The National Programme for IT, best known for being four years late, is not popular with politicians at the moment. It is appearing on lists of government projects that could be scrapped, along with identity cards, ContactPoint and various military hardware programmes. Its £12.7bn budget appears to represent a tempting economy measure.
The programme's two relatively new leaders, both appointed in September last year, seem to have decided on a two part defence. Firstly, to talk about the elements which are working, such as NHSmail, and point out that these could actually save the NHS money. Secondly, admit that deployment in hospitals – the late-running element – is not progressing, and promise changes.
Christine Connelly, the Department of Health's director general for informatics, used her presentation to talk about the latter. She told the conference that lessons would be learnt from early users such as Royal Free Hampstead. The Royal Free has yet to see any cost savings from its problematic implementation due to the high cost of going live, its director of information systems Heather O'Brien told the event later.
Connelly said that trusts will be expected to adapt the core systems to meet their own needs, and they will be able to share their adaptations through a central library. The centre will act as a facilitator for sharing of applications and experiences.
Perhaps most significantly, she set a deadline. "If we don't see significant progress by the end of November 2009, then we will move to a new plan for delivering informatics to healthcare," she said. The 2015 completion date remains in place, she added.
Martin Bellamy, the head of Connecting for Health, highlighted NHSmail, which has just migrated its 350,000 users to a new Microsoft platform, and said the health service could save £100m by 2013 if all trusts moved to it – although CfH does not expect this, and does not have the capacity to cope with a rush of transfers.
In his presentation, he pointedly split the programme into its constituent parts, comparing them to jigsaw pieces. "We've got most of the piece in the right place," he said, with others in the right area. "And we've got a relatively small number of missing pieces."
Getting the green light
He showed a diagram in which elements of the programme were rated by traffic light colours and graph heights. The N3 network, picture archiving and communications systems, NHSmail and the Spine were green. Choose and Book, which is now used for 55% of first outpatient appointment but is undermined by big disparities between areas, was a blend of green and yellow. "If we got Choose and Book to 100% usage, think of the opportunities for the NHS to close down fax based booking and telephone based booking," Bellamy said.
The Electronic Prescription Service and the GP2GP system for transfers of data between family doctors were both yellow. All of these were represented by bars at least half the heigh of the graph. Meanwhile, three little blobs of red represented those missing pieces: Summary Care Records, Lorenzo and Cerner, the latter two being the acute hospital systems for the north and the south of the country respectively.
"To a significant extent, the acute systems have been the Achilles' heel of the national programme," Bellamy said, adding that such failures did not mean the whole was failing. "But we can't say our job is done until it is in place." So far, just 12 Cerner and three Lorenzo systems are installed, out of about 200 acute trusts in England.
Bellamy echoed Connelly's pledge that the programme will learn from the Royal Free's experiences, saying that in future it will be more important to check thoroughly than stick to a planned go live date, and that CfH will support trusts for four months after that go live, to go through a quarterly reporting cycle.
He talked about how important it is for suppliers and NHS staff to work together – how, in previous jobs at the Department for Work and Pensions and in the private sector, he'd encouraged both sides to "leave name badges at the door" and not resort to threats related to the contract.
For example, Bellamy said that iSoft, which is building Lorenzo, and CfH have introduced much improved joint working between their teams in both the UK and India, where the software is written. "We're seeing some problems, that would have taken weeks to fix, taking days," he said.
As NHSmail shows, Connecting for Health can deliver. But as its leaders have recognised, it has to do so for the core hospital systems. The clock is now ticking on the organisation's self-imposed November deadline.
