Parliamentary briefing paper sets out challenges for NPfIT

‘New NHS IT’ a Parliamentary briefing note prepared by the Parliamentary Office of Science and Technology provides a succinct and up-to-date overview of the main features of the NPfIT, following the February award of the New National Network (N3) contract to BT.

Introducing the NPfIT the document notes: "The Government has recently signed contracts for a £6 billion modernisation of NHS computer systems in England." It then sets out the four main components: electronic patient records, electronic appointment booking; electronic transfer of prescriptions and an upgraded NHS broadband network.

Commenting on the key challenges ahead it observes: "However it involves managing a large IT procurement and imposing change on a highly devolved NHS." 

The document states that while the aims of the programme have been widely welcomed, "some stakeholders are concerned over the ability of the government to deliver such a complex IT project to meet users’ needs and within such a rapid timescale."

Turning to the issue of funding the note says that in addition to the estimated £850 million the NHS currently spends on IT each year (excluding staff), funding for the national programme is £370 million in 2003/4; £730 million in 2004/5; and £1.2 billion in 2005/6.

However, it adds that further central funding will be needed to fund the supplier contracts for their full lifetime.  In addition it states "central funding will not cover all aspects of the national programme’s delivery and it is not clear what proportion of funding will need to be found locally."

On funding the report concludes: "While national funding for IT has been ring-fenced, local funding to make it work may vary."

Moving to the issue of managing change the briefing paper says: "For the new IT to be introduced successfully, substantial effort will need to be given to non-technical issues, such as rationalising how work is carried out, encouraging people to use new systems and learning from experience."

Citing NHS Confederation figures that the costs of managing the changes introduced by IT will be least as much as delivering the IT itself, the briefing document states:  "This is not within the remit or funding of the national programme, but will be the responsibility of SHAs, supported by the Modernisation Agency.

"Funding for such initiatives will be a key issue, including the balance between central funding via the Modernisation Agency and local support from existing budgets."

Training the 850,000 NHS staff expected to use IT from the national programme is also identified as a major challenge.  While suppliers will develop training material it will be down to trusts and SHAs, supported by the NHS Information Authority to pay for and organise training.

The briefing note states: "Trusts will need to buy-out time while people train, and make allowance for the fact that productivity is likely to decrease temporarily after introduction, as people get used to new systems."

Addressing the issue of stakeholder engagement and communications, the document cites National Audit Office research that found lack of effective engagement with stakeholders is one of the most common causes of project failure.  It says that NHS CRS has been developed with the input of clinicians, but that surveys carried out – including one co-sponsored by NPfIT – "suggest that overall clinician awareness of the national programme is low".

Noting that many previous NHS IT systems have been under-used the briefing paper says there is a general consensus that clinicians and other users should be closely involved in the national programme to: ensure systems deliver what people need; lessons can be learnt from current best practice and past mistakes; ensure leadership in local trusts; and encourage buy-in, and overcome scepticism created by previous IT failures.

"One of the most important issues will be the cost of "buying-out" clinical time, so clinicians can be involved in training and implementation."

On the question of health IT professionals, the paper says that while the national programme has ruled out wholesale transfers of NHS IT staff to suppliers, ASSIST, the NHS IT staff organisation, remains concerned that many NHS IT staff may move into the private sector.

Moving on to technical issues it notes that to create the NHS Care Record, it is envisaged that some data will come from existing systems in GP practices and hospitals, with records built up over several years. "In addition to the costs of collating the data quality will be a key issue."

On the issues of security, consent and confidentiality the paper says that according to research undertaken by the Consumer’s Association and the NHSIA "patients’ main concern about the NPfIT is over security, with worries about viruses, hacking and reliability."

The paper points to the difficulty of effectively implementing effective consent systems, with opt-in approaches described as more expensive and difficult to implement than opt-out.  "Experience with the introduction of electronic records in Alberta, Canada, showed that clinicians saw 30% fewer patients, in part due to the time needed to obtain explicit consent to share records." 

Patients’ concerns over who will see their record, and possible future function creep, also need to be addressed.  "As each NHS Care Record will be identified with a personal NHS number, some groups have expressed concern over future potential links with a national ID card.  It will be important for the national programme to specify explicitly whether and when external bodies will be able to see the NHS Care Records."

Despite robust measures proposed by the NPfIT to ensure that only authorised users can access clinical information it comments that "some clinicians have expressed concern that a stringent security regime will need to be implemented carefully, if it is not to discourage doctors from using the system."

The report concludes: "Clinicians, patients and other stakeholders will need to be heavily involved in implementing the programme if it is to meet their needs and be widely used."    

POST is an office of both Houses of Parliament, charged with providing independent and balanced analysis of public policy issues that have a basis in science and technology.

Link: ‘New NHS IT’, Parliamentary Office of Science and Technology, Feb 2004