Tony Collins's IT Projects Blog

Comment

Kevin Barron, the chairman of the House of Commons' Health Committee, gave a sympathetic hearing last week to Richard Granger, head of the NHS's £12.4bn National Programme for IT [NPfIT].

Barron's fireside friendliness towards Granger was a contrast to a hearing on 26 June 2006 when the House of Commons' Public Accounts Committee investigated the NPfIT.

Loyalist Labour MP Kevin Barron, who is chairing an inquiry of the House of Commons' Health Committee into aspects of the NHS's National Programme for IT [NPfIT], has warned that too much questioning may harm scientific Progress.

Barron set out his views at the first of a series of hearings of the Health Committee into aspects of the NPfIT. MPs including Barron asked some witnesses whether they were in favour of an independent review of the NPfIT.

Barron's own comments suggested he was not in favour of too much questioning of the NPfIT.

He said: "If you go back in years in medical history, into some of the things that doctors were doing at the time, which made major breakthroughs, people were sceptical about [these]. People were questioning even what their peer groups were doing in terms of whether it was the right thing to do."

The NHS Confederation, which represents more than 90% of statutory health service organisations, has expressed concerns to the House of Commons' Health Committee about aspects of the National Programme for IT [NPfIT] in the NHS.

In a paper to the committee, which is investigating aspects of the NPfIT, the NHS Confederation said that organisations continue to be "fully committed to the overall vision" of a Care Records Service" which aims to give 50 million people in England an electronic health record.

But it said that "delays in the delivery of key operational systems which feed the NHS Care Records Service, such as patient administration systems, are "causing real problems and costs within the service".

One highpoint of the first hearing of the Health Committee's inquiry into the National Programme for IT [NPfIT] on 26 April 2007 was an exchange between Martyn Thomas, who has called for an independent review of the scheme, and the committee chairman, Labour MP Kevin Barron.

Thomas made a good case for a review of the NPfIT and Barron appeared to remain sceptical throughout. Barron had not particularly welcomed his committee's deciding to hold an inquiry into the NPfIT.

Richard Granger, head of the NHS's National Programme for IT [NPfIT], when asked whether he supported the call for an independent review of the scheme, had made it clear that his door was open to critics whose comments were based on robust evidence.

But Martyn Thomas, visiting professor of software engineering at Oxford University's computing laboratory, emphasised the need for a review that was independent of the programme team

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing, Independent MP, Dr Richard Taylor, summed up the spoken evidence of the first group of witnesses, Richard Granger, Harry Cayton and Dr Gillian Braunold, as "bland platitudes".

These three witnesses had left the committee room after giving their evidence, without waiting to hear what the second group of witnesses - Martyn Thomas, Dr Paul Cundy and Andrew Hawker - had to say.

Speaking to Thomas, Cundy and Hawker, Dr Taylor, MP, said: "I am echoing David [David Amess, Tory MP on the committee]. It is so good to have you three after the bland platitudes we had from the first lot - absolutely refreshing. We were told user involvement was there from the beginning, and you said obviously it was not..."

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of the things that concerns me about the programme is that there is no definition of what is an acceptable level of security breach.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy was asked by David Amess MP: "Dr Cundy, is it a good thing that general practitioners will be offered a choice of suppliers for their electronic record system and does the decision to offer choice represent a change of direction by Connecting for Health and will it mean a less centralising approach to these issues?

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy said: "I know from my system in my practice is that there are times when I, quite frankly, do not have an immediate clue as to what is going on with a patient, and we have 20 years' worth of patient electronic records.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Richard Granger said: "...I would say with the time overruns that one of the problems with this programme is there was no financial contingency.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of my concerns about the way the programme is going is that it is in danger of locking itself out of the advances that will be made in the availability of healthcare systems around the world.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said:

"It seems to me that there are two issues that are being run together here. The overall objectives of the system seem to be trying to tackle two problems in parallel and those two issues are perhaps in conflict.

"On the one hand, there is the question of putting in good IT to support the clinicians supporting the patients, and I think everybody in the NHS is entirely behind that. Where IT can improve healthcare, it is sensible to deploy it once you are in a position to be able to be able to roll it out without disturbing things too much.

There is also the issue of transforming the way that the Health Service operates and the way that the Health Service is managed and the need for information to be available in order to be able to change the management structures.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the first Health Committee hearing MP Jim Dowd asked Richard Granger: "When you say it [the NPfIT] has got more functionality than originally envisaged, is that because the original estimates were just wrong?"

Richard Granger replied: "I do not know of a large-scale IT enabled transformation programme in a complex organisation that from its starting point to its mid point has a direct correlation.

"I think it would be a fantasy to imagine. I know people write fantasies, but in the real world it would be ridiculous to imagine that halfway through a ten-year programme you would only be doing the same things as you set out five years ago.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing the chairman Kevin Barron asked Martyn Thomas why he was calling for an independent review of the NPfIT. Barron's view appeared to be that the facts independent reviewers would discover would already be known to the project team. So why have an independent review? In reply Thomas gave a sound summary of the benefits of an independent review over one commissioned internally.

Barron asked: "Do you think that people who are involved in the National IT Programme at the moment are aware and conscious of those facts, whether reviews have been published or not in terms of that? Do you think they are not capable of knowing that as something in their daily business, as it were? The programme is not without its problems. Are these people who are developing it not capable of being able to do that?"

Thomas replied: "I have reviewed a lot of large technical programmes over the years, and I want to stress, I am not asking to review this one personally, I am not for a second bidding for that job, but my experience of carrying out those reviews is that people get blinded by the fact that they are too close to the project and they get compromised by the fact that they cannot stand back and admit errors.

Statement from Connecting for Health, which runs the NHS's National Programme for IT, on Computer Weekly's article on duplicate patient records in Greater Manchester.

Download file

Connecting for Health, which runs the NHS's £12.4bn National Programme for IT, has responded to some our questions. These are its replies.

A team of people is working to stop medical information going missing after a software upgrade under the NHS's IT Programme led to hundreds of unwanted, incorrect and duplicate patient records being created every day.

