CRN's NHS IT hub aims to shine a light on IT spending among England's NHS Trusts. Cindy Fedell is CIO for the Bradford Teaching Hospitals NHS Foundation Trust, a position she has held for the past three and a half years.
Our figures show that IT spending among NHS IT Trusts is on the up, increasing seven per cent annually. Does this chime with what you're seeing in the market, and can you assess the landscape for NHS IT more generally?
The seven per cent figure surprised me a little bit because, on the ground, it feels we are not spending as we should be, because of the financial position of each Trust. But having said that, I accept the figures.
IT here in the NHS is a mix of being told do some things and you have the freedom to do other things - some of the IT spend is what you're told to do. We're pretty much being told 'you must do e-rostering'. You can't really ignore some of these messages we are getting from the centre. I wouldn't be surprised if [the increase] is what we're being told to do.
Are we spending more? Yes, we absolutely are. We're making big investments in electronic patient records, in particular, which is quite expensive. In other areas we are just trying to keep the cost of things down, which is hard. The other thing affecting our spending right now is Brexit. We've tried to do a couple of procurements - just refreshes of things - where the prices have substantially increased over last year because of the value of the pound. Most of the pricing for kit comes from the US. So I wouldn't be surprised if changed prices are behind the increase in spend as well. For example, we're ready to design a contract for an upgrade, but the price has drastically increased.
To what extent does the pressure you're feeling on investing in the areas you are required to prevent you from spending more in areas such as digital transformation? Are you limited with how much you can achieve because of these tight constraints?
Absolutely. You only have so much money and there are some things you have to do. You either end up cutting the scope and leaving things for longer than they should be, which we all do a little bit, to be honest. Or you plan to do another [transformational project] and you end up not doing so. It's a bit of a vicious cycle because if you leave stuff too long, it's going to bite you. It's going to come back to haunt you. It's not a good place.
If you didn't have to worry about investing in the basics, are there other, more transformative projects you'd like to focus on in an ideal world? How much does your ideal to-do list and your actual to-do list vary?
In the NHS, the ideal list is a whole lot longer! You're constrained by how much money you have and we don't spend near the amount industry analysts would consider appropriate. For us, we're in the middle of a full-scale EPR (Electronic Patient Records) so we got lucky because we approved and committed to that a few years ago. We committed the funds to that. A lot of Trusts are not at that place; they haven't got the funds, and they can't do it. We got a bit lucky in that we were in a good place when we approved it.
"It's a bit of a vicious cycle because if you leave stuff too long, it's going to bite you. It's going to come back to haunt you. It's not a good place."
What's on my to-do list? There are other things I would have liked to have done this year. It's a mix. There are things in our upgrade I would improve; it was a bigger scope and I had to bring it in a bit. And then there are some [general] improvements - people want to use technology. It's about general usability things people are asking for that we just can't find.
Our data suggests that Windows XP is still going strong among NHS Trusts, despite support for it ending in 2014, and extended support the year after. What do you make of that?
Nobody wants to be on XP, it's unsupported and it's risky. Given cybersecurity, it's going to hurt. There's a mixed picture out there. We wrapped up our XP project a few years ago. We only have a couple of isolated machines on it where we are waiting for things.
A number of other Trusts said they had just one or two machines running XP. Why would a Trust need to continue to run XP in any form? And are you concerned about this small number of machines?
It's about compatibility with other stuff. With those three machines we have, we are waiting for an upgrade of software from a supplier to run on Windows 7 or Windows 8 - they haven't got back to us. We've segregated them so they are no risk and they can't harm us. The suppliers I am waiting on are NHS-specific suppliers. So there must be other people like me out there. The alternative would be to turn off the software [running XP] and that software does some kind of automation, so we would need to plug that with labour and paper and it is crazy. They're segregated so I am not feeling at risk in any way.
How do you see the future of NHS IT? Do you see the starved spending environment you described continuing?
I do see that. If every Trust is in debt - most are - how is IT ever going to get anything? IT money comes from two places: it comes from within the Trust, either as annual budget and money they've saved. But no one is saving for capital expenditure any more. Or the money comes from funds - NHS Digital or somebody - and that doesn't seem to be happening.
The government has been keen to talk up its efforts to digitally transform the public sector as a whole, encouraging bodies to work with smaller, more agile suppliers in order to digitally transform. It has also said that digital transformation is hugely important, with papers such as the Government Digital Strategy and the Government Transformation Strategy going into specific detail on this. What do you make of the messaging?
It's a Catch-22 - IT can be transformative, it can make patient care safer, more effective and more efficient. But you need to do the investment to get the benefits. You can't get the benefits without doing the work.
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