NHS IT: Hospitals will struggle to fund upgrades on their own

Paying for new systems may be too bitter a pill for hospitals to swallow

Government plans to give doctors greater powers to choose the IT systems and services they use have led to warnings that many hospitals may struggle to afford their own IT systems.

The £11.4bn programme to revamp NHS IT - known as the National Programme for IT (NPfIT) - has faced criticism for forcing English hospitals to take the same centrally-chosen electronic record patient systems, funded by the Department of Health, during tech upgrades. However, for any hospitals choosing to opt out of the central system and deploy an alternative, no DoH cash will be made available.

Last week Department of Health (DoH) CIO Christine Connelly said that - with the exception of a handful of trusts in the south of England - NPfIT money will not be diverted to enable hospitals to purchase computer systems and services locally: "What's inside the National Programme doesn't change from what it is today," she said.

"[The announcement about] trusts buying what they want is them having the freedom to go beyond the scope of the National Programme and do whatever they want beyond that - how much they choose to spend, that's up to them."

Hospitals may struggle to afford upgrades to their electronic record patient systems under new coalition plans
(Photo credit: Shutterstock)

However, Brian James, CEO of Rotherham NHS Foundation Trust - which last year became one of the first NHS trusts to go outside of the NPfIT and to purchase its own electronic patient record system - said that hospital trusts that have spent years waiting for new computer systems to be delivered under the NPfIT will have to fund sizeable and expensive upgrades to bring their legacy computer systems up to scratch.

"For those who can't wait [for a new computer system to be delivered under the NPfIT] or decide to go outside the National Programme, if they have to fund it entirely themselves, then this does seem to be rather against the laws of natural justice," he said.

"There is a real choice here... it's just a very expensive one, and only those who really believe that IT is the answer to many of the problems we are facing will drive down that path, at their own expense.

"There is now no money in the system to fund the borrowing required for a major upgrade - those who wish to do so will need to look for commercial deals, whilst recognising that income streams are likely to be under severe pressure over the next four years."

He added that after eight years of IT upgrades being managed centrally under the NPfIT, many health trusts also lack people with the skills needed to manage a major IT programme.

A spokeswoman for the British Medical Association also expressed concerns that there would be "local variances" in the ability of hospital trusts to afford to implement new IT systems and in the quality of systems that they are able to deploy themselves.

The rollout of centrally-chosen patient record systems will continue until...

...2016, with the DoH's Connelly saying that assurances had been given to suppliers to the NPfIT that a certain number of English hospital trusts will take up the systems - although she was unable to specify how many trusts that will be.

"We guarantee that a number of trusts will take their systems - that's part of the contract arrangement," she said, adding that these are trusts that have already told the DoH that they want to take the systems.

The DoH is cutting how much it spends with the NPfIT suppliers BT and CSC by more than £600m and the reductions, when taken with other savings, will reduce the lifetime cost of the NPfIT from £12.7bn to £11.4bn.

However the savings will come at a cost to what is delivered, as it will mean that fewer new and fully-featured IT systems are delivered to hospitals and GP surgeries.

Describing how the DoH has decided what to cut from what is delivered under the contracts with BT and CSC, Connelly said: "We have gone out and talked to the NHS and said 'When you look at the future modules that you want and the time that we still have left in this contract, what is it that you really want to have?'."

The Department of Health is cutting the lifetime cost of the National Programme for IT from £12.7bn to £11.4bn
(Photo credit: Shutterstock)

As an example of type of cuts that will be made to the contracts, Connelly said that CSC may no longer deploy a new system for GPs as originally planned, saying that many GPs were happy with the IT systems provided under existing arrangements with the DoH.

The project to replace hospitals patient record systems has been the most heavily criticised part of the NPfIT, as technical problems with the systems has led to the rollout of new systems running at least four years behind schedule, and CSC failing to successfully deploy its patient record system to a single health trust.

However Connelly said that the DoH will keep CSC to a new delivery timetable for the rollout of the patient systems, and that changes to the way that the DoH manages the contracts will help keep future rollouts of the patient record systems on track.

"How we govern the contract will change significantly. We believe that we can drive good value for the contracts and we can deliver both the flexibility that we need and the control of how that money is spent," she said.

Connelly admitted that if the NHS IT revamp were started again today, eight years after the programme first got underway, that it is unlikely that the same approach would have been taken.

"If you started in 2010 I am sure that you would design how you spend that money and what you do in a different way," she said.

"Any IT programme - if you started it again two, three, five years later - you would do it differently, because technology has moved on and the whole world you are playing into is different."