NHS boss puts programme tender on table

Tags: A Cerner Christine Connelly Connelly CRS David Nicholson England Fujitsu Information iS iSoft London Lorenzo Millennium Nicholson NPfIT Operating Framework South Strategic Summary Care Record Tender US

12 Mar 2009

NHS chief executive
David Nicholson

NHS chief executive David Nicholson told MPs on Wednesday that the Department of Health is going to tender for alternatives to the iSoft Lorenzo and Cerner Millennium care record systems.

Nicholson said that the tender was being carried out as insurance because the National Programme for IT in the NHS is now at a “critical phase”. He said both the iSoft and Cerner products needed to come good in the next few months.

Speaking at a Health Committee hearing into the Operating Framework for 2009-10, he remained cautiously optimistic about this happening. But he said: “It’s helpful to us, I think, to have reserves if one of them fails.”

E-Health Insider understands that NHS Connecting for Health will say that Nicholson was only referring to the South of England, where Fujitsu left as local service provider a year ago.

EHI also understands that a deal is close to being done to support the “live eight” sites that have already deployed Millennium, but other trusts will now be allowed to look at suppliers and products on the Additional Supply Capability and Capacity framework contract. Trusts outside the South will not be given the same freedom.

Nicholson’s comments were made in the context of questioning by Health Select Committee member, Lib Dem MP Sandra Gidley. She asked what would happen if one of the two systems for delivering the programme’s strategic care records systems failed.

The NHS boss said the option remained to give the rest of England to the remaining supplier - “there is that possibility” - but indicated this would not be the preferred route.

He said he was now confident that Cerner Millennium was a product that could be rolled out across London and that Lorenzo had great potential, but said while he was optimistic it was “not inevitable” it would be delivered.

“What we are also doing in parallel with this is going out again to tender to a variety of other organisations, to see whether there are now other organisations, who can also provide this service. It’s helpful to us I think to have reserves if one of them fails.”

He added: “But I think we’ll know in the next period whether Cerner and Lorenzo will deliver a fantastic product for us. We’re pretty confident it will.” He agreed that should such a switch be required necessary it might risk having to start over from scratch. “There is that issue.”

However, the NHS chief executive also said the world, and technology, had changed since the original contracts were tendered. “Some organisations who felt they didn’t want to be engaged with the programme now might in the future, so we are keeping our options open as far as that’s concerned,” he added.

Nicholson said a key problem that the NPfIT programme had faced throughout was the unique requirements of the NHS and what it is trying to achieve. “There is no system off the shelf we could go for.”

And he insisted that despite the lengthy delays, the two systems contracted for remained the best prospect. “We’ve been scouring the world and the two we think that are most likely to deliver are Cerner and Lorenzo.” Nicholson personally visited iSoft’s Chennai development centre with chief information officer for health Christine Connelly in November.

The NHS boss aknowledged again that both electronic record systems “are in a particularly delicate stage in their development”, although he said the problems with Millennium appeared to have been “fixed.”

“The Lorenzo product is being developed at Morecambe Bay, so we’re really optimistic that something will come out of that, but its not inevitable,” he went on. “And I think we’ll know over the next few months whether these products will actually be able to deliver the things they promised to do.”

The other issue he said that was being focused on is how to deliver products more quickly and to give trusts more flexibility. Answering questions on the Summary Care Record, the NHS boss said it was possible to de-couple the Summary Care Record from the wider CRS development and simplify it.

Later in the session, which went on to discuss the impact of the recession on the NHS, Nicholson said that change was inevitable: “You wouldn’t expect us to set up a programme four years ago and not change it.”

His boss, health secretary Alan Johnson, mounted an even firmer defence of the programme, rebutting what he described as some of the “drivel spoken”: “We’ve wasted billions of taxpayers money. Well no we haven’t. We’ve spent £3.2 billion on this. Part of the problem is that we haven’t spent enough money. Our problem has been the delay in getting this in place.”

Link

www.parliamentlive.tv/Main/VideoPlayer.aspx?meetingId=3644

Jon Hoeksma

Readers Comments

Reaping The Seeds Sown

12 Mar 09 18:41

This is good news and long LONG overdue.

Geninely positive

cunpr@globalnet.co.uk

12 Mar 09 23:22

If this means that Trusts in the South will be getting in effect, the secondary care equivalent of primary care's "Systems of Choice", then this is a very wellcome development. Regards Paul C

Does anyone upo there know what's going on?

13 Mar 09 07:00

Tender being carried out as insurance? What happened to the Granger programme's much-vaunted risk management strategy? Was this re-tender always part of the plan?

And some of the other comments are interesting. The unique nature of the NHS was always going to be an issue, as was the lack of "off the shelf" solutions. These are the reasons why predecessors organisations (IMG, NHSIA) were cautious in proceeding to large-scale implementations. History seems to be vindicating their approach.

David Nicholson might choose to believe that NPfIT was set-up only 4 years ago: this rather nicely understates its delays! However, there are news items on EHI dating back to April 2003 that relate to the National Programme: that's almost 6 years ago.

(post edited by ehi)

A New Approach

roy.dainty@ntlworld.com

13 Mar 09 10:28

Is standard tendering the best approach given the past history of the Programme? Thinking back to the original bids, the scale was only viable to the largest of IS companies who each chose their own principal applications' supplier. Perhaps a better approach would be to identify application solutions that do work for the NHS - there are some good ones out there which, being home grown, do not require anglicisation or cause the problems normally associated with it - and then support their suppliers through partnering with companies that can provide the necessary scale of deployment capability and on-going service management. Such partnerships may already exist within ASCC such that they could be harnessed within that framework.

Whilst this proposed approach might be considered radical to some, it would provide a considerably greater probability of delivering acceptable and successful solutions. The traditional approach to procurement has been found wanting and should not be repeated.

