True costs of NPfIT greater than predicted?

Murray Bywater, managing director of Silicon Bridge consultants and a leading healthcare IT analyst, predicted that effective user involvement could add more than 20% to the costs of Local Service Providers (LSPs) who have won the five contracts to implement to new systems for booking, care records and electronic prescribing.

“Engaging the end user will be a difficult, complex, time consuming process,” he told the conference, "Effective NCRS Implementation" organised in London by eyeforhealth

Providing change management support to ensure that the new systems yield maximum benefit was another source of cost identified. "Some money, some resource, has to be found.  It isn’t clear who’s doing that," said Bywater.

Funding was a strong theme for another speaker, Martin Bell, head of IM&T at North Bristol NHS Trust who urged IT staff in trusts: "Get the money.  The national programme is not the whole answer"

"You don’t need to move to 2% [of total budget] to implement the national programme.  You may need to invest more if you are down at the half per cent level. It’s about using the money wisely.  It’s about spending it better."

In the immediate future, Bell’s robust advice was that trusts should also: engage with their LSP "early and often"- even though the official advice is against this; come up with some early wins and hang onto IT staff.

Bell admitted that trusts probably could not keep staff who were driven solely by the money offered in the private sector, but he said staff could be offered the challenge of the national programme and the knowledge that their work will help people get better or stop them falling ill. A good HR infrastructure and career path growth were vital too.

A sceptical view of the national programme’s forthcoming implementation phase came from Dr Grant Kelly of the British Medical Association. "I wonder if the LSPs have fathomed out the job in front of them?" he mused, revealing that he had advised several consortia bidding for LSP contracts and found the losers sounded far happier than the winners.

He identified cultural and political problems likely to hinder implementation.  "The national programme assumed a culture change.  The reality is that the culture change has not taken place and there are no plans for it to take place." he said.

Looking at the other priorities facing clinicians, he concluded that the changes to be driven by the national programme were well below the radar for most.  "It’s just not on anyone’s clinical horizon," he said.

Dr Kelly portrayed the current agenda as being driven very much from the centre, from No 10 Downing Street, in particular.  Asked what he would do in IT director-general, Richard Granger’s position, Dr Kelly said he would talk to Downing Street and manage expectations "in a huge way".

"I’d start winding back.  It would then help if he went humble and started to sell it [the national programme] to people.  You have to try to persuade people.  You can’t command them.  You are dealing with a lot of eccentric individuals and they will say ‘no’," he warned.