Only 10 days ago a deal aimed at rescuing theNHS's National Programme for ITin the
south of England seemed imminent.
Officials and Fujitsu had spent nearly a year negotiating
changes to a 10-year contract worth £896m, signed in January
2004.
The two sides had
agreed a deal in principle. Papers were ready for signing by
David Nicholson, the chief executive of the NHS, who is also the
predominant senior responsible owner of the £12.7bn National
Programme for IT (NPfIT).
But at what one NHS official said was the "59th minute of the
eleventh hour" Fujitsu informed Nicholson that it was withdrawing
from the negotiations. The NHS responded decisively, by terminating
Fujitsu's contract.
The NHS had threatened to terminate the contract even during the
"contract re-set" negotiations. Nevertheless, the way Fujitsu
withdrew has taken many in the NHS by surprise.
"Up until the end of last week the signs were that agreement had
been reached. Things were looking positive on a reasonable
implementation timetable," said one executive involved in the
NPfIT.
Why did a proposed deal collapse? NHS officials believe that
Fujitsu's board in Japan decided to intervene. The board was
concerned that Fujitsu's potential losses on its NPfIT work, as one
of three local service providers to the NHS, could be much greater
than its directors had thought at first.
Fujitsu is the monopoly supplier of
Cerner's Millennium care records service, which is mandated to
be the main hospital system for the south of England.
Now that Fujitsu is withdrawing as the local service provider
for the South, and trust boards do not have the freedom to buy
elsewhere, uncertainty has been piled onto
uncertainty for the boards of NHS trusts. Some in the NHS say
this is a characteristic of the NPfIT as a whole.
"We are into a period of turmoil. There are the exit
arrangements with Fujitsu to manage, especially for the
early-adopter sites, and there will probably be some months of
discussion about what we should do. There is no uniformity of view
within the NHS on that," one official said.
There are several options. One is for the government to give
trusts the freedom to buy care record systems from other suppliers,
under Connecting for Health's Additional Supply Capability and
Capacity (ASCC) framework, which came into force recently.
This would give trust boards in the south of England the option
of buying the Millennium system directly from Cerner - rather than
from Fujitsu as the middle-man. Or they could choose to buy from
another accredited Care Records Service supplier.
Most IT executives in the NHS are expected to favour this
option, particularly if the software is funded centrally
irrespective of what ASCC choice the trust makes.
Other options include passing Fujitsu's work to one or both of
the two other local service providers, CSC and BT. But both of
these suppliers have had serious difficulty delivering a national
strategic system to the NHS.
Some NHS staff believe that Cerner can be made to work across
the UK. It is a successful product in the US and elsewhere. But
others are concerned that Millennium is a client-sever system
rooted in the 1990s. NHS staff need extensive training to use it.
It is not as intuitive as, say, an online banking system.
There are also wider concerns among some officials that the
NPfIT itself is dated in concept as well as practice. Since the
programme was announced, trusts have become subject to competition
for patients from private companies and even within the health
service, particularly foundation trusts. They want IT to give them
a competitive edge, which makes them less inclined to favour
systems chosen for them centrally.
It will be of little comfort to the Department of Health and
ministers that Computer Weekly warned them in 2002 that the NPfIT
was too ambitious to be achievable, and that the programme
incorporated some of the biggest mistakes of the past. For this
warning ministers and some parts of the media branded us
doom-mongers.
We still hope our critics will prove us wrong. But it is six
years since the NPfIT was announced. How much longer do they
need?
Read
more about the NPfIT on Tony Collins' IT projects blog
>>