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Scaling back the National Programme for IT

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(16)2010
Author(s): 
Adam Oliver
Health Policy Issues: 
New Technology, Political Context, Quality Improvement
Reform formerly reported in: 
Implementing an Electronic Patient Record
The long journey of the Electronic Patient Record
Progress on the electronic patient record
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no yes

Abstract

As indicated in previous Health Policy Monitor Reports, developing a national, centralised programme for IT, including a national electronic health record, was one of the signature NHS policy initiatives of recent Labour Governments. However, the new UK Conservative/Liberal Democrat Coalition Government has recently taken the decision to scale back this initiative significantly, by instead promoting a more locally-led plural system of IT.

Recent developments

In September 2010, the Department of Health announced that the National Programme for IT will be scaled back. In short, the centralised, national approach adopted by previous Labour Governments is to be replaced by a locally-led approach. This essentially means that local health care services will be encouraged to keep, and if necessary, develop their own systems of IT, rather than replace them with a nationally mandated alternative. The intention is then to connect up the locally-developed systems. The decision has been taken by the Coalition Government elected in May 2010, which is advocating a much more locally-led NHS. However, the decision is also motivated by the significant cost savings from abandoning the more centralised approach, attractive in this era of public sector spending constraint. It is anticipated that this change in direction will save £700 million.   

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

I have answered this above.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no yes

Initiators of idea/main actors

  • Government
  • Providers: I think most doctors now support the use of IT, and I suspect that most of these will be happy that they can retain systems that many of them have developed over the years

Stakeholder positions

The idea to change the direction of the National Programme for IT comes from the new Coalition Government. As stated in previous Health Policy Monitor reports, the National Programme has had serious problems in the past, which has included companies failing to meet their commitments. However, as also stated, the evidence suggests that the successful implementation of a national programme takes many years, and requires patience. Most policy makers probably lack the patience to see the originally intended project through, particularly given the brevity of electoral cycles. However, major motivations for the change in direction also come from the current Government's rhetorical preference for locally managed initiatives in all areas of public life (epitomised by David Cameron's 'Big Society'), and also by their need to cut public sector spending. The National Programme for IT is an expensive initiative, and was bound to come under scrutiny.

All in all, the change in direction is not necessarily a bad idea. It would seem sensible for local providers to continue using and develoing local IT initiatives, many of which have been in place for many years, rather than to ask them to replace these with new programmes which may not best reflect their preferences and needs. The locally developed progammes will then be connected up nationally, although one can imagine that cross-regional understanding of different programmes and different modes of storing information will be less easy than if a uniform, national framework had been put into place.  

Actors and positions

Description of actors and their positions
Government
The Coalition Governmentvery supportivevery supportive strongly opposed
Providers
Health care providersvery supportivesupportive strongly opposed
current current   previous previous

Influences in policy making and legislation

The change was implemented because of the change in Government. Had the Labour Party won the 2010 general election, it is probable that they would have persisted with developing the IT programme as initially envisaged, not least because of the sunk costs already expended on this policy direction. The new government does not need to engage in a legislative process to make this change - it is a relatively minor part of their overall health care policy.

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
The Coalition Governmentvery strongvery strong none
Providers
Health care providersvery strongstrong none
current current   previous previous
The Coalition GovernmentHealth care providers

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Coalition Government announced this policy change only very recently (in September 2010). Some private sector companies who would have otherwise developed the nationally mandated IT will lose out, because the estimated £700 million that would have been spent on doing this will now be used elsewhere. Many NHS doctors/providers/purchasers will no doubt be pleased with the change in direction, as it will enable them to continue to use IT that they have developed over many years, and have thus gotten used to using. A national, standardised programme would probably have reaped benefits had it been persisted with (as indicated in previous Health Policy Monitor reports on this issue), but the current Government clearly feels that even if that were possible, the current fiscal environment prevents the continued investment at previous levels.  

Monitoring and evaluation

This section is not applicable, although it is possible that the resistance of some providers/purchasers to changing their systems of IT did not escape the Coalition Government's attention, and may have been a factor in the government deciding against necessitating the replacement of these local systems with a nationally mandated one.

Expected outcome

As I have indicated above, on balance I think it is probably sensible to continue to allow local organisations to use the IT systems that they have designed and become accustomed to, and then to link all these systems up nationally. There will no doubt be problems associated with lack of uniformity across the whole country, but these are obstacles that will have to be summounted when patients either relocate or receive health care treatment outside of their local area.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high
current current   previous previous

I have indicated a high cost efficiency only because the new direction is estimated to save £700 million and yet will probably have no direct impact on the quality or outcomes of health care, at least in the short term. In the longer term, it could be argued that a uniform nationally mandated system would have been better - or worse - depending on whether you take the perspective that uniformity would have improved ease of use, or whether differences in local preferences and needs should be accounted for in IT infrastructure

References

Sources of Information

www.connectingforhealth.nhs.uk/newsroom/news/npfit090910

Department of Health. Equity and Excellence: Liberating the NHS. Stationery Office: London, 2010.

www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119293

Reform formerly reported in

Implementing an Electronic Patient Record
Process Stages: Implementation
The long journey of the Electronic Patient Record
Process Stages: Implementation, Evaluation, Change
Progress on the electronic patient record
Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Adam Oliver. "Scaling back the National Programme for IT". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/uk/a16/3