Computing talks exclusively to the head of the NHS Information Authority

The Department of Health's recently published National Programme puts IT at the heart of NHS reform. The strategy followed recommendations in the Treasury-backed Wanless report published in April, and sets out how the extra funding for the health service outlined in this year's budget will impact on IT.

The report establishes four key areas of investment - a high-speed communications infrastructure and electronic records, bookings and prescription applications to run on top. It also includes plans for a ministerial taskforce and a DoH Programme Board to take responsibility for the plan.

Gwyn Thomas, chief executive of the NHS Information Authority, talks exclusively to Computing about the National Programme and health service IT.

How important is the National Programme and what are the most important things it covers?

The four areas identified in the programme are the basic platform and the cornerstone of future developments. Other things will come into the programme over time but those four really set the direction and are the bedrock. They are a necessary stepping stone.

The key shift is that the three applications are described as services rather than systems. That is the absolutely critical shift in emphasis and mindset that this programme brings about because it means that at heart of the strategy is the patient's journey through the NHS, rather than just buying IT.

So the real change is an organisational change, not about implementing IT systems per se. And this is how it should be - IT in the enabling role rather than just buying for its own sake.

How important is IT to modernising the health service?

IT is cornerstone of NHS reform. The patient's journey is thing that binds service together because the one thing that remains constant is the interaction between the clinician and the patient. Information and IT can now provides information services to both at any one time and because we have information about how that is working we can re-design processes, set standards of patient care and demonstrate we are meeting them. We can also collect information that allow a comparative performance assessment of one organisation against another. Once we have that in place we can really delivery patient choice.

Do the political masters recognise the importance of IT?

Lord Hunt recently announced he is setting up a ministerial task force [to take responsibility for health service IT strategy] which certainly suggests it's at the top of the list and the commitment is there. All the signs point to this being genuine commitment.

There is also the sense that it's becoming more mainstream in NHS management, which is also a key step forward - IT is no longer seen as an add-on but as integral.

The National Programme appears to send a clear message of centralisation for NHS IT, with more and more strategies and even systems, being organised from the Department of Health.

I think it is a more corporate approach, rather than centralisation as such. It's not a pendulum swinging between devolved and centralised. We are trying to strike a new balance. Some things can best be done centrally like setting standards and working with suppliers. But there is still an argument for diversity because not every area has the same needs. We have to move away from plethora of solutions in past and this programme will do that but like to think this new NHS behaving as a corporate entity which I applaud whole-heartedly.

Does the National Programme contain anything new?

It is the same strategy but expressed differently - better co-ordinated, pulling together under a single umbrella things that are happening anyway. The key change is the step up to programme management that the NHS is unaccustomed to. In other industry sectors big projects are run as programmes and this is the first attempt in NHS at proper programme management.

How does the new strategy affect the NHSIA?

The NHSIA is there to do four things: to support the development and use of electronic records, to run a secure infrastructure, to provide information and knowledge management services to support decision-making, and to step support health informatics as a profession. That always our role and those four strands all appear in the National Programme, either directly or in a supporting capacity, so this puts the NHSIA right at heart of the strategy.

The key is setting up the programme and making it work - putting people in position, doing the detailed planning, setting up development projects so there is the right level of support and training. All that preparation work has already begun.

What problems or issues will be faced when the strategy is put into practice?

Sustained investment is crucial. If it's not sustained over the long term it will be wasted. Like all infrastructure this goes on and on, it's not just the three to five years to deliver the main points of this programme. Health service IT needs a short-term boost to catch up but then that will have to become normal.

It's not a technology problem we are trying to solve, but an issue of change management. So another issue will be the capacity of both the NHS and industry to collectively achieve this task. We should not under-estimate the difficulty - this is major challenge. The health service has about one million employees, and sixty million patients - so the scale of the organisational change is a capacity issue not to do with technology. To meet this we must balance what we are trying to do with the resources available and the timescale we have set. This is a step up to programme management and every decision now being made should be on the basis of those three things. The new approach to major suppliers will help to manage the capacity problem on private sector side because it moves away from the fragmented market where lots of energy and effort are expended on so many different procurements.

What is the most difficult area of development?

Of all the components of the programme developing electronic patient records (EPR) is the most difficult but that is where the shift from thinking about systems to thinking about services will help.

Standards, procedures, applications can be run as a national service. Then, by using open technology standards, we can link those national services with local services such as moving x-rays around. In between are whole range of services and we will need to decide what fits where. That is the difference in approach - mapping out the electronic record from the perspective of setting up services rather than procuring systems. The National Programme is a reflection of that changing perspective taken up at the top of the tree.