Exclusive: All trusts will buy new IT via NHS 'exemplars'

Matthew Swindells, NHS England’s director of operations and information, told HSJ the Treasury had approved £385m for its flagship digital programme, and a further tranche of funding was expected by the end of 2017-18.

Exemplar organisations, which covers providers and will in the future cover health economies, will be put on a new procurement framework where they will work with their IT suppliers to sell digital transformation services to less digitally advanced organisations, he revealed.

“We are looking for our global digital exemplars to build systems internally, where they effectively sell implementation support from their IT teams and their clinicians,” Mr Swindells said.

The exemplar programme, launched in September 2016, is the first large scale attempt to digitalise the NHS since the National Programme for IT, which was widely considered an expensive failure.

For the past few years providers have been left to purchase their own clinical systems. However, soon any trust wanting central support will be expected buy from the global digital exemplar framework, essentially paying another NHS organisation to help them deploy the clinical system it is using.

Mr Swindells said: “If you go, ‘I’ve just seen the latest fantastic system in Turkey and I’d like to bring it to the NHS’, [then] we will say, ’You can still do that but you’re on your own, that’s not our recommendation. Our recommendation is build what works and spread them and at the end of that we will end up with half a dozen systems running across the NHS.’”

To date, 16 acute digital exemplars and seven mental health exemplars have been selected. These trusts are being given between £10m and £5m of central funding, to be matched locally, equating to about £195m.

The remaining £190m signed off by Treasury will fund the first wave of 16 “fast follower” trusts, the first trusts to partner with their chosen exemplars; new ambulance trust exemplars; and around five “place based” exemplars.

Placed based exemplars were first revealed by HSJ in May, and will focus on integrating health and care records across heath economies, likely through sustainability and transformation partnerships.

In addition, Mr Swindells said NHS England was in talks with Treasury about releasing another “fairly significant” tranche of capital and revenue for digital projects, hopefully by the end of the financial year.

This money would be allocated to STPs, which could use it to fund priority digital projects across their footprint.

These projects would include bed management, acute e-prescribing, social care integration and picking new fast followers.

“Once we have established the model and the framework, we would like it to be applied locally,” Mr Swindells said. “There comes a point where we stop picking winners from the centre and ask them to pick winners locally.”

Both rounds of funding are a mix of capital and revenue drawn from the £1.3bn “Paperless 2020” funding health secretary Jeremy Hunt announced in February 2015.

The exemplar programme was developed in response to Professor Bob Watcher’s review of NHS IT, which found as many as half of NHS trusts were not ready for digital transformation.

The review recommended prioritising funding for the most digitally advanced trusts, which could serve as models and partners to lead the rest of the NHS.

Mr Swindells said every trust would eventually become a “follower”, picking a global digital exemplar and their clinical system from the framework.

New trusts, running different IT systems, could be added to framework if they proved they were up to exemplar standard.

Existing exemplars could also be removed if they failed to prove their worth, he said.

Fast followers would go through a truncated competitive procurement process within the framework to choose their exemplar partner, which Mr Swindells said would dramatically cut costs.

“It’s not like the National Programme for IT, where you’re in the South so you have to take the system. It’s quite the opposite. It’s saying, these are the systems that work and we are backing what works,” he said.

With the exception of primary care and national digital services, the new approach means clinical IT suppliers without a relationship with a digital exemplar will effectively be shut out of the NHS.

“If you can’t prove your system works in a global digital exemplar, who is going to follow it?”

The new exemplar trusts and areas in line for funding are expected to be announced at the Health and Innovation Expo event in September.