Insider view: Jon Hoeksma

More than two years after Fujitsu had its contract to update NHS IT systems in the South of England ended, hospital trusts in the region no longer expect to receive nationally funded systems.

As EHI exclusively reports this week, hospital trusts have been informally advised there is now almost no chance of national funding for a new acute ASCC deal this year, and that they should plan accordingly.

No official guidance, email or letters have been issued, but NHS hospital IT directors in the South of England tell E-Health Insider they are planning on the assumption that ASCC acute is unlikely to happen.

If informal guidance firms up into policy, the shift is dramatic and marks the formal end of a single ‘national’ programme for IT in the English NHS. It also means individual trusts will once again become the main decision makers in procuring and funding new IT systems for local use.

The picture may be of mixed fortunes. A separate proposed £85m new ASCC deal for community systems remains sat on the Secretary of State for Health’s desk, and may yet get approved. A further business case for ambulance systems in the South also may get support.

But for hospitals the prospects look bleak. Since the departure of Fujitsu as local service provider hospital trusts have been left in limbo, awaiting new central direction and not clear whether they could count on NPfIT funding.

Asked to confirm whether hospital trusts are on their own, NHS South Central and NHS South East Coast both said there has been no change but stressed the planned ASCC deals had been “an opportunity” and “not an obligation”.

While true, this only tells part of the story. Hospital trusts in the South have been in limbo since the departure of Fujitsu – and in reality even longer. The Japanese firm’s departure, like Accenture’s before it, came only after lengthy negotiations.

But after interminable delays, a decision on what next finally appeared to have been taken last year, when Department of Health director general of informatics Christine Connelly announced her plans to run a series of new ASCC procurements.

Crucially, Connelly told EHI last June that new procurements would happen within months and would be funded nationally.

“They will be funded as part of the National Programme for IT.” (23 June 2009). There followed a furious burst of activity as Connelly’s team and trusts reviewed products, culminating in a closed door demonstration event in late November.

But it now appears obvious that as with CSC failing to get a new LSP deal signed, new ASCC deals in the south have missed the political boat by failing to complete before April.

Since 6 May, political realities have dramatically shifted. A new strategy for the south, based on off the shelf and best of breed systems, simply came too late in the life of NPfIT, a project the new government has committed to scale back and wind down. The Treasury is now vanishingly unlikely to sign off new central NHS IT expenditure.

At the beginning of the year, the DH Informatics Directorate, NHS Connecting for Health, and the three southern strategic health authorities had been planning on the basis that three ASCC procurements would reach contract award this year, and all be funded out of unspent NPfIT funds in the South.

As recently as April, trusts were improbably being told new ASCC procurements for community, acute and possibly ambulance could be funded from the “existing total contract value” of money left in the NPfIT pot.

But the problem is that NPfIT funding in the South has almost all been spent. By September 2009 just £407m of the original £1.2 billion contract value remained unspent.

This despite the fact just eight NHS hospital trusts, out of a total of 43 in the South, had received new electronic patient record systems. A number that will hopefully rise to 11 with the addition of three Cerner ‘greenfield’ sites at Oxford Radcliffe, Royal Bath and North Bristol.

An improbably large chunk of the money spent was eaten up by the £546m April 2009 deal with BT to take over eight existing Cerner sites, move them onto a standard version of Cerner, shift them into a BT data centre, and deliver four (later three) new Cerner implementations. The deal also covered 25 RiO implementations.

So while many have been sceptical about whether new ASCC deals would ever see light of day, or be funded, they have had to plan on the basis they might.

Over the past few years it has required a bold trust IT director, chief executive or head of finance, to step outside SPfIT; risking opprobrium and possible financial penalties; or missing out on a ‘free’ IT system; or not receiving a potential NPfIT subsidy.

So while the demise of a new acute ASCC deal would not be cheered – a lot of people have worked very hard on ASCC, just as many more did in trying to make the various LSP plans work and to make progress under NLOP – it would at least create some clarity.

If a decision has been taken, and the signs are that it has, it would mark a U-turn on the policy of national selection and funding of NHS hospital IT systems pursued for almost a decade.

Since early 2003, trusts in the South have been told that they were obligated to use those systems purchased for them by the DH centrally under the National Programme for IT in the NHS.

The formal award of an £896m contract to Fujitsu in January 2004 came only after a series of existing individual and collaborative hospital IT procurements had been stopped.

If, as appears likely, we are now on the verge of a return to local decision making by hospitals in their selection and purchase of systems, the stated Conservative policy, then we truly are at an end of the Granger era.

NHS hospitals are unlikely to see any national investment in IT systems but they would certainly benefit from early clarity.