Tories uncomfortable on what they'll do about the NPfIT?

For tonight’s R4 File on 4 programme, the BBC interviewed the Conservative Shadow Health Minister Stephen O’Brien who is well informed on the progress and problems of the NHS IT scheme, the NPfIT.

Now that a general election is approaching, and one the Conservatives may win, O’Brien must choose his words particularly carefully when answering questions on what the Tories will do about the NPfIT. 

He was asked by File on 4 what the Conservatives will do on the local service provider contracts [with BT and CSC]. O’Brien made the point that the LSP contracts haven’t been published and until he sees them it is difficult to say whether the agreements can be halted and renegotiated.

BBC: What would the Conservatives do if you become the next government? Would you simply scrap the programme?


Stephen O’Brien: “We have said in the absence of the government being prepared to makeavailable copies of the contracts with the LSP’s ( local serviceproviders) that we would have to halt and renegotiate contracts.

“It’s of vital public interest that we know what those contractscontain and that we should therefore know what our scope is, both interms of what can be the future and indeed what  we need to make the future for good IT well applied in the NHS, so that patients andtheir their health-care outcomes can benefit.”

The BBC asked O’Brien what has gone wrong with the NPfIT.

“Against the forecast plan and expenditure  … we have got no obvious healthcare improvements for patients that can be  attributed to the success of the government ‘s IT programme in the NHS, and that’s  more or less largely attributable to the fact that it ]the NPfIT] didn’t really take into account or consult with the doctors in the first place in any meaningful way.”

BBC: No meaningful benefits? What about [PACS] x-rays, imaging and GP-to-GP record transfers?
 

Stephen O’Brien: “What’s been very interesting is that the things that were already on course to produce good benefits like imaging [were] captured by the programme – the new things the  programme  was meant to deliver have not produced the results that were proclaimed for it.”  

BBC: Some of these contracts are knee high. Do you think you’ll just be able to get out of them?

O’Brien: “Well I’m sure they are knee high as we’ve had parliamentary answers telling us how much has been spent on lawyers who negotiated them.

“For the millions of pounds that have been spent on these contracts I imagine a lot of paper  was produced.

“What really matters is the ambition that you have for improving health-care outcomes and IT to support that…”
 
BBC: Do you think you’ll be able to get out of the contracts?

O’Brien: “Well we have said until we can see them I can’t give you a clear answer on that.
 
“I do think it’s wrong that I should not be given the sight of the contracts. We have asked both under the Freedom of Information Act and in Parliamentary Questions.

“We’ve got a government saying it’s [the NPfIT’s] vital for healthcare yet at the same time the Chancellor  is saying £600m can be saved… it’s absolutely vital we see these contracts to know exactly where they [the local service providers] are able to deliver what they say they can deliver …”

BBC: Do you have an ambition as to how much money you could save on the National Programme for IT?

O’Brien: “To be really clear, straight and honest, I really can’t give you a number because, until I see the contracts, it would be speculation.

“… It stands to reason, to change the approach, to really base your IT to deliver improving health-care outcomes for patients,  [IT-led change] is best done locally where people can … access good IT products from a catalogue that has been approved to good standards, where the development of the product has taken place at the risk of the private sector, not taxpayers.

“Funding that and [ensuring] that those products are all interoperable … is suitable for your local health economy, whether its in my constituency in Cheshire or anywhere else in the  country…

“… the patients themselves …can access their records and at the same time the doctor can have the confidence that they have a system of records that they can rely on, that have neither been tampered with or are difficult to use.”

BBC: Last August the Conservative Party said it would seek to dismantle the IT central infrastructure of the NHS IT

O’Brien: “That is still our policy … to put the decision-making and the choice at local level..
 
“We would then have, as we have proposed, a catalogue of  good products – already proven and tested for value but functionality as well; and that are inter-operable…

“So yes there would be a dismantling  – but we would keep of course the benefits …”

BBC: But you’d dismantle the central infrastructure?

O’Brien: “There’d be no need to have what is called The Spine, both as its both currently proposed and is not really being delivered …”

The BBC pointed out that Dr Glyn Hayes, who helped compile a report for the Conservatives on the future of NHS IT, had said that the next government shouldn’t dismantle the whole of the central infrastructure because a central directory is needed to store local registers and care records.
 
O’Brien: “Of course I have accepted the Dr Glyn Hayes independent report …”

BBC: Do you accept his view that you would need a central directory to show  where care records are?

O’Brien: “… we would  keep central/essential elements of  what is currently called the spine.”

BBC: So when you say you would seek  to dismantle the central infrastructure what you actually mean is you would dismantle parts of it and keep other parts of it?
  

O’Brien: “The current top-down, one-size-fits-all infrastructure is neither needed nor [has] it been proven to be of benefit …”

BBC: You wouldn’t dismantle all of it?
 

