IT in the NHS will empower both patients and professionals by offering explicit choice. Health Minister Lord Hunt outlines the challenges ahead
Without fully modernising its information and communication technology systems, the NHS cannot deliver the prompt, convenient, high quality patient centred care that we are all committed to. Due to increased investment, the final Wanless report on securing the future health service and the publication of Delivering the NHS Plan, we are able to supply the NHS with the IT systems they require to ensure this happens.
Delivering the NHS Plan develops the vision already set out in The NHS Plan of a "service designed around the patient". Patients will be offered more choice of where and when they get treatment. IT in the NHS will support that vision and empower both patients and professionals by offering explicit choice, for example with information about capacity and performance. IT will also ensure that the appropriate information is available at the time the patient consults the clinician and at any place the consultation, diagnosis or treatment is provided.
By December 2005 patients will be offered electronic booking of appointments, the electronic transfer of prescriptions and by then the first generation of electronic records will be available. Underpinning these critical NHS wide services will be a network with sufficient broadband capacity and connectivity to additionally support secure encrypted communications for the 1.2 million NHS staff and a range of local applications and clinical tools.
The IT infrastructure and the three national electronic services are at the core of Delivering 21st Century IT support for the NHS, a new national IT programme to be delivered between April 2003 and December 2005.
We also need a radical change of direction for managing IT in the NHS and the step change in improving implementation will focus around:
increased funding for IT that is targeted on providing critical national services on a national basis improved central direction and performance management for IT streamlined procurement a more corporate approach that includes the setting of clear national standards and specifications for IT.
Our first measures will be to improve the leadership and direction given to IT by:
establishing a Ministerial Taskforce under my chairmanship to bring together the national programme with representatives of the NHS, Treasury, E-envoy, and the Chief Executive of the Office of Government Commerce (OGC) and to show commitment from the heart of government. having Sir John Pattison as the DH director responsible for the programme to report to myself and Nigel Crisp (Chief Executive of the NHS) appointing a new Director General for the national programme reporting to Sir John, and supported by a new central programme team drawn from the Information Policy Unit, NHS Information Authority, the NHS itself and possibly from outside sources. requiring strategic health authorities to appoint Chief Information Officers to co-ordinate investment plans across health communities and to performance manage progress on key deliverables.
IT in the NHS has always taken too long to implement. Quite often technology has moved on or requirements have changed by the time trusts have been installed the systems. We are seeking to accelerate the pace of IT implementation in the NHS through a new national approach to streamlined procurement.
We will look to selectively outsource major components of the IT programme, for example networks. This has been the approach for the backbone NHS network. One national procurement provides the national service with the backbone used by the NHS for e-mail.
In the case of systems and services around electronic records, prescribing and appointment booking the new procurement strategy will optimise the use of national framework contracts for a range of systems and services that comply with national standards. By insisting on national standards and specifications for IT we will ensure that a range of systems can interoperate and that broad progress is made across the whole of the NHS.
Let us be clear about the challenges ahead, what we are proposing is extra-ordinary in scale and scope. It is the IT challenge of the decade but with the proper planning and direction for increased IT funding, clear national standards for proposed systems and a streamlined procurement process for compliant systems, we will be able to significantly accelerate the pace of IT development across the NHS.
We will be able to turn around the piecemeal approach to implementing IT and get modern IT support into the place where it really matters - the front line delivery of patient centred care and services.
The enforcer: Peter Gershon and the OGC
After a series of high-profile IT procurement failures the government moved to stem the criticism of the lack of professionalism in the management of its IT contracts by establishing the Office of Government Commerce. The OGC, with Peter Gershon at its helm, has introduced new measures to help ensure that future procurement plans will run more effectively and deliver value for money.
A series of problem areas in IT procurement were identified, including: ambiguous contracts, lack of specialist knowledge, unrealistic deadlines, unwieldy structures, unclear lines of command and no built-in penalties for missing deadlines.
Experts highlighted the fundamental lack of risk management within the public sector - a failure to develop contingency plans should a project fail.
New procurement projects in central government are now subject to a process called "Gateway Reviews" which is intended to ensure that major new systems are introduced incrementally rather than adopting the kind of "big-bang" approach which contributed to the spectacular problems experienced by the Passport Office in 1999.
Launched in February last year, the process examines a project at the critical stages in its life cycle to provide assurance that it can progress successfully to the next stage. It is designed to be applied to projects that procure services - whether that is for IT or for a hospital construction project.
The OGC describes the Gateway Review process as a "powerful technique" whereby a thorough review of public sector procurement projects is carried out at key decision points ("gateways") by a team of experienced people, independent of the project.
Peter Gershon says the process ensures that all stakeholders have a "common understanding" of the project objectives. "It helps to ensure that well recognised and repeated deficiencies are remedied and best practice is promulgated and deployed to all projects."
But with the huge failure rate of large scale IT procurement both in the public and private sector on first implementation, the claims are ambitious. Just this August news emerged that a new IT system for the Child Support Agency will be delayed another year - with the project already £50 million over budget. And with the government spending billions on IT in the NHS, the OGC is going to have to keep its eye on the ball.
