PAC says NPfIT suppliers are 'struggling to deliver'

17 Apr 2007

A damning new report by the influential House of Commons Public Accounts Committee (PAC) questions the basic business case behind and contracts awarded for England’s £12.4bn NHS National Programme for IT.

The report focuses on the lack of progress on implementing electronic patient records which it says "suppliers are struggling to deliver" and calls for an urgent independent review.

The committee says the programme is running two years late so far on its core objective of developing electronic patient clinical records, has lost three key suppliers and continues to struggle to engage with clinicians.

"At the current rate of progress it is unlikely that significant clinical benefit will be delivered by the end of the contract period," states the report which says delivery of clinical and electronic records rather than patient administrative software has barely begun.

Edward Leigh, chair of the PAC, said the programme, if successfully delivered, still offered huge benefits, but today warned that if it fails "it could set back IT developments in the NHS for years".

Improved communication with clinicians is identified as a priority area, with the report being blunt about the current position. "The department has failed to carry an important body of clinical opinion with it, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians."

The report continues: "Four years after the start of the programme, there is still much uncertainty about the costs of the programme for the local NHS and the value of the benefits it should achieve." It says the performance to date "raises questions over whether the contracts will deliver what is required".

Today's report calls on the Department of Health (DH) to publish an annual statement outlining the costs and benefits of the programme.

It also calls on the DH to commission and publish an independent review of the business case for the programme "in light of the progress and experience to date". A review of local service providers' (LSP) performance is also called for: "In view of the slippage in the deployment of local systems, the department should also commission an urgent independent review of the performance of the local service providers against their contractual obligations".

The report notes that there "is a shortage of appropriate and skilled capacity to deliver the systems required by the programme", a situation exacerbated by the withdrawal of Accenture.

Despite the £2bn spent so far on the programme the MPs say they have been unable to find a published plan for the delivery of the shared electronic records that are at its heart.

In the absence of electronic patient clinical records the report says that the DH, through its Connecting for Health agency and its LSP suppliers, has been deploying patient administration systems, "but these systems are no substitute for the vision of a shared electronic patient clinical record and no firm plans have been published for deploying software to achieve this vision."

The report spells out how far behind original delivery schedule the programme is just on acute hospital PAS deployments. "Plans published by NHS Connecting for Health in January 2005 indicated that by April 2007, 151 acute hospital trusts would have implemented patient administration systems of varying degrees of sophistication. As of 18 April only 18 had been deployed."

In June 2006 the DH said it would deliver 22 to acute trusts between June and October 2006, it managed five. Commenting on the failure to meet its own revised targets for delivery of PAS systems, the report says this suggests "that the programme is still unable to meet short term targets".

In light of the failure of suppliers to meet delivery objectives the report recommends that the DH "should seek to modify the procurement process" to allow acute trusts and others "to select from a wider range of PAS and clinical systems than are currently available". Such a move it is argued would speed up deployments and help secure clinical buy-in.

Noting the number of suppliers – ComMedica, IDX and Accenture - that the programme has lost the PAC report expresses serious concern about the very heavy reliance on iSoft. "We are concerned in particular that iSoft's flagship software product, 'Lorenzo' – on which three fifths of the programme depends – is not yet available despite statements from the company in its 2005 annual report that the product was available from early 2004."

Leigh summarised the conclusions reached by the PAC: "There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected."

Leigh called for "resolute action". "The department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including NHS organisations, can have more confidence."

He added that if advanced electronic patient record systems cannot be delivered by current suppliers within the framework of the programme, "then the local NHS should be given greater freedom to look for alternative systems which do work."

Leigh warned that "the stakes are high" saying that the programme, if successful could revolutionise the way the NHS in England uses information, significantly improving patient care. "But if it fails it could set back IT developments in the NHS for years, and divert money and time from front line patient services."

Today's report, follows last summer's National Audit Office report on the NHS IT programme, and is the product of months of work which has seen the PAC take and assess written and oral evidence, together with detailed questioning of the DH.

Link

PAC Report

PAC report reveals postcode lottery on GP systems

Reader's Comments

Reading between the lines

17 Apr 07 08:59

Urgent remedial action at the highest level. Replacing the DG? Abolishing CfH? Re-thinking the NHS IT strategy? All of these?

Outside Suppliers

17 Apr 07 10:04

Having worked with some of the existing suppliers, none of the approved suppliers, I think it is time for the Health Sector to look to other suppliers in the private sector on a more local & case by case basis.

Systems are designed for many complex solutions and delivered everyday and these can be implemented to fit with any current and future national objectives. For example many CRM / CIS providers offer tailored customised solutions for all types of industry and sectors and “deliver” for the customer.

Having moved out of the Health Sector I now work for a CRM/CIS supplier and it never fails to surprise me the state of the current situation, “them and us”. There doesn’t appear to be any form of partnership, which will always cause resentment and lack of support.

What a waste….

