No news is not good news

NHS England’s technology funds were supposed to “catalyse” a “technological revolution.” But continued delays to the announcement of the outcome of the second fund are leading to disillusion and concern about the future of hard-worked plans.

“Our project was to move our paper based records to a digital service, using document scanning, to meet the 2018 digital NHS ambition,” one respondent wrote in response to a short survey that EHI ran last week on the impact of the delay.

“The delay in the announcement has had a huge knock-on effect; the cost of the solution has gone up, so we may not be able to afford to implement the service we bid for. Suppliers and staff are starting to doubt our commitment.”

“The delay has caused us to re-phase and re-plan to enable in-year spend, and prevented proper project kick-offs,” another reported. “Currently, we can still spend the in-year funds, but this will cease to be the case should [the announcement] be delayed beyond the end of January.

“Our project plans to replace our NPfIT [National Programme for IT in the NHS] contracts too, and this has to be completed by 2016. We are starting to look at alternatives to mitigate risk [but] the effects of the TF2 debacle are a criminal waste of public resources.”

Assume the best

The technology funds were launched in response to health secretary Jeremy Hunt’s call for a ‘paperless’ NHS by 2018. The first – or ‘Safer Hospitals, Safer Wards: Technology Fund’ – promised to deliver £260m of central funding for e-prescribing, document management and scheduling projects.

In the event, trusts won up £8.1m for projects that included major electronic patient record implementations. But around £60m went unspent because of the difficulty of meeting Treasury demands for return on investment from its money, and delays to the process that made it impossible for some money to be spent in-year.

The second – or ‘Integrated Digital Care Technology Fund’ – was launched in May last year, and promised a total of £240m of central funding for acute IT (particularly e-prescribing, again) and community-wide shared records and information sharing projects.

Trusts had until July to submit bids and EHI reported in August that 226 bids worth £360 million had been made to the fund, which was due to distribute £160 million in 2014-15 and £80 million in 2015-16. The bids were evaluated by September.

Some trusts were told in November that they had been unsuccessful, after NHS England’s director of strategic systems and technology, Beverly Bryant, told EHI Live 2014 that she was “beyond sorry” there had been no announcement.

Bryant said the hold-up was with Treasury ministers; but since then trusts have been told to assume that ‘no news is good news’; which they are finding it increasingly difficult to do.

“No news is in fact not good news,” one respondent to the survey wrote. “There must be reason for the delay, and that should be communicated honesty and openly, because that would allow trusts to decide how to progress or not.

“This lack of clarity is not good and contributes to money being wasted unnecessarily which, at a time when budgets are being exceeded is irresponsible.”

Another added: “No news creates uncertainty, delay and costs to already stretched trusts.” Another was blunter: “Silencing is wasting NHS time and money.” Another was blunter still: “Drink and brewery come to mind.”

Projects for sharing

The survey received a total of 50 responses, of which 32 came from people working at acute trusts, and most of the rest came from people working in clinical commissioning groups or consortia looking to run information sharing projects.

Seven had been told that their bids were unsuccessful, and three said they had been told by NHS England that they had been successful.

Almost all the rest (30 of the 48 who answered the specific question) said they were assuming they had been successful because they hadn’t been told that they hadn’t; eight said they simply did not know what had happened to their bid.

Most respondents (31 out of 46) had made bids for integrated digital care record or other information sharing projects, while five were looking to roll-out e-prescribing, and the rest were looking to implement electronic document management systems, portals, or named electronic patient records.

Although NHS England has said it wants to spend money on open source through the tech fund, only eight (out of 47) respondents said their bids were open source.

Most respondents were also looking for relatively small sums of money; with 16 (out of 48 who answered this question) saying their bid was worth less than a million, and the majority (28) saying they wanted between £1 million and £5 million. Two respondents wanted up to £10 million, and two more than that.

Time, money, effort

Respondents involved in shared record or information sharing projects were likely to say that they delay in announcing the outcome of tech fund 2 had strained their relationship with partners.

“The delay in announcing the level of funding has led to delays in the commitment of the partners to allocating further funding,” one wrote. While another commented that: “There is now no serious prospect of being able to proceed on a project that secures health and social care information exchange, supported by multiple partners.”

Respondents from acute trusts were likely to flag other problems, such as increased cost, and the difficulty of effectively spending money for 2014-15 in what remains of the financial year. Some warned that it would not be easy to reboot projects, if the tech fund 2 money fails to come through in the end.

 “Because this was a 50-50 funded project, due to be spent mainly in this financial year, and involved recruitment of staff to implement, we will now not be able to adhere to the original timetable,” one wrote. “The internal trust funding is no longer secure, so the whole project is at risk.”

“The predicted cost for the [electronic document management solution] has gone up, so we may not be able to implement the service we bid for,” another said. “The delays [mean this project now overlaps with] another major IT programme, so resources will be overstretched, with an adverse impact on both.”

Many respondents were furious about the potential amount of time, effort and money that had already been spent, and might go to waste. “Board approved, plans drafted, OJEU done. Now waiting and wondering what next. How can we claim reimbursement for this waste of time?” one respondent wrote, pithily.

Damaging the digital agenda

A lot has happened in the two years since Hunt made his ‘paperless’ speech and NHS England managed to secure what Bryant described as “tactical” cash for IT through the tech funds.

NHS England has changed its chief executive, and its new boss, Simon Stevens, has issued a ‘Five Year Forward View’ for the health service. This makes eye-watering demands for demand reductions and efficiency savings through public health improvements and service reconfigurations.

These will be needed even if a future government stumps up the£8 billion that will also be needed to close a £30 billion funding gap by 2020-21. And, with a ‘winter crisis’ and a general election campaign under-way, politicians from all parties are now trying to decide how much cash to promise, and when.

Yet, the 5YFV says that IT will be important, both to ‘glue’ the new structures together, and to provide patients with new digital services, including a ‘front door’ to take the pressure off A&E. Indeed, a new IT strategy, ‘Personalised Health and Care 2020’ has been put out to support these ambitions.

This makes it particularly odd that there should have been no announcement about the outcome of tech fund 2 when, presumably, it would have helped lay the foundations for these ambitions.

Certainly respondents to the survey feel the money may have gone in more immediate political priorities. “Bit of a cock-up, innit?” one suggested. “The whole thing is evidently being hijacked for political purposes.”

Despite this, there was sympathy for those trying to support NHS IT at the centre. “I have some sympathy with them in terms of dealing with the Treasury, especially this close to an election,” one wrote. “Nevertheless, communication has been poor and, I believe, has damaged the whole digital health agenda.”

Past time to bury bad news

If there is one certainty, it is that trusts and healthcare communities with tech fund bids in limbo need to know what is happening one way or another. Also, that they really, really need to know by the end of January. Several trusts identified as the last point at which they could commit – or otherwise – to significant spending or sign contracts.

“I fear the funds have gone. But some statement a la ‘nothing will be announced until we’re post election’ would help,” one said. “Even if the answer is ‘no’, just tell us and we can plan accordingly,” another concluded.