This week, health secretary Jeremy Hunt has been back on the TV sofas talking about his ambition for a ‘paperless’ NHS by 2018.

Specifically, he was announcing a further £240m for the ‘Safer Hospitals, Safer Wards Technology Fund’ that was launched in May, and that will channel £1 billion of national and local money into healthcare IT over three years.

Despite this high-level, ongoing backing for investment in technology, The Big EPR Debate that EHI ran earlier in the year revealed plenty of scepticism about whether ‘paperless’ is achievable or even desirable. After all, there are some good uses for paper, and some patients like it.

Alex Abbott, the chief technology officer of NHS England, says the idea that the NHS can operate without any paper “is probably going a bit far”, but it should certainly be removing paper whenever possible.

“If patients want to receive paper, there should still be the functionality to do that; but where we can introduce efficiencies by removing paper where appropriate we should absolutely be trying to do that,” he says.

New approaches

Abbott’s part of the big picture on making the NHS as paperless is possible is infrastructure. He is the senior responsible officer for a suite of big projects that were developed and then maintained by the National Programme for IT in the NHS, many of which are now due for renewal.

Specifically, he is responsible for the N3 network and its replacement, for the Spine and Spine2, and he is a sponsor for NHSmail2.

“All of the old national programme contracts are coming to an end, so making sure that we are going to provide continuation of service and keep the NHS running is the key thing for me,” Abbott says.

However, he is also responsible for the development of NHS England’s technology strategy, which is due out in December.

This should add detail to the guidance that the commissioning board issued on applying to the technology fund in July, which it presented as the first step towards creating an integrated digital care record.

When asked why the new approach to NHS IT will bring results where NPfIT failed, Abbott argues that the key difference is that the government is not being prescriptive about the solutions.

He argues that the IT programmes that have been successful have had strong local ownership and clinical leadership.

“Local autonomy and buy-in is absolutely critical. We’re trying to learn lessons from the national programme; not being prescriptive but providing the environment in which local organisations can make their own decisions about investments within a framework of standards,” he says.

Lots of projects with a 2 in them

A new approach is also being developed for the delivery of core NHS IT infrastructure. The large, national contracts for the Spine and the electronic booking service Choose and Book are being dismantled.

In their place, developments are being created that are led in-house, using agile development principles and open source software.

NHS Choices has also been moved in-house, to the Health and Social Care Information Centre. However, tenders will be run for various parts of its replacement – the Integrated Customer Service Platform [now being called the Health and Social Care Digital Service] – from next April.

The Spine2 project is the furthest advanced. The new data Spine is being developed by Leeds-based software firm BJSS and has already been through informal supplier testing. Formal supplier testing will start within a few months.

“There’s a lot of excitement around the approach being taken for Spine2 and we are very keen to make it a success,” says Abbott. “It’s got a potential to be a model for other programmes that want to look at different ways of working.”

There is also a lot of interest in the replacement for NHSmail, which was one of the first, national services to be delivered after the launch of NPfIT, but which has been dogged by periodic complaints about capacity, speed, and a general inability to keep up with commercial communications services.

Abbott confirms that NHS England has extended the contract for NHSmail with its provider, Cable and Wireless, until June next year. He says it hopes to start procurement for a new service towards the end of 2013.

Although the idea of using the G-Cloud framework to procure NHSmail2 was floated, this is unlikely to happen. Instead, Abbott suggests, a secure mail ‘lot’ will probably be created on the Public Service Networks framework.

PSN is a ‘network of networks’ across the public sector, allowing authorised users to access and share data securely. One way or another, and despite floating the idea of using a range of suppliers, the government is likely to look for just one supplier to take on the new service.

What about N4?

When looking at a replacement for the N3 broadband service, NHS England is again looking to the PSN. BT currently powers N3 and recently had it certified as a PSN.

“We want to align the replacement service as closely as we can with PSN, while still delivering the requirements of the NHS, and we’re working very closely with the PSN to do that,” says Abbott.

“There are aspects of the N3 model that have proved very beneficial to the NHS – the end to end service management capability that large parts of the NHS find to be extremely useful and would struggle to replicate if it was removed – so we’re looking at taking forward some kind of capacity into the new world.

“We’re looking at PSN compliant networks purchased through frameworks but with potentially elements of N3 with regards to the service model being built on.”

The end game

When Hunt was out doing his TV interviews this week, he faced many hostile questions of the ‘why would you repeat the disaster that was NPfIT’ kind. But not all of NPfIT was a disaster. Many of the infrastructure elements worked, so it’s not surprising that Abbott is keen to make sure that they keep on working.

At the same time, there may be cost and service benefits from changing the way they are delivered, and Abbott is clearly keen to capture them, not least to respond to the new environment that NHS England is trying to create for the future.

“We have an existing service and are fundamentally changing the platform on which it’s delivered,” he says. “But what we want to achieve is a seamless transition. Our goals are around continuity of service and patient safety is paramount.”

Alex Abbott and his NHS England colleague Beverley Bryant will be speaking at EHI Live 2013 in a new ‘paperless or paper-lite’ stream. Their boss, Tim Kelsey, the national director of patients and information, will be the keynote speaker at this year’s conference, which is free for all visitors to attend.