Life After NPfIT: Do We Have A National Strategy For Health IT Or Not?

Nov 21, 2014

“One of the worst and most expensive contracting fiascos in the history of the public sector.”

Don’t feel too proud of yourself if you immediately know the subject of that damning statement… as it’s not just anyone involved in health IT, or who follows public sector ICT, or has a passion for good project management and procurement who will know to what that sentence refers: to be frank, it’s us – the taxpayers of this country.

Why? Because it’s us who have footed the bill for the National Programme for IT – a massive New Labour pipe-dream that despite being ‘cancelled’ in 2012 still rumbles on in some parts of the NHS and which, as the NAO and Public Accounts Committee have so repeatedly told us, never managed to deliver a working EPR (electronic patient record) despite around £12bn being spent.

We immediately have to say that yes, as we all know, good things did come out of the Programme that are still with us, though now migrated and adapted, such as the Spine. (And of course, ‘only’ £2.7bn was spent on the EPR work – though notoriously, not all the money that will eventually go to contractors has been trousered by them, yet; earlier in the year, we reported that one of the first suppliers to be exited from the scheme, Fujitsu, still stands to get £700m for work it never did).

But overall, it’s hard to disagree with the speaker, longtime NPfIT critic MP Richard Bacon; yes, the Programme was a landmark case study of how not to do IT procurement for a major, indeed critical, public service.

But there is just no point any more beating the drum on this (though MBA students in perpetuity, and, we hope, senior civil servants, will surely profit from reading well-researched documents like this one about what went so horribly wrong. We can always hope they do, and heed the warnings!). That ship has sailed. It’s time to move on.

And in many ways, we have. And as the Programme stopped in March last year (if you want ‘official’ confirmation that it really has stopped, even if you don’t personally believe it, see here), we do sort of need to know where we are now?

Go Paperless. Only, With No Paper Money To Do It

Well, we think the Coalition dismantled the Programme and then, well, rather confused us all by saying we had to do it anyway… only with no money.

How else to understand Health Secretary Jeremy Hunt’s ( focus on attaining greater patient safety via going massively digital: “It is crazy that paramedics cannot access a full medical history of someone they are picking up in an emergency - and that GPs and hospitals still struggle to share digital records.”

So there is a clear demand for widespread use of EPRs, or EPRs in anything else by name, by DoH (see here), which is convinced that by 2018 at the latest we will be having fully electronic patient data exchange, plus an ability to contact our doctors by Skype or email and get consultancies by videochat if we so desire, more or less at a time of our own choosing.

We said ‘no money’ to do all this - and it is true that no huge war chest has been made available to do all this, as was the case with NPfIT. Yes, we have things like the £100m nursing tech fund and what seems (the figures sometimes feel like the money is being double counted, Gordon Brown style) like a £500m or so EPR-encourager pot of money being driven by NHS England.

But it’s all been a bit vague. Whatever else it was, the National Programme was a supertanker whose direction you might worry about but whose ‘motion through the ocean’ was unmistakeable. In fact, so dominant was NPfIT in HIT (health IT) procurement that, in effect, whatever UK health informatics market there had been was totally subsumed by it. In the months since the end of the Programme, apart from some activity porting people off former LSP radiology contracts and some work on the Spine we’ve not really seen that much life in the NHS IT market.

We now may have a glimpse into the post-NPfIT future, courtesy of still relatively new-in-post NHS England chief executive Simon Stevens and his genuinely landmark ‘Five Year Forward View’ document, published last month.

Why is this so significant for understanding a truly post-NPfIT NHS HIT ecosystem? Stevens is very clear – repeating but making his own the oft-observed assessment on NHS IT initiatives that they never work as they are all driven from the centre – that it’s now up to the local IT leaders – you guys – to make it all work.

What Stevens and his team are prepared to do: provide a subset of what he calls ‘national’ IT systems that are meant to act as a defining framework only… with the rest being sourced, perhaps built, certainly managed, at the grass roots (“We [NHS England] will focus on the key systems that provide the ‘electronic glue’ which enables different parts of the health service to work together. Other systems will be for the local NHS to decide upon and procure, provided they meet nationally specified interoperability and data standards,” p31).

Which is great…

But how will it work?

Is There Some Sort Of Middle Procurement Option?

We accept that the top-down approach got tried and it failed.

But given the enormous strains on an NHS that is supposed to be finding £20bn worth efficiency savings (, while seemingly lurching from crisis to scandal to total reorganisation to winter crunch point…

Who on Earth is going to have the time, resources and mental capacity to really do this?

That’s why even though we might well be glad to see an end to the excesses of NPfIT, we remain very concerned about the state of NHS IT.
Is there perhaps an argument for some kind of midway point: a relatively well-funded but certainly tightly managed procurement agency, a kind of Connecting for Health that worked, to be set up and help create and support the kind of internal ‘market’ Stevens seems to want to bring to life?


Next week we will examine what use private healthcare is making of innovative ICT; contact us if you feel you have something to add to that discussion

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