Health IT rethink needed amid “colossal” financial challenge

Sir David Dalton has called for a radical shake-up in the way that NHS IT is bought and deployed in a health select committee report that warns the NHS is facing a "colossal" financial challenge.

As part of an inquiry into the impact of last year’s spending review on health and care, MPs visited Salford Royal NHS Foundation Trust, where chief executive Sir David told them that technology was a “key enabler of successful transformation”.

Salford deployed the Allscripts electronic patient record in 2013, in support of its ambition to be “the safest hospital in the NHS”. Sir David told the committee it had enabled the trust to standardise care pathways and to link acute to primary care, “reducing variation in care standards and achieving economies of scale”.

But he also told them that too many trusts failed to achieve the same. “He said that too often the NHS procures IT in the wrong way and continues to implement systems that do not deliver the expected results,” the committee’s report, published this morning, says.

“He believes that improvement could be achieved by designating trusts [that have] a track record of successful implementation and delivery as project managers of implementation at other trusts.”

Sir David’s trust is part of one of the most high-profile ‘vanguard’ projects, set-up as part of the ‘Five Year Forward View’ plan. The plan is intended to help close a gap between funding and demand that could otherwise reach £30 billion by 2020-21.

The vanguard is looking to create an ‘integrated care organisation’ by collapsing barriers between health and care organisations, and to set up a ‘new model’ of care based on population risk management.

Salford is also at the forefront of the movement for hospitals to form ‘chains’, which have already shown a tendency to pick the same core systems. So it is perhaps not surprising that Sir David told the committee: “He favoured a hub and spoke approach, rather than every trust retaining its independent approach to digital improvement.”

Last year, a similar report from the health committee warned that the government needed a detailed plan for implementing the Forward View.

Since then, the country has been through a general election and a spending review process that has seen the NHS promised an additional £8.4 billion above inflation by the end of this Parliament, with some of this money ‘frontloaded’ for transformation initiatives.

The committee’s report criticises the government for changing its definition of NHS spending, to exclude major items such as Department of Health and public health spending to meet its ‘above inflation’ pledge. It notes that “using the original definitions, and taking 2015-16 as the base year, total health spending will [in fact] increase by £4.5 billion in real terms by 2021”.

It also warns this means “the scale of the funding challenge is colossal, especially given the timescale for achieving it”. The worsening financial state of the acute sector, which finished the last financial year £2.4 billion in deficit, and the collapse of social care, also adds to the challenge, the report says.

The Government’s “proposed strategies” for getting hospital finances back on track are unlikely to work, since “cutting the tariff paid to hospitals, strict pay restraint, imposing agency price caps and reducing capital spending are not sustainable ways of securing efficiencies in the longer term”.

Committee chair and GP Sarah Wollaston also warned that the sustainability and transformation fund was likely to be “used almost entirely to plug provider deficits, rather than to resource essential changes to the health and social care system at scale and pace” and called for it to be “protected”.

Such a move would make it more likely that there would still be central funds for IT over the course of this Parliament, since the government has already linked IT funding to the local digital roadmaps and Sustainability and Transformation Plans that healthcare communities had to submit by the end of June.

However, as part of a financial “reset” expected later this week, NHS England is predicted to impose conditions on access to the fund; and to lock-out trusts that fail to meet savings and key performance targets.  

More broadly, the health committee report reiterates its call for a detailed plan for delivering the Forward View and says ministers should be upfront about what the plans will entail; and what will happen if they fail.

“We believe it is time for the government and NHS England to set out how they will manage shortfalls in NHS and social care finances if the measures proposed by the Forward View fail to bridge the funding gap. If funding is not increased, there needs to be an honest explanation of what that will mean for patient care and how that should be managed.”