Tony Collins's IT Projects Blog

Richard Jeavons, senior responsible owner for service implementation in the NHS’s £12.4bn National Programme for IT [NPfIT], is leaving for a different health service job.

He is the latest in a succession of senior responsible owners to leave the NPfIT. Others who have left include Richard Granger, formerly Director General of NHS IT and senior responsible owner, John Bacon, the Department of Health's Director of Delivery and overall senior responsible owner for the NPfIT, Professor Aidan Halligan and Sir John Pattison who was the original SRO and who retired.

At NHS Connecting for Health, which runs part of the NPfIT, Jeavons has been responsible for delivering the benefits of the national programme.

Congratulations to the Cabinet office and the Government CIO John Suffolk for establishing a commodity price for a large network of supported PCs.

It has not been easy to achieve. Suffolk has had to ask the same questions of suppliers time and again, to nail down the specific costs of supplying and supporting networked PCs in a standard configuration – allowing for flexibility over security and location – and including support for open office software.

The final price is about £800 to £1000 per PC depending on how many machines are bought. It’s a price that’s available to the public sector through the Cabinet Office’s thin-client “Flex” deal with Fujitsu.

After our inquiries on the forthcoming departure from the National Programme for IT (NPfIT) of one of its leaders and a senior responsible owner, Richard Jeavons, NHS Chief Executive David Nicholson has issued a statement.

Healthcare consultancy Silicon Bridge has published a well-rounded article on the National Programme for IT - NPfIT - and its legacy.

Some of the comments:

Conservative leader David Cameron has outlined his party’s IT strategy for government saying there would be a “level playing field for open source software in IT procurement” and no room for projects like the hubristic NHS supercomputer”.

Some hospital executives in the South of England have put on hold plans and deployments of replacements for legacy systems during extended negotiations of a contractual “re-set” with the main IT supplier Fujitsu.

The re-negotiations of the contract have involved the Secretary of State for Health Alan Johnson and Fujitsu’s parent organisation in Japan.

The NHS and Fujitsu are expected to sign a new memorandum of understanding as they continue to renegotiate important parts of a £896m contract signed under the NHS's National Programme for IT, NPfIT, in January 2004.

As they try to sort out the problems at Heathrow's Terminal Five building, BAA and BA may wish to note that United Air Lines spent more than 10 years trying to make a futuristic computerized luggage-handling system work at Denver airport. Eventually United abandoned the system.

A United spokesman was quoted as saying in 2005:

“It’s never worked up to its potential. “We’ve spent enormous amounts of money over the last decade” to try to make the system work, but only parts of it did. PCs were linked to 4,000 remote-controlled carts which carried baggage from check-in counters to sorting areas and then straight to flights. There were 5.5 miles of conveyors and 17 miles of track. Luggage was supposed to be carried at speeds of up to 24mph – so fast some of it was thrown off the carts.

Ben Bradshaw, the minister in charge of the NHS’s National Programme for IT [NPfIT], has responded to a post on this blog about his having made an incorrect statement to the House of Commons.

On 21 February 2008, in a Commons debate on the Health Committee’s report on electronic health records, Bradshaw cleared suppliers to the NPfIT of any responsibility for delays. He told the Commons that the delays have not been because of problems with supply, delivery or systems.

Barts and the London NHS trust ended up in "The Sun" newspaper yesterday [9 April 2008] after going live with a basic version of Cerner's "Millennium" Care Records Service under the NHS's London Programme for IT.

The newspaper claimed that "two top hospitals descended into chaos last night as a multimillion pound computer scheme crashed on launch day" . It said the system should hold all patient records and bookings of operations, but it "failed, forcing doctors at the Royal London and Barts hospitals in East London to write notes on slips of paper."

Responding to story, Barts and The London NHS Trust issued a statement which denied the system had crashed but made no comment on The Sun's claim that doctors had resorted to writing notes on slips of paper.

The trust's statement gave the impression of minor problems only, saying the "majority" of issues had been resolved within 24 hours. It apologised to patients for a "slight delay" while staff familiarised themselves with the systems.