The problem involves NHS sites in Greater Manchester and raises questions about how well some systems are being tested before going live as part the £12.4bn National Programme for IT [NPfIT].

Internal documents show that the duplicate patient records are incorrect. They have been created on the assumption that patients do not already have a record - even if they do. If these duplicates are left in place it could lead to clinicians seeing patients without access to important medical history.

To stop this happening, patent records have to merged with the duplicates quickly. If a backlog of unmerged records builds, hospital record libraries could send to clinics, days in advance of an appointment, the wrong patient file based on the duplicate record - which could be that of an entirely new patient.

Hundreds of unnecessary and incorrect patient records have been created daily as hospital appointments were booked on the National Programme for IT's Choose and Book system when linked to iSoft's iPM system.

It has come to light after an Maintenance Release 1 upgrade of iPM system over the weekend of 21/22 April 2007.

The problem means that when appointments are made on some Choose and Book systems in Greater Manchester where the MR1 upgrade has been installed, and the system cannot find the patient's correct identification number on the Personal Demographic Service of the National Programme for IT [NPfIT], it will create a duplicate record.

Connecting for Health, which runs the NPfIT, says that up to 400 duplicate records are being created every day. It denies there is any effect on the care and treatment of patients.

Internal documents show, however, that the problem is being categorised as a potential risk to safety. To avoid accurate patient data being lost in the mingling of correct and incorrect records, a team has been formed to merge the records carefully and safely.

Comment

When Computer Weekly began researching the cause of duplicate patient records at Manchester we contacted one of the trusts involved, the University Hospital of South Manchester NHS Foundation Trust.

The immediate reaction of a spokeswoman for the trust was to say that she had received a note about the incident a few days earlier from Connecting for Health, which runs the National Programme for IT [NPfIT].

"I am looking at it now," she said. "It is saying: 'if trusts have any press inquiries regarding the GM [Greater Manchester] Incident they should contact the Connecting for Health press office."

The note was dated 27 April 2007, several days before Computer Weekly contacted the trust. It seemed, therefore, that neither Connecting for Health nor the trust had issued any statement on the problem of duplicate records in Greater Manchester. They were prepared, however, to make a statement if a journalist rang. This may appear at first to be effective crisis management but it's not a good way to disseminate lessons.

The following are separate events reported as "Major Incidents" to NHS Connecting for the Health, which runs the NHS's National Programme for IT [NPfIT]. The particular incidents mentioned below were categorised as "Severity One".

After attacking the media for inaccurate reporting of aspects of the National Programme for IT [NPfIT], NHS Connecting for Health, which runs the programme, has accused some NHS trusts of "inaccurate reporting" of incidents that involve NPfIT systems.

An academic study of staff views of the progress of the National Programme for IT [NPfIT] locally has found that financial deficits and poor communication have hampered its implementation.

And the study found that continuing delays could constitute a growing risk to patient safety. The research was published online on 17 May in the British Medical Journal.

It's not good news for the NHS's National Programme for IT [NPfIT] that Richard Granger, Director General of NHS IT and head of the technology part of the scheme, is to leave.

Lord Hunt, the health minister most closely associated with the launch of the NHS's National Programme for IT, has left the Department of Health in Gordon Brown's shuffling of ministerial posts.

Less than four months ago, in March 2007, Lord Hunt told the HC2007 healthcare conference at Harrogate that he was pleased to be back as health minister.

Caroline Flint, a Health minister and government spokeswoman on the NHS’s National Programme for IT, has been moved out of the Department of Health as part of Gordon Brown’s ministerial changes.

A medical organisation cited by the Department of Health as a reference site for the NHS Care Records Service has been criticised by a US regulator after 1.3 million sensitive files went missing.

Analysis

NHS Connecting for Health has published on its website one slide from a “confidential” briefing presentation to the former Prime Minister Tony Blair on the NHS’s £12.4bn National Programme for IT [NPfIT], following inquiries by Computer Weekly.

Other slides in the presentation to Blair, which Connecting for Health hasn't published, give an insight into how officials wish to counter criticism of the programme.

In an interview before he announced he was leaving his job as Director General of NHS IT, Richard Granger is reported to have criticised some early installations of software from Cerner, a US-based health software supplier.

In CIO Magazine Richard Granger referred to Cerner whose "Millennium" software is scheduled to be deployed by NHS trusts across Southern England and in London as part of the £12.4bn National Programme for IT [NPfIT].

Fujitsu, the local service provider to the NHS in Southern England, has chosen Cerner as its main software subcontractor.

Richard Granger was quoted as saying:

“Sometimes we put stuff in that I’m just ashamed of. Some of the stuff that Cerner has put in recently is appalling. It really isn’t usable because they have been building a system with Fujitsu without listening to what the end users want. They have taken some account but they then had to take a lot more. Now they’re being held to account because that’s my job.”

We asked for a comment from NHS Connecting for Health, whose chief executive is Richard Granger. We put it to CfH that a number of hospital trusts were preparing to implement to Cerner's systems and were already, before Richard Granger's reported comments, concerned about the risks of failure and the uncertainties over how well Cerner's Millenium product could be adapted for widespread use in the UK. We asked whether such concerns may be deepened by the reported comments about Cerner.

An official at NHS Connecting for Health did not play down Richard Granger's remarks.

David Nicholson, Chief Executive of the NHS, has appointed three top-level executives who could provide some of the skills of the outgoing Director General of NHS IT Richard Granger.

The appointments, to strengthen leadership at the Department of Health, could indicate that top management of the £12.4bn National Programme for IT [NPfIT] in the NHS is to become more diffuse.

The most notable appointment is that of Mark Britnell, one of the NHS's most experienced NPfIT executives, who has been appointed Director General for Commissioning and System Management.

Last year Mark Britnell was Chief Executive of University Hospital Birmingham which installed a "Reference Solution Patient Administration System" from CSC, the main NPfIT local service provider with contracts worth about £3bn.

The President of CSC Europe, Guy Hains, met Britnell last year at the hospital.

CSC said in a promotional brochure that Britnell's hospital was "at the forefront of the current transformation in the NHS".

