NHS reform makes IT a political issue

The NHS National Programme is the most ambitious IT project ever undertaken in the UK.

With 1.4 million staff, the health service is the world's second biggest employer after Indian Railways. It is divided into 28 autonomous Strategic Health Authorities and a complex network 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, Delivering 21st Century IT Support for the NHS, which was published in June, outlines a five-year technology programme for health service reform, for which £5bn has been allocated.

"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."

The programme's priorities are a high-speed broadband infrastructure, an electronic patient record system, and electronic applications for appointments and prescriptions.

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

"We will shortly be unveiling the new purchasing strategy for NHS IT. Further details of how the strategy will work, the time scales and funding details, will be available then," said a Department of Health spokeswoman.

All the industry knows is that there will be between two and five consortia, each led by a prime contractor the role of which 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 the technology, which can be provided by other consortium members. So the field will be open to be more than just the usual suspects.

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

The time scale is inordinately tight. To meet the overall targets the contracts will need to be defined, advertised and signed by the end of April so that work can start in the autumn.

Bearing in mind that the public sector purchasing process can take up to a year, it's just as well that there are plans for a streamlined version.

"Suppliers know that, until this work starts, there'll be a lack of money in the sector, so there's a strong drive to get underway," said Laurence Harrison, healthcare programme manager at trade body Intellect.

"But it has to be right for everyone, and there will have to be a balance struck."

NHS: THE TARGETS

2003

• Data standards defined.
• NHS clinical and management staff connected to NHS network.
• Electronic transfer of certain test results.
• First stage of electronic patient records.

2004

• National directory service.
• Broadband infrastructure in place.
• Electronic radiology messaging.

2005

• National applications for electronic bookings, prescriptions and patient records, including electronic discharge summaries, integrated patient index and initial connections to health records infrastructure by all Trusts.

2006-7

• Broadband access for NHS local and wide area networks.
• Added functionality for electronic patient records, bookings and prescriptions.
• Tele-medicine in GPs' surgeries.
• Picture archiving and communications systems.
• Full electronic results reporting and order communications.