DH Preparing £5 Billion IT Strategy

This week E-Health Insider provides an advance preview of the yet to be released, yet to be approved, draft implementation strategy, "Delivering 21st Century IT Support for the NHS".

Two months ago Sir John Pattison announced at Harrogate that a new national strategy for NHS IT, based on common standards, new investment and a new relationship with suppliers was under development.

With the deadline for submitting the strategy for approval to No.10 falling at the end of May, the past two months have seen a frenzy of activity, meetings and speculation. The carpet into Sir John’s office has been worn threadbare as a succession of suppliers have been called in.

What is immediately apparent is just how ambitious the draft implementation strategy is. It aims to dramatically step up the pace of NHS IT development and to harness modern information technologies to ensure delivery of the NHS Plan.

The programme set out represents probably the most complex IT project ever to be undertaken in the UK, and the draft strategy explicitly acknowledges the scale of the risk involved. "This programme is very substantial, and it is quite clear that significant risk will be involved".

The magnitude of the project is reflected in the scale of investment being sought: a total project cost of an additional £5 billion in IT investment between 2003 and 2009.

Added on top of the £1.1 billion a year the Wanless Review estimated the NHS already spends on IT, the additional investment would take total NHS IT expenditure up to £11.6 billion over the six years from 2003.

With any new investment not due to become available until next year the strategy aims to ensure all the elements are in place to enable extremely rapid progress from April 2003. "Ruthless standardisation" is promised.

But to ensure a flying start will require systems to be need to be specified, designed and procured at breakneck speed. Just agreeing basic system specifications and data standards will be a huge programme of work.

Immediate priorities set out are to work on developing the IT management structure, capacity and capability within the NHS; define the data and data interchange standards needed; develop system specifications; begin building a National Health Record Service; and work to streamline procurements.

To drive the programme forward a ministerial Task Force is to be established, while a new national NHS IT Programme Director will be appointed to oversee implementation and control investment funds. At the regional level each strategic health authority will appoint a chief information officer to co-ordinate implementation in PCTs and NHS trusts.

One of the most significant aspects of the strategy is the much greater role envisaged for partnership with the private sector. Major components of the strategy are to be outsourced to new consortia of suppliers.

The immediate priority on technology is to upgrade the basic IT infrastructure across the NHS, by providing high-broadband connectivity to all NHS staff, backed by means of authenticating users to access sensitive patient information.

Once this expanded IT infrastructure is in place core national patient-facing applications can then be delivered and accessed by staff.

In the initial phase these national applications will be electronic records, booking and prescribing, all of which will be implemented based on standard specification and developed into national services.

The ‘National Bookings Service’ is due to be 100% implemented by December 2005, with the ‘National Health Record Service’ and ‘National Prescriptions Service’ fully operational by December 2007.

Though the draft strategy does not make clear exactly what these three new ‘National Services’ may entail it seems likely that together with network services they will be strong candidates for strategic outsourcing to the new "development partnerships" envisaged with consortia of suppliers.

The DoH is known to regard NHS Direct as a model for rapid technology implementation, which moved from pilot phase to national roll-out without lengthy evaluation. Both the Booked Appointments Programme and Electronic Transfer of Prescriptions project are at pilot phase and could potentially provide platforms for rapid national roll-outs.

Other systems such as Electronic Patient Records (EPR) will be implemented locally, chosen from a list of accredited suppliers compliant with a new national standard XML-based specification. Elements of EPR systems are to be partly implemented by all PCTs and NHS Trusts by December 2005, with full implementation by December 2007.

Specifications are also being developed for PCT information systems, primary and acute EPR systems, community and mental health, electronic health records, and a national ‘Health Records Infrastructure’.

In the longer term — 2008-2010 — the strategy tentatively pencils out goals for home telemonitoring to be available to all homes that require it and for the electronic health records to have evolved into a ‘Unified Health Record’ containing both health and appropriate social care information.

Will it fly? The investment required is huge, most of the detail remains to be worked out, and to ensure the whole programme is actually delivered the DH appears to be relying heavily on "development partnerships" with industry consortia led by heavyweight prime contractors.

But any green light will be far more about politics than standards or programme management skills. IT has clearly been identified as capable of delivering rapid tangible improvements in the quality and responsiveness of NHS services. This will probably be enough to ensure an investment bonanza, but in return the Government will demand delivery like never before.