A far-reaching review of the NHS IT modernisation programme is underway that will result in a re-prioritisation of the systems to be delivered by the £6.2 billion project.
Richard Jeavons, Connecting for Health (CfH) director of service implementation told delegates at the first day of Healthcare Computing 2006 that the review now being carried out was a “refresh” to reflect the changing context of the programme.
The CfH director gave no indication of whether the current review would see some of the programme’s main projects, such as the Care Records Service, further delayed, its impact on the original NPfIT targets and objectives, or whether the refresh would include publication of clear revised delivery schedule.
He stressed that there had been huge changes in the government’s NHS policy since the National Programme for IT (NPfIT) was launched in 2002, such as the move to a much wider range of NHS service providers, including private sector companies, and focus on care outside hospitals. “There are significant changes arising from that.”
The landscape had dramatically changed since NPfIT was first drawn up, said Jeavons. “It means we need a new operating model. We can’t believe the world is as it was in 2002.”
“We need to refresh the proposition and make sure that NPfIT fits into that context. Work is being done on that now,” said the CfH director.
When the NPfIT programme was launched the NHS was essentially a “corporation”, but the whole thrust of recent reforms has been to devolve and decentralise the service, while maintaining national NHS funding and a strong centralised regulatory environment.
Jeavons said the other main strands to the changed NHS strategic context included shifting the focus from what politicians want to what patients want; moving from a “dependency culture to one in which patients take more control of their care”; “moving from measuring what the NHS does to looking at what patients really experience.”
He said these reforms were being translated into changes on the supply side of the NHS through “by opening up the supply of NHS services to more forms of provider and ensuring contestability”. They are also being seen through the new regulatory framework designed to cement patient care and NHS values, and in the flows of money through the system.
These fundamental NHS reform themes – described as creating “more choice and a stronger voice for patients” – made it imperative for CfH to revisit the assumptions and priorities of the NPfIT programme said Jeavons. “We need to change our approach to implementation to meet that context”.
The CfH director said that following the current round of NHS reforms, which he acknowledged were highly unlikely to be the last the NPfIT programme must flex to accommodate, patient information was going to be absolutely paramount within the resulting healthcare system. “Patient information and money will probably be the only common characteristics in this new world.”
The current review and subsequent challenge over the next 12 months will be to answer the question: “Where does information and IT fit into that changing context?”
Adapting the already extremely challenging NPfIT strategy to meet the demands of this radically changed policy environment will not be easy for anyone concerned, Jeavons acknowledged.
He also made clear that it will involve CfH reprioritising current work programmes and delivery schedules. “This changed world will inevitably change and challenge our priorities, including things we thought incredibly important a few years ago.
“Some things we were not planning on do when we started three years ago are now very, very important,” said Jeavons. Although he didn’t name specific programme areas he did point to the care outside hospital white paper and current reconfiguration of PCTs as developments that would require greater prioritisation from the programme.
In addition, Jeavons stressed the need for a very clear emphasis on information and tools to support the collaborative delivery of the healthcare services to avoid the potential risk of current NHS reforms leading to fragmentation.
“I see some anxiety arising from elements of the reform programme. I see there is, and have people say to me there is, large potential for fragmentation. What is needed is clarity on collaboration.” He cited his own recent experience of NHS services as showing him just how much the NHS was crying out for tools to be joined together.
To deliver this complex agenda Jeavons said there was an urgent need for leadership at a national and local level, and for CfH to develop a much clearer message as to its purpose. “It’s not a well-understood proposition… We need total clarity.”
Once the current CfH refresh was complete Jeavons said that the coming year would see the onus of responsibility shift to local NHS organisations. “The next year will be one of transition from a national programme to one of local implementation, where executive leadership must seize what needs to be done.”