CfH stuck ‘addressing yesterday’s problems’

A leading health economist and advisor on public expenditure to the Commons Health Select Committee, has called for a radical rethink of the NHS IT programme, arguing that Connecting for Health does not reflect the current direction of health policy and fails to address the most pressing issues now facing the health service.

Speaking yesterday at the end of Healthcare Computing 2006, Professor Nick Bosanquet, professor of health policy at Imperial College, London, called on Connecting for Health (CfH) to urgently rethink its priorities to meet the new financial, organisational and competitive pressures reshaping the health service. Civil servants at the Department of Health (DH) and CfH otherwise risked being stuck “addressing yesterday’s problems”.

His central argument was that the latest NHS reforms create a fundamentally different set of requirements than those CfH was designed to meet, and the programme urgently needs to be recast to make it relevant. “We’re now moving to a new set of policies to control cost and improve productivity, such as practice based commissioning, payment by results, foundation trusts and independent treatment centres – leading to a mixed economy of care.”

He argued that the current CfH programme addressed none of these issues, and was conceived for a highly centralised NHS rather than the confederated healthcare system now being engineered. “CfH seems to exist in an economic Garden of Eden, where they are spending £6.5 billion without any real purchase on the key economic issues for the NHS.”

He stressed that the NHS is about to see funding increases of recent years come to an end and that the top priorities now facing the service are increased efficiency and productivity, within a far more competitive environment in which there will be a much wide range of providers. “Real growth in NHS spending will have to tail off, unless we want to move to a US situation in which health accounts for 20% of GDP.”

Describing how spending increases of recent years had been spent on items like PFI hospitals, the National Programme for IT (NPfIT) and the consultant, GP and pharmacy contracts he said: “The NHS is like a lottery winner with very poor cost controls.”

He concluded: “At some point the question has to be – how do you make better use of the finite amount of healthcare resources available?” Based on current DH spending commitments and available funding Professor Bosanquet said there was a £6.8 billion gap to be met.

He criticised what he described as the rigidity and ponderous nature of the CfH programme, “CfH at times seems like a cast iron framework…” He later warned that unless CfH was recast it risked being swept away by a torrent of health service reform. “CfH is like a bridge where changes in water level are threatening to wash it away.”

Picking up on the “challenge” set on Monday by his former colleague, Richard Jeavons, CfH’s service implementation director, to refresh the NPfIT programme to meet the changed policy objectives set out by the government, he said the new policies had some profound implications for the type of IT systems and support that was now needed.

Prof. Bosanquet said that it was vital CfH recognised that a change in the nature of information was occurring within the emerging NHS – particularly where information could mean competitive advantage over a rival. “What they must first recognise is that in the new system of greater variety, competition and choice the nature of information has changed.

“CfH sees information as something that everyone wants to share – and there is of course much that falls into this category – but information is also now about power and money. Increasingly there will be incentives not to share information, even about what patient base a provider has.”

The central challenge, he suggested, was to re-examine “how to use CfH infrastructure, so that it really does contribute to the better financial management of the NHS which is the number one priority. You’ve got to have an information system that gives local NHS managers, clinicians and organisations real ownership.”

Turning to how IT systems can best support clinical care, he said the objective must be to focus on the care pathway concept "as there will be a much greater range of providers and organisations involved in a patient’s care.” Unless these different providers can be tied to clear care pathways, we will get a very fragmented service, he warned.

Meeting these requirements “requires a complete rethinking and re-engineering of CfH,” argued Professor Bosanquet. He stressed that much had been done, “and many important private sector suppliers have been engaged, but they are threatened with being swept away”.

Looking 12 months ahead Prof. Bosanquet predicted: “I think we will be looking at a very significant change in the power balance with a shift back to local innovators.”