Mark Britnell was later appointed as Chief Executive of the South Central Strategic Health Authority and was lead Senior Responsible Owner of the NPfIT for the South of England.

He has worked closely with David Nicholson on plans to try and revive support for the NPfIT among the boards of directors of local trusts and strategic health authorities. Britnell was national Senior Responsible Owner of the NPfIT Local Ownership Programme [NLOP].

NHS Connecting for Health, which is largely responsible for the NHS's £12.4bn National Programme for IT [NPfIT], is facing new financial pressures.

In the foreword to his first annual report of the NHS’s National Programme for IT [NPfIT], Richard Granger gave an account of the scheme's progress and some of its challenges.

At that time, in 2005, Granger expected that the organisation he managed, NHS Connecting for Health, would publish another annual report a year later.

This was the prediction he made in NHS Connecting for Health's 2004/5 annual report: “I am confident that our Annual Report for 2005-2006 will contain details of our success in delivering systems which will help tens of thousands of NHS personnel to better serve millions of patients using tools which have been delivered by NHS Connecting for Health”.

But there would be no more annual reports on the NPfIT. And thus no further annual account on the progress NHS Connecting for Health.

The future of the National Programme for IT [NPfIT] is looking indistinct.

Computer Weekly is today [14 August 2007] publishing a series of articles that, when considered together, suggest that the government wants the NPfIT to blend into NHS IT in general. The NPfIT would, therefore, have less of a clearly discernible – and controversial – character.

There are some of the recent developments:

- There are signs the programme is in flight from ruthless standardisation

- Whitehall has dropped plans to give NHS Connecting for Health, the organisation set up to run the programme, the status and independence of an executive agency

- Officials are struggling to find money for plans to localise the scheme

- A more diffuse leadership at the Department of Health is poised to subsume some of the skills of Richard Granger, the departing Director General of NHS IT.

We congratulate Barnet and Chase Farm Hospitals NHS Trust on becoming the first London hospital to go live with the Cerner Millennium patient administration system as part of the National Programme for IT [NPfIT]

Although it’s the basic, non-integrated R0 release of the system, it combines the data from two separate patient administration systems, the McKesson TotalCare system and IRC PAS - no small feat. Another major challenge has been training staff to work in a different way.

Corporate America hates the word “but” whether spoken or written. But sometimes it’s unavoidable.

Progress is a beguiling thing. Pushing a broken car up a hill is a form of progress. Before the advent of the NPfIT in 2002, there were regular announcements of advances in regionally-based electronic patient record systems. Now we’re delighted when a single patient administration system – unlinked to others – goes into a hospital without too much disruption.

Links:

Head of IT at Barnet and Chase Farm NHS trust quits

Barnet and Chase Farm Hospitals NHS Trust announces go-live of new Cerner system

Barnet and Chase Farm switch on Cerner

October 2001 - MInisterial statement on progress with electronic patient record systems

A separate posting on this blog refers to a decision of the Information Commissioner to order the release of "sensitive" papers from a meeting at Downing Street in 2002 at which the NHS's National Programme for IT was given tentative approval.

The meeting was chaired by the then Prime Minister Tony Blair and attended by several ministers, civil servants and business consultants. Computer Weekly requested the Downing Street papers in January 2005 under the Freedom of Information Act.

The Cabinet Offfice, on behalf of Downing Street, rejected our request. We appealed to the Information Commissioner who has now ruled that the papers should be published.

Today, 21 August 2007, we asked the Cabinet Office if it would appeal to the Information Tribunal against the decision of the Information Commissioner. It has until 10 September 2007 to submit a formal notice of an appeal.

Its spokesman said only: "We are still studying the decision." He would not say whether the Cabinet Office will appeal. We would be surprised if it didn't.

So what are Whitehall, Downing Street and the Cabinet Office hiding?

We know from Sir John Pattison, a participant at the seminar at Downing Street in February 2002, that ministers were told that a national programme would take less than three years, from April 2003 to 2006. It is now a programme lasting more than 10 years.

We also know that the Department of Health in early 2002 filled out a Project Profile Model - a form in which departments and agencies self-assess the scale, complexity and risks of IT- based programmes and projects. On the form, the Department of Health put the whole-life project costs of an NHS IT-based modernisation at an estimated £5bn. It is now estimated to cost £12.4bn.

The Department of Health did not publish the Project Profile Model for the NHS's National Programme for IT [NPfIT] and indeed did not give a copy to the National Audit Office which spent nearly two years investigating the programme. I'll publish separately on this blog the Project Profile Model for the national programme.

Jeff Jacklin, Head of ICT at Milton Keynes General Hospital until April 2006, has given a candid account of the NHS’s National Programme for IT [NPfIT] from the viewpoint of a user.

His article in E-Health Insider is revealing even for someone who has observed the NPfIT since it was announced in 2002. Jeff Jacklin has 35 years experience in the IT industry, the last 20 at director level within the NHS.

This is a summary of some of the points he makes:

The government under the new Prime Minister Gordon Brown is continuing to portray the NHS’s National Programme for IT [NPfIT] as a success and is rejecting calls for any type of independent review of the programme.

Robin Guenier, chairman of the medical online research company, Medix UK plc, and chair of the medicine and health panel of the Information Technologists’ Company, had written an open letter to Gordon Brown, which made recommendations to improve the NPfIT.

Below is an open letter sent by Dr Hamish Meldrum to Ben Bradshaw, Minister of State for Health Services, on the National Programme for IT.

Among other things it says there should be "no further roll out of the Summary Care Record (SCR), beyond the six early adopter Primary Care Trusts", until an independent review has been completed.

The summary care record is part of a plan, under the NHS's National Programme for IT [NPfIT], for a national database of electronic health records, called the NHS Care Records Service. The summary record would initially contain basic information such as the patient's date of birth, address, details of allergies, current prescriptions and adverse reactions to medicines.

Hamish Meldrum is a GP Principal in General Practice and chairman of the General Practitioners Committee of the British Medical Association.

This is the letter, dated August 2007:

"The National Programme for IT (NPfIT) is an important but contentious aspect of health policy. I would like to take this opportunity to express the BMA’s hopes, to raise our concerns and to suggest recommendations as to what the programme should deliver to support patient care. I hope this will help inform debate at this crucial time for re-defining the future of the programme.

