More delays likely in PAS rollout, says Granger

Tags: Cerner CfH Granger iS iSoft Nicholson PAS PAS Prescribing

27 Nov 2006

A combination of the NHS’s financial troubles and problems with software, means that the installation of new patient administration systems in hospitals is likely to be further delayed, Connecting for Health chief executive, Richard Granger says in an interview.

He admits that London’s local service provider, BT, is having difficulties finding any hospital in the capital willing to put in a new patient administration system (PAS).

Speaking to the Financial Times, Granger said: “It is not a great time to ask people to take new computer systems. Money is tight, targets are tight, these systems are disruptive and there is not an enormous benefit to trusts at the moment.”

He said greater focus would now put on other projects including digital imaging systems, electronic prescribing and providing software to help the NHS’s new payment system work.

At the end of October, an investigation by E-Health Insider found that only four of the 22 systems promised to the Commons Public Accounts Committee had been implemented.

Shortly afterwards, CfH said new PAS systems would implemented in 120 trusts by April 2007 .

Granger gave a frank account of the problems with the software available to trusts from iSoft and Cerner under the National Programme for IT.

He told the newspaper that Cerner’s software provided clinical benefits but did not easily provide reports on patients’ appointments in a format preferred by hospitals that enables them to claim money from primary care trusts. iSoft’s product fulfilled that function but, as yet, offered few clinical gains.

But Granger says these problems are “transitory” until new versions of the software become available.

He acknowledged the pending review of the National Programme for IT (NPfIT) by the Department of Health chief executive David Nicholson, as exclusively reported by EHI earlier this month.

“We are not far into a 10-year programme and we have achieved an enormous amount…People are searching for an easy answer, saying let trusts do more or punish the suppliers more and it will be easier. I don’t think it is going to get easier. It will continue to be a difficult task.”

Granger also acknowledged that the changes Nicholson is planning, which place greater emphasis on local ownership, would lead to CfH getting smaller in size.

“The job is going to take longer, so the team needs to be made smaller,” he said.

Readers Comments

These excuses don't hold water

27 Nov 06 12:39

The NHS's current financial situation has been evolving for years: nothing new there. Software development processes (and problems) have been exhaustively documented: nothing new there either.

Not far into a 10 year programme? Mr G has been in post for over 4 years (i.e. 40% or almost half-way). "Going to take longer so the team needs to be made smaller:" just what sort of project planning methodology is he working to?

These issues should all have been predicted and Mr Granger should have ensured that they were factored into the planning of his programme. Given the track record on forecasting, I wonder what is the basis for his prediction that the problems will be transitory?

solutions

Pete.marsh@whnt.nhs.uk

27 Nov 06 14:02

A not uncommon configuration, particularly in USA is to have the business sofware (ie PAS) seperate but joined to the clinical supplier. Cerner as with most big EPR vendors run in this config. So maybe BT should think of a Isoft/Cerner sandwich. Or take the alternate Wirral solution and try and get Cerner integrated to its EDR (Eelctronic Data Repository) - a formidable task so far, but Wirral will not surrender, it cant afford to, for the reasons Granger has stated.

Because Trusts can't afford his barely working systems

27 Nov 06 15:09

With the struggle in the Southern Cluster to get any sites live, it is hardly suprising that London Trusts are voting with their feet.

What is suprising is that the LSP model has survived, and that Cerner was chosen in this knowledge.

Burning money

27 Nov 06 16:19

OK, so Granger admits that with new computer systems, "there is not an enormous benefit to trusts at the moment.”. So why on earth do they aim to install 120 before April? What is in the business case?

And in the meantime?

27 Nov 06 16:21

So the implementation of replacement PASs is going to take longer than planned. Does Mr Granger have any suggestions for trusts which are having to live with their stagnant legacy PASs in the meantime, and the ever-increasing support costs for them as contracts for these legacy PASs have to be extended, and manual workarounds undertaken to meet evolving DoH requirements?