Matthew Swindells, who has been leading a review of NHS informatics including the £12.4bn National Programme for IT[NPfIT], has resigned and is to leave the Department of Health “shortly”. He has played a key role in leading NHS IT since the departure of Richard Granger in January 2008.

News of his departure comes only weeks after Computer Weekly revealed that Richard Jeavons is leaving the NPfIT as its much-respected senior responsible owner for service implementation.

Their resignations are a blow to the credibility of the NPfIT which is now left without strong independent voices. Some will see the departures as indicating that the programme is now in trouble.

An informed specialist reports on the go-live earlier this month of a Cerner system deployed by BT at Barts and The London NHS Trust. Managers at Barts have seen the article and given their response at the end.

"Staff working at Barts & The London described the go-live as a “roller coaster ride”. The hospitals benefitted from a very high level IM&T team experience being available. Kevin Jarrold is said to have personally injected his expertise – He is now head of the London Programme for IT and was Head of IT at University College Hospital when it implemented IDX Carecast, the original American CfH choice of acute hospital system.

“Kevin Jarrold was supported during the last few months by the highly regarded Phil Jones, now Director of ICT at Barts & The London and previously in a similar post at St Mary’s Paddington.

"Patrick Brady, who successfully installed Cerner at Homerton and Newham, was Programme Manager bringing with him his unprecedented level of expertise in Cerner implementation in the UK. Nevertheless, all was not successful as The Sun points out.

"The question posed by one of the Barts & The London staff was ‘what do other trusts with less experience and expertise have to do additionally to enjoy a trouble free implementation?’

Comment

Robert Mugabe blames Zimbabwe's problems on the white man. Much less significant, but no less ridiculous, are the comments of Whitehall officials who ascribe to the media all the ills of the NHS’s National Programme for IT.

There are some excellent comments on NPfIT spin on E-Health Insider’s website. Here’s one comment:

“NPfIT has for too long focused on busting myths when many of the so-called the myths are real perceptions based on real user experience... Rather than ridicule the myths and roll out the same tired pointless statistics get out on the front line and deliver systems …”

Iain Marsland former chief information officer for Essex Strategic Health Authority, has written an article for Microsoft on the Care Records Service, a key part of the NHS National Programme for IT [NPfIT]. He referred to the importance of giving clinicians the opportunity to decide how new system works best for them and their patients.

He said the NPfIT Care Records Service has been designed as a "standard build with minimal local tailoring across both clinical specialities and entire hospitals". He added: "The enforced standardisation has not been well received by clinicians, whose practice is essentially judgement-based and continuously evolving.

"The idea of an EPR [electronic patient record] is widely perceived as a positive step change in developing clinical practice and patient care. But the benefits may not be fully realised unless clinicians themselves are allowed to decide how the system works best for them and their patients. No matter which deployment model they used, the early EPR sites all understood this basic fact."

A week ago we reported that Matthew Swindells, who has been leading a review of NHS informatics, including the £12.4bn National Programme for IT (NPfIT), has resigned.

Since then there have been suggestions that Swindells has finished his work on the report but that it is undergoing editing which is contributing to a delay in its publication.

In 2006 we received, under the Freedom of Information Act, various draft versions of the National Audit Office on the NPfIT. Sections of the draft versions which had negative connotations were deleted or the wording changed. This happened during the report's "clearance" process with the Department of Health, which took about six months.

In the light of this we asked the Department of Health about whether Matthew Swindells has written his report following his review of NHS Informatics. We also asked if the report was being watered down. The reply was in the passive: that the report was still being written.

The spokeswoman said only: "The report is still in the process of being written and will be published in due course".

When we asked whether Swindells was doing the writing or whether his report was being edited by others, the spokeswoman declined to comment. She made it clear that the wording of the reply was not to be elaborated on.

Swindells is still due to be the keynote speaker at Healthcare Computing conference, HC2008, at Harrogate next week. It will be interesting to hear whether his report is undergoing a cleansing of any negatives.