"The BMA wants to see the programme succeed. We recognise that there have been some successes. We believe that with a change in leadership it is an appropriate time to review progress and set out a clear strategy for the future of the programme.

"At the BMA’s recent Annual Representatives Meeting, doctors from both primary and secondary care expressed their frustration about the programme. Doctors called for a public inquiry to review the problems encountered by Connecting for Health (NHS CfH), the cost to the tax payer and whether this has been a cost effective use of public funds.

"The BMA believes there are some essential steps that must be taken to sustain successful delivery.

It’s unclear why there is so much secrecy over Microsoft’s dealings with the NHS which are, after all, in the interests of taxpayers.

Officials at the Department of Health say that the NHS receives exceptionally low prices for Microsoft licences. But the details are subject to confidentiality clauses.

They have declined to give the House of Commons’ Public Accounts Committee any information on the:

- committed volume of business which the NHS has agreed with Microsoft
- the total cost of the commitment
- the maximum potential financial penalty for non-compliance.

And in October 2007 there will be a unique event at Microsoft’s headquarters at which the supplier’s worldwide CEO Steve Ballmer will have an opportunity to address the chief executives of primary care trusts across England on the £12.4bn National Programme for IT [NPfIT]. The Chief Executive of the NHS David Nicholson will also be present.

Gordon Brown, his ministers, the Department of Health and NHS Connecting for Health, which runs part of the NPfIT, are confident that the programme is already a success.

Officials, then, should have nothing to fear if any trust chief executives at the October event express misgivings about the NPfIT or facets of it. If the NPfIT is a success, officials will be able, with authority, to counter any concerns and criticisms.

So why has the Department of Health NHS Connecting for Health barred the media from attending this unique event?

The Department of Health is asking the heads of all primary care trusts across England to attend a private event at which the worldwide Chief Executive of Microsoft Steve Ballmer will address them on the NHS’s National Programme for IT [NPfIT].

The unique event – from which the media are barred – is in October 2007 at Microsoft’s headquarters at Cardinal Place in London. A spokeswoman for Microsoft declined to confirm that Ballmer will be speaking at the event. She said only that he is expected to be in England at around this time.

However a list of keynote speakers for the event puts the Chief Executive Officer of Microsoft at the top: and it gives a short biography of Steve Ballmer.

The event comes six years after the co-founder of Microsoft Bill Gates met the then Prime Minister Tony Blair at Downing Street where an IT-based modernisation of the NHS was discussed.

For those who'd rather not read the 250 pages of the latest Wanless report the following paragraphs are excerpts that relate directly or indirectly to the NHS's National Programme for IT [NPfIT] They are in the order they appear in the report. There is some repetition in the paragraphs.

Jean Roberts,who leads the British Computer Society Health Informatics (HI) Forum Policy Group and sits on the general BCS Council, has given a personal reaction to the findings of the latest Wanless report.

Derek Wanless, a founding father of the NHS's National Programme for IT, questioned in a report published this month [September 2007] whether the NPfIT should continue without an independent audit.

Mary Hawking writes:

The only thing surprising about this incident is that anyone should be surprised! Ross Anderson [of the Cambridge University Computer laboratory] pointed out the risks in 1995...

The amiable and knowledgeable Remon Gazal, IM&T director at Barnet and Chase Farm Hospitals NHS Trust, spent his last day at the trust yesterday (20 September 2007). He said he was leaving to get married in Australia. He has not yet decided on his next job.

Computer Weekly interviewed him on his last day at the trust about the lessons learned from implementing in July 2007 the basic "Cerner R0" Millennium system from BT as part of the NHS's £12.4bn National Programme for IT [NPfIT].

The go-live, which was strongly supported by the NPfIT and BT, brought some important benefits to the trust, such as real-time management of bed occupancy and also brought disruption for some patients. Workarounds have been developed for defects that continue to have an operational impact.

Barnet and Chase became the first trust in London to use the Cerner R0 patient administration system as part of the NPfIT.

My interview with Remon Gazal will be published as a separate blog entry.

Link:

Congratulations to Barnet and Chase Farm Hospitals NHS Trust

Health Minister Professor the Lord Darzi opens the introduction to his interim review of the NHS by saying he is a doctor not a politician.

But in his comments about the National Programme for IT [NPfIT] Lord Darzi knows he needs to be the quintessential politician. He is a consultant in the field of robot-assisted, minimally-invasive surgery; and when he mentions the NPfIT in his interim report he manoeuvres delicately over the thin skins of ministers and officials at Whitehall who do not want to read any criticism of the scheme, particularly by public figures.

The National Audit Office in a report on the NHS's IT strategies of 1992 and 1998 made the worthwhile points that:

- the "objectives and targets should be made specific and measurable if they are to be useful in monitoring expenditure and achievements"

- there should be clearer plans for evaluation of the Strategy.

In 2002 there was a third IT strategy, the NHS's National Programme for IT [NPfIT]. The same mistakes have been repeated: no clear objectives and targets which are specific and measurable and no clear plans for evaluating the strategy.

Plus ca change.

A blog reader has taken issue with comments made by Richard Granger, the Director General of NHS IT, who compared the initial distrust by physicians of the stethoscope with the anxiety of some in the NHS over adopting new technology as part of the NHS's National Programme for IT [NPfIT].

Richard Granger's comments had been published in the blog entry "In 200 years people will look back on this [the NHS's National Programme for IT] and wonder what the fuss was about - Richard Granger, head of NHS IT."

Bolton Primary Care Trust – the first in England to test the summary care record as part of the NHS’s National Programme for IT [NPfIT] – has reported “excellent progress”, though the scheme has met some strong local resistance.

Dozens of GPs in the Bolton area where the first trials are continuing of the summary care record - a central part of the NHS's National Programme for IT [NPfIT] - have indicated that they are against proceeding with the scheme.

Their reservations - five years into the NPfIT - raise further questions about how ministers and the Department of Health were able in early 2002 to launch the programme before there was widespread support for its general principles from its main potential users - doctors.

