The Government is to scrap the NHS Modernisation Agency (MA), the agency charged with delivering the change management programme that is meant to accompany the new computer systems to be delivered by the National Programme for IT (NPfIT). 

The MA, which has 760 staff and a £230 million budget, was meant to be responsible for helping local trusts deliver the change management agenda associated with the NPfIT, but the DH has confirmed that it will be scaled back to about a fifth of its existing size as part of a Whitehall efficiency drive.

Set up less than three years ago to lead reform in the health service, revive failing hospitals and spread best practice the MA will be replaced by a new central organisation in April 2005.

Explaining why the decision had been taken the DH explained that the MA had done its job. "Modernisation is now embedded in the NHS with many front line staff having gained the skills to improve services."  It added that the time was right "for modernisation to move into its next phase".

It is not clear yet whether the drastically slimmed down successor to the MA will still have national responsibility for ensuring delivery of the change management and business process re-engineering programmes necessary to realise the benefits of over £5 billion investment in new NHS IT systems.   

In its statement the DH said: "The NHS Modernisation Agency has provided strong leadership for improvement at a national level.  That leadership role will continue but with a stronger emphasis on local implementation and with a devolution of skills and resources to support this."

The MA’s work in health IT is meant to focus on supporting local healthcare organisations deliver benefits for patients, staff and the service from the NPfIT.

With barely 150 staff in the future, however, it is extremely difficult to see how the scaled back successor to the MA will have the in-house resources or capacity to adequately support trusts and Strategic Health Authorities (SHAs) in delivering one of the most complex change management programmes ever attempted.

According to the DH: "The intention is to strengthen improvement capability at all levels of the NHS by ensuring that there is effective leadership and adequate resources for modernisation within every PCT and NHS Trust."

It added that the new pocket-sized MA will focus on "innovation and on driving the adoption of leading edge practice throughout the NHS."  It will commission support for its activities from a range of public and private sector providers.

In 2003 the NHS Confederation estimated that the costs of managing the changes introduced by IT will be least as much as delivering the IT itself.  In December 2003 the British Computer Societies Health Informatics Committee estimated the costs of critical business and other changes could be four to eight times the cost of procuring systems.

However, delivering this change management is not within the remit or funding of the national programme, and is meant to have been the responsibility of SHAs, supported by the MA.

Scrapping the MA comes against the backdrop of a much wider drive to scale back Whitehall and slim down the machinery of central government, in line with the recent review of Government efficiency by Sir Peter Gershon. 

In his February report into Whitehall efficiency Gershon highlighted the potential savings available from rationalising the numerous organisations that inspect, regulate and improve the delivery of healthcare. 

The DH, under health secretary John Reid, is at the van of this efficiency drive and is currently due to see its numbers slashed by 38% – 1,400 people.

Just within the field of health IT policy and delivery there are currently three separate bodies: the NHS Information Authority (NHSIA), which is a special health authority; the NPfIT, which is currently hosted by the NHSIA; and the Information Policy Unit, an arm of the DH.

Final decisions about the future of the MA will be made as part of the Arm’s Length Bodies Review due to report later in the year.