The Wachter review has rightly been praised for its bold statements on timetables and funding – and its pragmatism - but a robust plan is still needed for digitally-challenged and non-acute trusts, writes James Illman

Jeremy Hunt’s announcement this month that around 30 of the most digitally mature hospitals will be first in line for central IT funding, including 12 “global exemplars”, instead of trusts which are further behind on technology adoption, marked a significant shift in policy.

The plan earlier this year was for “everybody to get some” of the circa £1.3bn new funding earmarked for what has to date been known as the “Paperless 2020” agenda. Indeed, as former NHS England technology director Beverley Bryant tells HSJ today, the plan had been to “prioritise investment in those health economies with the most work still left to do”.

Money was due to be allocated based on a combination of areas’ local digital roadmaps and organisations’ scores on the digital maturity index.

This has now shifted as a result of Robert Wachter’s government-commissioned review, Making IT Work.

While the review was only published earlier this month, it had been complete for some time (its launch was held up by the EU referendum), and policy makers have been busy working on its recommendations, of which the health secretary’s aforementioned announcement was one.

The review proposes a phased approach for allocating central funding. Digitally advanced trusts should be given money first. The less advanced, around half of trusts, will have to wait until after 2020. And this is assuming there is any – the current funding commitment only goes up to 2020, as the review points out.

Professor Wachter’s review’s focus on the acute sector also meant non-acute trusts were not able to even apply to be global exemplars, which has only heightened their sense of a lack of fair play.

The rationale for the focus on the top end is that many trusts are not yet ready to spend the money to ensure optimal clinical and financial return from investment. The argument is not without merit, but 2020 feels a long way off, given the painfully out of date state of many hospitals’ technology systems.

Ms Bryant, NHS Digital’s new head of digital, makes the case for the new approach in her HSJ interview. She argues the case for a trickledown effect, whereby the digitally mature will drive forward their less advanced partners.

Others are less convinced, however, not least many trusts in the lower echelons on the DMI. One senior health IT observer told HSJ the digitally challenged are being “left to rot” under the plans as they stand – a sentiment shared by others.

Consultant Ewan Davies says: “I don’t see what will be achieved by concentrating on [the exemplars]. They are already doing good things already, so let them get on with it. There is some validity in the argument that some trusts are not ready for financial investment at the moment, but leaving them to rot won’t help the problem or best serve their patients.”

“It won’t help if the challenged trusts have to wait until after 2020 for central funding. They need investment sooner than that and support to make good use of that investment”

NHS England director for commissioning and information Matthew Swindells said earlier this month that no one would be “left behind” and trusts not in the most mature cadre could expect funding support too.

Cash committed to the 30 digital leaders announced to date totals a maximum of £210m (12 global exemplars to receive up to £10m each and 20 more national digital champions to get up to £5m) - out of a total £1.3bn promised new funding. So the lion’s share remains, theoretically at least, uncommitted.

NHS England and government have not yet made their full response to the Wachter review. These will need to covert the sentiment expressed by Mr Swindells into a robust plan for those who stand potentially to be left behind.


Not prioritising cash for tech laggards is 'right'