It was announced in April 2007 that Bolton Primary Care Trust had been chosen as the first early adopter in England of the national summary care record. An aim of the scheme is to provide a database of allergies, medication and other important information that would be accessible to doctors out of hours or when a patient goes into hospital unexpectedly.

Whitehall officials are making no commitment to replacing Richard Granger, Director General of NHS IT and Chief Executive of NHS Connecting for Health, which runs part of the £12.4bn National Programme for IT [NPfIT].

Richard Granger will remain in post until the end of this year. When asked whether he will be replaced an official, when pressed, replied: "Sometimes the simplest questions are the most difficult to answer." He gave an answer, however.

NHS Connecting for Health, which runs part of the National Programme for IT [NPfIT], is to write to the BBC about parts of its documentary “Wiring the NHS”.

The Radio 4 documentary on the NPfIT included a slip of the tongue by Dr Gillian Braunold, Clinical Director for the NPfIT summary care record and HealthSpace.

Imagine if the Department for Transport were to argue that its programme for reducing road deaths had been successful on the basis that:

- 10,589,446 tonnes of an innovative anti-skid road surface have been deployed
- 61,778 new traffic lights have been installed
- More than 100,000 new tax discs have been issued to vehicles with the highest safety ratings
- Registration of Blackberry-carrying lollipop ladies has reached 10,000
- Government road safety experts have exchanged more than one million e-mails
- More than two million points have been issued to 550,000 new users of the Safety Camera Partnership Scheme
- At least 1,600 road humps of both flat top and round top, of heights varying from 50mm to 100mm, have been installed in 49 towns and cities under the Highway (Road Humps) Regulations and their map coordinates are available to billions of users via the internet.

Such statistics without context would be meaningless. And statistics in support of claims that the NHS’s National Programme for IT [NPfIT] is a success are almost as meaningless.

Yet below is part of a speech by the Exchequer Secretary to the Treasury Angela Eagle MP in the House of Commons on 23 October 2007.

NHS Connecting for Health, which runs part of the National Programme for IT, NPfIT, has issued a statement on the Choose and Book system that bears similarities to a government announcement five years ago, in 2002.

Both statements – on 6 October 2007 and 20 May 2002 – said that more than five million patients have been able to pre-book hospital appointments.

In a report on its latest financial results BT has issued a reassuring statement about its work on the NHS’s National Programme for IT [NPfIT]. The statement does not deviate from the government’s position that the NPfIT is a success.

The results of the latest Medix survey of more than 1,000 doctors, who were questioned on the NHS’s National Programme for IT [NPfIT], make grim reading.

Looked at on their own, the results imply that the NPfIT is failing, at least in terms of its big objectives and gaining the support of doctors.

A Department of Health document reveals that a review has been underway into the possibility of allowing sensitive NHS patient data to be processed overseas, we have learned.

Some GPs are concerned that if patient records are sent abroad there is a risk their contents could be revealed.

The disclosure comes only days after the government’s statement on two missing CDs that contained the personal details of all families in the UK with a child under 16. It has been described as the UK’s worst IT security breach.

The document seen by Computer Weekly said in August 2007 that the review into the possibility of patient data being processed overseas was “current” and that further guidance would be issued. The document has not been updated.

On 22 November I asked a straightforward question of NHS Connecting for Health which runs part of the NHS’s £12.4bn National Programme for IT [NPfIT].

The question: Could you let me know, by end of today please, if the possibility is being considered of having patient data processed abroad? If so could I have a statement please?

NHS CfH’s answer was straightforward: “No,” said its spokesman.

This is summary of a conversion with a senior executive who is working on the NHS’s National Programme for IT [NPfIT]. He lamented the departure of Richard Granger who has resigned as Director General of NHS IT and Chief Executive of NHS Connecting for Health which runs part of the national programme.

- A case study on NHS Connecting for Health’s handling of news of £5m worth of penalties accrued under the NHS National Programme for IT

Comment and analysis

Officials at NHS Connecting for Health who run part of the £12.4bn National Programme for IT [NPfIT] are deeply committed to the success of the programme: they’re doing their best in trying circumstances.

When they make public statements on the state of the NPfIT they have no wish to deceive. So why, when we ask difficult questions on the NPfIT, do they respond by reaching for a form of words that is anything but an affirmation that problems exist?

The reason, it seems, is that they’re hidebound by Whitehall’s convention of sidelining openness and honesty as two naughty schoolboys in a classroom of gifted pupils.

A culture of introspection and defensiveness reigns. It means that officials are allowed to answer difficult questions from journalists with statements that are succinct or prolix, imaginative or dull, but not artless and simple.

GP Mary Hawking makes the point that the NHS is receiving penalties from CSC under the National Programme for IT [NPfIT] - but CSC also has a contractual right to claim penalties from the NHS if the health service fails to meet obligations to the supplier.

The NHS's contractual obligations to CSC were negotiated centrally by the Department of Health; and the Department has now kindly transferred these commitments to the NHS under the NLOP, the NPfIT Local Ownership Programme.

NLOP means in part that primary care trust chief executives are senior responsible owners with accountability for the delivery of NPfIT in their geographical areas. They also have direct deployment responsibility for the NPfIT Electronic Prescription Service , Choose and Book, and GP systems.

And they have the responsibility of ensuring that the NPfIT's Care Record Service is implemented in hospital trusts - and that it delivers benefits, when fit-for-purpose is software is available.

Now that penalties from CSC have accrued in the North, Midlands and East of England region of the NPfIT, is CSC more likely to claim penalties from the NHS?

An IT project to computerise the Isle of Man’s hospital services has gone live on time and within budget.

The successful project – systems went live without delays or changes in the contract or requirements – sets a different tone to some of the delays and changes in England’s NPfIT, the NHS National Programme for IT.

Some of the major NPfIT issues identified by Helen Bellairs, Chief Executive, Western Cheshire Primary Care Trust, seem at odds with a briefing paper to the prime minister in February 2007

Helen Bellairs is a local senior responsible owner of the National Programme for IT [NPfIT] in the NHS. Under NLOP, the NPfIT Local Ownership Programme, all chief executives of primary care trusts in England have been appointed senior responsible owners. It means they may be held accountable for failures and realising any benefits of NLOP and the NPfIT.

