How much of NHS tax rise is destined for international IT companies?

By Tony Collins

Matt Hancock, the health secretary, told the BBC’s “Today” programme yesterday that part of the £20bn a year extra funding for the NHS will pay for “vital” new technology.

“The money is coming,” said Hancock in reply to Today presenter Justin Webb who asked whether it was right for the £20bn to be spent on technology rather than, say, more GPs.

Webb asked, “This money [for new systems] comes out the money recently announced for the NHS that I think people will have thought was for patient care but a significant amount of it will be spent on IT?

“Improving the IT does improve patient care,” said Hancock, “You need the best technology to get the most out of that [£20bn] money.”

Hancock said lessons from the disastrous £10bn NPfIT have been learnt and it’s time to move on.

“One of the problems of the history of bad NHS IT decisions is that people have run away from this subject,” said Hancock, “Leadership has run away from this subject in too many cases. We must all embrace it [new  technology].”

He said the new approach to NHS IT will be markedly different to the NPfIT.

“The £10bn NPfIT imposed a top down solution on every trust in the land.” The new plan means “required standards – data protection, cyber security and crucially standards of interoperability – but you buy the kit and crucially it has got to be able to work with the rest of the NHS’s IT”.

He said the new money will go into much more than having systems talking to each other. “Clinicians are demanding the sorts of changes we are proposing.”

In the short term, more than £200m will be spent to make a “group of NHS trusts into internationally recognised centres for technological and digital innovation”.

Justin Webb said the Hancock plan sounds much like the NPfIT – which Hancock denied.

Comment

NPfIT was a disaster for taxpayers but not for all international IT companies.

About £10bn was spent, much of it with IT companies and on consultants. Perhaps for this reason parts of the private sector have good reason to take a pragmatic view of public sector IT disasters.

And behind the scenes, the lobbying of senior officials over new NHS IT plans has become routine, from the sponsoring of break-off groups at party conferences to off-the-record events and briefings.

It’s unlikely Hancock will have been in the job long enough to have been lobbied personally but it’s likely his officials have – and for the best of reasons: to ensure they are keeping up with what’sh on the market and what new technology is capable of achieving in the NHS.

To his credit, Hancock acknowledged this week that the biggest problem with NHS IT is that systems do not talk to each other.  Indeed, he is fond of the vogue word beloved of NHS IT suppliers – interoperability.

Matt Hancock’s Telegraph article 6 Sept 2018

But much of what he said this week in his Telegraph article and speech at NHS Expo in Manchester could have come from the press release of an international IT company. That same press release has been issued numerous times over the past 20 years: about the spending of more money on an IT-led transformation while learning lessons from the past.

What ministers and the press releases rarely say – if ever  – is that the NHS’s biggest IT-related problems could be solved with only little money. There’s no need for self-aggrandizing announcements. No need to buy warehouses of new systems from IT corporations. It’s simply a question of finding the best and cheapest way to allow existing NHS systems to talk to each other: perhaps using secure web links in the way banks enable customers to see their accounts and carry out banking transactions.

Why don’t NHS England and the Department of Health and Social Care fund a joint practical study into the best and simplest way of linking existing systems – rather than spending money centrally on a new app for booking GP appointments – which sounds like a repeat of the NPfIT  “Choose and Book” system?

Too boring perhaps. No politician wants to announce a mere study, especially when one where there’s no big money involved, no guaranteed mention of either artificial intelligence or a new app and no mention of an IT-led transformation that will save the NHS hundreds of millions. And no mention of a paperless NHS by the end of 2018 or the use of leading-edge technologies for the benefit of officials’ CVs.

But, as Apple said, and Da Vinci was purported to have said, “Simplicity is the ultimate sophistication”.

Would that Hancock were lobbied to learn the main lesson from NHS IT disasters of the past 20 years: that the biggest reforms don’t have to be wrapped in big financial packages.

It won’t take much to make interoperability happen. But sorry – it’s a reform that doesn’t come with glory. No immortalised legacy for ministers.

Please Mr Hancock do not talk about artificial intelligence and new apps while people are dying because NHS systems don’t talk to each other.

For those who are faced with a tax rise to fund an extra £20bn a year for the NHS, “investment” in new IT from international suppliers will not be top of their list of priorities.

Given the pressures within the health service to meet increasing demands from an ageing population, perhaps the new maxim for central planning of NHS IT ought to be: do nothing other than what is absolutely necessary.

Nobody is inspired by technocratic talk. What inspires is the bringing about of a major common good at a surprisingly low cost.

BBC Today interview with Matt Hancock on NHS IT – 6 September 2018