NHS budgets for IT 'must be doubled'

The headlines following Gordon Brown's Budget last week concentrated on tax hikes paying for more doctors and nurses.

But the Wanless report commissioned by the Treasury on the NHS takes a longer-term view with considerable emphasis on infrastructure and IT.

Derek Wanless calls for a doubled annual budget of more than £2bn every year until 2022, starting next year. Investment levels should peak at about £2.7bn in 2007-8 and then level off once the core infrastructure is complete.

IT budgets should be ring-fenced to make sure money is spent on the systems for which they were intended, and there should be centrally agreed standards to guarantee the free flow of information.

IT is the lynchpin for delivering improved healthcare, Wanless told Computing.

'Without a major advance in the effective use of IT, the health service will find it increasingly difficult to deliver the efficient, high-quality service which the public will demand,' he said.

The Treasury report has been widely welcomed.

'We are pleased by the recommendations. They reinforce many of the things we have advocated for some time - increased investment, targeted funding and centrally-set standards,' said NHS Information Authority chief executive Gwyn Thomas.

Extra cash needs to be spent in three stages.

At the lowest level is the network infrastructure underpinning the health service as a nationwide organisation.

Running on that network will be applications to improve efficiency, such as electronic patient records, prescription and booking systems.

Beyond that are initiatives looking at different ways to deliver the information wherever and whenever it is needed, using mobile technologies such as mobile phones and palmtops.

Wanless's suggestion that IT budgets rise from one per cent to three per cent of total health spending still err on the side of caution, says Murray Bywater, managing director of healthcare IT consultancy Silicon Bridge Research.

'In the long run it's more likely to be five per cent, which translates as about £4bn to £5bn a year,' he said.

An extra billion a year across key investment areas - patient-oriented systems such as access to NHS Direct through TV set-top boxes, internal systems such as electronic patient records, and centrally-run infrastructure systems - would take UK healthcare a long way forward, says Bywater.

But it's not just a question of money. The bigger the budget, the greater the need for co-ordinated spending and a clear fundamental strategy.

The structure of the NHS creates major management issues for technology strategy, and firm decisions must be made as to whether projects are run by the hospital, the trust, the health authority or across the region.

Different kinds of project require different kinds of management, but it needs to be consistent, says Bywater.

'There needs to be a combination, some things done centrally to build up the infrastructure and other things to done locally. The issue is where to draw this line.

'The biggest risk is doing neither one thing nor the other, or changing our minds halfway.'

Responses on the ground suggest the first priority for extra funding will be networks.

'If you're going to put in this kind of money, you have to build the infrastructure. It's like the railways: it's all very well having good rolling stock, but without the tracks you're buggered,' said Will Willson, deputy chief pharmacist at Addenbrooke's Hospital.

The danger is that political pressure for short-term results to justify raising National Insurance contributions will detract from the need for long-term infrastructure projects, where purchasing alone can take 18 months.

'The real worry is that the fundamentals will be bypassed in favour of quick results, which would be a tragedy because we have a real opportunity to fundamentally re-engineer processes of healthcare and support that with well thought-out IT,' said Willson.

Bart's and the London Hospital acting director of information management and technology Douglas Howe said: 'Network infrastructure is key at the moment because we need to be able to get the electronic record to where the clinician requires it.'