NHS IT: the way ahead

With the National Programme for IT in the NHS cut back, what's the new direction? Whereas NPfIT was based around centralist control of everything, the new approach will be federalist it seems.

"We expect to move to a world where we connect up multiple systems in different places,'" said Christine Connelly, director general informatics at the Department of Health. "Evolving to where we want to go will be different depending on where you are geographically and according to contractual arrangements. We are trying to be as pragmatic as possible."

Then there's the NHS' promised Information Revolution. "We need to give patients control. We are committed to engaging with patients, moving beyond surveys into dialogue," she said. "Empowering patients leads to informed choice. The Secretary of State is committed to giving people control of records.

"That's not an easy thing to say or deliver. We don't mean to give patients access to every computer system in the NHS. At the moment, our thinking is to allow patients to download information from the systems and share it with whoever wants to share it. We need to free data from where it's trapped. We have lots and lots of data. We need to get it out!

"To improve the quality of data and have quality data in the system, then the person who records it has to have responsibility for it. We need to capture data at the point of care. We don't have systems that make that easy at the moment. We can't continue to have reams and reams of text. We need to increase the amount of structured data.

Of course the question of how to fund all this at a time when the health minister has stated that there is no new money on the table was raised. Connelly's view is simple. "It's incumbent upon us [IT professionals] to come with compelling propositions. In the past when people have found themselves needing to be more efficient and make dramatic savings, they have turned to information and to technology."

But this does leave Trusts wondering what to do next. "There is still no real clarity about the National Programme," suggested Brian James, chief executive of Rotherham NHS Foundation Trust which broke away from the National Programme. "Many trusts are being left to find their own solutions. But after eight years of waiting, it's hard to start from scratch. There's no more NHS Bank, no financial support from the centre and many of the vendors no longer have fit for UK purpose offerings. There's also the question of where did the £12.5 billion go? We've got to wait for another inquiry into another NHS IT disaster."

James has a wider perspective on the challenges facing NHS ICT strategy. "The biggest problems are the stability of the system to allow people to get on and do something with constancy of purpose. It's difficult to do that when the system is unstable. We need much bolder leadership of the ICT agenda.

"We faced quite a lot of hostility and condemnation. I can understand why. There was a national strategy, but it wasn't working at the pace and scale for us. As a Chief Exec, you've got to be willing to take risks - and the NHS doesn't like that much. The NHS doesn't want leaders, it wants managers. Managers do what they're told and work within the status quo. The NHS doesn't cultivate or value leaders."