The Conservative party has pledged to scrap the NHS Spine and halt and re-negotiate the two main contracts with BT and Computer Sciences Corporation in order to revamp NHS IT. The two deals are worth in excess of £4 billion.
The promises came as the Conservative’s endorsed the findings of an independent review of the £12.7 billion NHS National Programme for IT, which has called for the five-year old project to be radically rewritten and the local service provider contracts to be “halted and re-negotiated”.
The role of the centre should also be confined to standard setting and catalogue procurement centrally “The catalogue should encourage smaller providers to innovate and develop solutions that better meet the needs of patients and the clinicians providing their care.”
The Conservative-endorsed review says the national NHS infrastructure, including the NHS spine, should be broken up; the LSP contracts held by BT and CSC halted and rewritten; and nationally procured systems replaced by a wider range of accredited systems chosen locally.
It concludes “the National Programme must not be abandoned”, and calls for an immediate freeze and renegotiation of the NPfIT local service provider (LSP) contracts. “Subject to any applicable constraints, halt and renegotiate the Local Service Provider contracts to save further inefficiencies with regard to cost and delivery”.
The focus for planning and decision making on IT systems should instead be passed back to local NHS trusts, with centre only retaining responsibility for essential infrastructure and standards.
The Conservatives and the review reaffirm the central objective of universal adoption of electronic patient records within the NHS, but say a new locally-based approach is needed to achieve this. To achieve this they say the two current two LSP-provided clinical systems, iSoft and Cerner, must be supplemented by a wider choice of accredited systems, through a framework catalogue.
Shadow Health Minister Stephen O’Brien said “The top-down bureaucratic National Programme has been plagued by delays and cost over-runs.” He said that without sight of the BT and CSC LSP contracts it was impossible to say how they could be changed, or how much had been spent or committed, but promised “there will be savings”.
Asked about the cost of re-negotiating the LSP deals, O’Brien said he was giving the firms advanced notice of a future Conservative government’s intentions and hoped to be able to work with them. But he also acknowledged getting out of current deals was unlikely to be cost free.
On the costs of a future re-negotiation he said: At the moment you have a lot of duplication, and have a lot of people trying to buy their own local systems and go outside the national contracts.”
The review says that personal health records – such as Google Health and Microsoft HealthVault – may have a useful role to play, but are no substitute for development of detailed local electronic patient records, which should remain the focus of NHS IT strategy. O’Brien said the Conservatives will launch a public consultation to find out how much control of their records people want.
Speaking at the launch, the chair of the review panel Dr Glyn Hayes, said the review had deliberately steered away from blue sky thinking, and focused on what could be achieved with systems currently available. He called for an immediate priority to be given to the introduction of e-prescribing systems.
The review identifies delivery in the acute sector as the area of greatest weakness. It says GP and hospital patient record databases must instead be kept locally, only exchanging data when necessary, to maintain the primacy of the doctor-patient relationship.
It calls for the national database of health records, the NHS Spine, to be scrapped, saying it has caused “extreme anxiety in many individuals and organisations”. The review states “a central database is not required in a localised vision of NHS IT”.
Asked whether this entailed abandoning the spine and national summary care record, O’Brien said: “We don’t see it needing to survive. So why should it.”
The review says the world’s largest civil IT programme must be rethought from the ground up if it is to deliver joined-up information systems that improve patient care. The formulae offered to achieve this is far greater localisation and choice of accredited within a framework of standards and interoperability.
The aim instead should be to identify suppliers able to provide core clinical functionality, rather than specify systems. “Systems which succeed in gaining accreditation can enter a catalogue in which prices of solutions have been agreed centrally. Trusts can then select a system in the knowledge that it is compatible with the NHS as a whole and yet choose a solution which meets local needs.”
O’Brien stressed these should be proven existing products, and said the government had been spending “a lot of money on getting companies to develop products for it, rather than buy off the shelf”.
The review argues abandoning a national patient record database and moving to localised electronic records “will enable the patient to take a more active role in their health data within the trusted environment of the doctor-patient relationship.”