cost CEOs their jobs.

They can be expensive and require several years of expenditure before a return on the investment materialises.

Big players still rule

When Matt Hancock took over the reins at Richmond House, he promised an end to “big IT contracts” and claimed the NHS was often taken advantage of by suppliers. He said he had heard “horror stories” from staff over “clunky IT” and called for splitting big contracts into smaller and shorter ones involving SMEs.

But two years, not much appears to have changed.

According to research into more than 200 trusts by HSJ Intelligence (subscription required), the majority of trusts with EPRs are using systems provided by a small number of big suppliers.

These are Servelec and TPP, which hold much of the community and mental health trust market share, and Cerner, DXC Technology and System C, which dominate – to a lesser extent – the acute market.

HSJI found 16 trusts which are running in-house solutions or taking a best of breed approach, while 21 trusts use suppliers which only provide services to that organisation (this number includes several SMEs).

A dozen or so companies, such as Allscripts, Meditech and EMIS, hold contracts with smaller numbers of (largely) acute trusts.

In short, the research shows that the EPR landscape is still dominated by a small number of large companies, rather than the other way around which was Mr Hancock’s inferred preference.

It is harder to ascertain to what extent trusts are changing their behaviours on contract length, but some recent decisions by high-profile trusts add further woes to Mr Hancock’s vision.

Within the last 12 months, three renowned trusts (Manchester, Frimley Health and Guy’s and St Thomas Foundation Trusts) have all agreed long deals with Epic.

While the company undoubtedly offers a well-performing EPR, the 10-year contract duration (confirmed for Manchester and GSTT) goes against Mr Hancock’s 2018 speech. 

Another big trust, Sheffield Teaching Hospitals FT, is also eager for a long-term deal with a new supplier. 

NHSX’ alternative approach

But, as The Download noted last year, Mr Hancock’s tech policy unit appears to take a somewhat different approach on EPRs to its creator.

NHSX’ framework for EPR providers includes largely the current dominant companies, although it is not yet known which bidders missed out. Asked about the GSTT deal with Epic earlier this month at HSJ’s virtual digital strategy summit, NHSX chief Matthew Gould hailed the news and said he was “delighted when trusts take digital transformation seriously and are prepared to invest in it”.

Rather than attempt to break up the EPR market, Mr Gould suggested NHSX’s focus lay on tackling an “asymmetry between suppliers and buyers” and helping trusts make smarter decisions during their procurements.

This job falls to NHSX chief commercial officer David Howie, who joined from the Home Office earlier this year.

With HSJI’s research suggesting at least 81 EPR contracts (the true number is probably higher) across the NHS expire in the next five years, Mr Howie and his team will have much work to do.

Ultimately, changing the culture of EPR procurement across the whole NHS was always going to take much longer than two years. Hopefully, NHSX’s attempts to drive greater use of shared records and consistent standards across the service may prove to be a more effective way of reaching Mr Hancock’s vision than focussing on the length and size of IT contracts.