Investing in ITNovember 2007 “I don’t know! I reckon this hospital’s gone down the pan. I remember when it was good to get up and go to work. Now I dread it. I hate it!” grumbled Paul, the A&E receptionist. He and Charlie were sat in the canteen drinking their tepid coffees. “I reckon it’s because you now have to go outside to smoke,” said Charlie the theatre nurse. “You were all right before the ban! What’s got you all worked up now then?” "I’ve just heard about how much they were spending on IT in our hospital. I think they’d be better spending it on you and me?” “I used to think that too, but then I read this article in an old hospital journal while I was waiting at my dentist the other day.” “NHS dentist?” “Yip!” “Can I have your autograph?” “Okay. Anyway. I read this EPR Arms article published way back in 2001 which talks about IT spend. Here have a read. I pinched it!” “Okay.” “This coffees tastes like mud” “It’s no wonder. It was ground this morning!” “Don’t give up your day job. Now read this while I go get some fresher coffees.” And with that Charlie handed over the April 2001 edition of bjhc&im. The EPR Arms April 2001 “You’ve got to speculate to accumulate... who said that?” I asked my mate in the pub the other night. This time it was my mate Liam Nelson I was asking, a banker (No. it’s not rhyming slang). His name is almost a film star, but not quite. A dusty dry banker, with a shrewd head for figures and a pot-belly sponsored by CAMRA. "I’m not sure. It was somebody you wouldn’t expect, he said, like Albert Einstein or Mark Twain. Whoever it was, they’re right: you only get out what you put in.” Minus bank charges, I thought. “So how much does your bank spend on computers then?”,I asked. “Mmm,” he paused, “mmmm...” After a while, I realised that he wasn’t carefully considering my sensible question but extolling the virtues of the Badger’s Crushed Paw bitter. “Sorry, what did you ask me?” I tried again: “How much of your bank’s vast income do you spend on computers and such like?” “Mmm. Well, let's think...” While he’s thinking, let me ask you how much your trust spends on IT. I know. It depends on what you mean by IT. In the IM&T Costs Benchmarking study, they included IT and information staff, but excluded switchboard and medical records staff and clinical coders. They included all hardware and software costs, but excluded printer ribbons and paper. Included training, excluded trips to the massage parlour… You get the idea don’t you? The total is then expressed as a percentage of a Trust’s total income. It might be worth finding out. Is your trust a little or large investor or somewhere in between? Liam was still computing so I got him another pint of Badger's. “Approximately 13%”, came the result for which I handed him his ale. “Thirteen per cent? that’s … gosh! Why do you spend so much on IT?” I asked. “Because we can’t run the banks these days without it. We have thousands of holes in the walls, we have online banking on the telephone, on the handheld and on digital TV, not to mention the Internet. When you overdraw by 30p for three hours we have to send out a silly letter and charge you £25 for the privilege. We can’t do that without computers. We value them. We trust them. We need them. How much does your NHS spend?” “Errhhm, between 0.5% and 3%.” “Lllwearchllhhle!” he spluttered. I thought he had bought a “learn Welsh in a day” tape and was practising it on me but realised he had spluttered 97p worth of good Badger's ale onto the floor. “You have got to be joking! How can you expect to run an efficient health service, or any business for that matter, without investing in information?” With that he tried mopping up his spilt beer with a beer mat. I had recently had a conversation with a senior manager in a hospital up north. “If the Government gives us the money then we’ll do it,” she’d said, “otherwise we won’t bother!” If senior people in the NHS still see computers as an optional extra, to put in only if they are given some extra money, then we have gone wrong somewhere. These same people who will “do it if the government gives them money” probably put up with an unacceptable level of DNAs in the outpatient departments, and probably have no idea as to whether their treatments are effective or not and appropriate or not. They probably don’t even know which beds patients are in! Or if they are dead or alive! Liam came back with two more pints. “Hey! A special deal! Buy a pint of Autumnal Hedgehog and get a packet of hedgehog-flavoured crisps free. What a pub, eh?” Oh, sad, sad banker, I thought. “Mmm. 6½%. Not bad.” “Is that your bank’s current interest rate?” I asked. “Alcohol content of the hedgehog.” I looked at my glass, “Mine’s a bit flat!” Pause... There is a case to invest in IT. The costs can’t be completely covered with new central monies. Many trusts have made a substantial investment, of their own money, into EPR and associated systems (including the EPR pilot sites). They make the case on there being some cash-releasing savings and some time savings, releasing clinicians for more appropriate clinical duties. But the real benefit of all of