Last week E-Health Insider ran a report on leaked guidance from the National Programme for IT (NPfIT) to chief information officers that there would be no allocations from the national programme to local NHS organisations beyond the current financial year.

We asked readers how they are planning for implementation of the NPfIT locally, and what they anticipated the financial implications would be for their organisation. A number of frustrated readers responded, each on condition of anonymity.

The first response came from the head of IT at a well known acute hospital:

The short answer is, we are not planning. We have a Strategic Health Authority heads of IT meeting in October and it is the first since early this year. I have not been asked to participate in any planning process. I do not know what we will be implementing or when. I have not been asked to submit ICRS plans as part of the three year funding process.

My expectation was that the revenue consequences of the National Programme would be picked up using national funding. I would not be allowed to contract for a service unless I knew such funding was in place.

I have received more information about ICRS through E-Health Media that via NHS routes. My plans for EPR and PACS (the latter had reached second business case stage) were both put on hold last year.

Please do not use my name!
(name and address supplied)

The head of IT for a number of primary care trusts (PCTs) expressed similar frustrations on lack of guidance and money:

From the point of view of PCTs we are in a nightmare situation. NPfIT and the GP contract have promised 100% funding for the system of the GP’s choice, and access to records in real time from any place, i.e. mobile computing.

From the PCT’s point of view we have only the same amount of money that we had last year to support 50%, plus the prospect of some more, we don’t know how much, in October. Now we are told that will be it, there will be no extra next year.

We have GPs saying they will be taking their PCTs to court to honour the terms of the contract. They are demanding 100% funding for systems costing up to £70K, and mobile equipment at £500 per GP. Nowhere is there any guidance on how to assess priorities, where the importance of value for money comes in, and what to say to your GPs when there is no money to meet their expectations.

Will it take a PCT to be sued to the point of bankruptcy before the DoH realises what it has created?
(name and address supplied)

The director of IM&T for a leading acute hospital, meanwhile, contacted us by phone:

Together with her colleagues she said work was now beginning locally on summary plans to “work out what the national programme means for us financially and how we go about funding it”.

One of the biggest issues faced locally, she explained, was that contracts for critical legacy systems, such as the patient administration system, were due to expire soon, “We don’t know how we should plan for that.”

The impact of the national programme on the supplier market was a major cause of concern for her as she was no longer sure key legacy systems would be supported, or if they any longer provided a platform to continue local developments.

Another key question she was grappling with was whether the applications to be provided by national and local service providers would be mandatory. “If they have not been tested in any detail, and don’t meet our local needs do we have any choice? My big question is do you have to take that solution if your having to fund it yourself?”

On the issue of finding local money from existing baseline spend to pay for implementation of systems procured by the national programme she admitted to being very worried, and working on the assumption that local trusts would be expected to find much of the costs of implementing systems, together with the ongoing revenue costs.

“The assumption is that the money is in the system already, and there is also the assumption that we can swap it out. But we’ve already done that, and I can’t see what more we can swap out from legacy systems.”

The anonymous IT director added: “Richard Granger can decide what he spends his own national money on, but he can’t make commitments on behalf of individual trusts.”

Contrasting the current uncertainty with the situation two years ago, she commented: “Two years ago we had a plan, we knew where we were going, knew how broke we were and what we could afford. But we had a clear vision of what we wanted to do and how we would deliver. Now we just don’t know.”

She concluded: “If we’d had the [£2.3 billion] national money locally we could have done all this with bells on.”
(name and address supplied)

E-Health Insider would like to hear from more NHS readers on how they are planning for implementation, and the likely financial implications for their organisation. Email (in confidence)