Storm over Fujitsu executive's 'honest' NPfIT remarks

Tags: A consultant England Fujitsu HIS iS Labour London NPfIT South

15 Feb 2007

A senior executive from local service provider to the Southern cluster, Fujitsu, has said that the intense pressure suppliers are under to deliver short-terms risks the wider aims of the NHS National Programme for IT systems, resulting in a danger of it delivering “a camel, and not the racehorse that we might try to produce.”

Andrew Rollerson, healthcare consultancy practice lead at Fujitsu, the prime contractor for the NPfIT project in the South of England was speaking at a conference in London last week where he was delivering a presentation entitled ‘Lost?’.

Rollerson was quoted by Computer Weekly as warning there was a "Gradual coming apart of what we are doing on the ground because we are desperate to get something in and make it work, versus what the programme really ought to be trying to achieve."

His reported remarks were seized upon up by a series of national newspapers as 'proof' of the programme's failings.

The public acknowledgement of widespread problems and project drift certainly comes at a delicate stage for the NPfIT programme, with the agency responsible Connecting for Health needing to attract new players into the market.

One senior supplier told EHI that such a frank public exposure of NPfIT's difficulties may also not help iSoft's quest for a buyer, who would necessarily have to address many of the issues raised by Rollerson.

Rollerson was reported to say: “The more pressure we come under, both as suppliers and on the NHS side, the more we come under, both as suppliers and on the NHS side, the more we are reverting to a very sort of narrowly focused IT-oriented behaviour. This is not a good sign for the programme.”

His public warning echoes concerns that key suppliers have repeatedly acknowledged to E-Health Insider in private, about how intense pressure to deliver is working in known problems being let through, a focus on targets and payments rather than quality.

Rollerson’s comments were accepted by some in the industry as welcome breath of fresh air, providing a necessary and honest account of the state of the NPfIT programme. Benedict Stanberry, managing director of healthcare consulting firm Avienda who also presented at the conference. He told E-Health Insider that Rollerson had simply given an honest opinion of the project.

“Andrew Rollerson tried to give an honest, open appraisal of what’s needed to make the NHS IT programme work, and landed up on the front page of all the national newspapers when he was in fact speaking in the best interests of the programme. Everything that Andrew had to say was motivated by a deep commitment to the NHS and a genuine desire to see the IT programme deliver lasting improvements in patient care.”

Rollerson said in his presentation to EyeforHealthcare's 'Successful implementation of NPfIT' conference that the enormous size of NPfIT means that the standard management techniques used needed to be rethought.

He was reported to say: “What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn’t working. And it isn’t going to work. Unless we do some serious thinking about that – about the challenges of scale and how you scale up to an appropriate size – then I think we are out on a limb.”

He also reminded the audience that Connecting for Health was effectively a national IT department and there was a need to dismiss the fallacy that the NHS IT programme would transform the NHS 'simply by delivering an IT system.’ “Nothing could be further from the truth. A vacuum, a chasm is opening up. It was always there,” he said.

Defending Rollerson’s comments, Stanberry added: “A good consultant is always honest with their client and that means they have to be neutral and objective about the challenges involved in achieving the changes the client wants.

“Andrew Rollerson was very much reviewing the IT programme from the point of view of the massive organisational and cultural changes that still need to take place if the NHS is to realise all the benefits and opportunities that single, shared electronic records and booking systems will create.”

Ian Lamb, NHS account director at Fujitsu said: “We refute any inference that has been drawn to the effect that Fujitsu in any way questions the success of the National Programme.”

According to a press report in the Evening Standard, Labour insiders say health secretary Patricia Hewitt has been ordered by Tony Blair to explain how the project has gone wrong.

Readers Comments

Not as if we didn't know ...

colin@clinformation.com

15 Feb 07 08:24

I can't believe for a moment that there are many people who will have been surprised by what Andrew Rollerson said, though such openness and realism from those close to CfH is a refreshing change.

The Evening Standard report apparently suggests that NPfIT is now believed to have somehow "gone wrong" - implying that there was a time when things were actually going well. Can't remember that time myself .....

Ouch, honesty hurts

15 Feb 07 11:32

I guess it is something we have all been saying but nobody took any notice of. An open invite to drop by my site at http://www.frontpointsystems.co.uk/weblog for more happenings.

