NHS wrestles with erratic demand for IT
- Posted:
- 14:38 28 May 2004
- Topics:
- Security | Application Services | IT Applications | IT Strategic Planning
A confidential paper has revealed that
the level of demand for BT's services under the national programme
for IT may be different from what has been anticipated
The Department of Health is in danger of not meeting commitments
made to BT under its £996m contract to modernise healthcare in
London, a confidential paper has revealed.
The document highlights the successful work achieved so far and the
problems faced by the Department of Health and BT in timetabling
the roll-out of new IT-based services to clinicians.
The paper sets out BT's obligations under a 10-year contract as
local service provider for London to help modernise the capital's
health services under the government's national programme for IT in
the NHS.
The programme has five local service providers and two national
systems providers across England, with BT having the largest share
of the contracts.
One of BT's first obligations after winning the London local
service provider contract in December 2003 was to set out its plans
for modernising the capital's health services.
It conducted a survey of trusts to assess their state of readiness
for new systems and what they would require from the company. The
results were compiled in a BT paper, London LSP Project - Detailed
Implementation Plan, which is marked "confidential and commercially
sensitive".
Among its disclosures is the existence only five months into the
deal of "material contractual issues". These were detailed in
Computer Weekly last week.
The paper also revealed that far fewer hospital trusts and general
practices in London have ordered new systems in the first year of
the deal than the contract envisaged.
The NHS/BT contract provides a number of remedies if trusts and
general practices order fewer products and services from BT than
the deal specifies. These specific remedies do not apply to the
first year of the contract.
However, the BT paper gives an early indication of the difficulties
that will be faced by the health service as it seeks to meet its
commitment to local service providers. The documents show that
compliance with the contracts is in many ways at least as onerous
for the NHS as it is for the contractor. This is because the
Department of Health has made contractual commitments on behalf of
trusts, but is not always in a position to force them to comply. On
the other hand, BT, as a private company, has control over its own
share of obligations in the contract.
An especially challenging commitment for the Department of Health
is an undertaking to, in effect, pay contractors for systems that
are not necessarily needed if the amount of business falls below
predefined levels.
The BT paper referred to "bundles" which the health service
described as "units of services" which are bought from suppliers to
support NHS staff. Core bundles will support the recording of
clinical notes and the generation of clinical correspondence.
BT's paper said, "Analysis of the information currently provided
from the trusts indicates that the nature of demand for bundles is
different from that set out in the agreement between the contractor
and the authority."
It added that demand from trusts for phase one, release one, of
BT's services is "considerably lower than anticipated during the
bid phase" which was 19 bundles requested against 86
anticipated.
The paper lists the demand for a Care Records Service portal, a
service that will allow trusts to link into a national data spine
of medical records and the electronic booking of hospital
appointments.
As from 31 March 2004, the demand for access to the Care Records
Service portal in the first year of BT's contract was only seven
against 73 specified when the deal was signed. Demand for an early
electronic patient record was one against 14 in the contract.
These figures will have changed by now, as Department of Health
officials seek to increase demand in the first year. However, the
national programme declined Computer Weekly's invitation to update
the figures.
The consequences of a failure by the NHS to meet a minimum value of
services which the government is obliged to buy in any particular
year is set out in the contracts of the local service
providers.
It said that if the health service does not take up the required
level of core bundles, it must purchase other bundles or services
"to a value sufficient to bring the cumulative spend to the minimum
committed value". If the NHS fails to so, it is "obliged to pay the
minimum commitment regardless".
The BT paper disclosed that demand for bundles in the financial
year 2005/06, in which the systems on offer promise much greater
functionality than in the initial release, is "considerably above
that anticipated in the agreement".
It added, "A total of 141 bundles have been requested versus 50 in
the agreement. Clearly this level of demand is undeliverable
without a massive, and perhaps unsustainable, spike in activity and
resource input by both the authority [the health service] and the
contractor [BT]."
The paper said work is continuing to prioritise excess work in the
second year, but IT executives in trusts fear this could leave BT
unable to meet the demand in some hospitals for new systems.
The difficulty for some trusts is that there is already an urgent
need to replace old systems, which, in the case of pathology
equipment, may be in danger of not meeting safety standards.
However, the local service provider may have its hands full
delivering systems as part of the national programme.
Despite the contractual and other challenges, officials on the
national programme are confident it will be a success.
A spokesperson for the national programme, when asked whether
demand from trusts for new systems should have been ascertained
before contracts were signed with local service providers, said the
information in the BT paper was "well out of date".
The spokesperson added, "There have been tens of iterations in the
London cluster and further iteration is ongoing. When the final
drafts are concluded, a summary will be published.
"A key underpinning principle of the programme is not to accept
technologies until they have been fully implemented and positive
benefits have been achieved for the NHS. The contractual terms and
minimum volume commitment fully supports this principle."
Tim Smart, chief executive of BT Syntegra, the local service
provider for London, said the paper was an internal document which
was circulated widely across stakeholders. "It seeks feedback and
represents work in progress," he said.
He added, "There are more than 7,000 detailed requirements in the
contract we agreed with the national programme for our work in
London... and yet, as the programme advances, issues are
identified, discussed, clarified and resolved in agreement with our
customer. This was anticipated and is how it works in any complex
programme." He underlined BT's commitment to making the London
project a success.
Implementation of systems under the national plan for IT
|
Dependency |
Current |
Impact |
| Complete W3 domain scoping report (EBS, PDS, LRS) | Complete EBS/LRS still outstanding | We have made further assumptions and if they are wrong, there may be further delays to the programme |
| Complete W5 detailed communication | Complete EBS still outstanding | |
| Complete NASP interface requirements | V5 received 19/3 but still missing detail | |
| Complete HL7 message definition specifications | Several drafts received with considerable changes; areas of PDS, EBS late | Design proceeding on assumptions |
| Interim GP solution deployment strategy not complete with respect to data migration | Need closure with the authority on requirements for data migration and to ensure that can completed in timescales | If we do not identify the migration needs and receive the migration plan, it will be difficult to meet the interim GP deployment plan |
Source: London LSP Project - Detailed Implementation Plan
EBS - electronic booking service, the first
service to go live
PDS - personal demographic service (required for
data spine information)
NASP - national application service provider for
the national programme for IT in the NHS
HL7 - messaging standard
