IT in healthcare pt1: Can innovation thrive under the knife?

Pressure on NHS budgets is forcing IT chiefs to explore shared front- and back-office systems, new procurement frameworks and cloud computing

Efficiency is the last word many people would associate with IT provision in the NHS, especially with the memory of the National Programme for IT (NPfIT) debacle still fresh on our minds. Despite costing taxpayers an estimated £12.7bn over nine years, the NPfIT failed to achieve its primary goal - an electronic care record for all UK citizens - and was finally scrapped last month following a report from the Cabinet Office, though some individual projects will be returned.

According to the government, the NHS spent £1.6bn on IT alone in 2009. Meanwhile, the National Audit Office (NAO) estimates that England's 165 hospital trusts could save at least 10 per cent of their £4.6bn annual spend on consumables, including A4 paper, printer toner and other IT-related items, by abandoning inefficient procurement practices that currently result in them paying different prices to different suppliers for the same equipment.

"The original vision for the NPfIT in the NHS will not be realised," said Amyas Morse, head of the NAO in May this year. "The NHS is now getting far fewer systems than planned, despite the department paying contractors almost the same amount of money... another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme."

Additional budgetary pressure prompted by Secretary of State for Health Andrew Lansley's programme of NHS reforms, which some experts say will see the NHS budget reduced by up to £900m a year in real terms for the next two years, means healthcare IT managers need to be even more focused on squeezing maximum efficiency out of existing systems and upgrades.

Many primary care trusts (PCTs), or whichever organisational bodies take their place, will continue to negotiate volume software licensing agreements with major vendors, including Microsoft, but others are looking to new outsourcing models, particularly cloud computing and shared infrastructure arrangements, to deliver operational cost savings.

Specialist patient administration and electronic patient record systems (EPRS) suppliers such as System C have been providing various NHS trusts with software for years, for example, and it is possible that some of those applications will now move into the cloud in a bid to make IT service delivery more cost efficient and flexible. That said, concerns about cloud performance, reliability and security remain and could prove to be barriers when it comes to storing patient records.

One hospital that is exploring the potential of the cloud to deliver savings and efficiencies is London's Chelsea and Westminster Hospital. It is running a two-year pilot scheme using simulated patient data, using a platform developed jointly by cloud service provider Flexiant and Edinburgh's Napier University, which allows patient records to be accessed from computers and mobile phones.

"It is important for NHS patients' data to be secure in the cloud, should this e-health system become official. We aim to eliminate potential security risks associated with non-standardised CSPs [cloud service providers] by suggesting that the CSP storing NHS patient information in the cloud is standardised and secure," says Andy Burton, chairman of the Cloud Industry Forum.

Elsewhere, the Barnet, Enfield and Haringey Mental Health NHS Trust (BEH-MHT) has appointed HP Enterprise Services to provide managed IT services under the government's latest Desktop21 procurement framework. According to BEH-MHT's head of IT, Louise Felstead, the resulting infrastructure could eventually be available for neighbouring trusts to share.

Desktop21 (Desktop for the 21st Century) is a collaborative procurement process outlined by government procurement management agency Buying Solutions (formerly OGCbuying.solutions and part of the Office of Government Commerce) and the Department of Work and Pensions (DWP), which is designed to provide public-sector organisations with approved standards and suppliers for the delivery of desktop computer services to staff.

HP Enterprise Services, Fujitsu and Atos Origin are the only suppliers approved by the Desktop21 framework, raising fears about potential vendor lock-in and overcharging (Fujitsu's contract as an NPfIT provider was terminated in 2008), but Felstead is confident the seven-year contract will deliver better value for money.

"The way we have planned the agreement is that we will achieve substantial savings over the term of the contract that are in excess of any savings we would have made had we stayed doing what we were doing," she says. "The bills will not go up, they will do down."

The NHS Shared Business Services (NHS SBS) - a joint venture between the NHS and systems integrator Steria - is looking to set up a similar framework to make a range of shared clinical information systems available to PCTs. It will cover information and resource sharing for R&D, clinical audits, teaching and training, and clinical and non-clinical service systems. Management may also be extended to back-office systems used by the GP consortia, which are expected to take over some of the functions currently carried out by PCTs once wider reforms are complete.

Opponents of shared services argue that the only economies of scale they deliver derive from one-off savings that result from redundancies or terminating property leases, while the standardisation involved will mean IT services are tailored less to the needs of individual systems or departments.