Kwote, unkwote

15 Feb 07 11:56

Honesty hurts indeed! It seems has to be its own reward in NPfIT

http://www.theregister.co.uk/2006/08/08/nhsit_flush/

Take a step back here sheeple

15 Feb 07 12:54

This whole programme has been shrouded in top secrecy from government. Now all of a sudden, something comes out like this. Do you really believe this isn't scripted and planned by the government? Wouldn't have anything to do with setting the scene for NLOP would it? NLOP can be heralded as a cure to the ills put out by the Fujitsu presentation. NLOP: http://www.e-health-insider.com/news/item.cfm?ID=2288

Tinkering around the edges

15 Feb 07 17:01

The NLOP is unlikely to have much to add, they do not have knowledgeable clinical involvement either, I should know. having dealt with a few SHA's re healthcare IT.

http://www.frontpointsystems.co.uk/weblog for more happenings.

truth from the top

drgordon.caldwell@ntlworld.com

15 Feb 07 21:24

Good to hear the truth from the top at last. Strange how no one believed us end users, who said using CERNER would be the end, if we had to use CERNER as was in Autumn 2006

Andrew has my full support

bruce.kay@btinternet.com

16 Feb 07 00:41

I worked directly for Andrew Rollerson in the Fujitsu Services team in the Southern Cluster account. Earlier this week I saw the flurry of sensational coverage that appeared in papers like the Daily Telegraph and other London rags. They make it their business to rubbish the NHS on a daily basis. So I went out of my way to search for what Andrew actually did say compared to the mis-reporting. All of Andrew's remarks are valid when read in context. I loved working for him and I admire him always for his honesty and integrity. Andrew Rollerson's vision from back in the days of the NPfIT tendering process and continuing through to now has always been that this is a business transformation programme involving tremendous change for NHS people. Not merely a programme to implement computer-based technology. He has always been correct. The pressure on suppliers and on CfH to roll-out technology and to divert attention away from improving healthcare services has been tremendous. And politicians and newspapers have performed their part in exerting that pressure. A little bit of honesty is refreshing and I applaud my friend and colleague Andrew for that. He was voicing a sense of frustration that I feel too. This is one of the largest programmes in the world. The UK government were brave in taking a lead in introducing system-wide electronic healthcare records. Other governments are following this same trend and are taking a lead from the UK NHS. It is about time people realised that large programmes of this nature are necessarily complex and we all should show a little patience if we want to harvest to business benefits the CfH programme is seeking to deliver - better health outcomes for patients, better continuity of care and a reduction of medical error. People like myself who have lived and worked in many other countries will tell you that despite all the (sometimes valid) criticism the NHS does offer one of the best healthcare systems in the world. Cheers Andrew - well said mate.

We need NPfITSOC not NLOP or centrally driven NPfIT Implementation plans

16 Feb 07 08:33

Not all of NPfIT has gone wrong – PACS is a big success, choose and book is getting there – but the success is nothing to do with NLOP/SHAs – nor was it to do with clusters either. Bottom line is if NPfIT offers fit for purpose systems the NHS at a local level will take it and make it work – despite interference from Clusters/SHAs.

CFH leadership and staff, Regional Implementation Directors, SHA CIOs and anybody else working that far from the coal face of the NHS are so far from the delivery part of the NHS that they have a purely theoretical understanding of what is required and how to make this work. They have no idea about what local resources are required; they believe that clinical engagement, rather than wider operational engagement will solve all problems; they believe that benefits exist with early deployments – where often there are more disbenefits – I could go on.

NPfIT is hugely ambitious and is still controlled and governed by people to far from the NHS coal face – and this include SHAs. Under the NHS operating framework we all have to produce IM&T plans out to 2011 by the end of March. These will not be Trust/PCT IT plans but high level Trust/PCT NPfIT Deployment plans. A True Trust IT plan would need to pick up admin systems, business support systems, telemed, communications etc etc. We must have plans to use NHSmail – when most of us have in place email/scheduling systems with functionality way beyond what NHSmail offers. If NHSmail is good enough – all of us would move to it – in the same way we have embraced PACS.

So – what we have is a centrally driven programme by people with no idea of the day to day workings of the NHS and worse – they want to coerce us into doing what they think is best (e.g. NHS mail). If NPfIT offers fit for purpose, value for money systems – I am sure we will all opt in to it. This is the model for GPSOC so why not have a wider NPfITSOC – a roadmap for increasing integration/standardisation as suppliers can demonstrate they have fit for purpose solutions.

