Waiting for 2 long

It’s a question Beverley Bryant must be sick of hearing; but one she is all too used to dealing with by now. What has happened to tech fund 2?

When EHI News asked, at a recent event, what hole the ‘Integrated Digital Care Technology Fund’ had fallen into, NHS England’s director of strategic systems and technology balanced optimism about an impending announcement with reality about not having a satisfying answer.

“I can’t say anything. I’m literally homing in. I can’t even tell you. You won’t believe the level I’m talking to – please just wait. As soon as I know how much money I’m getting, you’ll know.”

That even Bryant can’t confirm the whereabouts of £240m of NHS IT money is alarming; and speaks volumes about the morass of uncertainty that the second round of the tech fund is now drowning in.

More than seven months after applications closed – on 14 July 2014 – trusts are still waiting to hear officially whether their bids have been successful; and if they have been how much money they will actually get.

The delay has frustrated IT directors and suppliers alike, as the market stagnates and projects are put on hold, downsized or abandoned altogether.

‘Imminent but unconfirmed’

Back in January 2013, health secretary Jeremy Hunt announced that he wanted a ‘paperless’ NHS by 2018. Initially, there was no money to support this vision, but in May the government found £260m for e-prescribing and other patient safety initiatives.

This money became the first, or ‘Safer Hospitals, Safer Wards: Technology Fund’ when it found a further, £240m of central funding in September.

The outcome of tech fund 1 was duly announced in May 2014, after a scrambled bidding and assessment process, and some to-ing and fro-ing with the Treasury over the return on investment that it might get.

A calmer process was put in place for tech fund 2, which also allowed joint bids with councils for shared records and information sharing projects.

This process was completed by September; at which point 226 bids worth £360 million had been made. But since then, NHS England has only been able to say that the announcement of which trusts will get money and for what is “imminent but unconfirmed.”

Sources have told EHI News that the Treasury is responsible for the hold-up, having failed to give its final approval for the funds to be released.

There have also been rumours that it has slashed the fund by £90 million to shift money towards dealing with A&E pressures in the run up to the general election.

However, in a frustrating round of calls this week, a Treasury spokesperson told EHI News that the issue was “one for the [Department of Health]”.

And a DH spokesperson told EHI News that: “The Integrated Digital Care Technology Fund applications have been assessed by NHS England and are with ministers for consideration.”

A reprehensible delay

Last month, EHI News ran a survey asking trusts to share information on how the delays have affected their IT plans.

Almost two thirds of the 50 respondents said the lack of news had put their project in jeopardy or led to additional trust spending, while one said their trust had already abandoned its plans.

Several said the end of January was the ‘point of no return’, after which they would no longer be able to commit funds or sign contracts. That date has been and gone.

EHI News has subsequently spoken to a number of chief information officers, IT directors, and other senior IT leaders, who seemed, if anything, even more resigned to the loss of the fund and the projects they hoped to pay for with it.

 “We’re almost past the point of caring,” one said. “Someone’s teased us with this for a long time, and we’re trying to wait in anticipation… and wait… but it seems to have just dropped off the radar. If some fairy comes along and gives us money – great. But we presume it’s disappeared into the ether.”

However, another CIO said frustration is growing, with some people contemplating a collective expression of disgruntlement.  “It’s just the usual kind of madness – how can we still be waiting on news in February? It’s ridiculous.”

Successful or unsuccessful?

Confusingly, some trusts have announced “successful” bids in their board papers, despite the lack of both an official announcement and, according to the DH, ministerial approval for one.

Taunton and Somerset NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust have both included details of their projects and the size of their successful bids in recent board papers.

In Taunton and Somerset’s January board papers,  treasury and investment committee chairman Christopher Harvey said NHS England had told the trust its tech fund bid for its IMS Maxims open source EPR had been successful; but limited to just under £4 million.

In South Tees’ December 2014 board papers, chief executive Tricia Hart said she was “delighted to share… that the trust’s funding bid for £3 million…has been successful, subject to approval from the Department of Health.”

Both trusts have emphasised to EHI News that they are fully aware their funding is contingent on Treasury approval. However, neither has been able to explain exactly how they were given the impression that their bids had been successful.

Meantime, suggestions that any money that is still available is more likely to go on open source than other kinds of software have both caused outrage and been vigorously denied by NHS England sources.

Putting the brakes on future plans

The uncertainty facing trusts has flowed onto suppliers, many of whom were bracing themselves for a burst in procurement activity from successful bidders. One supplier said the hiatus had “killed the market dead.”

Electronic prescribing, named as a particular area of focus for tech fund 2, is just one sector where suppliers have had to reshape their plans in response to the lack of news.

Robyn Tolley, managing director of Noema Life, says the company has “put the brakes” on its planning for future NHS work until it gets more clarity about where funding will come from.

“The simplest thing to do is say that our strategic planning for NHS England is on hold: any level of investment that we were prepared to make in future work is postponed, because we don’t really know what that future is.”

The impact of the delay can be seen in the number of procurements Noema Life has in train, with only a handful currently being worked on against the “20 to 30” it expected to be dealing with only nine months ago.

Rob Blay, chief executive of JAC, agrees that the on Tech fund has created uncertainty in the market which has not helped planning.

“Expectations were running high, both from the supplier and trust perspective, especially after the early momentum of round 1.

“Planning for round 2 has had to be put on hold until [there is] clarity over whether the funding will actually be approved, for which trusts, for what products and for which financial year.”

In addition, Tolley says, suppliers who “ramped up” their staff and resources in anticipation of a boost in activity will now be paying the price.

While he says suppliers are accustomed to dealing with a lack of communication from NHS England, he has particular sympathy for the trusts that have been waiting on answers.

“These guys have to do an awful lot of planning, and here we are on 18 February, when the vast majority of funding was meant to be for 2014-15, and there’s nothing.”

A loss of confidence

The long-term impact of this fiasco remains to be seen: for his part, Tolley says the delay will merely slow, rather than kill, the adoption of new systems.

“The opportunity doesn’t go away, because there are still a huge number of trusts who don’t have e-prescribing – but the funding and take-up is going to take a much longer time.”

Blay says the main risk is that NHS England’s plans to digitise the NHS by 2018, backed by health secretary Jeremy Hunt, come increasingly under threat as a result of significant delays.

The real damage, rightly or wrongly, is set to be a loss of confidence in NHS England. While it may be the victim of ministerial machinations, the organisation is the obvious scapegoat for angry trusts and suppliers; and radio silence has hardly helped.

There is no doubt about how hard Beverley Bryant is working to secure the release of the funds, and even critics of NHS England’s handling of the matter acknowledge that she is not to blame for the delays.

Nevertheless, until she can give a clear answer on how much trusts will be getting and when, the barrage of questions about tech fund 2 is unlikely to subside.