In a briefing paper to the North West Strategic Health Authority NPfIT board, Helen Bellairs outlined what has been achieved locally; and she identified six “major issues” with the NPfIT. Some of the issues have a general significance to the national programme.

Comment

The executive chairman and CEO of Australian company IBA Health Gary Cohen has spoken briefly about the future of the “Lorenzo” product. IBA has acquired iSoft which is due to supply Lorenzo, a product that's important to the success of the NHS's National Programme for IT [NPfIT].

The board of an NHS trust has learned of a “significant” risk of Fujitsu ending its £900m contract to supply and implement hospital systems across Southern England as part of the National Programme for IT [NPfIT].

The warning was issued to the board of the Royal United Hospital Bath which has waited nearly three years to go live with systems under the NHS’s National Programme for IT [NPfIT].

A withdrawal of Fujitsu would add to delays in installations of NPfIT systems and deepen scepticism among doctors over whether the programme is feasible - though it could leave NHS trusts with the benefit of dealing directly with Fujitsu’s main software subcontractor Cerner.

NHS Connecting For Health which runs part of the NHS's National Programme for IT, announced yesterday [22 January 2008] that the Choose and Book electronic referrals system has "broken through the six million patients milestone".

Analysis

When advisers to ministers write replies to Parliamentary questions they have no legal duty to be candid. Within reason they can say what they like. So for them answering written Parliamentary questions may be no more challenging than playing tennis with the net down.

Indeed, when asked about the NHS's National Programme for IT [NPfIT], ministerial advisers can use Parliamentary replies to make light of the concerns of clinicians and others. And this is what happened when Worthing MP Peter Bottomley put a question about Cerner sites to Ben Bradshaw, who's the latest in a series of ministers to be put in charge of the NPfIT.

To keep secret the Downing Street papers on the NHS's National Programme for IT [NPfIT] the Cabinet Office climbed a succession of legal steps.

For three years the Cabinet Office put up legal arguments against our request under the Freedom of Information Act to publish the Downing Street papers on the NHS's National Programme for IT [NPfIT] - so why has it suddenly confirmed it is to release them?

"There is a lot of information where there might be little expenditure, but very little information where there is a lot of expenditure"

This is quote attributed by the Health Service Journal to Tom Denwood's team. Denwood has been appointed Programme Director for the National Programme Office at NHS Connecting for Health.

Now that a memorandum of understanding between Fujitsu and the NHS has expired the two sides have reverted to the original contract - which both view as obsolete.

The timetables and products set out in the contract are seen as irrelevant, even obstructive, superseded by changes in the NHS.

The “Downing Street papers” released under the Freedom of Information Act reveal the names of some of those who attended a meeting, chaired by Tony Blair, which spawned the NHS’s £12.4bn National Programme for IT [NPfIT].

By the end of next month (March 2008) just over £4bn of centrally-directed funds will have been spent on the NHS's National Programme for IT. The figure includes money spent by NHS Connecting for Health which runs part of the NPfIT but excludes spending allocated locally.

About £600m was spent in 2004/5, about £1bn in 2005/6, £1.1bn in 2006/7 and a projected £1.32bn by April 2008.

Summary of article

- Tony Blair tried repeatedly to shorten the time to make health records available online, which would have made them available to patients shortly before the 2005 general election

- Original timetable for NHS National Programme for IT [NPfIT] is revealed in Downing Street papers released to Computer Weekly under the Freedom of Information Act, after our three-year campaign for their disclosure

- Downing Street meeting in February 2002 gave birth to the UK government's biggest IT investment, but no minutes were taken

The National Audit Office is at a draft report stage after a second investigation into the NHS's National Programme for IT [NPfIT]. It's expected the National Audit Office will publish its second report on the NPfIT by May 2008.

Among the Downing Street papers released to Computer Weekly by the Cabinet Office under the Freedom of Information Act is a letter which indicates that the NHS IT programme was agreed largely before a meeting of Tony Blair on 18 February 2002. It seems that Blair's main influence on the programme was, initially at any rate, to compress the projected timescales.

The letter is from Simon Stevens, then No 10 health adviser. He writes to Tony Blair to brief him before a meeting on NHS IT at Downing Street. The meeting is to be chaired by Blair and attended by representatives of two IT suppliers, Cabinet Ministers, policy advisers, and health experts.

The letter leaves the casual reader in little doubt that a plan for a "step change" in NHS IT has been all but decided and that one of the biggest remaining challenges is speeding up progress.

Among the Downing Street papers released by the Cabinet Office under the Freedom of Information Act was the Department of Health’s briefing to Tony Blair. The briefing was given to Blair four days before an NHS IT seminar at Downing Street on 18 February 2002 which spawned the National Programme for IT – NPfIT.

On a planned IT-led modernisation of the NHS, Tony Blair said at a meeting at Downing Street on 18 February 2002 that there were three main issues:

- to ensure the NHS had the right systems
- how these were implemented locally by managers and clinicians
- how we increase the pace of development.

This is the set of papers supplied by the Cabinet Office after my request under the Freedom of Information Act in January 2005 for details of a meeting at Downing Street in February 2002 to discuss a modernisation of the NHS based on IT.

A separate set of documents (1.3MB) discloses the Cabinet Office's legal arguments against a ruling of the Information Commissioner that the Downing Street papers should be released.

Links:

Irrational exuberance over clinical IT

Openness and accountability

Richard Granger leaves NHS

Is the Freedom of Information Act any use?

News analysis

It went largely unnoticed but the minister for the NHS’s National Programme for IT, Ben Bradshaw, has confirmed that data on a central database of millions of confidential health records will be made available to police where there is an “overriding public interest”.

The phrase “overriding public interest” is not defined.

In response to the blog entry about police being allowed to request searches of a national database which supports the Secondary Uses Service an anonymous reader makes points many will agree with. The reader writes:

Lord Warner, one in a line of health ministers who was once in charge of the NHS’s National Programme for IT – NPfIT – suggested to the BBC “Today” programme on 18 December 2006 that police will have access to national health records only in court cases.

