The politics of 2010

As 2009 went on there was mounting concern about how the credit crunch would affect NHS spending and the National Programme for IT in the NHS. Sarah Bruce asked politicians and policy makers to predict what 2010 will bring – and to set out their wish lists for the coming year.

Quick links

• Mike O’Brien, health minister with responsibility for NHS IT
• Andrew Lansley, shadow health secretary
• Stephen O’Brien, shadow health spokesman
• Norman Lamb, Liberal Democrat shadow health secretary
• Frances Blunden, senior policy manager, NHS Confederation
• Murray Bywater, managing director of Silicon Bridge Research
• Jonathan Edwards, Gartner’s European healthcare research director
• Mik Horswell, spokesperson for UKCHIP

Mike O’Brien, health minister with responsibility for NHS IT

The recent party political knockabout around the future of the National Programme for IT in the NHS has settled down, as politicians realise the government’s firm commitment to delivering its vision.

I expect delivery to continue to pick up pace in 2010, particularly with the Summary Care Record and the Electronic Prescription Service, as well as in the acute sector. Coupled with the work we are doing on mobile technologies and telehealth, potentially 2010 should be a year of great progress, establishing informatics at the heart of delivering high quality, personalised care.

Giving patients and staff access to crucial information is also a priority for 2010. We want patients and service users to be involved in their care and confident about their choices. This means providing accurate and accessible information about outcomes. It also means offering channels for their feedback to impact directly on the services they use.

The Luddites on IT may well pretend the project is going to hell in a hand-basket and that somehow the NHS can survive disconnected, but political realists know the vision of a connected NHS is essential to its future.

Andrew Lansley, shadow health secretary

It is clear that 2010 will be a year in which we see a fundamental re-evaluation of the implementation of the NHS IT programme. The independent review [that the Conservatives commissioned from Dr Glyn Hayes and which reported in July], gives us a sound basis for this.

As part of this, we think it is time for the government to abandon the flawed local service provider contracts. Whilst the contracts remain shrouded in ‘commercial confidentiality’, we suspect that it would now be possible to abandon them without penalties in either direction, because the costs of fulfilling the contracts to the companies would exceed the value of the contracts to them.

We want to see hospitals choosing their own software within a framework of interoperability, innovating locally to deliver IT solutions tailored to the needs and wishes of their community. This will require a level playing field for software and hardware suppliers, and a commitment to open source solutions across the NHS.

Taken together, these measures would free the local to focus on developing quality IT systems that deliver local accountability to patients, and empower clinicians to focus on improving the results of patients’ treatment.

Stephen O’Brien, shadow health spokesman

A pressing issue that I would like to see resolved in 2010 is where the £600m spending cut recently announced by [health secretary] Andy Burnham will hit the NPfIT. At the top of my wish list, however, would be a transparent renegotiation of the programme’s LSP contracts.

The public has a right to assess whether these contracts offer value for money and I think it is high time the government returned to the negotiating table to ensure that NHS trusts can access competitive, innovative and flexible IT solutions.

If the government is going to persevere with the current LSP arrangement with BT and CSC, I would like to see hard evidence that the Lorenzo and Cerner systems are making a real difference to patient care at the grass roots.

I would also like to see a more detailed explanation of the local costs incurred by trusts installing these systems – it emerged this year that both the Royal Free and Barts and the London spent over £4m implementing Cerner.

The final item on my wish list would obviously be that the Conservatives earn the chance at the next election to implement their localised, interoperable vision of IT, so that innovation and choice can finally get the chance to flourish.

Norman Lamb, Liberal Democrat shadow health secretary

As a result of the Pre-Budget Report there is a complete lack of clarity around NPfIT. Nobody knows the details around the LSP contracts, and this is something that I will take up with the Secretary of State for Health personally. Nobody can plan anything without that clarity.

Beyond that, there needs to be a radical shift away from centrally imposed systems. NHS Connecting for Health’s central operation needs to be dismantled, as does the effort to secure national databases. There should also be changes to Choose and Book, recognising its limitations and the problems with its robustness.

I’m not in the school of thought that says you can scrimp on IT. I think that more efficient health systems depend on IT, but there is a need to move away from this nightmare of the national programme in order to improve care for patients. I would also like to see much smarter use of resources and a lot more investment in telecare.

Frances Blunden, senior policy manager, NHS Confederation

The forthcoming election, its implications for the future of NPfIT, and the squeeze on NHS resources as a result of the financial crisis will be the dominant themes for 2010.

The Pre-Budget Report has already identified the need for savings from NPfIT, but where and how they will be made is still unclear. We would urge caution on this front; whatever happens, trusts will need to invest in effective IT systems as these will be crucial tools in delivering the efficiencies and more effective working that will be needed.

Wholesale abandonment of the programme would be unhelpful, particularly for trusts that have already signed-up; although it certainly needs to adapt to changing circumstances and the lessons learnt from earlier deployments.

The NHS Confederation would particularly like to see more flexibility in the programme so that it enables more local configuration, development and innovation. Top of my wish list for 2010? For Lorenzo to work and prove to be a really effective system, as so much of the NHS is waiting on this.

Murray Bywater, managing director of Silicon Bridge Research

Expect no big changes with NPfIT – the present government gave up on the original concept years ago, and most of the recent ‘action’ has been political window dressing and damage limitation. No surprises are likely from either of the opposition parties – they too have clearly signaled their intent to wind down much of NPfIT.

Whoever wins the general election, trust chief executives are going to be encouraged to take much more responsibility for their own destiny in terms of local IT. That will be a positive and welcome move away from the dead hand of central direction – albeit without the comfort of central funding.

My big wish for 2010 is that the incoming government will move swiftly to put details of all the LSP contracts into the public domain, so that we can finally see what has been going on. There are some big lessons still to be learned from NPfIT about how not to implement clinical systems.

Meanwhile, business intelligence and clinical data integration at the point of care are going to emerge as pivotal application areas at the local health community level.

Jonathan Edwards, Gartner’s European healthcare research director

As the NHS prepares for cuts in funding, NHS trusts will be exploring areas of potential savings in IT. These include IT procurement and the cost of IT itself. However, it will be vital to maintain confidence in the value of IT.

Despite its promises, NPfIT has made little progress in reducing the fragmentation of patient data. Increasingly, NHS trusts will be investing in low-cost interoperability solutions that enable them to share critical data between GP, community and acute-care organisations.

Hopefully, the NHS will pay equal attention to aligning the incentives of trusts to create joined-up health communities – even joint IT governance structures – which would open up even more opportunities for IT consolidation.

The last year of the current funding cycle will be a window of opportunity for trusts to invest in electronic patient record systems. The market will favour systems that can also meet the administrative and financial needs of trusts that can generate high-quality information for managers, and that can help trusts as they adapt to the growing trend of payment for quality in the acute sector.

But trusts will need to pay close attention to the total cost of ownership of such systems, including the upgrades in infrastructure necessary to support them.

Mik Horswell, spokesperson for UKCHIP

Likely themes for 2010 are going to be reduced central funding for NPfIT systems and correspondingly increased emphasis on local responsibility/choice, plus hiatus/indecision/paralysis created by pre and post election uncertainty on policy and priorities for NHS health informatics.

My wish list for 2010 is for systems that are approachable and user friendly to clinical/operational staff; for example: single sign-one, comprehensive use of NHSmail, a whole system understanding of confidentiality, greater emphasis from the centre on health informatics professionalism for all staff and a properly designed study on cloud computing in the NHS.