this is improving clinical care, on improving clinical communications between health professionals. How do you put a price on that? Do you think we are spending enough on IT in the NHS? Have you had sight of the extra money yet? Will it be enough? Email me your thoughts and your views will be treated in confidence. “Yours is a bit flat! Hedgehog! I get it”, he slurred. Banker! When Charlie returned sloshing fresh frothy cappuccinos down the side of the over-large cups, Paul threw the magazine back at him. “Whoa — wait till I put the coffees down!” he said. “Yes — it is good that article — point well made. But I hear we have moved on — and at a pace. I mean, this was written way back in, what, 2001? NPfIT wasn’t event a glint in the old dog's eye then, was it?” “No — true, but the fundamental principles are the same. Should we be spending money on IT in healthcare!” “But some reckon this NPfITTY thing will now cost billions of pounds. Billions. That’s the bit that gets up my nose. Billions and I can’t get on any training courses cos we’re skint. Billions!" “Ok — well actually yes. Over the ten years of the contracts it will cost £6 or 12 billion.” “Which?” “Depends what you count!” “Well, tell me!” “According to the Parliamentary answer of 12 December 2006 we now know the costs will be: data spine will cost £620 million over the life of the programme. "The New National Network (N3) will cost £530 million, and Choose and Book £64 million. "The LSPs' NCRS offerings are London — £996 million, the North East — £1399 million, the West Midlands/North West — £973 million, the East and East Midlands — £934 million, and finally the South — £986 million. "It comes to a total of £6.5 billion.” “You said it may be more,” said Paul. “Actually, it will be considerably more than that when implementation costs and training are included. The cost of the contracts is only a part of the overall costs of the programme. £6bn — possibly £12bn when all costs are added. Is a lot of money isn’t it?” “Too flippin’ true it is!” “But consider it in the wider context of the NHS spending. "Over the same period (let’s take the programme life as 10 years rather than the seven immediate years of the initial contracts) the NHS will spend £3.3bn on electricity and gas. It will spend £20bn on drugs, £14bn on X-rays, £6.6bn on transport, and £42bn on agency staff. "And consider this spend against the amount that other industries spend on IT. It will still amount to less than 3% of overall NHS spending. "Local Government already spends 4–5% of revenues on IT. Banking spending considerably more at 6–7% of total income. "Derek Wanless (2002), who was asked to review IT spending in the NHS, hinted at a target figure of 4%. That would amount to around £34 billion over 10 years.” “OK I can see that," said Paul, "but it’s a lot of money. And all that just for a national electronic record — it’s not worth it. Give us more nurses and us A&E staff a pay rise." “It’s not just for a national electronic record though, Paul. In fact some would agree with you that there is not a very strong case for that at all. They reckon those particular sums don’t stack up really.” “In what way?” asked Paul again, blowing the skin from the top of his coffee to the edge of his cup where he could remove it cleanly with his finger. “Well, the cost of ensuring everyone’s record is available wherever they need treatment is a very expensive business and probably not justified — yet.” “No business case?” “Correct. The times when you need treatment outside of your own local area are few and far between. The real benefits are to be gained locally. And ignoring the national record, the benefits for local NPfIT developments are huge and worth every penny.” “But billions? That’s a lot of pennies!” “Yes, but our NHS is an expensive business. In every day, our NHS will spend: £170 million (ie £2000 every second). With £10 million settling litigation claims, £2.8 million on treating patients who have MRSA, £1.3 million on treating patients who have had an adverse drug event. "Every day! So it’s no wonder underpinning such a complex business with intelligent IT will cost a lot of money.” “Phew!” “So if you think about it, and ignoring the national component of the electronic record for this moment, implementing IT in the NHS to underpin the local delivery of clinical care is actually done to reduce risk and improve patient safety. "If it is also used appropriately to re-engineer service delivery where appropriate, it has the potential to reduce these NHS costs significantly. The NPfIT programme is not just about creating the national record — the benefits are far far greater than that.” “OK — but 6 billion?” “Yes. Cheaper than the cross-London rail link. Cheaper than the 2012 Olympics. Cheaper per year that the war in Iraq.” “OK — You’ve convinced me. Let’s do it!” Wa-hey — another convert. ~ How about you? What do you readers/surfers think about the NHS investment in IT — justified? Wasteful? Email Sean now with your views and comments at If you want to know more about NHS IT you should read this book:
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