£8.8m NHSIT threat "hypothetical" (but already served its use)

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The Department of Health and South Central Strategic Health Authority may have forced inadequate, incomplete and immoderately priced BT RiO software down the throats of health Trusts under the threat of a £8.8m fine. But it didn't actually impose any fines because every Trust earmarked for a BT care records system did what it was told.

So, say those involved, the question of whether or not there was a fine was hypothetical. So if you'll just move along now please because there's nothing of interest here.

They said this after Computer Weekly asked them about the Business Case that Oxfordshire and Buckinghamshire Mental Health Trust (OBMH) built in favour of doing what it was told. The case rested on the threat of a financial penalty: BT RiO would have come near the bottom of the list of available options were there cost of doing anything else not inflated by an £8.8m fine.

The DoH refused to answer questions about the fine because the it had never been collected. OBMH hid behind the SHA.

Bill McAvoy, chief information officer of South Central SHA, told Computer Weekly it was "a hypothetical question about past events" and therefore "a relatively moot point".

"No penalty was invoked because the Trust deployed RiO," he said.

The penalty was not hypothetical when OBMH came to decide whether it should use RiO not. Then it was a very real threat. But there were some things that were moot points.

The most important was how the money would have been extracted from OBMH had it decided to stick with the care records system it already had or chosen some other better or cheaper alternative to BT RiO. The next most crucial moot point was just how BT was going to get paid for software it hadn't delivered.

The first question was unsettled. So it might not have necessarily meant lopping £8.8m off health budgets by turning away cancer patients, closing wards or sacking nurses. Though we cannot discount the possibility that the money wasted on NHSIT hasn't already led to such events indirectly, nor indeed that it helped the ConDem government hasten plans to privatise the whole beloved shebang on the false premise that it's not affordable.

Just how the penalty would have been levied on Trusts that failed to implement RiO was never determined, said McAvoy. Had the situation arose, the DoH and SHA would have got together with the offending Trust and worked it out.

"Any cost recovered from a defaulting Trust would be recovered by the Department of Health," said McAvoy. They would have referred to whatever general guidance was then available on the DoH extracting penalties from Trusts.

The money would then not have been paid directly to BT, at least not in the sense of there being a brown envelope or an invoice item reading, "Penalty for not installing BT RiO: £8.8m".

The penalty would have been "offset" against the Department of Health's contract settlement with BT, said McAvoy, "rather than being passed through to the supplier on an individual basis."

In other words, he said, parties to these large contracts sit down periodically to settle their costs and fees to one another, effectively squaring them off. A supplier might have spilled coffee over the database server, for example, while the customer might have decided it didn't want the software after all because it was over-priced tat (speaking hypothetically, of course).

At the end of the day, no money would have been passed back to BT, but it would still have collected the penalty payment. It would still have been paid for nothing, but would have been saved the embarrassment of bereaved relatives waving placards as BT money men drove off from the DoH headquarters at 79 Whitehall with their suitcase full of readies.

No doubt the DoH would have been saved the same embarrassment over collection of the penalty from offending Trusts in the first place. It wouldn't have actually sent the bailiffs round to take incubators and anesthetic equipment from delivery wards. It would have just squared it off in a quiet room somewhere. As long as BT got its £454m. That's all that mattered really.

And now all Mental Health Trusts in the south of England have done what they were told and installed RiO, the Department of Health has told them they don't have to use RiO if they don't want to. It's the DoH's new strategy of local autonomy. Looks like that's hypothetical too.

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