The NHS in England would benefit from central purchasing of some IT products and services, particularly Microsoft software, some acute trusts have said.
The calls, made in Achieving a digital NHS, a research report by health thinktank the Nuffield Trust, would reverse government policy of nearly a decade under which individual NHS trusts have largely taken responsibility for their IT. This was introduced by the Coalition Government of 2010-15 in response to the failings of the highly centralised National Programme for IT (NPfIT) of the previous Labour Government.
The report said that interviewees saw some value in returning to centralised procurement, particularly for Microsoft licences, and noted that 2016’s review of NHS IT by Dr Robert Wachter warned that it was important not to “overlearn the lessons of NPfIT… centralisation sometimes makes sense, particularly in the context of a national health system”.
“I think the benefit would be in potentially moving back to a number of national contracts like the Microsoft licencing, those kinds of things that are universal across the NHS and also give a level of protection and assurance,” the report quoted the leader of one trust involved in the Global Digital Exemplars programme.
In England, many NHS organisations continued to use Windows XP for years beyond its security expiry date, partly because the operating system had been covered by NPfIT but trusts would have to pay themselves to replace it. The National Audit Office partly blamed the impact of the 2017 WannaCry attack on the English NHS on this continued reliance on XP. In 2018, the Department of Health and Social Care bought access to Microsoft’s Windows Defender Advanced Threat Protection security service centrally.
Other parts of the UK have chosen to do more centrally for their health services. In November 2018, the Scottish Government said it would move all 161,000 employees of the country’s health boards – which run most NHS services in Scotland – to Microsoft Office 365, spending £80 million over five years.
The Nuffield Trust report’s authors recommended that the NHS in England considers where it would make sense to undertake national procurement, noting a “clear appetite” for this. More generally, it said that the Government could usefully provide a stronger system of accountability for suppliers, such as through frameworks. However, they warned against following the “overly restrictive” GP Systems of Choice framework, which they noted has led to an effective duopoly.
As well as discussing procurement, the report recommended better co-ordination between central bodies, more flexibility for trusts in recruiting and retaining IT staff and better guidance on sharing data, which they said is often frustrated by individual organisations refusing to take part due to information governance concerns.
The chief executive of NHSX has said the new NHS App should have relatively few features and allow other apps to interact with its data. In his first blogpost as leader of the new joint organisation for digital, data and technology announced in February, Matthew Gould said he envisaged apps tailored around particular conditions or processes, such as booking appointments based on glucose levels.
“I don't want us to make the NHS App all-singing and all-dancing,” he wrote. “We will keep the app thin and let others use the platform that we have created to come up with brilliant features on top.”
Gould noted that people have complained that the NHS App only provides access to a small number of GP appointments. To tackle this, the new GP contract will require GPs to allow at least a quarter of their appointments to be booked online.
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