The UK government today brought an end to the national IT healthcare scheme stating that IT decisions should be made at a local level. The £12billion programme has received significant criticism since inception for increasing costs, limited functionality and poor delivery. I have never worked directly in the programme so can not comment on these criticisms but I do have several questions.
Will there be a central set of standards published that all health providers must adhere to? To give an example all health organisations will eventually deploy Instant Messaging and Presence. Given that all the health organisations need to communicate will there be a central standard? What happens if a surgery has Sametime, a hospital has Jabber and the trust has OCS? Without central standards the IT provision within the system we be chaotic.
How will de-centralised costs be tracked? While centralised costs by their very nature create large top line figures that can attract significant attention. De-centralised costs are extremely difficult to track and monitor, how will we know that the health organisations are procuring effectively?
Again no idea if this is the right thing for the UK government to do, I just hope they understand the ramifications of their decisions. Strong central standards and close understanding of costs are required and it can prove very difficult to implement with many different autonomous organisations making decisions on IT infrastructure that ultimately have to work together to make the system work for patients and tax payers.
I do have one customer service question. Technology is clearly going to play a significant role in the provision of services to patients in the future. How within a system that is specifically and intentionally designed to provide a standard level of service to all patients can the UK government ensure a consistent level of service across the nation. What happens if the North West implement IT 200% more effectively than the South West? Will citizens from the South West have to travel 500 miles to the North West to receive more effective care?
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Some interesting points in here, and certainly some real challenges, but can we not compare locally run health authorities to businesses? Enterprises have the same challenges as you suggest above, with integration, but it doesn't stop them pressing on with projects to enhance communications. Can you imagine what would happen to the CEO of a business if he/she wasted that much money? After all CEOs of health authorities are paid private sector salaries, because apparently tax payers have to fund for the best people, so lets see them square up to the challenge. The consortia approach in theory should be more cost effective, but in practice it's been a disaster. Let local heads work out the benefit they can bring to their own authority rather than having to wait for central office to do something.