NHS Confederation: National Programme for IT hurt hospital technology ambitions

Hospitals are increasingly sceptical of the benefits of new IT systems, following continued turmoil in the National Programme for IT, according to a strong warning from the NHS Confederation.

The membership organisation, which represents NHS bodies, said in a newly published report that there was real concern in medical circles that major IT changes were not useful. The National Programme and health advice site NHS Direct were cited by doctors as deserving to be “leading candidates” for cuts.

“The popular belief that digital health services are an add-on to the ‘core business’ of the NHS is implicit in much of the scepticism that is often expressed about their value,” it wrote in the report.

The news follows recent comments by Intellect, the IT suppliers’ association, that said the National Programme had left NHS trusts stripped of key in-house technology skills.

The NHS Confederation noted in its new report that the sheer scale of the NHS posed challenges for any technology rollout, but wrote that attempting to create a national system in a centralised fashion was a mistaken tactic. NPfIT had led to the Department of Health having the “dubious accolade” of running the world’s largest non-military IT programme, it said.

NPfIT’s “extensive scope and scale” had proved “almost unmanageable for the public and private organisations involved”.

“While NHS IT development during the last decade was characterised by immense ambition, so too was it marked by continual failure,” said the report.

“Vast resources were committed to realising the visions of successive Department of Health IT strategies. Yet the principles governing these plans rested on questionable assumptions about technology and about large-scale organisational change that are, in part, responsible for the slow progress made today.”

Developers now see the digital economy in the NHS as “stuck”, which is a direct result of the problems on IT programmes so far, it said.

Central NHS purchasing was too large for many suppliers, but individual trusts were conversely too small for selling technology to, according to the report.

“Small and medium-sized developers spoken to during this study showed frustration at the vast scale of the organisation, which has centralised much of its IT development to a very few large contracts,” it wrote. “Multinational technology companies, on the other hand, explained how difficult they found it to find primary care trusts with sufficient scale to invest in their products and achieve a return.”

While the large scale of a centralised NHS posed well-documented problems for suppliers, it added that the challenges at trust level were less well known. They include the difficulty for trusts to make even small IT investments. “This mainly arises from size constraints – their geographic boundaries and budget limitations – as well as limited expertise in digital technology," it said.

“It is also a result of the shadow of NPfIT, whose wide-ranging, centralised approach has meant local organisations have been reticent to experiment and invest in technology in case it later turns out to be incompatible with some part of the nationally-designed model.”

The coalition government was right to move away from a top-down, centralised model, the NHS Confederation said. But it added that the government “must still contend with how smaller commissioning units are to achieve the sufficient scale and skill with which to make reasoned, long-term investments into developing digital services”.

In the report, the NHS Confederation made a series of recommendations on how to improve IT in the health service. Compatibility, including agreeing on an internationally recognised machine readable standard for electronic patient records, was crucial to the development of useful technology, it said.

The NHS also needed a “concerted effort” to develop IT skills, it said. This could include showcasing best practice and making small, early-stage product investments.

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