Problems with the Choose and Book system – part of the NHS’s National Programme for IT – have led to more than 300 patients receiving wrong appointments since Friday 11 April 2008.

In many cases appointments went to the wrong people. This meant that patients turned up for appointments at hospitals and clinics and found that they’d wasted their time because they were not expected, or patients were not advised of the correct appointments. The problems were spotted on Friday 11 April 2008.

One danger of database searches making it easy for unscrupulous insiders to obtain data on vulnerable people

The Local Government Chronicle and The Sun have reported that a rapist posed as a care worker to access council data on vulnerable teenagers.

Simeon Kellman, aged 42, used a system at Greenwich Borough Council in South East London, to identify teenagers who had recently come out of foster care.

The police, as quoted in The Sun, said that Kellman had made a “substantial” number of computer searches on profiles of former foster children. “The lack of security at the council was breathtaking,” said the paper quoting a “police source”. It added: “Kellman was able to log on and cherry-pick kids coming out the care system.”

Some staff at the Barts and The London were without their new systems, delivered under the NHS’s National Programme for IT, for half an hour on Tuesday during the busy morning period when many patients come into hospital.

A spokeswoman for Barts and The London NHS Trust said on Tuesday (15 April 2008) that they “experienced some technical issues” with the Care Records Service but “these were resolved within 30 minutes of the issues being reported”. The spokeswoman added that the technical issues “did not affect all users of the system which continued to be used by Trust staff during this [30-minute] period”.

A judge has criticised as “wrong” a government statement made to Parliament on its decision not to publish two gateway reviews – independent assessments – of the ID Cards scheme.

An anonymous e-mail to this blog suggests that negotiations on the contract reset between Fujitsu and the NHS in the south of England have not yet worked out, though the two sides have been trying hard to reach a deal.

There's no clarity on whether the two sides are still negotiating or that talks have stopped while each waits for the other to make concessions. Ministers are said to be reluctant to provide large sums in extra money for the contract.

Comment: Whitehall health officials should read the report of the Auditor-General in Victoria, Australia, on the state's "Healthsmart" project. The delays and problems are similar to those on the NHS's National Programme for IT. For example officials have spent less on the Australian programme than predicted because of delays in the delivery of core systems. Yet Healthsmart is far less ambitious, less complex. And it costs only about £150m. Which raises the question: Is the £12.4bn NPfIT too ambitious? The HC2008 Healthcare Computing conference at Harrogate learned this week that the NPfIT is set to become even more complex.

Australian IT, part of The Australian news group, has today [22 April 2008] reported on problems with a $320m [£152m] Healthsmart project, based in part on Cerner clinical systems.

The Healthsmart project was launched in Victoria, which is in the south-eastern corner of Australia and is the most densely populated and urbanised state. Healthsmart is described by the state as a “whole-of-health ICT strategy”.

Australian IT said:

“Victoria's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

“Auditor-General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

Acting NHS CIO Matthew Swindells, who is writing a review of NHS informatics, revealed to the HC2008 conference in Harrogate that, as IT buyer for South East Thames Regional Health Authority in 1989, he bought a KPMG “casemix” system for Eastbourne Hospital.

"This year," said Swindells, "iSoft promised to deliver the finished product."

Most people in the audience smiled or laughed. But in the context of the NHS's National Programme for IT [NPfIT] is 19 years such a long time to wait for the complete product?

**

One of the most “exciting” technological innovations since the launch of the NPfIT was discussed at a session on patient safety on the opening day of the HC2008 conference. It’s the infection-resistant keyboard that encourages users to wash their hands.

Thousands are to be released to the NHS, with the backing of NHS Connecting for Health. The keyboard has a flashing light which prompts those using it to clean its surfaces frequently, including underneath, and so serendipitously encourages people to wash their hands more often.

Countries around the world are watching progress on the NHS's National Programme for IT. If other products to improve patient safety continue to be delayed under the NPfIT, the washable keyboard could be seen abroad as the saving grace of the £12bn scheme.

**