Government says no plans to devolve CfH power

15 Nov 2007

The government has rejected calls by the Commons Health Select Committee for NHS Connecting for Health to hand over greater contractual power to trusts and strategic health authorities as part of the NPfIT local ownership programme.

The government’s stance appears at odds with the far-reaching contract renegotiations currently underway with the local service providers, to redefine how and when the core clinical systems can be delivered by the late-running £12bn IT programme.

Charlotte Atkins, Labour MP for Staffordshire Moorlands, a member of the Health Select Committee, told E-Health Insider that the greater moves to local ownership and responsibility must be accompanied by decision making powers: “Local ownership and local buy-in are very important, but responsibility without power has little benefits.”

Atkins told E-Health Insider: “There has to be some sort of central status for CfH, but it is important that local hospitals, and all the users in these hospitals, can ensure that the system they are getting is the right one for them without it being imposed on them.”

The Health Committee recommended in its September report that CfH’s role should switch as soon as possible to focus on setting and ensuring compliance with technical and clinical standards for NHS IT systems, rather than presiding over local implementation.

They called for a stop to SHAs, PCTs and hospital trusts holding responsibility for NHS IT without power to change the centrally negotiated contracts inherited from CfH.

However, in its written response to the Health Committee, the government made it clear that this will not happen: “There is no intention to change the contractual arrangements”.

The response added: “The central procurement exercise and management focus are the foundations for the work done so far and the value for money that contracts offer, as well as the technical requirements for interoperability.

“Through the National Programme for IT Local Ownership Programme (NLOP), the Department of Health will ensure that SHAs, PCTs and trusts, working together with NHS Connecting for Health, are in a position to hold their local service providers to account and participate fully in negotiations with them.”

The response gives an indication that despite the transition to NLOP, CfH is still envisaged as maintaining a central role on contracts. Stressing Connecting for Health’s continuing role, the document states: “NHS Connecting for Health remains responsible for commercial matters within the governance of the South, London, and North, East and Midlands Programme Boards.”

Outlining how NLOP will work the government’s response states: “SHAs now have accountability for managing implementation of the IT systems provided by local service providers. In respect of national applications, accountability remains with NHS Connecting for Health.

“Devolvement of accountability to SHAs for implementation of the National Programme’s systems means that NHS Connecting for Health is no longer presiding over local implementation.”

Ben Bradshaw, the Health minister responsible for CfH, this week defended the NHS IT programme in the House of Commons, describing progress to date as “good”. He went on to state that where suppliers had failed to deliver, they had been replaced.

Asked by Liberal Democrat MP John Pugh to make a statement on the effectiveness of CfH, Bradshaw replied: “Progress with NHS computer systems is measurable in hospitals, general practices and pharmacies across the NHS in England. Despite the challenges associated with all large IT programmes, the Connecting for Health system is bringing benefits to doctors, nurses and, most importantly, patients.

Bradshaw added: “Progress is good, as the Health Committee accepted in its recent report. There have been delays, but any cost overruns are being borne by not the taxpayer, but the private suppliers. When the private suppliers have been unable to deliver the goods, they have been replaced by other private suppliers.”

In their report, the government said the delays ‘are in many instances the consequences of taking longer over consultation and stakeholder engagement rather than simply delays in the production of the software’.

Atkins said of the delays described in the Health Committee’s report: “These delays are simply extending the cause of concerns for all NHS patients and should be curbed as quickly as possible. I am pleased that the government seems to have recognised their shortcomings and I would hope to see the Health Select Committee continue to follow through with our investigations into the electronic patient record.”

Links

Health Committee report on the Electronic Patient Record

The Government response to the Health Committee report on the Electronic Patient Record

Reader's Comments

what might have been

16 Nov 07 08:53

I don’t think I have ever read such an appallingly misconceived document as the response to the select committee’s reasonable and reasoned recommendations. What the minister seems to lack any comprehension of is the term ‘opportunity cost’. This is not some esoteric management speak. It means the dead weight that has been placed on what users – doctors and nurses – want and need from the systems that are there to support them. An example:

A London hospital that had agreed SHA and local funding to implement a clinical system, had clinical buy in, had been through procurement and was ready to go suddenly had their development quashed because ‘the LSP will do that for you’. Now 5 years later, no clinical system, no engagement with consultants and an IT department struggling through on their old PAS.

And this is what the effect of NPfIT has been up and down the country. The effort that enthusiastic clinicians put into Model Communities (remember them?) – wasted because the systems were never implemented

It seems pretty clear to me that without the control of funding moving to Trusts (no, not SHAs – Trusts) with the responsibility for implementation and a genuine market in systems being developed for acute and community care (as it has been for GPs) we will never get the services we need and deserve in the NHS.

What is in the central contracts?

maryhawking@tigers.demon.co.uk

16 Nov 07 12:22

There is a great insistence from the government that any financial risks for failure to deliver on the contracts will be borne by the LSPs - and not the taxpayer, yet at the same time, Yorkshire and the Humber SHA states that they need to "overperform" on transfering GPs onto CSC TPP (presumably under the LSP contracts) to avoid financial penalties for failure to conform to the delivery schedule. Maybe I'm missing something here. Has anyone seen the LSP contracts, particularly the bit with "delivery schedules" ,financial penalties and contracts for GP systems? From the Y&H SHA Board minutes, it sounds as though the financial risk for the failure of CSC to deliver acceptable PAS systems has been transferred to the SHA - with dire consequences for GPs!

BTW Has anyone seen the T&C and SLA for the LSP contract in NE and Eastern for the provision of a choice of at least two GP systems in General Practice? I mean those in existence before GPSoC and which presumably differ considerably? I accept that there is no such contract for NW cluster. What protection does *this* contract give for data security and confidentiality of your and my medical records?

(I note that neither CSC nor iSoft have been replaced for failing to deliver, and that Accenture also escaped any major financial penalties - and that Accenture's contracts were taken over by CSC without further bidding).

Is NLOP really good corporate NHS leadership

john.aird@uhl-tr.nhs.uk

19 Nov 07 12:12

It may be unfashionable to say so, but I had always thought that the responsibility of leaders was to lead, to develop vision and capability. NLOP could be viewed as the devolution of such a role saying, we can’t lead the programme we developed so you have a go. Yet we have many skilled and able leaders at Trust, Cluster and Regional level.

OK, I can find as many faults with the NPfIT programme as the next man, but I have been in the NHS long enough to have seen swings from centralism to devolution and back again, to see that while NLOP may be a appealing answer to a struggling centralist approach, it represents a corporate failure in the NHS. I fear that the more we unpackage the original NPfIT concept for local pragmatic reasons, the less sense NPfIT makes. Instead of fixing what was wrong with the NPfIT contracts and product specifications, and making work what was good with the NPfIT strategy, we could be throwing the baby out with the bathwater – again.

disaster zone

23 Nov 07 20:56

Having heard the clincal lead for hospitals last week spout that NLOP was "no longer our problem", as we had all suspected, it is heartening to know that MPs recognise that responsibility without power is useless, and depressing that the DoH fail to recognise this.

Not sure there is a baby in the bathwater.