Make cuts, but don't leave hospitals without computers

There are some sensible savings the government could make in its IT spending. The NHS National Programme is not one

The National Programme is intended to introduce computerised systems to every NHS trust in England. Photograph: Guardian

It would be easy to cut billions from government IT spending: cancelling identity cards and the National Identity Register would save more than £2bn over 10 years, for example. But instead, the chancellor, Alistair Darling, is aiming his scissors at health service computing.

"The NHS had a quite expensive IT system that, frankly, isn't essential to the front line. It's something that I don't think we need to go ahead with just now," he told Andrew Marr yesterday.

There are a few odd aspects to this. The first is that it is far too late for the government not to go ahead with England's National Programme for IT, which is a set of linked systems rather than one. Some parts are years behind schedule, but other elements are finished, working and largely paid for.
The £554m lifetime cost of the N3 broadband network run by BT to link NHS sites has all been spent, according to the Department of Health, while the electronic appointment booking system, Choose and Book, has been running for some time.
The programme is several years late in providing local patient record systems to NHS trusts, and as it pays suppliers by results, these could be delayed or cancelled (although the suppliers – BT and Computer Sciences Corporation – could well demand hefty cancellation fees). With only £4.5bn of the programme's £12.7bn projected cost by 2014-15 spent by March this year, the temptation for the chancellor is clear.
The big problem is that IT in many NHS trusts, particularly hospitals, is antique and in some areas non-existent. While most GPs paid to computerise their patient records some years ago, many hospitals wards still use paper. The idea of the National Programme was to introduce new computerised systems, focusing on electronic patient records, to every NHS trust in England.

The reasons for its lateness include the government's attempts to press standardised software on every trust, a cavalier attitude towards privacy, and a general failure to realise the size of the job. It is not because electronic patient record systems are a pricey indulgence, even though the government's chosen systems are costing several million pounds for each trust.

This is clear from other countries. Scotland's four-year-old Emergency Care Summary record system covers the entire population .

President Barack Obama wants every American to have an electronic health record by 2014, and Canada and France are aiming for similar results.

Even in England, trusts with the wherewithal are spending on computerisation: Newcastle Hospitals, a foundation trust with relative freedom, last month started using a multi-million pound software system it bought ready adjusted from the University of Pittsburgh medical centre in the US – it reckons the city has a similar healthcare profile to its own, with a legacy of industrial jobs.

The government has already given trusts in the south permission to buy such systems from an approved list, rather than the single suppliers dictated elsewhere, after Fujitsu walked away from dealing with this area of the country last year. It could extend that freedom to the rest of England, and some trusts might decide they could live with cheaper software.
But the idea that to leave hospitals working on paper represents an efficiency saving strains credibility.
• SA Mathieson is editor of SmartHealthcare.com, which provides news and analysis of health and social care ICT