Choice for Trusts to use smaller suppliers

17 Apr 07 11:04

While i believe the PAC have hit the nail on the head Trusts should be allowed to have a choice of software that both is the best fit for their organisation but at the same time conforms to a standard for the critical elements of a patient record. The question has to be are there any small suppliers left who want or able to get into this market?They have been shoved aside by the big boys(or bought out and shelved) only to be left with the scraps to scratch a living from if they have survived at all. Lets end this debarcle now! give the choice back to the Trusts,we need British solutions for a British market .We don't need management companies at all in this equation, the smaller suppliers have been implementing their products themselves for year's.The big boys have had their day,month and year++! !

What a Waste - Absolutely!

17 Apr 07 11:14

I agree with the comment about this being a wasted opportunity.

I've worked for all of the approved suppliers and some of the smaller suppliers out there too, and to be honest - I feel ashamed at the wastage going on.

This should be an opportunity to progress the NHS systems, connectivity etc, and concentrate on the benefits to the patient - but the suppliers seem to think (and I have seen many examples of this) that it is a chance to spend tax-payers' money, be extravagant with expenses and charges, and still not actually produce anything of substance.

Is anyone really surprised!?!?!

18 Apr 07 14:09

The same mistakes are made over and over again in the NHS!-the powers that be make the descisions against recommendations from the day to day grass roots level teams closest to actual patients who are best situated in the knowledge of what will and won't work out there, throw money after money at it and more NHS outsiders then heads are scratched and we all go through the same embarrassment project after project when it doesn't quite work out!!. Actually, not project after project..lets do it at the same time within unreacheable and unrealistic timescales !!..........amazing!

Any after months nothing changes - cheap solutions could work

19 Apr 07 22:46

So waht if the data are out of date - our go live has been delayed so far 10 months, and very few changes implemented, and the CRS looks as deadful as ever.

Some very simple, very light software solutions could transform healthcare and improve patient safety. I guess a robust secure system could be developed by an "A" level student in about a week, with one flat page per patient of demographics, diagnoses, current medications, allergies and a free text field, on an open architecture. This alone could improve my productivity and safety in patient care by 30 to 50% overnight.

Does CfH understand clinical systems?

20 Apr 07 10:18

Yes there are still clinical specialist suppliers out there and some have actually used the intervening period to rewrite their systems to meet the problems posed by the large integrated clinical systems required by the NHS.

The problem is does anybody on the purchasing side recognise what is required? The original clinical vision for secondary care clinical systems within NPfIT was based on an extension of the primary care model (never tried before in secondary care) which is heavily dependent on SNOMED (still not up to scratch for specialist secondary care). This is now self-evidently both the wrong approach and is fundamentally undeliverable.

Sadly there are very few people who understand clinical system design and none of them work for CfH. Instead we have an army of very highly paid (up to £1200 per day) consultants whithout NHS experience who continue to lead us up the garden path.

How unsuccessful does it have to get ?

20 Apr 07 22:05

All happened in my view. Time to stop the gravy train, if these contracts are as robust as CfH have always crowed, then it is surely time the LSPs are dispensed with.

(post edited by EHI)

The reality

sleepyfox@gmail.com

26 Apr 07 12:28

The above poster states: "I guess a robust secure system could be developed by an "A" level student in about a week, with one flat page per patient of demographics, diagnoses, current medications, allergies and a free text field, on an open architecture."

Having worked for both an LSP prime contractor and a HIS vendor on the National Programme what I can say is: If it were really that simple don't you think it would already be in place?

Yes, if you want a cowboy system that is up and down like a yo-yo, performs poorly and is impossible to change, is unavailable when you need it most and allows anybody to access your medical records you could probably have it done in a few weeks.

On the other hand, the CfH contract requirements schedule has over 4000 requirements, a substantial number of which are 'non-functional' - meaning not relating to 'functional' areas like clinicals or ordering but related to service delivery, implementation, Service Level Agreements, data security, data availability, authorisation of users etc. etc.

No clinical system on Earth currently fulfils the full 'non-functional' requirements of the National Programme, unsurprisingly the ISB, BMA and CfH have been very bullish about these requirements - possibly to the detriment of actually delivering *anything* as we have witnessed.

The current GP Summary record is pretty much as described above: free-text demographics, diagnoses, meds, allergies - but this is a world away from the visionary 'shared clinical record', with coded data that can be used for the *high value* benefits like decision support and evidence-based medicine. The only system I've come across with a truly cutting-edge clinical information model that could actually deliver what is required of PSIS (the repository of shared clinical records) is in the US, and IHC have spent the past 40 years developing and honing it - a little more than "a week"!

On the other hand there are free open-source EPR solutions like Tolven.org that could provide a robust shared clinical record to the level of detail that fulfils the Summary record criteria right now, for only the cost of training and deployment hardware. Tolven has been over a year in production, it's only by piggy-backing off of existing work that you would ever get a viable solution in 'weeks' - and I'd suggest you aim a little higher than 'A' level students! :)