But Ben Bradshaw the minister now in charge of the NPfIT, says that police will have access to a Secondary Uses Service – which draws on the summary care records database - “where it is in the overriding public interest” and not only in court cases.

A new national database of confidential patient records is being opened to access by NHS staff who need no professional qualifications – despite official assurances that access to the summary care record will be provided only to specialists who are providing care or treatment.

Documents obtained by Computer Weekly under the Freedom of Information Act also provide evidence that NHS Connecting for Health – which runs part of the £12.4bn National Programme for IT [NPfIT] – has quietly decided to weaken assurances given to patients about the confidentiality of records.

An article in Computer Weekly, which disclosed that NHS staff can, without the need for professional qualifications, access the national summary care records database, was discussed by GP Paul Cundy on BBC Radio 4's Today programme this morning [3 March 2008]

In a speech yesterday [6 March 2008] the Home Secretary Jacqui Smith announced a revised timetable for ID cards – as if ministerial predictions on IT-based projects have a profound meaning.

Spending on the NHS’s national IT scheme up to April 2007 was £1.5bn less than the Department of Health had expected, according to figures released by the government yesterday [13 March 2008].

The reduced spend on the main IT contracts under the National Programme for IT - NPfIT - was largely because of delays in the delivery of new systems. BT, CSC and Fujitsu, the local service providers to the NPfIT, are paid mainly when they meet milestones and have systems accepted by trusts.

Comment:

At a press conference in Whitehall last week [13 March 2008] doctors who work on different parts of the NHS’s National Programme for IT – NPfIT – flanked the health minister Ben Bradshaw.

Their repeated use of the word “exciting” to refer to the NPfIT or their work on it reinforced the impression that the programme has become politicized.

Richard Jeavons, senior responsible owner for service implementation on the NHS National Programme for IT - NPfIT – has affirmed his team’s commitment to the “Lorenzo” product from suppliers CSC and IBA Health

He has indicated that his team will stand by the product whatever happens.

Papers released by Bolton Primary Care Trust under the Freedom of Information highlight some of the lessons learned from its trial of the NPfIT summary care records system.

Martyn Thomas, visiting professor of software engineering at Oxford University's Computing Laboratory, has expressed concerns about the leaflet that's being given to patients who want to opt out of having their medical details to a summary care record.

He said:

"Opting out leaves patients with the same level of risk that they have currently, and the new summary care record introduces new risks: for example, that the information will be wrong or assumed to be complete when it isn't (most databases have a high proportion of incorrect data), that details of your medical history will be seen by people who should not have seen it, and that vulnerable people will be forced to reveal details of their medical history (by being compelled to log in to their HealthSpace website).

- NPfIT clinical director says opting out of national database of summary care records could be more prejudicial to health than not having a smear test

- GP IT spokesman says leaflet being sent to patients who want to opt out of summary care record is “alarmist”

- More than 250,000 patients may opt-out of summary care records on basis of today's numbers

Officials at NHS Connecting for Health answer most media inquiries – but they have not yet replied to questions about a little-noticed speech in the House of Commons by the health minister Ben Bradshaw on 21 February 2008.

In a debate on the Health Committee’s report on electronic health records, Bradshaw cleared suppliers to the National Programme for IT – NPfIT – of any responsibility for delays. He told the House of Commons that the delays have not been because of problems with supply, delivery or systems.

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.

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:

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.

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.

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."

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.

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”.

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.

**

The Department of Health has advertised for an NHS chief information officer. Headhunters have been recruited and interviews will take place in a couple of months.

Matthew Swindells, acting NHS CIO, told the HC2008 annual healthcare IT conference at Harrogate: "This is an absolutely crucial position, linking the policy to the strategy, to the informatics. If we can drive that from the top then other things become a lot easier for everybody."

Meanwhile the Department of Health has appointed its latest interim head of IT in the NHS, Professor Sir Bruce Keogh, NHS Medical Director. He has been appointed interim Director General for Informatics. His temporary appointment follows the resignation of Swindells who is joining consultancy Tribal.

Comment:

My highly subjective overview of some of the good and bad at HC2008, the annual Healthcare Computing conference in Harrogate..

Nearly 300 incidents have put patients at risk since 2005 when health officials began systematic recording of safety matters under the NHS’s National Programme for IT [NPfIT].

The incidents are evidence that new IT systems in the health service can place the safety and health of patients at risk if they, or the use of them, goes wrong - though they can also reduce risks to patients if they work well.

NHS staff and executives have reported about 290 incidents in which there was a potential for patients to be harmed although most major NPfIT systems have yet to be rolled out to England's hospitals.

It has also emerged that the NPfIT was launched by ministers in 2002 without any formal structure for identifying incidents in which the safety of patients was put at risk by errors arising from installations of new national systems.

Several people in the NHS say that health officials and Fujitsu have returned to the negotiating table after talks had stalled over a “contract reset” over the supplier’s £896m deal for installing Cerner’s Millennium systems in the south of England.

Officially nothing is being said about progress, particularly as the local elections are tomorrow [1 May 2008], but an employee at a local service provider says that a meeting was held last Thursday which involved:

- David Nicholson, Chief Executive of the NHS
- Sir Ian Carruthers, who is a former acting Chief Executive of the NHS, a senior responsible owner of the NPfIT and now Chief Executive of the South West Strategic Health Authority
- a European director of Fujitsu
- A director from Fujitsu’s headquarters in Japan

As a result Fujitsu has made significant concessions – a revised financial offer – and the NHS would have to pay tens of millions of pounds, not hundreds of millions, to keep Fujitsu in the National Programme for IT [NPfIT]. The figures being discussed are not dissimilar to the £55m extra paid to BT as part of its contract reset.

Whitehall officials have allowed only two weeks for people to apply for two top IT jobs in government – each offering salaries of at least £200,000.

The jobs were advertised on 13 April and the deadlines have passed. Some of those who were interested in the adverts say that two weeks is not enough time to prepare for applications that require comments to be made on a list of difficult questions.