At last what those inside NPfIT have been saying for ages

16 Feb 07 08:39

Those at the 'coal face' within NPfIT have been telling their masters much of what Mr. Rollerson said. Implementing to a timescale rather than to quality was bound to cause failure sooner or later. (Post edited by EHI)

A question for Bruce Kay

16 Feb 07 09:32

Which other governments are following the NPfIT delivery approach? As far as I'm aware, those which are looking at national electronic records seem mainly to be pursuing a more devolved implementation strategy resembling that outlined in the NHS's Information for Health (1998).

IMHO, NPfIT is an experiment that few would wish to emulate and well done to Andrew Rollerson (and others) for exposing the real issues beneath the veneer.

The Emporer's new IT programme

sleepyfox@gmail.com

16 Feb 07 11:47

Kudos to Rollerson, I hope he keeps his job (sadly unlikely) - but then the National Programme usually shoots the messenger.

NLOP (as linked above) is 'challenged' in the same way that the current programme is challenged, because the ownership of the requirements (and hence scope, and thus functionality and design) are owned by the centre, who as stated above have only 'a theoretical view' of the actual operations of a SCT/PCT.

Clinical engagement together with operational engagement at the 'coal face' is necessary, but missing. Engagement of regulatory bodies e.g BMA, Royal Colleges is also necessary, rather than the design by proxy that we have at the moment.

One might compare the current governance model to a representational democracy, although of course no-one actually elected NPfIT...

The solution: existing bodies such as the BMA need to set 'high-level' requirements and local users (clinical, operational and administration) need to set 'low-level' requirements. CfH should limit themselves to a hands off role as vision-makers and fund-holders.

The CfH OBS/Contract schedules are 'design by committee', and sadly few to none of those being actual end-users of the system. The requirements also carry the additional burden of the 'hopes and aspirations' of modernising the NHS by transforming it's current paper-based processes into an efficient electronic system.

Unfortunately what this means is nothing less than - as Rollerson alludes to - the largest and most ambitious change-management programme the NHS has ever embarked upon.

Of course we have experts in change management, big consultancies like Accenture for instance. But until CfH and the NHS in the large start treating this like a change management programme rather than an IT improvement programme with a hidden agenda we will continue to be fodder for the dailies.

Solution: make a choice; if this is an IT improvement programme then unburden it of the change component and give it a chance of success, if it is a change management programme then treat it as such and start by engaging the NHS and coming clean about the true aims and objectives.

NCRS SOC

16 Feb 07 20:28

The split off of GPs through GP SoC, nothing for Social Services, questions over Mental Health involvement for the South, and a separate solution for London, and then the prospect of the patient opting not to share records, or daring to be seen in another cluster blow increasingly large holes in the original strategy.

Then we have outposted 'outliers' - Wirrall, Plymouth, Salisbury and others, who are 'in the wrong cluster', and do not plan to change.

How far we have moved from the vision. How little the benefits now appear to stack up against the risks of throwing away working clinical systems for Trusts.

Systems of Choice for the Detailed Care Record sounds excellent, except that the contractural framework appears set to make this impossible, even with the extended non-delivery.

And it is increasingly hard to see how NCRS underpins the migration of work into community and primary care.

Catch 22

colin@clinformation.com

18 Feb 07 11:06

I've always believed - and the ERDIP Programme's findings reinforced this for me - that there is a "catch 22" situation regarding the DH's strategy for NHS IT. If you didn't understand the NHS's complexity and diversity, then you might attempt to deliver a programme such as NPfIT (and fail). If you did understand the issues (and might just have a chance of succeeding), then you probably wouldn't be prepared to try!

IMHO, the challenges are more than just the permutation of technical plus change management that is often cited. The organisational nature of "the NHS" (little more than a brand for a multiplicity of diverse and semi-autonomous entities) calls into question the feasibility of any centralised and uniform approach.

PACS performance

26 Feb 07 21:43

Your correspondent states that PACS has been a success. In the West Midlands and North West cluster the original PACS procured did not work and has been replaced, adding delays to the process ( and possibly extra costs). There are problems with the PACS systems as they have difficulties supporting radiotherapy requirements. Has anyone fully validated the performance and reliability of the central PACS archive? How reliable will the new centrally hosted RIS systems be, and how much extra did the new architecture cost when compared to locally hosted solutions.