Political row over NPfIT: London on hold

Tags: Cerner CfH London Lorenzo Millennium O'Brien Royal Free South

28 Oct 2008

Opposition politicians have renewed their condemnation of the National Programme for IT in the NHS following press reports that the programme is “grinding to a halt.”

Conservative shadow health spokesman Stephen O’Brien said the reports confirmed that, with the “hugely expensive” programme “desperately behind schedule” suppliers were “deserting in droves” and “frontline professionals” were “voting with their feet and insisting on local solutions.”

Meanwhile, Liberal Democrat health spokesman Norman Lamb issued a statement saying that the “centralised project” had been “a shambles from the start” and it was “time for a re-think on how to proceed.”

The latest round of political attacks on the national programme follow the publication of an article in the Financial Times, arguing that progress on one aspect of the £12 billion project, the deployment of “strategic” care records systems, has stalled.

The article reviewed a number of recent stories that suggest this and questioned whether the programme would ever be completed.

It noted that the contractor originally hired to build the patient record system for the whole of the south of England, Fujitsu, was fired in May and that BT, one of the two key remaining contractors, has been unable to agree a price for taking over the work it began.

It noted that hospitals that have taken the London Release 1 version of Cerner’s Millennium care record service are experiencing problems with it and that further deployments that were scheduled for this year are showing no sign of going ahead.

And it noted that although health ministers promised that the much-delayed first installation of iSoft’s Lorenzo care record system would take place in Morecambe Bay this summer, the system has not gone live and neither the trust nor NHS Connecting for Health can give a date for go-live.

Jon Hoeksma, editor of E-Health Insider, was quoted as saying that while other parts of the programme continue to make progress, “this key part seems to be simply stuck. It has ground to a halt.”

Other national papers picked up the story, prompting an apparent admission that in London at least further deployments have been put on hold indefinitely.

The Daily Telegraph quoted a spokesman for NHS London as saying: "Because of the general problems, and in particular the problems at the Royal Free, we have decided to stop any further roll out in other London trusts until these have been sorted out. The important thing is to get this right."

The Royal Free Hampstead NHS Trust deployed a Cerner Millennium system earlier this year. Although it initially insisted there had been no problems beyond what might have been anticipated by such a major installation, board papers have indicated the deployment was “extremely challenging."

Conservative Party leader David Cameron said earlier this year that he would “scrap the NHS super-computer.” However, in an interview with EHI ahead of his keynote appearance at this week’s Healthcare Interoperability event in Birmingham, Mr O’Brien indicated that Tory thinking has moved on to what should replace it.

Mr O’Brien pointed out that the party has commissioned an independent review of NHS IT, led by Dr Glyn Hayes. He also indicated that, in future, there would be far more focus on local systems, built and linked by standards. “Interoperability is the key to achieving those links. That is our first principle,” he said.

A spokesman for CfH told newspapers the problems did not indicate that the introduction of computerised care records had ground to a halt. He said: "Many elements of the national programme are advancing and some are complete.

"The programme is one of the largest IT change programmes in the world and it is inevitable that such transformation will present challenges. We are working with the NHS and our suppliers to ensure that systems are implemented as smoothly as possible.

"It is clear that patients and clinicians are now beginning to see the potential benefits these systems bring to improve patient care."

Link

Hear Stephen O'Brien in person at Healthcare Interoperability

Lyn Whitfield

Readers Comments

Wow - some sense at last?

29 Oct 08 00:25

In Autumn 2006 I wrote to the CMO suggesting that the NPfIT CRS was a major threat to patient care across England, and advised a 2 months pause in the programme. During that time I suggested that the providers spent a month on the shop floors of many hospitals, finding out how doctors, nurses, secretaries, ward clerks, coders, etc actually worked, and how computers might support their work, rather than distract and frustrate users. The CRS I had seen demanded that clinical workers instead of spending time listening to patients, thinking, planning and reviewing individual care, they did mundane repetitive frustratingly slow admin tasks, demanded by the computer but not needed in current care processes.

So maybe at last this is good news? Perhaps BT and CERNER are going to try to find out how computers can help clinical and admin staff to do their jobs in "fixing sick people" and also how they can cause distractions and annoyance - annoyed doctors, nurses and others are unlikely to make the best diagnoses and management plans, be vigilant for deterioration and ready to revise the plans.

I firmly believe that computer systems can aid these processes, but the current NPfIT CRS needs reworking so that the CRS works for clinicians, rather then clinicians working to feed the CRS beast.

Business change

29 Oct 08 22:05

The Detailed Care Record dwarfs all other aspects of NPfIT, and in my view has been awry from the start.

There is a wider problem that CfH appear to have thought that the NHS should just change business processes to match sloppy programs designed for a different purpose, rather than have the suppliers design these to build around the most efficient UK clinical processes and practices.

Which is why I still don't believe Cerner will deliver an efficient system to match UK practice, and will Isoft Lorenzo ever deliver enough ?

The litmus test is ultimately whether clinicians will gladly use the technology, or shie away from it. Which is where experience with Choose and Book, Electronic Prescriptions, and most other things yet delivered under the CfH banner also appears piteous.

Slow, badly fitting systems are not going to win friends from busy clinical staff. However they are dressed up.

Finally, a part of the truth

radonco@live.com

30 Oct 08 12:02

This was great coverage, Lyn. The moratorium is validation of what health care professionals have been repeatedly stating. The risks and benefits of such systems have not been vetted at all. What has happened over the past few years is an uncontrolled experiment in a new way to provide medical care that has gone bad risking injury to patients. I commend the NHS for acting as they did. It is never too late to acknowledge the truth. P:ropensity

view from a patient

31 Oct 08 09:30

I am a victim of the new system in place at one of the hospitals mentioned. I have had appointments 'lost' and 'cancelled' and been accused of failing to attend appointments which I never knew I had, worse - I have arrived for an appointment - letter in hand only to be sent away as I 'was not on the system'. When the latter occurred I was one of many in the same predicament. This has resulted in me missing reviews of my condition over the last 6 months. Letters of complaint have been answered with the explanation that the new system has cused some minor problems.

My condition has deteriorated, a change that may have been prevented had the system allowed me to be seen.

Stop this damage to patients now. The systems you are using are obviously inferior to those in previous use (30 years as a patient and never such administrative errors).

Where is the blame to be laid - at NPfIT, the government or those at the local level who seem to be imposing these systems on the hospitals?

Maybe not just a computer problem?

31 Oct 08 12:36

I wonder if BT's current financial problems are also relevant in this context. http://news.bbc.co.uk/1/hi/business/7701626.stm

Extremely Challenging

31 Oct 08 12:54

I love this term - the last time I saw it in this context was a DH paper just before NPfIT was announced covering the possible roll-out of systems as recommended under the 1998 Information for Health strategy paper with a three year timetable to get systems installed across the NHS in a 3-year timescale (to meet milestones planned in 1998). Strangely similar to the timescales quoted in the Private Eye article of March 2007. DH had two years to plan and produce requirements, with 'industry' having about 9 months to implement with a final 3 month evaluation/bedding-in of systems. The author admitted that the timescale was 'extrememly challenging'. Isn't hindsight a wonderful thing!