Connecting for Health, which runs much of the NHS’s £12.4bn National Programme for IT [NPfIT], is expected to be criticised in a government-funded report into "early-adopters" of online health records.

A year-long study, the results of which are due to be published next week, is also expected to highlight criticisms of the government by some executives at NHS Connecting for Health [CfH].

The government wanted CfH to implement online health records quickly because of the high political profile of the scheme. This was despite the difficulties gaining support from clinicians, achieving the necessary changes within NHS organisations, and the technology being unproven.

Comment and analysis

A study published this week into the summary care record – a pivotal part of the £12.4bn NHS’s National Programme for IT [NPfIT] – raises questions about the underlying assumptions behind the scheme, and highlights flaws in the organisation which runs it.

And Computer Weekly has learned that significant changes were made between a draft report by researchers at University College, London, and the approved final report. The final report softens or omits some of criticisms of the government and NHS Connecting for Health [CfH], which runs much of the NPfIT. Even so the final report is enlightening, comprehensive and authoritative.

The NHS's National Programme for IT [NPfIT] has taken a different direction with NHS trusts being given a choice of a range of systems from various suppliers - which they were able to do before the advent of the NPfIT in 2002.

Whitehall officials would like to control the language and information on the NHS’s National Programme for IT [NPfIT], but the laws of Nature are, at times, pitched against them: The Sun has begun to take an interest in the scheme.

Following on from its article on the implementation of the Care Records Service at Barts and the London NHS Trust, The Sun has reported on a potential security breach with the “Choose and Book” system – part of the NPfIT - at a GP practice at Essex; and it has an editorial under the headline “Data Dunces”.

Alan Spours, Chief Information and Knowledge Officer at NHS Northwest, has told his board that a review of the National Programme for IT [NPfIT] by Matthew Swindells is expected to give the NHS more flexibility to implement interim solutions where products from local service providers are not available or not fit for purpose.

He has also told his board that a contract reset with CSC, one of three main suppliers to the National Programme for IT, was due to be signed by 6 May 2008.

The IT head of an NHS health authority has suggested that CSC's contracts under the National Programme for IT [NPfIT] - may be extended, which would extend the programme itself.

If it happens, it could signal an intention of Whitehall officials to keep extending contracts to local service providers in the hope the NPfIT can be seen to succeed at some point.

These are excerpts from today's report [16 May 2008] by the National Audit Office on the NHS's National Programme for I.T

Much has been published by Connecting for Health on the achievements so far of the NPfIT. The excerpts here highlight some of the important lessons to be learned from the challenges of implementing the NPfIT.

A fellow blogger for Computer Weekly, Philip Virgo, has an excellent post today [22 May 2008] entitled "Why do we never learn and keep replicating failure?"

Three points in particular struck me about central government projects such as the NHS's National Programme for IT [NPfIT].

The sharing of passwords on a hospital x-ray system at a hospital in Devon has made it difficult to identify which doctor wrongly verified the treatment of a patient who died after a blunder.

The case sheds light on the collison between culture of the NHS - where the sharing of passwords is said to be common practice - 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].

The Guardian has an article that NHS executives may not replace Fujitsu as the local service provider in the south of England for the National Programme for IT [NPfIT].

Indeed there have been high-level meetings in recent days at which the idea of not replacing Fujitsu has been floated. Some NHS staff want ministers and Connecting for Health, which is part of the Department of Health, to give them the freedom to buy from a range of accredited ASCC suppliers rather though a local service provider as a middle-man.

For ministers, the issue appears to be mainly one of presentation: how it is possible not to replace Fujitsu while being seen to keep the original shape of the NPfIT intact. 

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.

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.

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].

- 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.

There has been some criticism by NHS users of the Fujitsu helpdesk. But a blog reader writes:

At a conference on spin, PR and government press officers last week, I was asked to speak briefly (a challenge).

I said I had noted over about five years an increasingly aggressive approach on the part of some government communications directors - with some honourable exceptions.

I said: "We often get supplied incorrect information. We know ministers are given incorrect information...the Prime Minister has even been given incorrect information about the NHS computer system". This is not usually the fault of press officers but is sometimes the responsibility of senior civil servants or advisers who brief ministers - or who brief press officers. 

When a producer at BBC's "Ten O'Clock News" contacted me about "another government computer project that has gone wrong" she was genuinely interested to know why failures cannot be prevented.

I gave the producer a choice of comments and she sent a cameraman to record them. This was the comment the Ten O'Clock News decided to broadcast on Friday evening [4 July 2008] in a short film on delays with school exam tests:

"You don't have the scrutiny in the public sector that you do need to have," I said. "There ought to be reports to Parliament about how these projects are going. Unfortunately the government is extraordinarily secretive about big IT projects."

Minister's unfulfilled promises on Cerner go-lives

Officials at Royal West Sussex NHS Trust - St Richard's Hospital, Chichester - seem relieved that Fujitsu is departing the National Programme for IT [NPfIT], for it means they can keep their existing "robust" patient administration system.

But Health Minister Ben Bradshaw had told the House of Commons that the West Sussex trust was expected to go live with the Cerner Millennium system - supplied by Fujitsu - in the early part of 2008".

A review of the future of NHS informatics by the health service's departing interim CIO Matthew Swindells is due to be published tomorrow [Thursday 10 July 2008]. Meanwhile the British Computer Society's Association for Informatics Professionals in Health and Social Care (ASSIST) has published some replies to four questions it asked of Swindells and Gordon Hextall who is Director of Informatics and Interim Director of Programme and Systems Delivery at NHS Connecting for Health.

Links:

BCS questions Matthew Swindells and Gordon Hextall

Whitehall advertises for NHS CIO

BCS- ASSIST

The Department of Health has published its long-awaited Health Informatics Review.

I haven't read it yet apart from the opening pages. The second page summary of "action required" is a little disconcerting . It says:

"Action required - Health Informatics Review to continue engagement with NHS and key stakeholders."

Is this that the only action required - vague as it is - after such a major review? Are there recommendations which can be measured as carried out or not? Or is the document mainly aspirational? S