CfH could face a £10 billion funding gap

 A new consultation paper produced by an influential health computing industry group has raised concerns about the medium-term funding of the NHS National Programme for IT, suggesting that there may be a funding gap of up to £10 billion.

"It is felt that there is a medium-term funding gap estimated at over £10 billion pounds that needs to be covered locally," says the paper, although it does not indicate how it has calculated this figure.

"The ‘Radical Strides’ paper from the British Computer Society’s Health Informatics Forum states: "There is concern about overall CfH longer-term finance too as the NHS has not publicly committed to it."

The paper does not quote a source for the projected funding gap. However, although the DH has signed contracts for NPfIT that have a lifetime value of £6.3 billion it has only publicly committed £2.3 billion of central investment to date.

The paper also questions whether NPfIT will deliver cash-releasing efficiencies that will help offset the upfront costs of implementation: "Operational practitioners feel that NPfIT will not save cash as similar informatics initiatives may have done in the corporate sector."

It also notes: "The ministerial claim that the new informatics will save funds through efficiency gains is fallacious, as the anticipated outcome is a greater output at best within the same funding."

Overall the paper says that the National Programme for IT is going in the right direction, but says the first phase is only producing benefits for some of the sites involved, particularly those that had no previous patient administration system.

“Those who are well ahead and had high expectations of what the new strategy would bring them are, in the main, still disappointed. It is felt organisations with some informatics, but not at the leading edge, will gain most from Connecting for Health (CfH) ultimately” the draft paper says.

The paper lists over 100 bullet points about informatics support for health under 12 wide ranging headings. It is a preliminary document described as an “interim synthesis for consultation.” Eventually it will be worked up into a final position statement entitled Radical Strides.

Many of the issues cover familiar territory. For example on clinical engagement, the paper says: “There are still concerns that a lack of engagement will lead to solutions without appropriate clinical focus and that are unwieldy in operation.”

However, it says that the six clinical leads introduced by CfH are already bringing benefits.

But the paper also says: "Clinicians see that informatics will improve healthcare but have yet to be convinced the products under development will reflect their requirements and realise operational benefits. Experience to date with the emerging Patient Administration Systems and Choose and Book support this concern."

The paper notes significant concerns remain about legitimate professional access to sensitive patient/client records. “In terms of who can see what data the role-based access concept is proving useful; but it must take into account the fact that many professionals have a number of roles with different requirements at different times.”

Communication about health IT developments – another continuing source of concern and comment – is perceived by the health informatics forum to be getting better, but also seen as being patchy and a one-way process, not a dialogue or genuine debate.

Commenting on the huge training agenda created by IT modernisation, the forum praises CfH’s commitment to training staff to get the best out of solutions being installed, but notes there is still a large agenda to cover.

“Involving outside agencies, local education and training co-ordinators and supporting existing services, like PRIMIS, are key,” says the forum. “Staff need to be (re)trained in how to do their jobs professionally utilising IT as a tool, not trained in IT in isolation.

“Greater emphasis should be placed on facilitating different professions working together effectively; but the current responsibility is confused between human resources, local change agents and those in the centre of Agenda for Change.”

The paper calls for health informatics to be integral to professional education and training, especially as only a small percentage of professionals indicate they would seek out specific health informatics training.

On funding, the paper notes that, to gain commitment, the plans need to be fully funded at all levels from the Department of Health to the local NHS.

“Maximising commitment to change is difficult and [it] should be recognised that situations may get worse before they get better, which is very likely where savings generated do not accrue to organisations that make the most radical change,” the paper notes, adding later that because the pressures from funding operational informatics are not understood locally, local managers do not place priority on funding it at present.

Management engagement and ownership is essential at all levels the report stresses. "Management ownership of CfH initiatives is required at operational, tactical management and strategic policy levels. This will only come by demonstrating benefits and a continuing briefing on progress and pitfalls. At present senior managers are not convinced of success and are therefore distancing themselves from CfH and any other technology-based developments."