The last few years have seen a steady erosion of the NHS National Programme for IT (NPfIT) - Fujitsu's recent contract termination in the South, Accenture's withdrawal from North East and East of England, GPSoC, and the new framework for additional supply capability and capacity (ASCC).

As the Department of Health loosens its vice-like grip over procurement of IT systems and services, freedom of choice is flowing back to NHS trusts.  But have we not been here before?  When the regional computer centres were privatised in the late 80s, trusts spent more than a decade creating islands of legacy systems and data that NPfIT was designed to fix.  Is this a case of going Back to the Future?

NPfIT is now moving into uncharted territory; as a result, Trust executives are facing some difficult questions :

  • "I'm the CEO of a Foundation Trust. Can we buy IT systems outside NPfIT?"
  • "If we do, will we be penalised by being forced to pay non-deployment charges?"
  • "Can we use the new ASCC framework to buy IT products and services?  How do we use it?"

NPfIT and foundation trusts

Monitor's guidance is that Foundation Trusts must achieve technical and functional compliance with NPfIT, but are not obliged to procure particular systems or hardware under NPfIT.  But Foundation Trusts must exercise their functions "economically, efficiently and effectively", reflecting section 39 of the Health and Social Care (Community Health and Standards) Act 2003.  Chief executives are also personally accountable for ensuring value for money. Like any other form of investment decision,  the Trust board will need to be satisfied that buying IT systems outside NPfIT is supported by a robust business case, based on effective due diligence.

Outside of the Southern cluster, (where Fujitsu was the local service provider), they may struggle to justify a decision to buy outside NPfIT, given that they would otherwise get the benefit of central funding.  In the Southern cluster, NPfIT has broken down, and it's not obvious what the future holds.  Will BT step in to Fujitsu's shoes?  Will the Department run a new procurement?  Or will Trusts be encouraged to use the new ASCC framework, but with central funding?  Faced with this uncertainty, but with the absolute certainty of further lengthy delays, Foundation Trusts in the Southern cluster should find it far easier to justify buying outside NPfIT.      

Non-deployment charges for trusts opting out of NPfIT

This is becoming a bone of contention between Trusts and the Department.  The Department's legal right to penalise Trusts buying outside NPfIT is unclear, but anecdotal evidence suggests that the Department is using its political and financial muscle to force trusts to follow NPfIT, and so perhaps Monitor needs to look into this urgently.

New ASCC framework

The new ASCC framework provides a streamlined vehicle for procuring IT systems and services from pre-approved panels of suppliers: Lot 2 (Clinical Information Technology) has 61 suppliers covering many different systems and services.  ASCC is intended to supplement the existing supply capacity provided through NPfIT and to enable new requirements to be met.  Although ASCC is already being portrayed as a symbol of a return to local procurement of IT, it's not a 'get out of jail card' for Trusts that wish to ignore NPfIT.  But things are different in the Southern cluster.  In the words of Monty Python, NPfIT here isn't dead – it's 'simply resting.'  Those Foundation Frusts in the South which are currently considering what to do next would be well advised to use the ASCC framework.  Trusts should not under-estimate the effort involved in framing their requirements, tailoring the model contract and running a mini competition before selecting a supplier.  And then they need to manage them.  

Of one thing we can be certain - we haven't heard the last of NPfIT.

First published in Health Service Journal.

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