Tony Collins's IT Projects Blog

Ashford and St Peter's Hospitals NHS Trust has commissioned a review of its IT strategy in view of what it calls the "virtual demise" of the NPfIT, the National Programme for IT in the NHS.

An executive paper to the Trust's Board in June 2010 shows how little impression the NPfIT has made in some parts of the NHS, despite a spend so far on the national programme of about £5bn.

Since its launch in 2002, the NPfIT has been spoken of with reverence by notables and ministers who include Lord Hunt, John Read, Patricia Hewitt, Caroline Flint, Ben Bradshaw, Andy Burnham, John Hutton, Tony Blair and Gordon Brown.

Too soon to say the NPfIT is dead?

In my view it's too soon to say the NPfIT is dead. The Coalition is unlikely to cancel the Summary Care Record even though there are signs it will be little used by hospital doctors. There is a strong PR campaign within Connecting for Health and the Department of Health to sell the SCR to the latest NPfIT minister Simon Burns. 

Internal PR campaign on Summary Care Record a success

This internal PR campaign has been successful so far, partly because an undisclosed sum - which is believed to run into hundreds of millions of pounds - has already been spent on the SCR; and BT, which runs the scheme, could claim a hefty sum in compensation should the SCR be cancelled.

But  some NPfIT Care Records Service implementations are in trouble

That said, the NPfIT's success could be said to pivot on the Care Record Service implementations by local service providers BT and CSC of Cerner Millennium and iSoft's Lorenzo. Some prominent NHS sites are struggling with Cerner in London and Lorenzo in the north, not least at NHS Bury which has been trying for about eight months to embed Lorenzo Regional Care Release 1.9. CSC has yet to be paid for the go-live of Lorenzo at University Hospitals of Morecambe Bay NHS Trust. 

Will Burns & Co decide eventually to put these sorts of implementations out of their misery?

The British Medical Association's Annual Representative Meeting, which starts today in Brighton, will hear a motion from the Northern Ireland Council which says:

"This Meeting believes that there has been little demonstrable benefit to the National Programme for IT for the NHS with an unacceptably high cost to benefit ratio and poor value and therefore, in the current time of financial constraint in the NHS, demands that the government cancel the National Programme for IT and divert the monies into frontline direct patient care."

It's also likely that the BMA ARM will hear a call for it to abandon its acceptance of the "opt-out" model for the summary care record scheme.

               "The National Programme for IT: it's time to acknowledge the elephant in the room"

Professor Trisha Greenhalgh OBE is Director of the Healthcare Innovation and Policy Unit at Barts and the London School of Medicine and Dentistry, Queen Mary University of London. She led the independent evaluation of the Summary Care Record Programme.  

By the end of the summer the Identity Documents Bill should become law. 

Yes, to judge from the views of senior officials at the Cabinet Office who oversee IT in government. 

 

These are my questions and the Cabinet Office's replies on Government plans to freeze projects over £1m and review major IT-related projects and programmes.

 

Me: I understand that an initial review of projects between £1m-£50m will be undertaken by departments, by the end of July. Given that some departments and agencies have been defensive and self-justifying in the past, can the Cabinet Office be certain that departments will be objective when reviewing their projects?

[For instance the Department of Health has said that the NPfIT is within budget, although the original contracts were announced as being worth £6.2bn and have since increased to a cost of about £7.3bn. The Department would say that the budgets have not increased; the contracts are delivering much more than originally intended. Some may see the increase, though, as scope creep.]

 

 

Government CIO John Suffolk and his colleagues are preparing plans for the publication of IT-related documents that have always been secret and  difficult to obtain even under the Freedom of Information Act.

The plans include the publication of:

- Gateway reviews

- Project reports of all types

- Risk registers

- Business cases

- Minutes of project meetings

- Health Check reports

 

The heads of Government IT, John Suffolk and Nigel Smith, are working with Government CIOs and senior responsible owners of major projects on "validation reviews" to assess whether savings on 80 large IT and non-IT projects, which cost £50m or more, can be made.

The reviews will also assess the impact of making the savings and how much the cuts will effect the overall feasibility of projects.  

