Delays continue on NPfIT local ownership programme

A review is underway to establish new priorities and additional requirements for the NHS National Programme for IT Local Ownership Programme (NLOP) with the results due to be reported to the NHS Management Board in June, E-Health Insider has learned.

The review – known as the Butler Review – is being carried out to identify and prioritise new requirements to be delivered by the programme, based on the priorities identified by local strategic health authorities.

It forms part of the wider National Programme for IT (NPfIT) Repositioning Programme, which includes the late-running NLOP, first due to have been implemented by the end of April, and now projected to occur in July.

SHA board papers seen by EHI indicate that NLOP is facing further delays and will only offer limited freedom to local NHS organisations to set IT priorities, instead chiefly making them responsible for implementing nationally-determined systems.

Begun by NHS chief executive David Nicholson in November 2006 the stated aim of NLOP is to transfer ownership of NPfIT to the NHS "to reinvigorate the programme." This includes "giving the SHAs, with their trusts and PCTs, greater participation in the choice of NPfIT products and in the planning and timing of deployments." The aim is to better match the programme to local NHS priorities, better ensure clinical engagement and accelerate its impact on transforming services to patients.

Recent SHA board papers seen by EHI, make clear that although NLOP is making progress the timescales are now stretching out into mid-summer and beyond, with some staff transfers not due to occur until the end of July.

EHI has learned that key parts of the NLOP reorganisation, including decision making and governance arrangements, have yet to be determined. A May SHA board paper from Yorkshire and the Humber SHA says: "The programme office is unable to complete the governance work in full as the decision making authority for the programme as a whole has yet to be agreed. It is understood that this will be resolved within the very near future."

A May board paper from South East Coast SHA says that final arrangements for the transfer of staff and financial arrangements are due to be presented in June, suggesting final agreement may still be several months off.

On staff transfers the plan now appears to be to transfer NPfIT cluster staff "from each cluster to the SHA closest to their geographic base". The SHAs in turn are to be placed in three groupings matching them with the different LSP products: London, the South and North of England.

In some parts of the country it appears that something resembling the cluster office will be retained or recreated. In the area covered by South Central SHA 18 posts will be transferred from CfH to the three Southern SHAs by the end of July. But another "34 posts will be retained as ‘Pan-SHA’ support for all the Southern Central as the employer SHA".

The broad shape of the split of responsibilities between SHAs and the central programme now appears to have been agreed, and are set out in the board paper from South Central SHA.

Functions that will transfer to SHAs include:

• requirements development for the Care Record Service

• design, build and test for the Care Record Service

• local deployment

• local service management

• communications and stakeholder engagement

• benefits realisation

• service implementation

Functions that will remain with Connecting for Health include:

• the NPfIT commercial strategy

• contractual negotiations with suppliers

• management of NPfIT funds

• national services and products

• national programme office

• national NPfIT architecture

• central requirements design, build and test

• central deployment

• central service managements

If implemented in this form it would represent a massive re-organisation of the national programme, raising questions such as whether SHAs in effect become responsible for implementing systems already determined centrally by CfH? Will they have the freedom to set local priorities beyond the order in which they take nationally mandated systems?

An indication of the extent of the very limited scope for local flexibility within the constraints of the national programme comes from a May East of England SHA board paper: ""Whilst the existing contractual arrangements with suppliers allow for substantial variations, the degree of change is effectively constrained by cost and commercial considerations."

The same paper makes clear that while a central objective remains to not lose "the advantages of having a national IT approach and benefits of a national procurement led by a single agency in NHS Connecting for Health" the scope for local freedom will be limited.

"The maintenance of these benefits necessarily limits the freedom of action of individual SHAs of trusts to make significant changes, in the shorter term, in products, services and deployment plans".

Another major question mark exists over whether they will have the capacity and expertise to undertake design, build and test of CRS, together with deployment and implementation responsibilities?

An indication of the resources required by major deployments is provided in a May board paper from South East Coast SHA which updates progress over the past month: "During this period virtually the whole SHA team has been immersed in the final stages of implementation of the Patient Administration System at Surrey and Sussex NHS Trust."

All of the SHA board papers reviewed seen by EHI make clear that a great deal of work has been going on locally by trusts and SHAs to develop and collate local Information Management and Technology (IM&T) plans and priorities.

Yorkshire and the Humber SHA says local trusts have submitted their IM&T plans which are now being reviewed. "The intent is to pull together a consolidated plan for Yorkshire and the Humber to be used to inform the SHA’s programme plan."

The South East Coast SHA says that it is working to ensure local trust requirements shape the future direction of NPfIT. "As a first action, the SHA team has been distilling the future requirements that trust need to drive forward business benefit. This is being fed in to a national consideration of how the National Programme for IT will develop."