Tony Collins's IT Projects Blog

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A comment by market researcher Ovum on the background to Fujitsu's decision to withdraw from contract "re-set" negotiations on the NHS's National Programme for IT [NPfIT], is informed.

It's written by Tola Sargeant who leads Ovum's relationship with NHS Connecting for Health, providing market intelligence and supplier liaison services to the organisation.

The current thinking in Whitehall seems to be not to replace Fujitsu as the local service provider for the south of England on the NHS's National Programme for IT. 

It has been widely reported that the Care Records Service, a key component of the National Programme for IT [NPfIT], is four years late. If credence is given to a ministerial statement to MPs in November 2002, the plan for integrated care records is actually running six years late.

On 12 June 2002 the then Health Minister Lord Hunt announced the NHS IT programme with the mildly hectoring zeal of someone selling a high-priced vacuum cleaner to a sceptical householder.

[A summary of each other's writs follows.]

IT services and systems supplier Qinetiq is suing the National Policing Improvement Agency after the agency cancelled a national web-based system, the Police Portal, which was designed to help the public report incidents and hate crimes online.

The Police Portal was also designed to allow the public to contact the police during a terrorist incident such as the London bombings, and would have provided secure communications between police forces.

Qinetiq claimed that the NPIA, which oversees national police IT, caused delay and hindrance after September 2006, which prevented the project from progressing.

Using the portal a police force might have created a message advising "Protected Registrants" of an impending major incident and might then have created a separate message advising the public not to travel to an area.

Last Wednesday, 11 June 2008, several MPs on the Public Accounts Committee walked a short distance from their offices to Richmond House in Whitehall, the headquarters of the Department of Health.

One was the Conservative MP Edward Leigh, chairman of the committee. They were there to see a demonstration of the delayed "Lorenzo" Care Records Service software, a product that's vital to the success of the NHS's £12.7bn National Programme for IT [NPfIT].

Lorenzo is due to be being delivered by CSC and IBA Health, in part to provide an electronic health record to the 30 million people in CSC's constituency.

Officials at Department of Health and NHS Connecting for Health would have been delighted if the demonstration had been reassuring - proof that critics of the NHS's National Programme for IT were ignoring the good news, the parts of the NPfIT that are working.

One MP smiled inwardly when he saw that the Lorenzo demonstration was on a large screen built by Fujitsu whose contract as an NPfIT local service provider was terminated last month.

The head of the NHS told MPs yesterday [16 June 2008] that he has no regrets about rejecting calls by 23 leading academics for an independent review of the NHS's £12.7bn National IT scheme - even though the main software programme is four years behind schedule.

Comment:

When Labour commissioned a genuinely independent report on what was needed to put right a project to deliver software for a new air traffic control centre at Swanwick, it did so largely because of the tenacity of the House of Commons' Transport Committee and its remarkable chair Gwyneth Dunwoody. It's a pity there is no Gwyneth Dunwoody in the field of health.  

One MP on the Public Accounts Committee says that ministers oppose a genuinely independent review of the NHS's National Programme for IT [NPfIT] because they don't want solid facts to come into the public domain which would undermine their presentation of the programme as a qualified success. "It's really about presentation," said the MP, "You want to be able to say something's a success without fear of credible contradiction."   

So much for the government of Gordon Brown distancing itself from spin. More seriously, the victims of the NPfIT spin are patients. We've said for years that there's an urgent need for reliable electronic health records to replace paper that goes missing; and to their credit some  hospital IT departments are replacing paper, sometimes because of innovations outside the NPfIT. Unfortunately the NPfIT has turned out to be a rickety vehicle for delivering electronic health records. 

As long as ministers and officials continue to be obsessed with how the NPfIT is perceived they won't order an independent review. How is that going to save patients who do not receive the necessary treatment because it's not known what previous doctors said or did? 

Link:

NHS head is content about rejecting NPfIT review

On Monday 2 June 2008 an NHS trust IT manager was so irritated by a lack of access to the Personal Demographics Service - a part of the National Programme for IT [NPfIT]- that he sent an email to this IT Projects blog.

After suggestions in 2007 that Fujitsu might not remain as a local service provider on the National Programme for IT I formally asked the company: "Will Fujitsu be a local service provider to the NHS in six months time?" That was in September 2007.

The reply ... "Fujitsu confirms it's in NPfIT to stay." It added: "Our commitment to delivering better healthcare for all continues with the work we are undertaking with the Southern Programme for IT."

There's nothing like experience to cure optimism. 

Specialists preparing software for a roll-out to NHS hospitals this year under the £12.7bn NHS's National Programme for IT [NPfIT] have been trying to fix hundreds of issues in the initial release, according to a confidential report seen by Computer Weekly and The Guardian.

The specialists have also had to contend with hundreds of new issues as fixes arrived to close old problems.  They are working on the delayed "Lorenzo" system for hospitals which cover 30 million people in the Midlands and the north of England.

Peter Curry, Clinical Lead eHealth, NHS Fife, makes some pertinent comments in response to an article on this blog about the sharing of passwords on a hospital PACS x-ray system.

He says the clinical priority for medical staff to access clinical information to provide care needs to be recognised; that password-sharing for these systems is the norm in the NHS across the UK; that resolution of this issue is a key priority within a national strategy and that shooting doctors and nurses for sharing passwords will be "counter productive as systems will not get used". 

The blog article had said the sharing of passwords at a hospital in Devon had made it difficult to identify which doctor wrongly verified the treatment of a patient who died after a blunder.