And presumably the published CfH 12-week forecast (at least as it relates to PAS implementations in the acute sector) at http://www.connectingforhealth.nhs.uk/implementation continues to be a work of fiction? Do I not recall that the format of this forecast was going to be re-structured so that we could see actual achievement against forecast etc?

eelectric progress

27 Nov 06 16:22

The eel slip above suits this news. Having failed to deliver working software to date, sounds like just dumping the problem on HAs and PCTs, and retracting any support to help us out of the mess the CfH grand vision & poor delivery has created.

Viable and affordable ways to EPR functionality

john.aird@uhl-tr.nhs.uk

27 Nov 06 17:12

If the PAS is functional and stable then consider keeping it as a back-of-house admin process-engine, feeding a bolt-on modern Order Comms product and GUI front end (for ward and clinic use) through an integration engine. Our NPfIT supplier (iSoft) and LSP (CSC) seem to have the necessary products, with both the ability and desire to assist us implement them.

Another day another excuse

27 Nov 06 17:13

I work in a Trust with considerable financial pressures. Despite the business, clinical and financial pressures the Trust has succesfully implemeted PACS, choose & book (including direct booking), ESR and a number of other must do systems in the last 2 years. Each has been disruptive but thanks to the vision and recognition of the long term business and clinical benefits - have been resourced - both financially and people wise.

If Granger and the LSPs were bringing fit for purpose sulutions to the NHS, we would be queueing at his door to be next in line. His lack of willingness to accept responsibility and blame everything but the ridiculous process and timetable for procuring such visionary and therefore complex solutions, lack of understanding of the NHS at the sharp end, inability to simply put his hands up and say this isn't working, time for a rethink that works more by evolution than revolution, I could go on.

What makes me most angry is that there are so many people in the NHS who can buy into the vision. The failure of CfH to deliver, the constant spin, the denials, the blame game etc, are in danger of killing NPfIT off. The biggest problem with NPfIT is not the suppliers, Trust financial positions or any other of the Granger smoke screens. The biggest problem with NPfIT is with the leadership of the programme.

Virgin's rest?

27 Nov 06 20:16

At http://tinyurl.com/uqx79 CFH says : "The work of NHS Connecting for Health is about delivering benefits." How does this fit with our DG's view of the world? Also, completely agree with the timetable query. RG appointed September 2002. If the Programme began then we're nearly half way through not "not far in".

Delays...

28 Nov 06 09:42

It is about time that Granger let Trusts get on with things and let them implement any PAS system that is on the market so long as it integrates with the spine. We can then intgrate our clinical systems into it as we have done for may years!

Wasted opportunities and viable EPR

28 Nov 06 21:54

The biggest shame is the enormous effort put in by clinical and NHS technical staff in trying to make the nonsense work.

CfH have created an expensive industry to fail to achieve progress many had already been making with good UK PAS, and modern Electronic Requesting, aspirations for Prescribing, sensible ways of transitioning from paper, and ensuring tie-in with local GPs.

Had we been allowed to continue, and had a fraction of the funds wasted by CfH/NPfIT/LSPs, we could be reaping these elusive benefits by now. No-one pretends it is easy, but many predicted this, included Frank Burns in 2002 (quoted in Sean Brennan's book) - read it, eg "The higher the level of centralisation, the lower the specification".

Doing anything via the LSP/datacentre model with the state of N3 does not give the robust support to healthcare we will need. If Trusts and local communities could implement Cerner and Isoft to locally agreed timetables, and meeting their priorities and expectations, then they will make it work. Paperless practice of healthcare is too complex to put in a standardisation straightjacket.

Funding was always the problem. If Granger can pull anything back from the abyss, it has to be local autonomy, and not just dumping the current model on HAs and PCTs to flounder on with.

Architecture Review is needed

28 Nov 06 23:42

Yet again, the CfH/Governments refusal to review the architecture is crippling the National Programme. Logic is out of the window and instead of a needed national programme to deliver a shared record, we end up with an expensive mess that will probably not deliver now. Any sane architect would have mandated local systems interfacing to the SPINE. As all we have now is the same local systems hosted in a datacentre, all the associated overheads and the systems are not reliable. The word is out and business is down.

Re: Viable EPR

29 Nov 06 11:40

Now where did I put my copy of IfH and those CDs with the ERDIP reports on???