- Smart Healthcare, Wednesday 2 September 2009 09.00 BST
You can go your own way: England's regions are already taking different courses, and individual trusts are likely to follow. Photo: jiunlimited.com
The NHS National Programme for IT (NPfIT) is a highly ambitious initiative created in October 2002 with the aim of modernising the health service in England. Unfortunately, NPfIT has been dogged by failures, delays and media negativity, which have overshadowed some important achievements.
Kable suggests that there were at least two major problems with the programme. Firstly, the focus should not have been on IT, but on applications. Health organisations are looking solutions to their problems, but not for complex technologies, with complicated systems integration, implementation and protocol requirements. Secondly, it should not be a national programme, but one which covers regions which have different requirements.
One of NPfIT's biggest components is the NHS Care Record Service (CRS), a highly complex project, which will eventually enable authorised care professionals to access electronic patient records in all regions of England and is key to the modernisation of the NHS. The CRS is being delivered by CfH and most, but not all, of the project sits within the scope of NPfIT.
Although roll out of the CRS was expected to start in 2004, along with other elements of NPfIT such as the successfully delivered N3 broadband network and Pacs, it only began to show significant progress in 2009. The delay has been attributed to problems with software packages and a lack of definition about access levels and security standards. There is no provisional completion date and Fujitsu's NPfIT contract termination will probably contribute to further delays.
In April 2009 Christine Connelly, the DH's director general for informatics, said that LSPs must make "significant progress" by the end of November 2009, or the department will "move to a new plan for delivering informatics in healthcare". BT and CSC are now working towards Connelly's deadline. They do not want to engage in lengthy contract reset negotiations and risk having work terminated (as with Fujitsu, which where negotiations lasted about a year and culminated in its departure). Also, BT and CSC will not benefit if the CRS is opened to a large pool of new suppliers.
Six years later
Kable believes that the CRS project could be more than six years late, a view also expressed by some ICT suppliers. If this is the case, the initiative will not be finalised before 2016. The original completion date for NPfIT was 2014, but it is widely accepted that several elements of the programme, including CRS, will not be completed by then.
The value of BT's LSP contract was quoted at £996m in 2007 and is now valued at £1,567m. This discrepancy (£571m) represents 61% of Fujitsu's contract value (£896m) for the entire South, a very high figure for a relatively small "addition of work". BT has taken over just 12 acute trusts and a few mental trusts in the South, which accounts for a relative small number of the 93 NHS trusts in the region.
NPfIT had a decentralisation process from the beginning and this is continuing. The government failed to anticipate the technical challenges and real costs of the programme. Kable believes that responsibility for the development and delivery of the programme should have been devolved to regions from the outset. CfH's role should have been one of support and protocol compliance and, in Kable's view, the agency should never have been tasked with defining the scope of the project and selecting major suppliers, without full consultation with local trusts and the clinical community.
Connelly and Bellamy have indicated that programme disintegration is inevitable, although their vocabulary is more subtle. Connelly asserts that the LSPs must make "significant progress" by November 2009, but stops short of explaining what this will be. Bellamy compared the initiative to a "jigsaw puzzle", insisting that the pieces will eventually come together, words which mark a major shift away from the "largest civil IT initiative in the world" concept.
A large chunk of NPfIT spend has already been paid out (£3.55bn by March 2008, CfH has not yet published figures for 2008-09) and so it would make little sense to scrap the initiative as a whole. It is possible that the CRS will drive the programme past the £12.7bn mark. The early adopters - some of the best performing trusts in the country - have experienced major difficulties and absorbed large unforeseen costs implementing the first version of Cerner CRS software. It is likely that the least sophisticated trusts will experience an even more problematic process.
The future of CfH is uncertain. If the agency is scrapped following a structural overhaul, there will be serious implications for NPfIT: it would irrevocably cease being a 'national' programme. By completion NPfIT will have experienced so many changes that it will be hardly recognisable. This is not to say there will be no further achievements, but they will take place at a local level and at an incremental pace.
It is extremely likely that new suppliers will step into the CRS picture after November 2009, even if large achievements have been made by BT and CSC in the early adopter areas. Trusts will benefit from a more competitive scenario, with more software organisations being supported by CfH, or other health IT directorate. This would spark innovative ideas and new functionalities. It would allow trusts to choose the solution most suitable to their needs, while relieving iSoft and Cerner of developing a single software package for hundreds of different trusts.
Suppliers with inventive solutions and a strong health portfolio should engage in talks with CfH, the SHAs and the DH at the earliest opportunity. They could be selling software solutions with health department endorsement to individual trusts as early as 2010.
This is an edited extract from A diagnosis of NHS IT: UK Healthcare Market Profile to 2013-14, published by KableDIRECT for £2,950, or free to subscribers. Click for more information.
