Speaking frankly

E-Health Insider met up with leading healthcare members of Intellect, the trade association for the UK hi-tech industry to discuss the financial questions raised by the National Programme for IT (NPfIT). Is enough money being spent? Can the NHS demonstrate that it has been spent wisely?

These and many other questions kept the round table talking for two hours. Here are some of the participants’ comments reported under Chatham House rules.

Is the money currently being spent on healthcare IT being spent in an efficient way?

There was a divergence of view between participants who felt the relatively slow progress on some parts of the National Programme for IT meant it was hard to tell whether the money was being spent well or not and those who thought the delays indicated lost opportunities and money wasted.

“A number of patient administration system replacements are taking place which I personally view as a waste of money as a lot of trusts are reporting reduced functionality, certainly in the initial phases…”

“I think it’s very mixed. There are some trusts out there that have done very well; there are some that are very piecemeal…There has been some good headway made, but there’s a long way to go.”

“We’re still in a situation where Wanless said we should be on 4% [of total NHS spending on IT] but we’re actually on about 1.5% instead. Probably quite a lot of that spend is actually being spent on keeping going systems that are due for replacement.”

“We must be careful not to take the 4% as some magical thing…Spending 4% on IT in the health service is not going to solve any of the problems. Without a good infrastructure, you can’t do any of the things that have to be done. We are getting there. Most trusts have infrastructures but IT which is not usable yet. Suppliers say it’s all done – but nobody’s using it. If not you get white elephants, and you can’t afford to get white elephants.”

“Many of the issues within the national programme make sense like procurement, trying to promote learning across trusts, sharing best practice – good sensible things to do. What is missing? Clearly the structure overall hasn’t generated enough pull from local trusts – it’s probably too ambitious in total… although from my point of view, if half of that was delivered I think we’d benefit enormously.”

“What little money has been spent, on my assessment, has been spent on lawyers and therefore, I have to say, is probably not that efficient. If the objective was to improve IT in the NHS it has manifestly failed to do that with one or two notable exceptions. Those exceptions are the PACS initiative and – despite comments to contrary – the broadband and e-mail initiatives.”

Return on investment for suppliers

Participants from health IT suppliers were asked whether their companies had seen a return on investment. How did companies justify their involvement in the sector?

“You have to focus on what you are trying to achieve – a quality of service and a quality of patient care in the NHS. Sadly, things being done at the moment by CfH are not aiding this. They are creating an environment where it could occur but that is someway down the line like it always was. It was never going to be a fast process or route, but there are some shorter side roads to make it better in the short term.”

Benefits of local ownership

The shift in ownership to the local NHS will be led and overseen by the NPfIT Local Ownership Programme (NLOP). The NLOP will review the relationship between the national programme, the cluster and the local NHS and identify how responsibilities and accountabilities may be passed from CfH to the Strategic Health Authorities so that they own the realisation of the benefits and can better ensure the means of achieving that success.

The panelists welcomed this and hope it will help raise the profile of IT at local level, as well as other NHS initiatives.

“There is a huge requirement to make ICT board level at trust level and bring all communications of an organisation together. I hope NLOP will help to deliver the refocusing needed but in parallel we need to work out how to get more money into the marketplace to define some of these initiatives like Patient Based Commissioning in a shorter timeframe than we are going to get at the moment.”

One panellist felt strongly about the need to invest in staff locally. “They should be paid better money – there are no economical benefits for them and we never invest in new staff. It’s shocking; we are behaving like a third world country. We pay peanuts – managers don’t know enough, directors forget about IT – they are just number crunchers and they don’t have a clue so they call contractors.”

The next 12 months

In conclusion, the roundtable members were asked what development they would like to see in place in 12 months time. These were some of the items on their wish list:

“We should evolve to a much more ‘pull’ approach, so that trusts know what they get and when with complete plans to address any potential gaps. CfH should persist with the spine and work on other initiatives such as PBC (Practice-based Commissioning) and CDM (chronic disease management).”

“[We] would like more openness and trust from CfH and the DH. The national programme should learn from its successes and failures and there should be more investment in telehealth.”

“I’d like to see an acknowledgment at local level that the national programme is only part of NHS IT. I’d like directors of ICT on every trust board with a risk and reward culture.”

“More champions!”

“A transition from secrecy to openness.”

“Recognition from CfH that the national programme is a business – not just an IT – project…”

“Funding into strategic health authorities and trusts where initiatives can progress”

“People should feel that the infrastructure and the suppliers are working for them, so that everyone can see why there has been all the pain – hopefully we will see a few deliveries. If you picked a patient at random and asked them do you think the £12bn was a good idea the answer would be ‘yes’ and they should be able to identify potential benefits to them.”