The Department of Health has quietly turned away from central control of IT. But what will replace it? And what will happen if there is a change of government? Dave West reports

Taking IT forward

National programme

  • Summary care records stored on central “spine”
  • Systems implemented for organisations by small set of local service providers
  • HealthSpace to provide personal health record access in the future

Conservative proposals

  • “Dismantle” infrastructure and store records locally
  • Systems implemented by local NHS or any willing provider that complies with standards
  • Personal health records a priority to be provided by independent sector products

A reboot of NHS IT policy has begun and, although it throws up some difficult decisions and the potential for added cost, the new direction has largely been welcomed.

Under the national programme for IT NHS organisations wanting to develop a number of crucial systems had to look to the one firm that was contracted by the government for their region.

Now the Department of Health is performing a slow and quiet turn away from that centrally procured programme, allowing trusts to develop solutions of their own and other private providers to move in.

Meanwhile, the Conservative party has announced its intention to take this process further, renegotiating the national contracts and instead asking trusts to pick from an open “catalogue” of IT systems that can communicate with each other.

The implications of a change in IT policy direction were discussed last week at a roundtable event organised by IT firm Simpl, attended by HSJ and seven NHS IT managers as well as experts and consultants from the independent sector.

On top of the national programme’s well documented delays in delivery, much of the NHS IT community believes it has stifled local innovation.

Managers and developers often put off finding their own solutions while they waited for something to arrive, with DH blessing and potentially more cheaply, through the programme.

Great Ormond Street Hospital for Children Trust electronic patient record programme manager David Bowen says: “When we come to count the cost of NPfIT we will forget the billions which are just moving around the economy.

“The real cost has been the things that have been put on hold.”

The centrally run policy appears to have exacerbated the inability to innovate and share found elsewhere in the NHS.

Some argue it is a matter of perception rather than the programme actually prohibiting local development.

British Computer Society health informatics forum chair Ian Herbert says: “The national programme never said it would do it all. It looked as though [it did] but that was never meant.”

However, he is hopeful moving away from national contracts will allow trusts to create more flexible and successful systems.

He says: “Maybe we’ve been too obsessed with some of the concrete bits and ignored processes. If [a system] can’t evolve it will have a chequered history and will be thrown out. That’s why more granularity in procurement seems to me to be a good thing.”

Paul Malcolm is manager of Simpl in the UK, one of the IT companies hoping to benefit from the shift by working with trusts on their own projects. He says organisations, especially foundation trusts, are already coming up with more schemes that do not need DH or strategic health authority approval.

“We have seen a shift that is allowing trusts to make the decisions locally. There has been an active change just over the last few months or so.”

It is allowing foundations to develop business cases for their own IT projects and build relationships with companies that know the health sector.

Cost - whether from building in-house expertise to develop systems or procuring them locally - is one of the potential pitfalls of a new direction.

While well planned IT can save money in the medium or long term, both routes require cash which is unlikely to be available in coming years: billions of pounds are still committed to the national contracts.

The NHS Confederation’s main concern about the Tory plan is that it could add cost, and must take account of the current “skill mix” in the NHS.

Another risk, if the national programme continues to dissolve, is that while some organisations will develop successful systems others will stagnate altogether. David Bowen warns the NHS must avoid a return to pre-programme days of allowing pockets to fall behind.

A third pitfall is that localising IT will exacerbate the difficulty of creating systems that can talk to each other. The Conservatives propose a “catalogue” of systems that are checked and accredited as compatible, or interoperable.

However, while organisations are finding solutions on a case by case basis, it is far from clear to what extent integration and sharing is appropriate, and how it could work across the health service.

Deciding what to share is one of the big dilemmas in health IT both because of security and information governance concerns, and difficulty discerning what is actually useful to the NHS and patients. Ian Herbert says: “Most health professionals don’t want to see all information about their patient but they do want relevant information.”

The Tories made headlines recently by proposing personal health records - allowing patients easily to access, alter and control information about their own health on the internet.

Integrating a user-friendly interface with the rest of the NHS, as suggested by their name-checking of Microsoft and Google as potential providers, is likely to be some way off.

But many in health IT are convinced a solution must be found to enable the level of preventive and self care required to balance the NHS books in coming years.

Great Ormond Street’s work with children with rare and complex long term conditions often requires many parties, from families to a large range of health and social care professionals, to be kept informed.

David Bowen says it had spent a long time looking for technology to aid the process but had found little inspiration within the NHS, and in the end turned to other sectors.

It is hoping systems such as corporate social networks will allow a set of authorised individuals to quickly contribute to and share information about a patient.

He says: “The implications of this are terrific. If we are going to afford healthcare in the future then patients and families have to do a lot for themselves.”

Nationally, the public sector could still lead development of personal health records - the national programme’s HealthSpace is an embryonic attempt - but the private sector is sceptical the NHS has the expertise to deliver.

The Conservatives, who look to the idea to “empower” patients as well as improve care and cost, say private products will be cheaper and more efficient.

Microsoft NHS marketing manager Mark Treleaven says: “Patients should have access and control of their data.

“It’s about them and they should be able to decide who to share it with. There is a great role to play [for personal health records] whether through HealthSpace or greater private involvement.”

Whether public or private, the idea changes the relationship between patients and the NHS and will face further questioning, particularly from clinicians.

The British Medical Association has warned of the patient safety risks if, for example, a patient chooses to exclude the results of certain tests.

Northern Lincolnshire and Goole Hospitals Trust consultant radiologist Richard Harries, who has developed numerous IT projects, cautions: “We have to be conscious that once you open that link communication is going to happen and it is going to affect the way we work.”

NHS IT leaders, while enthusiastic about new developments and the chance of a new direction, warn the reboot of NHS IT should not throw out the good with the bad.

They are almost unified in opposing the Conservatives’ suggestion of dismantling the “spine” element of the national programme, which is used to store and transfer data between organisations.

Ian Herbert says: “The national programme has provided things we couldn’t do without… However, the context within which we operate is changing quite rapidly.”

Patient records: jokes about doctors’ bad handwriting are no longer funny