Health officials are considering plans to double the amount of money spent on go-lives of new systems at large hospitals under the NHS National Programme for IT (NPfIT).
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Computer Weekly has learned that health officials in London and their lawyers have been discussing a new delivery model for the NPfIT in London which would increase by between 200% and 400% the amounts spent on installations of the Cerner Millennium system.
Ministers want to speed up the roll-out of NPfIT systems, particularly in large hospitals. But trust boards are wary after the installation of the BT Cerner Millennium system at several London hospitals hit the care and treatment of patients - and the go-lives cost millions of pounds more than trust boards had expected.
Doubling the money for each implementation of the Cerner Millennium system would encourage more trusts to go live. It would allow dozens of extra staff to be on hand in case new IT slowed down the running of hospitals or caused severe disruption.
The extra money would also ensure BT remains in the NPfIT as the local service provider to NHS trusts in London.
The Department of Health cannot allow BT to quit, as the NPfIT would then have lost three of its four local service providers and would be perceived worldwide as an unmitigated failure. BT has run up hundreds of millions of pounds of losses under the NPfIT.
As a further encouragement to BT, officials have given the supplier a generous settlement - worth at least £120m - to supply some NHS trusts in the south of England with Cerner's Millennium and maintain systems that had been installed by the outgoing local service provider Fujitsu. No single company will take over Fujitsu's contract in the south.
Another incentive to keep BT in the programme is giving it a deal to supply the Rio system to primary care trusts throughout the south of England. Rio has proved a popular choice for trusts, whether they are taking it through a local service provider or are buying it outside the NPfIT directly from supplier CSE Healthcare Systems.
Already each go-live in a large hospital under the London Programme for IT costs much more than pre-NPfIT installations of patient administration systems. This is because the original NPfIT plan was for centrally-bought systems to be integrated and able to be upgraded en masse.
But those working on the NPfIT say that integration has been put to one side. Instead, NHS Connecting for Health's priority is for systems to be installed even if the technology is tailored locally in such a way as to make integration and standardisation with other NPfIT systems difficult.
It's unclear, therefore, whether an extra spend on deployments will represent value for money.
To fund the extra spend officials have considered using unspent cash on the NPfIT. They could do this without necessarily increasing the total cost of the contract with BT because the Department of Health has a "bounty" of four years of running costs for systems that were not installed by the end of 2005, as had been expected when contracts were signed.
The plan, if adopted, would commit some of the unspent cash on the NHS's National Programme for IT, ahead of any change of government at the next general election.
But there are many uncertainties. In the rest of England, outside London and the south, local service provider CSC is due to install dozens of Lorenzo systems by the end of December 2009. It is unclear whether this will happen.
Martin Bellamy, head of NHS Connecting for Health and director of programme and systems delivery at the Department of Health, has said that the top priority for the next 12 months is to demonstrate that Cerner and Lorenzo can be deployed over the next year in large, complex hospital trusts and provide value to patients and clinicians.
NHS Connecting for Health made no comment.
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