A call for leaders of the National Programme for IT to demonstrate confidence in the capabilities and professionalism of NHS staff came at E-Health Insider’s conference in London last week. Martin Bell, director of IM&T for North Bristol NHS Trust said:“The national programme is information poor, and it needs to share and let go; it needs to be confident in the people it is dealing with, and confident they will deliver.” His comments to the conference,“The Healthcare IT Revolution: What’s Happening to the People?” came as the national programme announced a review of engagement with clinical staff. Bell cautioned that the national programme was not an end in itself but just a means to improve the NHS’s core business: treating sick people and stopping people from getting sick. To succeed, Bell said, the programme must engage with clinicians. “It needs to engage with all the people who have been disengaged.” And clinicians did not just mean doctors. “Nurses are the people we’ve really got to pull in and make them see the benefits. If they are not comfortable with it, it will fail. And if it fails, it will be an absolute mess, and we will absolutely have failed the communities we serve.” Despite the challenges, he said for anyone in IT the only place to be at the moment is the NHS. “When is the last time you had any other industry say, ‘We are going to invest £2.3 billion in IT?’” However, investing in technology was relatively easy compared to the investment needed in people, he said. “People are the soft infrastructure; investing in IT itself is easy.” “Where there is training in the contract, it’s for training the trainers. There is no funding for implementation, that is down to the trust.” One of the key points about the national programme contracts, said Bell, was their emphasis on deployment rather than implementation and the challenge trusts faced in bridging the gap between the two. “The national programme talks about deployment – that means making applications available from a central data centre, and then they [LSPs] get paid some money. What we need, though, is implementation.” But huge barriers remained to successful local implementation of NPfIT applications, even when they become available from LSPs data centres, not least finding NHS staff with the right skills and experience. “One of the biggest problems is that people don’t know how to implement stuff as they just haven’t done it for years.” Funding will also remain a huge issue. Bell estimated that national programme funding only covered about half the costs of implementing systems locally. “So make sure you get the funding from other sources that meets the 50-60% not funded by NPfIT.” A key part of the current problem said Bell was that “at the moment the national programme thinks it can do everything locally.” Instead of even attempting such micro-management he urged the programme to think globally and act locally. He pointed out that the national programme was not all-encompassing but limited to a national infrastructure and a few core applications. Much key IT used and needed by trusts remained outside its aegis, or had to be purchased through LSPs. Areas outside included departmental systems and areas like local networks and knowledge management. “Only core elements of the national programme have to be bought from the national programme. There is a market there.” He also stressed there be a need for more not fewer NHS IT staff. “You are still going to need guys on the ground. The LSP, Fujitsu in the South, will not manage very local components. There will actually be a need for new jobs.” But the absolute key he stressed was implementation: “The challenge for all of us is implementation, and service reconfiguration. The national programme or LSPs can’t do that, it’s our responsibility, but that is where the benefits come from.”
