NHS reform makes IT a political issue

The NHS National Programme is likely to be the most ambitious IT project ever undertaken in the UK. With 1.4m staff, the health service is the second biggest employer in the world after Indian Railways.

It is divided into 28 autonomous Strategic Health Authorities and a complex variety of related agencies.

But size isn't everything. Even more important is technology's move into the upper echelons of the political world.

The strategy published in June last year - 'Delivering 21st Century IT Support for the NHS' - outlines a five-year technology programme to underpin health service reform, funded by an extra £5bn.

'For the first time big IT projects are critical to the success or failure of the government,' said Liberal Democrat IT spokesman Richard Allan.

'When things go wrong in the Passport Agency, for example, it might be annoying for a lot of people but it is not make or break for the government.

'The National Programme is a sink or swim issue,' he said.

The programme's four central priorities are a high-speed broadband infrastructure and electronic patient records, booking and prescribing applications.

But the size and complexity of the strategy's requirements will tax both the customer and IT suppliers, and as yet few logistical details have been agreed.

'We will shortly be unveiling the new procurement strategy for NHS IT. Further details of how the strategy will work, the timescales and funding details, will be available then,' said a Department of Health spokeswoman.

At this stage, all the industry knows is that there will be between two and five consortia, each led by a prime contractor whose role will be to co-ordinate the work of a range of smaller suppliers.

Prime contractors will not necessarily be IT firms. Programme management and organisation skills will be more important than actual technology - likely to be provided by other consortium members - so the field will be open to be more than the usual suspects.

But details such as how the programme will be broken up into individual contracts, how prime contractors will be selected and how they will then advertise themselves to smaller suppliers, will not be specified until a streamlined procurement procedure is released at the end of this month.

The timescale is inordinately tight. To meet the overall targets (see box) the contracts will need to be defined, advertised and signed by the end of April, so work can start in the autumn. Considering the public sector procurement process can take up to a year, it's just as well there are plans for a streamlined version.

The NHS strategy can only succeed if the suppliers succeed, and that is delicate balance, says Allan.

'It's a carrot-and-stick situation: the centralised strategy is the stick to push suppliers in the direction the NHS wants to go, but there will also have to be sufficient carrots to keep suppliers both on board and in business,' he said.

Once the contracts are signed and the work is underway, technical standards will be of prime importance. There are plans for an agency to be set up by consultants and then taken over by the NHS Information Authority, to make sure any proposed solutions will fit together.