How Cameron and Clegg plan to change NHS IT

Conservative MP Andrew Lansley will become health secretary, as David Cameron's party goes into coalition government with Nick Clegg's Liberal Democrats. The former minister responsible for health IT, Mike O'Brien, lost his seat in the general election, and as this article was published his replacement had yet to be announced. Whoever does get the job, traditionally passed to the most junior member of the department's ministerial team, is in for an interesting time. The next few years are likely to see an increasing divergence between the NHS IT infrastructures in England and those in Scotland and Wales – with the English programme continuing to falter. The Conservative party will have found little difficulty aligning its ideas for NHS IT with those of the Liberal Democrats: both parties are keen to extricate the government from large contracts and national patient record systems. The Conservatives' election manifesto pledged to "decentralise power", "make the performance of the NHS totally transparent" and to put patients in charge of decisions about their care "including control of their own records". There are three reasons to expect policy decisions within weeks, rather than months. The first is the emergency budget promised by the Conservatives. While the scope for immediate savings through the cancellation of local service provider and national infrastructure contracts is limited, the budget will be ruthless with what the Tory manifesto describes as "expensive layers of bureaucracy". Few institutions would make more politically palatable targets than those associated with IT. One clue to policy is in the Conservative technology manifesto published earlier this year. As well as calling for an immediate moratorium on planned IT procurements it proposes to create a small IT development team under a strengthened chief information officer. This "skunk works" unit would ensure that systems developed in one part of the public sector are re-used in others and enforce compliance with open standards. It would also open the way to abolishing NHS Connecting for Health. Critical care The second development is the impending publication of the full evaluation report of the Summary Care Record (SCR) programme. This is likely to be critical of the SCR's clinical value as well as its implementation, and will attract high-profile commentary. A Conservative-run Department of Health can be expected to respond with a moratorium on the whole programme, devolving to a local level policies on sharing of health data. How this will square with the manifesto commitment to give individual patients access to a single budget combining health and social care funding remains to be seen. One clue is in the third development, the UK launch of Microsoft's HealthVault personal health record system, expected in June. Microsoft is likely to be followed closely by Google. Although the Conservative manifesto was coy on the matter, such systems still seem to be what the Conservatives have in mind when they talk of patients having control of their own records. The availability of commercial systems will give a budget-cutting government a good reason to kill off the HealthSpace project and greatly scale back the NHS Choices website. One clue to Conservative thinking here is the vision in the technology manifesto of government websites as "like public parks, where people can come together to discuss issues and solve problems". In all but one of these polices – the involvement of commercial health records companies – the Lib Dems go at least as far as the Conservatives. The Liberal Democrat manifesto says outright that it would cut in half the Department of Health and abolish "unnecessary quangos" such as Connecting for Health. However it would also integrate health and social care into a seamless service, which would require some central IT coordination. Such political uncertainty suggests difficulties for IT-based innovation. Although there are signs of renewed bullishness in the industry, the policies of the coalition's constituent parties means that the default position, even at trust level, is likely to be against any new procurement. That in turn will make it hard to realise the efficiency savings that all the contenders for government claim to be ready to make, but that is a lesson that will take several years to sink in.