No panacaea

13 Mar 09 10:46

The Additional Supply Capability and Capacity framework is mysterious in origin, variable in content, and I'm not at all sure that it is helpful.

Cerner and Isoft appear to have held a priviliged position, with masses of NHS time as well as money (3.5Bn is still a heck of a lot for what has been delivered). The idea that a choice of ASCC supplier, which represents some of the market players, offering their current products, is equivalent to the full Care Records we were promised is derisory.

"the NHS chief executive also said the world, and technology, had changed since the original contracts were tendered." Acutually I believe it had changed well before, and the contracts and central thinking have failed to keep up, and failed the NHS.

I think that the NHS would get far better and more focussed value if the hospitals in the South were free to go back to the market for tactical systems to solve real-world problems, ASCC is not equivalent to GPSoC.

Had the NPfIT strategy implemented tactical prescribing systems in every hospital, and Order Entry and reporting where not present, alongside the slowly progressing Ubersolutions, we would have been a lot further forwards.

The centre still seem to be in a state of delusion that this will all come good. Sadly, the vision on what needed to be joined up was always blurred, and the concept of a fatter Summary Care Record was the one that should have been pushed, with standards based XML exchange between systems that any willing provider could choose themselves.

And I think that was the original vision.

SOC - south

13 Mar 09 10:53

Well be good to see some more vendors trying, ALERT,EPIC,System C...all got creditable products. I hope the south focus on the clinical aspect and not think all PAS.

NHS Connecting for Health spokesperson

13 Mar 09 12:00

"We are confident that the Lorenzo and Millennium systems can be deployed successfully and will bring significant benefits for NHS patients. However, we have recognised that it may become necessary to bring in additional supplier capacity and to take advantage of technological developments. This is why we launched the Additional Supply Capability and Capacity procurement in 2007. The ASCC arrangements which Mr Nicholson referred to have been in place, and known to current suppliers, for some considerable time."

Posted on behalf of NHS Connecting for Health spokesperson.

Data Interchange Standards Reduce Lock In

tim.benson@abies.co.uk

13 Mar 09 15:11

Seven long years ago the strategy document on which NPfIT is based (Delivering 21st Century IT Support for the NHS) announced that one of the ten key elements of the programme was to: "Create national standards for data quality and data interchange between systems at local, regional and national levels" (para 2.3.2). It is not too late to prioritise the delivery and deployment of a full suite of national data interchange standards, taking full advantage of the work that has been done in the meantime in how best to use HL7 , SNOMED etc. Standards reduce lock-in.

Now we know what ASCC is for

brian.hogan@live.co.uk

13 Mar 09 15:30

The longer term plans in our own Trust have changed in significant ways several times in the past 5 years. What we need is some certainty from CFH. It seems to many of us that strategy is being made up as we go along. If the ASCC process meant anything at all (and justified its undoubted cost ) then we should be given permission to choose any accredited system now - and not at the convenience of the two monopoly suppliers. It is they who sometimes seem to be in charge of the whole project. If they cannot, or will not, deliver we all have to wait around patiently until they feel the time is right for them. Is it they or the Trusts who matter more to CFH? We have seen several ASCC ERP systems which exist today and have real users. We want to proceed with one in particular but didn't want to be wrong footed. Do readers think that we will be allowed to contract with an ASCC supplier soon? And will we get the money from CFH?

A contract for how long?

hilldunnassoc@btinternet.com

13 Mar 09 16:04

Last time I looked, ASCC Contracts in Lot 2 (the one with the meaningful applications in it) were awarded for four years from 2nd May 2008 (ASCC Guidance Notes Para 1.9).

On the basis that if one started now, and spent, say 6 months undertaking the required Further Competition Procedure (which for something like an EPR, or even the holy trinity of PAS, A&E and Maternity is a very short timescale), we'd be talking about a Contract Award in, say, October 2009, but the ASCC Framework Contract says you can award a contract only until 1st May 2012. All that pain for a two-and-a-half year contract? Something doesn't add up. Or have I got it wrong?

Morecombe Bay not the only Early Adopters

16 Mar 09 08:35

To say that the product is being developed just at Morecombe bay is wrong......if it were, it would not be representative of the NHS.

There are four Early Adopters for the next release of Lorenzo (R1.9 / 2 otherwise known as Care Management and Emergency care). They are Pennine Care (Mental health), Bury (PCT), Kettering (Acute and A&E) and Morecombe Bay (Acute). Whenever there are serious decisions need to be made, it is vital that all areas of care are represented.

Politics or reality ?

16 Mar 09 10:09

An excellent decision: the Programme is clearly dependent on two failing suppliers - we need to encourage outsiders in - Siemens et al - roll-up, roll-up for another ride on the procurement roller-coaster.

In reality, by doing another tender the NHS will be giving the two failing providers a good 6-9 months in which to deliver, and we may find that no other supplier is in the slightest bit interested in being a free "contingency" for the NHS - after all, the suppliers did this for the ASCC, and haven't seen a penny in revenue and there are much bigger projects in the US with much more money in the pot ($ not £, too)

The NHS needs to learn that "treating them mean, does not always keep them keen". So before you apply, make sure that the tender is for a funded program and will actually be used......

A couple of points

19 Mar 09 16:53

I am concerned that the only reason for seeking tenders from suppliers who were excluded 6 years ago is the failure of the suppliers who were selected.

I trust that the same transfer of risk principle is being applied, IE that suppliers do not get paid until delivery.

please, please, please.....

20 Mar 09 07:53

can we stop talking about this supplier or that supplier, this system or that system and start talking about what we need to do to support the changes to the business of healthcare.

The very last thing we need is yet another set of botched procurements based on inadequate understanding of what the NHS needs to be doing