Open source projects will likely be the stand-out winners of NHS England’s tech fund 2 awards, EHI News has learned.

Projects based on use of open source clinical software are expected to be largely spared the axe that has been wielded on other projects, after an estimated £90 million was slashed from the £240 million Integrated Digital Care Technology Fund according to EHI News sources.

NHS England had already indicated that it would afford preferential treatment to open source projects, allocating up to £20 million of the original fund to open source initiatives.

But with the Treasury thought to have now slashed the £240 million fund by more than a third, hard choices are required on where the axe will fall.

When the list of winners and losers is eventually made public, EHI News understands that the majority of open source projects will be funded, with only a handful of the weakest projects missing the cut. 

This is likely be in stark contrast to non-open source projects which had been expected to receive funds, many of which will now receive reduced awards or no money at all.

The relative weakness and immaturity of open source clinical software products currently available, and the lack of capable suppliers to implement and support them, will likely to raise questions from unsuccessful trusts and suppliers.

Privately, many commercial software suppliers are questioning why NHS England is subsidising open source software development and skewing the market.

One industry source told EHI News: “Most of the OS software currently available is not much more than a ‘hack’, which is fine in a single department or even trust, but to be able to scale to multiple sites and thousands of users, clinical software has to be properly engineered.”

Moorfields Eye Hospital NHS Foundation Trust, whose highly regarded OpenEyes ophthalmology EPR development remains the best-known NHS open source project, is believed to have run into just such engineering challenges as it scales the software to be installed into further trusts like Salisbury.

Enthusiasts say open source has a role to play in niche parts of the market that existing suppliers are unlikely to address due to limited demand, such as a proposed development for community dentistry.

Some advocates say that delivering the open source software matters less than getting changed behavior and pricing from existing commercial software suppliers. 

The NHS England Open Source Programme is currently advocating open source across a broad range of applications, and is helping to set up more than a dozen community interest companies (CICs) to act as custodians for open source products.

This far exceeds the number of viable open source products currently available in the market.

The first CIC, for IMS Maxims’ openMaxims electronic patient record system, has support in principle from Taunton and Somerset NHS Foundation Trust, St Helens and Knowsley Teaching Hospitals NHS Trust and Blackpool Teaching Hospitals NHS Trust.

However, with the exception of openMaxims and the open-eObs nursing observations system from Neova Health, very few proven products are in use in NHS trusts.  Most others remain ‘hacks’, projects or proofs of concept at varying degrees of maturity.

Just as significant, noted one observer, is the lack of viable companies developing and supporting open source health software in the UK and internationally.

Of the proposed developments, the most promising over time looks to be an open electronic prescribing initiative.

However, even the leading firms behind the initial prototype, shown at an NHS England open source event in Newcastle last November, say it will take at least 18 months to build a viable product.

The key, suggested one open source expert, is not necessarily the systems themselves but ensuring that a mixed economy of different systems use open standards and interfaces to share information.

“It’s not about open source software per se, but ‘open interfaces’, and here open source has a vital role to play.”

When the tech fund awards are announced, one of the key questions will be the extent to which NHS England will concentrate its open source efforts on open interfaces and standards, rather than software.

Another will be whether the awards are scattergun or target clinical projects with a realistic chance of gaining widespread adoption and use.