When the next government takes over the struggling national programme for IT in the NHS, it must breathe new life into this drive, says John Cruickshank

The next government will need to consider carefully what to do with NHS IT.

Last month 2020health.org published Fixing NHS IT: an action plan for a new government to provide some dispassionate clarity on the future of the £12bn NHS IT programme

Both Conservative and Liberal Democrat politicians have talked about localising NHS IT and cancelling elements of the national programme.

In response, our report laid out a detailed rescue plan, looking at what has worked, what needs to be stopped and what needs to be done next.

The NHS is shifting to a complex adaptive system and away from a centralised hierarchical model.

This has profound implications for IT.

Health IT projects cannot be viewed in isolation: their success depends on several integrated strategies and activities - policy, business decisions and processes, clinical processes, organisation, employee engagement and technology

Our analysis started from the view that a new government must work IT planning intrinsically into its policy, treating IT as an asset not a cost.

IT-enabled new ways of working are essential to productivity and improved outcomes.

A national approach to IT should only be taken when one or more of three principles apply:

  • to avoid redundant variation for infrastructure and once-only back office solutions;
  • to provide economies of scale;
  • to provide essential central coordination or regulation, eg for standards and for security.

The first year

We expect a new government would wish to do an urgent stock-take of NHS IT projects, assets and organisation against these principles. The report sets out 30 detailed recommendations for action, all to be executed within the first year of a new administration. Outside this, trusts should be free to set their own direction to meet local priorities, provided nationally agreed standards are met.

We also considered what action is needed with the care records service in acute hospitals where the IT programme failings are greatest. Here we set out a series of tests that the next government should apply in its first three months on the local service provider model and the follow-up steps needed.

For example, we argue that local service provider acute solutions should be exposed to competition, with trusts able to call off what they need based on their own capability, maturity, starting point and plans.

So, given the NHS now spends 3.5-4 per cent of its revenue on IT, how much could be saved? We see obvious ways to cut IT expenditure by rationalising and consolidating local IT functions and slimming down the centre.    

But much bigger savings come from IT impacting the wider NHS operational spend, through transforming care delivery.

For example, the European Commission recently co-sponsored an audit of the benefits gained from technology-enabled transformation at Nottingham University Hospitals Trust. They described how it provides “a persuasive account of the huge impact the new communications infrastructure deployed at the trust has had on re-engineering the day to day working processes of its emergency department”.

In particular, it shows a reduction in the patient journey time of 23 per cent for adult patients and 33 per cent for paediatric patients, and an increase in clinical productivity of 12 per cent.

In the US, savings have been made by providing more information about prescriptions to providers through sophisticated IT systems. Many states have reduced drug spend by 4-5 per cent.

Here, the electronic prescription service could similarly release major savings through reductions in fraud, less drug wastage and reduced back-office costs, as well as deliver patient safety benefits. A new government should give a major push to image technology to address the remaining barriers.

Vital connections

Key recommendations from Fixing NHS IT: an action plan for a new government

  • The elements of NPfIT which are a valuable platform for the future should be developed. We include: N3 - the NHS broadband network; and PACS, the capture and communication of radiological and other images
  • A course of national action and investment is needed in areas where IT is underexploited, notably telemedicine and collaborative technology 
  • The roll-out of the controversial summary care records project should be halted and reviewed
  • In combination with a consolidation and strengthening of IT provision at the local level, a radical reorientation and downsizing of the central IT organisation is needed, making it more transparent and accountable to the NHS