NPfIT - business as usual?

With only hours notice the Department of Health called a press conference at its HQ in Whitehall. It said there was to be “an announcement on the future of the National Programme for IT”.At about the same time a ministerial statement...

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With only hours notice the Department of Health called a press conference at its HQ in Whitehall. It said there was to be “an announcement on the future of the National Programme for IT”.

At about the same time a ministerial statement was laid in Parliament; and by lunchtime the media was reporting the death of the NPfIT.  The Department's press release said a review of the National Programme for IT had “concluded that a centralised national approach was no longer required”.

But is the NPfIT really dead? Putting aside the rhetoric, it is hard to see what the Coalition has changed over and above what Labour had changed. If anything the NPfIT is now unmistakably alive.

At her press conference at Richmond House Christine Connelly, the Department of Health’s CIO, disclosed, in answer to questions, that a controversial part of the original contracts with the local service providers remains.

The contracts specify that NHS trusts are obliged to buy sufficient core and additional services from the local service providers to bring the cumulative spend up to what the contracts call the “cumulative minimum commitment” in any particular year. 

In the contract between the Secretary of State for Health and CSC, the Cumulative Minimum Commitment’ represents up to 70% of the contract charges.

The NPfIT is far from dead

If NHS trusts don’t buy enough from BT and CSC, the suppliers are entitled to claim compensation.

In other words NHS trusts must continue to buy from the NPfIT’s two main providers who, between them, have more than £4bn worth of contracts. National, centralised contracts. 

Connelly said at the press conference:

"In terms of our contract with CSC and BT we guarantee them a number of trusts will take their systems. That’s part of the contract arrangements.”

Connelly was asked how she can guarantee to buy from BT and CSC if the NHS doesn’t want to buy from them.

"Because the trusts in the NHS have indicated that they do want these systems,” replied Connelly. “In the work we have done, we have talked with a number of trusts and they are saying that, subject to everything working the way it is supposed to, for example with Lorenzo, that they want to do that.” 

Will those trusts be obliged to buy from BT and CSC? 

"In terms of the commitments we have under the LSP [local service provider] contracts with CSC and BT, there is a legal obligation from the NHS to purchase systems under those contracts and we fully intend to honour that.” 

So more than £4bn worth of central NPfIT contracts with BT and CSC remain - unequivocally so.

The NPfIT's national systems remain

Connelly also confirmed that other national products under the NPfIT remain: electronic prescriptions, Choose and Book, the N3 broadband network and Summary Care Records.

What has changed from the original NPfIT contracts is that trusts can choose what systems to buy. But that changed under Labour.

Before losing the general election, Labour revised the NPfIT local service provider with BT to waive its commitment to deliver core systems to all of London’s trusts. In return BT took £100m off the price of its contract. The revised deal left half of London’s trusts able to buy their systems of choice.

Labour also gave trusts in the south of England a choice of centrally-funded systems under a framework ASCC contract, which remains in place under the Coalition’s plans.

Elsewhere in England - within CSC’s domain - some trusts under Labour had already begun to buy outside the NPfIT.

So what is being scrapped?

Connelly was asked about the future of NHS Connecting for Health, the centrally-organised part of the Department of Health that runs the NPfIT.

She said the central bureaucracy associated with the NPfIT will be dismantled. But nobody has decided how; and she made it clear that the 1,200 staff at Connecting for Health may be retained, though dispersed within the NHS.

"We need to be clear about the activities that need to continue,” she said. “When we are clear about those we then match people to activities… They [the 1,200 CfH staff] could be dispersed. That is absolutely an option. What we are clear about is that the future health service needs a highly-skilled informatics workforce.”

So the national NPfIT systems, central contracts and CfH staff will remain - if dispersed.

One change to the NPfIT that is exclusively the province of the Coalition is a promise of £700m savings on top of the £600m promised by Labour. But Connelly (who was at all times open and candid) conceded that the £700m in savings is an intention, not a reality as yet.

£700m in savings are aspirational

The £700m comprises £200m from CSC and £500m from local costs. The savings from CSC have yet to be negotiated and the £500m from local costs is an estimated - hoped for - figure, based on discussions with trusts.

As it’s business-as-usual with the NPfIT, why has the Coalition been content to allow the media to announce that the NPfIT is dead?

When an MP pointed out to Simon Burns, the NPfIT minister, that the media is saying the national programme is being scrapped, Burns indicated his approval. He could justify the headlines with the woolly argument that the Coalition’s intention is to move all decisions closer to the frontline.

The NPfIT cannot be scrapped 

The reality, though, is that Coalition MPs have discovered that the NPfIT contracts cannot be economically cancelled and the huge sums invested in the national systems such as Choose and Book and Summary Care Records make it impossible to cancel them.

Health minister Simon Burns may be comforted by the idea of the NPfIT’s death, even if it’s been greatly exaggerated. The novelist EM Forster said that death destroys a man but the idea of death saves him.

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Links:

NPfIT declared dead - Health Care renewal

The end of NPfIT announced - British Journal Healthcare Computing 

EMIS to benefit from NHS changes - Techmarketview

Reaction to the end of the NPfIT - Pulse 

Summary Care Record pushes ahead - Henry Porter