A successful programme must be fortified by healthy competition

As the NHS National Programme for IT (NpfIT) continues to press ahead with the largest civil technology procurement in the UK, the gap seems to widen between those suppliers who believe they are 'in' and the growing band of orphans.

Of course, this was always going to happen. We're in a £2.3bn procurement and there will be winners and losers.

NHS IT Tsar, Richard Granger has made it plain that market rationalisation was both 'inevitable and desirable'.

However, this must not be at the expense of a healthy, confident and competitive marketplace. Competition will grow naturally if the right environment is created, both contractually and culturally.

But if the source of life is stifled for all but the very strongest companies, the massive depth of experience in UK healthcare that exists in NHS IT could be lost to the country for good.

We are told that £850 million was spent on IT in the last financial year and that this level of investment will be maintained again this year. Richard Granger has also publicly stated that local investment in IT should continue.

Yet stories from suppliers regarding projects stopping or not getting off the ground due to lack of funding, uncertainty or directions from above continue. The problem may then lie in the communication trail.

Some in the NHS are continuing to invest but somewhere down the line the clear instruction to ALL local NHS managers and financial directors that appropriate local investment in IT should go on in addition to NPfIT is getting blurred.

In the longer term, of course, the new winners in the NHS Supplier market - the five major Local Service Providers (LSPs) who will be appointed to manage delivery of the new 'integrated care records service' (ICRS) - need the existing specialist providers. They need them to compete to ensure that they can deliver ongoing best value, functionality and innovation.

The NHS wants to see this too. Over time therefore, an LSP's preferred solution' will mature into a wider portfolio of service able to cope with the multiple demands of front-line NHS Trusts, as well as the NHS national and centralist ambitions.

Innovation, integral to a competitive market, must be fostered and developed within and across consortia. The responsibility for this will fall to LSPs, but all suppliers will need to understand clearly how innovations can be introduced, what the priorities are and how they can turn a profit - like retaining intellectual property rights and selling products to other consortia, for example.

Currently, Intellect members are meeting the challenges presented by NPfIT head on. LSPs are learning quickly and working hard to meet the tough requirements demanded by Granger's team, albeit with some casualties.

Other suppliers are doing their best to adapt to the changing landscape while competing vigorously within their niche markets.

Power is to be gained from collaboration with other players in the new environment and this is lost on no one.

So if the suppliers are ready to step up to the challenge of the national programme, does the NHS itself need to take some challenges of its own on board? Maybe a few, that we've learned from other IT programmes.

To start with, we need dialogue. Real, sincere, and thorough dialogue. The NHS doesn't have all the answers, and neither do the suppliers. But in partnership, we probably have a way forward.

To support the dialogue, we need belief in, commitment to, and investment in NHS IT, gained through a clear understanding of the benefits.

Finally, and most importantly: Don't stop. By the time all the LSP contracts have been awarded in December, the programme will have been running for two years from policy to procurement. Falter now, and there won't be anyone left to turn the lights out.

Laurence Harrison is healthcare programme manager at supplier trade body Intellect