I wrote about the end of the NHS’s National Programme for IT on many occasions. In each case, the changes represented a scaling-down, not a cancellation. On health records, while England planned something big then reduced it, Scotland planned something reasonable and did it.
The National Programme for IT (NPfIT) seems destined to survive several political deaths, including the one announced today.
The Daily Mail, reporting the scrapping of a £12bn NHS computer system, quotes health secretary Andrew Lansley as saying: “Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs. We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.”
According to a statement from the Department of Health, the justification for these comments is that the Cabinet Office’s major projects authority has reviewed NPfIT and decided “it is not fit to provide the modern IT services that the NHS needs,” and said that “the National Programme for IT has not and cannot deliver to its original intent”. A new partnership with Intellect, the IT industry association, will attempt to promote the use of smaller suppliers for government healthcare projects.
While this is a significant moment, it is part of a process towards localising NHS IT that has been under way for several years – and allows the Conservatives an attack on Labour just before it meets for its annual conference. It does not spell the end of centralised IT work, although it emphasises that in future key systems will be bought by individual trusts in England.
The Department of Health, which describes today’s announcement as “an acceleration of the dismantling of the National Programme for IT” rather than a scrapping, said that NHS Connecting for Health survives for now, although a decision on its future will be made later this autumn. It also said that it has nothing to announce on its contracts with BT and CSC, and points out that the move will not include the closure of existing national programme systems, such as Choose & Book, the N3 network, NHSmail and Pacs (picture archiving and communication systems).
“The NPfIT has provided us with a foundation but we now need to move on if we are going to achieve the efficiency and effectiveness required in today’s health service,” said Sir David Nicholson in the statement. “Restoring local control over decision-making and enabling greater choice for NHS organisations is key as we continue to use the secure exchange of information to drive up quality and safety.”
The shift from the central to local control of key NHS IT systems has been going on for years, focused on the care record systems for acute trusts which were to have been introduced through centralised deals with local service providers CSC and BT. These have faced rising criticism from the National Audit Office and Parliament’s public accounts committee. In August, Margaret Hodge, chair of the committee, recommended that the government “should now urgently review whether it is worth continuing with the remaining elements of the care records system”. This followed a devastating report from the National Audit Office in May and the government has now agreed with the criticism.
Ministerial responses to such criticisms began under the last government. Moves to local control over the programme were already under way when, in December 2009, then chancellor Alistair Darling told the BBC’s Andrew Marr that the NHS IT system was “something that I don’t think we need to go ahead with just now”. The implied scrapping of NPfIT was overdone: Darling’s pre-budget report, which followed a few days later, cut £600m from the programme’s budget but did not close it.
Then, in September last year, new health minister Simon Burns told Parliament that the programme would be localised. “The new approach to implementation will be modular and allow NHS organisations to introduce smaller, more manageable change, in line with their business requirements and capacity,” he said in a statement. Burns also announced that the programme’s total budget would be cut by a further £700m to £11.4bn.
Lansley has a difficult job getting his health and social care bill through the House of Lords, and no doubt the chance to talk about a Labour failure was hard to resist. However, like many political news stories, the end of NPfIT is too good to tell just once.
guardian.co.uk © Guardian News & Media Limited 2010