The case shed light on the collision between a culture of password-sharing and the high security needed when NHS staff and doctors access large databases of confidential patient information under the £12.7bn National Programme for IT [NPfIT].

Password-sharing in the NHS is said to be endemic partly because space for computer screens in wards is limited, as is time for clinicians to log in and out.

Unite, the UK's largest union, has called the government to act quickly and decisively to safeguard the jobs and skills of hundreds of people working on the £12.7bn National Programme for IT [NPfIT] in the NHS for services company Fujitsu.

On Friday 20 June 2008 Fujitsu announced the potential redundancy of nearly 700 people working on the NHS contract. It follows the decisions of Fujitsu to withdraw from contract negotiations and termination of the £1.1bn contract to supply NHS trusts in the south of England announced two weeks ago.

There are nearly 1,000 people in Fujitsu working on the NPfIT.

But NHS Connecting for Health, which runs much of the NPfIT, has issued a statement which suggests today (23 June 2008) that the programme may absorb some of the jobs.  CfH says:

"... We are examining with Fujitsu their desire to deliver the Picture Archiving aspect of the Programme, which could further reduce the number of staff potentially affected.

"We have indicated to Fujitsu that where any service transfers to another supplier, we expect TUPE to apply and staff associated with that work would transfer to that other supplier.

"Furthermore we have already agreed to bring together Fujitsu and other suppliers working on delivery of the National Programme for IT to assist in reducing the impact of the termination on skilled IT staff."

But CfH has been more forthright in its criticism of Fujitsu than in the past. It said in its statement that "the Department terminated the NHS IT contract with Fujitsu, following failures to deliver the contracted services".

Comment:

At the HC2008 Healthcare Computing conference in April - I was glad I attended - staff from CSC were on the stand of "Alert", demonstrating a Portugese patient management and electronic patient record system. Alert is a potential competitor to the "Lorenzo" healthcare system which is due to be installed by CSC and NHS IT staff at trusts in the Midlands and north of England. 

This was no clear explanation for this at the time, but perhaps it has something to do with the issues highlighted in a confidential report on Lorenzo, details of which we published this week. More on this on Monday.   

Links:

Alert at HC2008  

Alert's website

Learning lessons from the NPfIT - report from HC2008

CSC, the main supplier of the National Programme for IT [NPfIT], has confirmed that it is considering offering alternative software to NHS trusts ahead of the clinical functionality being planned for its "Lorenzo" system.

The change of plan will surprise board directors at NHS trusts in the North, Midlands and East who have been waiting for several years for the Lorenzo Care Records Service system from CSC.

Since £6.2bn worth of contracts were signed with local service providers in late 2003 and January 2004, Lorenzo has been at the heart of plans by NHS Connecting for Health - which runs much of the NPfIT - to roll out an electronic health record for 30 million people in all areas of England except London and the south where the "Cerner" Millennium is due to be installed. Lorenzo was being developed by iSoft [now IBA Health] to be deployed by CSC to acute, mental and primary care trusts.

The overall senior responsible owner of the NHS's National Programme for IT [NPfIT] has said the Department of Health does not wish to be told of day-to-day breaches of security.
 
David Nicholson, Chief Executive of the NHS,  was being questioned by a Labour MP Don Touhig about the IT programme and the security of its databases of medical records.

At the same hearing of the Public Accounts Committee, Nicholson said that NPfIT's systems were "more secure than internet banking".

But Touhig, a former Labour Defence minister, said this assertion by Nicholson was "recklessly courageous".

Hansard - the official recorder of proceedings in Parliament - has slightly cleaned up a tense exchange between an MP and a senior civil servant over the National Programme for IT [NPfIT].

It's not a conspiracy - the likelihood is that Hansard staff wanted to keep the substance of the exchange while making the transcript easier to read; and indeed the original exchange was hard to follow - but it's more interesting than the published version. The MP worked harder to get to get the answer than is implied in the Hansard version.  

The exchange was between Conservative MP Richard Bacon, and Gordon Hextall of Connecting for Health which runs much of the NHS's National Programme for IT [NPfIT].

 1) Letter from Dave Hartnett, Acting Chairman of HM Revenue and Customs to Jane Kennedy, Financial Secretary to the Treasury. 

2) Chancellor's statement to the House of Commons

3) Summary of report of the Independent Police Complaints Commission

Comment - and does Poynter report say anything about HMRC's £8bn ASPIRE contract?

The Poynter report is the best thing that has happened to HMRC for decades. It highlights the institutional weaknesses the department has always denied existed. It should lead to changes in IT and culture that HMRC's board of directors could not have brought about otherwise. One hopes among other things that the board will be humbled by the Poynter report and not continue to be obsessed with its public image.  

Meanwhile the institutional weaknesses identified in the Poynter report raise worrying questions about how well the department is able to manage an £8bn "ASPIRE" outsourcing contract with Capgemini, which was worth about £3bn at its start date in 2004.  There have been many changes and additions, but it's uncertain whether the extras are, or will,  prove value for money.

The Poynter report - some highlights. [Comments are taken directly from the report apart from the sub-headings and my explanations in brackets. When "my" or "I" is used, this refers to Kieran Poynter, the chairman of PricewaterCoopers, who wrote the report.]

- New system presents the "most significant" new risk to Barts since the start of the 2008/9 financial year

The new Care Records Service at Barts and The London NHS Trust has led to patients with suspected cancer not receiving urgent appointments to see specialists, Computer Weekly has learned.

BBC online and the Evening Standard have followed up the postings this morning on Computer Weekly's website and on this blog.