After sifting through more than 40,000 pages of documents, the team charged with giving the NHS a £2.3 billion IT upgrade this week announced which firms had been shortlisted for the biggest jobs. The 11 consortia, whittled down from 31, go into a final round to decide who will be awarded contracts to create an online repository of information about every NHS patient in England.
The man in charge of the national IT scheme, Richard Granger, said the contracts would be placed in record time. However, a group of NHS IT experts has expressed considerable concern about the process.
The firms are chasing two types of contract. The first is to run the national data spine, a repository of essential clinical information about every NHS patient. Three firms are in the running: BT, IBM and Lockheed Martin. The winner will be announced at the end of October.
Consortia will also be picked to modernise and standardise systems across one of five geographical regions. The first two regions, London and Northeast England, will place contracts with their "local service provider" at the end of October; the remaining three will follow by the end of the year.
The three national bidders are on the shortlist for these contracts, along with eight consortia headed by firms such as management consultancy Accenture, IT services giants EDS and SchlumbergerSema, and the services firm Jarvis. Isoft, a UK-based specialist healthcare software firm, which is in the process of merging with rival Torex, is understood to be working with most of the short-listed consortia.
Notable losers appear to be Oracle, which had bid for the spine contract, and McKesson, a US-based healthcare corporation which today is the third largest supplier of hospital systems to the NHS. Both firms declined to comment.
Granger, hired at a record £250,000 salary last year, said he was very pleased by the quality of the bids. The difficult parts, however, are still to come. Apart from picking the final winners, and fighting any challenges by aggrieved losers, the programme still has to win support in three key areas.
To begin with, NHS managers see their independence - and sometimes their jobs - under threat from the new nationally run contracts. One fear is that local innovation will be crushed: several NHS trusts are already doing locally much of what the new programme promises nationally. Lancashire ambulance service, for example, is already collecting data for electronic patient records on handheld computers at the scene of emergencies.
This week, the British Computer Society (BCS) and Assist, the NHS IT staff association, warned against "attempting to establish a monopolistic solution across the loosely federated NHS".
It said that Granger's team needs to give more attention to telling the NHS what it is doing and that the NHS "needs a balance between organic evolution and forced growth in its informatics".
Concern is also mounting about the amount of personally sensitive information that will be available on the spine. This will contain summaries of all treatment received by every individual in the country. Professor Peter Hutton, chair of the Academy of Medical Royal Colleges, said the information would be shared only with the patient's consent: "Individuals will be consulted far, far more than ever in the past about what information they wish to be stored about them."
Another big question is whether hospital doctors, who still usually write their notes, will use the new systems. The BCS/Assist statement said that doctors needed to be educated. "Few health informatics systems will perform up to their promise unless clinical involvement is enhanced and integral to day-to-day working."
Professor Hutton said doctors would notice the benefits of the new systems from the end of this year, but admitted that many are still sceptical. "We have to go through an educational programme that will, to a certain extent, be about winning hearts and minds. Initially, we will try to encourage usage on a voluntary basis."
Granger said that most doctors would be clamouring to use the new IT. But, in the long term, doctors would either have to like it or leave. "Usage of any system is always voluntary, in that if you don't want do do it, you don't have to be part of the greater whole."
· www.doh.gov.uk/ipu/programme