The aim of the reviews is to lead to cuts that will contribute to the £6bn of savings promised by the new government in this financial year.

The results of the reviews will be reflected in tomorrow's Budget. 

Government CIOs have also been asked to give their initial views to the Treasury - in time for tomorrow's Budget -  on what cuts can feasibly be made. 

An evaluation of the summary care records scheme by researchers at University College London has concluded that:

"Benefits of centrally-stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale."

BMJ summary of UCL report: 

The Summary Care Record must be abandoned for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights, says Professor Ross Anderson of Cambridge University.

He also says today that the SCR "brings very few benefits and has the potential to do serious harm".


Ross Anderson, professor of security engineering at the University of Cambridge Computer Laboratory, argues that the national database of national electronic database of patient records is not fit for purpose and illegal.

In the British Medical Journal his arguments go head to head with those of Mark Walport, a director of Wellcome Trust, who believes that the SCR will make valuable contributions to better care.

Their arguments come as a final report of University College London's evaluation of the summary care record scheme is published. A summary of the report is on the BMJ's website. 
 
Anderson says that a digital medical record system that shared information when appropriate between care providers, and was dependable and safe, would be of "great value". He adds:

"However, the summary care record isn't it. It must be abandoned - for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights.

Alex Deane, Director of Big Brother Watch - a campaign fighting intrusions on privacy - says of tomorrow's report by University College London on the NPfIT NHS Connecting for Health Summary Care Record scheme:

"This report reveals that there are serious and potentially irrevocable tensions at the heart of the Summary Care Record.

"Many GP practices aren't equipped to handle the technology and medical staff are suspicious of the data found on the system.

"We were told that the SCR would make our lives easier; this report shows that this insecure, inaccurate database is fraught with problems that pose a real danger to patients."

Links:

The coalition has performed a disgraceful u-turn on summary care records - Big Brother Watch

Highlights of confidential UCL report on summary care record scheme - IT Projects Blog

The danger of wrong data on an NPfIT system: a man with cancer couldn't make an appointment because a local Choose and Book system showed he was dead.

When NPfIT minister Simon Burns declared in a letter to the BMA that the government was reviewing the summary care records scheme, his announcement came at a good time: GPs were voting at their annual conference on motions to scrap the scheme.

Burns' letter was read out at the Local Medical Committees' annual conference last week. His promise of an SCR review averted a row with local GPs and the BMA.

Now it turns out that the Government is reviewing hundreds of large public sector projects that have a substantial IT element, including the summary records and indeed the £13bn NPfIT.

So Burns was announcing to the BMA a project review that would have happened anyway, as part of Cabinet Office ICT policy.

Extended

A report by University College London on the summary care record scheme is expected to be published on Thursday.

Today this blog publishes highlights from a draft of the UCL SCR report.

It'll be interesting to compare the draft and final reports to see whether the Department of Health has softened any of the already-nuanced messages in the draft report.

In 2006 draft reports of the National Audit Office on the NPfIT went on a journey from criticism to praise. They went through a "clearance" process in which the Department of Health recommended many changes and PR-related additions before final publication.

iSoft, an important supplier to the NHS IT scheme, issued a market update today,  which appears to have been well received by the market as the company's share price rose by about 16% to 28.5 cents. The share price over the past week had sunk to a five-year low of 24.5 cents.

The update was generally reassuring, though it referred to cost cutting in the current financial year and also said that, in respect of its contract with local service provider CSC in the Northern Cluster of the NPfIT in England, it expected revenue in 2011 to be significantly less than in this financial year, "which is why we have been working to build the order book of the company outside the CSC relationship".

iSoft said it doesn't have issues with CSC under the Northern Cluster contract. CSC has about £3bn worth of contracts under the NPfIT. 

"Our relationship with CSC is strong and the joint achievement of the successful 'go live' of Lorenzo Regional Care 1.9 at The University Hospitals of Morecambe Bay under the Northern Cluster Contract is a significant achievement as it operates as a validation of the Lorenzo platform in an Acute Care environment.

"The Northern Cluster Contract remains on foot and we continue to work with CSC in the continued roll out of the Early Adopter program for hospital trusts in that region."