The End of NPfIT

From Nhs It Info

The future of the National Programme for IT (9 Sep 2010)

The Department of Health

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119293

A Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured. A new approach to implementation will take a modular approach, allowing NHS organisations to introduce smaller, more manageable change, in line with their business requirements and capacity. NHS services will be the customers of a more plural system of IT embodying the core assumption of ‘connect all', rather than ‘replace all' systems. This reflects the coalition government's commitment to ending top-down government and enabling localised decision-making. The review of the National Programme for IT has also concluded that retaining a national infrastructure will deliver best value for taxpayers. Applications such as Choose and Book, Electronic Prescription Service and PACS have been delivered and are now integrated with the running of current health services. Now there is a level of maturity in these applications they no longer need to be managed as projects but as IT services under the control of the NHS. Consequently, in line with the broader NHS reforms, the National Programme for IT will no longer be run as a centralised national programme and decision making and responsibility will be localised. Health Minister, Simon Burns, said: "Improving IT is essential to delivering a patient-centred NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this. We will allow hospitals to use and develop the IT they already have and add to their environment either by integrating systems purchased through the existing national contracts or elsewhere. "This makes practical sense. It also makes financial sense. Moving IT systems closer to the frontline will release £700 million extra in savings. Every penny saved through productivity gains will be reinvested to improve patient care." Director General for Informatics, Christine Connelly, said: "It is clear that the National Programme for IT has delivered important changes for the NHS including an infrastructure which the NHS today depends on for providing safe and responsive health care. Now the NHS is changing, we need to change the way IT supports those changes, bringing decisions closer to the front line and ensuring that change is manageable and holds less risk for NHS organisations."

NPfIT future is modular and locally-led (9 Sep 2010)

eHealth Insider

http://www.e-health-insider.com/news/6228/npfit_future_is_modular_and_locally-led

The National Programme for IT in the NHS' centralised and national approach is "no longer required" and trusts will instead be able to operate "a more locally-led plural system of procurement", health minister Simon Burns has announced. In a ministerial statement this morning, Burns said that a Department of Health review of the national programme had concluded that a new, "modular" approach to implementation should also be adopted. The statement said that the two changes together would allow "NHS organisations to introduce smaller, more manageable change in line with their business requirements and capacity." "Improving IT is essential to delivering a patient-centred NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this," Burns said the statement. "We will allow hospitals to use and develop the IT they already have and add to their environment, either by integrating systems purchased through the national contracts or elsewhere." A spokesperson for the DH's informatics department stressed to E-Health Insider that the programme was not being "scrapped", since elements of it will be retained and its contracts honoured, although the key implementation of detailed electronic care records will be taken forward in a new way. Burns' statement says that the national infrastructure elements of the programme and applications such as Choose and Book will be retained, although "they no longer need to be managed as projects but as IT services under the control of the NHS." New arrangements for the oversight of these services will be in place by 2012. These may involve them moving to the NHS Commissioning Board, which is given responsibility for IT and information standards in the white paper, ‘Liberating the NHS.' The changes to the programme will help to make additional savings of £700m to the £600m announced in labour's pre budget report. A further £200m will be taken off CSC's local service provider contract for the North, Midlands and East of England, while the other £500 will come from "local savings." The statement argues the reconfiguration is in line with the current Operating Framework for the NHS in England, which stressed a new approach of "connecting all" rather than "replacing all". It also says that it is in line with the broader NHS reforms set out in the white paper. The Department of Health's director general for informatics, Christine Connelly, said: "It is clear that the National Programme for IT has delivered important changes for the NHS including an infrastructure which the NHS today depends on for providing safe and responsive health care. "Now the NHS is changing, we need to change the way IT supports those changes, bringing decisions closer to the front line and ensuring that change is manageable and holds less risk for NHS organisations." The statement does not mention any changes to the Summary Care Record, but says that a separate review is underway which will report at the end of September.

NHS National Programme for IT - the last of the government mega-projects (9 Sep 2010)

Computer Weekly Editor's blog

http://www.computerweekly.com/blogs/editors-blog/2010/09/nhs-national-programme-for-it.html

And so it came to pass - the £12bn NHS National Programme for IT (NPfIT) is no more, replaced by a decentralised approach that aims to save £700m. The clock has been ticking loudly for NPfIT for some time, and while the formal death knell has finally been sounded today, its demise has been inevitable ever since the government white paper in July that announced the coalition's radical reorganisation of the health service. The Department of Health has managed to come up with a smart compromise that avoids the risk of legal action from the two main suppliers to the programme, BT and CSC. The existing central contracts with both firms remain in place, but NHS trusts will have the freedom to determine when, how - and most crucially, if - they avail themselves of the applications on offer. The most contentious element of NPfIT, the Summary Care Records system that would put a national electronic patient records application in place, may yet be cut further, with a review underway that will report back by the end of September. Officially, NPfIT is being "reconfigured" - but the announcement today by health minister Simon Burns gives free reign to local managers to pursue their own IT plans. In effect, that means BT and CSC will have to compete for every deal they win in every NHS trust, instead of being rolled out automatically in the regions they were responsible for. "Localised decision making and responsibility will create fresh ways of ensuring that clinicians and patients are involved in planning and delivering front line care and driving change," Burns said in a written ministerial statement to Parliament. And therein lies perhaps the main reason why the over-ambitious National Programme floundered - clinician's anger at the lack of involvement they had in what they perceived as centralised decisions that took little consideration of their needs. That fundamental flaw was the common theme through all the problems that ensued. Project reports from the early days of NPfIT revealed poor relations with suppliers and concerns from clinicians. One of the original suppliers, Accenture, pulled out of the programme because it saw costs ballooning and profit shrinking. A second, Fujitsu Services, was sacked. BT was forced to make a £1.2bn write-off because of its contract to deliver NPfIT and had to renegotiate with the Department of Health. But it wasn't only the suppliers who suffered financially. In November 2008, the Royal Free Hampstead NHS Trust in London reported a £7.2m deficit as a result of problems with the rollout. NHS IT managers will undoubtedly be pleased to have regained control over their own systems, but within a national framework that looks to take advantage of common systems that have been delivered by NPfIT such as Choose and Book, digital imaging and electronic prescriptions. At the time the programme was initiated, way back in 2003, the concept of regional providers with some national applications was pitched as a compromise between total centralisation and complete decentralisation. In truth, it was what the technology available at the time was best at delivering. Since then, the internet has connected everyone, and if you started NPfIT today, it would be blatantly obvious that you set common standards, and allowed everyone to do their own thing with a standardised, interconnected infrastructure. For government IT, perhaps that is the most important thing to learn from the demise and debacle of the NHS programme. Technology changes faster than any such large-scale project can deliver, and putting in place a huge, 10-year programme based upon trends and technical limitations at its inception is doomed to failure. The future of government IT is smaller, decentralised, faster to implement, standardised, interconnected systems. The lasting legacy of the NHS National Programme should be that it is the last of the overblown, over-ambitious mega IT projects.