O’Brien: “…Actually what would happen is that the parts that would remain would then not belong to the centre. There would be what’s necessary for the interoperability of products that are  sourced and chosen locally.”
 
BBC: You’re on shifting ground here aren’t you?
 

O’Brien: “No, no. I don’t  believe that we are shifting ground here. We have been very clear to  make sure we look at this …on the evidence…

Glyn Hayes has made it very clear to us, and indeed others, that the overall architecture the government has with its central one-size-fits-all, top-down central programme for IT is not the way forward.

” … the  way forward is to give the ownership of  this choice and the products to local professionals …”
 

Links:

BBC R4 File on NHS and Government IT projects – BBC Online

Tories plan access to medical files – BBC Online

Minister to sew up NPfIT deals before the election? – IT Projects Blog

Minister to sign new deals before an election? – ComputerWeekly.com

Come clean says O’Brien – Conservatives

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What can I say - we have entered the 'search for the guilty and punish the innocent' phase of the NPfIT contractual lifecycle. Here's the thing: for the £13b (and add 30% when you add up all the related spend like renewals of old antique systems BECAUSE the programme hasn't delivered in timescale orginally committed) ... we should keep it running until the suppliers have delivered everything originally promised at a first customer site. No more payments until this occurs. No can do? Okay, let's close down the contracts and you guys pay us back everything we spent on you + you pay for a working alternative system to be selected and deployed. I swear we are asking the wrong people to pay (the taxpayers; the suppliers, laywers, CfH, management consultants - give our money back and we will use it to really fix some stuff. Forget about Labour, Lib Dem, or Conservative party - let's have a TEA PARTY!

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What should the next Government, Conservative, Labour or Coalition do about NPfIT?

The next Secretary of State for Health would be well advised to apply what is often known as the Harvard TEAMS test.

T – Is the proposal Technically sound or even feasible? There have been major technical doubts expressed since the scheme’s inception. The new Minister should pick up the phone to Martin Thomas and request him to form a professorial team to report on the technical issues. The rejection by Ministers and the Parliamentary Select Committee of his offer a few years ago to conduct such a study is felt by many to have cost the taxpayer as much as a £1Billion.

E – Does the scheme make Economic sense? The Treasury spokesman, Mr Mortimer, told the Public Accounts Committee that the Treasury did not believe there should be an overall business for the NHS IT programme. The Treasury got it wrong. In Nov 1999, the NHS National programme was 5 years away and was going to cost £1 billion - now for the same objective, it is still 5 years away and is going to cost £ 12 billion. The new Minister should require a national NHS IT business case to be produced and published as a matter of urgency.

A – Is Accountability aligned with responsibility? Currently, very few Trusts have direct contracts of consequence with the Local Service Providers (LSPs). Contracts are held centrally, and suppliers are accountable to the Secretary of State. But the cost of poor implementations is felt locally by the Trusts. The new Minister should first suspend all new work under the contracts, and then announce a termination date for all contracts that are not for genuine national purposes, such as N3 and Choose & Book. Trust that wish to continue to use LSP services can contract for them locally and ensure that they provide value for money.

M – Are the Management arrangements sound and has the Management deployed been competent? There are many areas of deficiency and even more questions. One perhaps is the anomaly disclosed in recent Parliamentary Questions. Why, in the three northern LSP areas, had to Sept 2009 less than half a Million Pounds been paid to the LSP on Lorenzo deployment (set-up) activity and service charge (running cost) payments, while the total payment to the LSP in the Northern three areas had already exceeded £780 Million. What has the management in the centre and the northern SHAs spent the £780 Million on if not on Lorenzo? The new Minister should transfer to local Trust posts at least half of all central and SHA IT management, thereby slimming down the expensive centralised bureaucracy, whose achievement record is suspect.

S – Are the arrangements Statutorily compliant? The Opposition believes that the present Government policies for NHS IT are flawed. Severe doubts exist over the arrangements for patient privacy and data protection, over responsibility for inaccurate patient data and the liability for errors arising from reliance upon it. Questions are asked about Monitor’s apparent failure to vigorously defend the freedom of foundation trusts from SHA ‘interference’ and its role in the present sorry national NHS IT state of affairs. Views have been expressed recommending that the Darzi ‘Five’ requirements for implementation by April 2010, but whose delivery has not been achieved by most Trusts, should now be put on a statutory duty basis. Yes, policy is unclear. The new Minister should abandon the national centralised patient data objective for NPfIT and would be well advised to adopt the principal Obama objective of “replacing all paper records by electronic ones for each practitioner” as a sufficient challenge for NHS IT during this decade, with its expectation of tight financial constraints and over-stretched NHS management and clinical staff.

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