But assurances to Parliament contrast with new uncertainties at NHS trusts
NHS staff at Bath were unable to answer 25% of phone calls for Choose and Book appointments within 5 minutes partly because they were training to use the Cerner Millennium system. The Cerner go-live was later cancelled.
The termination of Fujitsu’s contract on the £12.7bn NHS IT scheme is a sign of the programme’s strength, says a government minister.
The comments of the minister Baroness Thornton show that the departure of Fujitsu as a major supplier to the National Programme for IT [NPIT] has left unchanged the government’s official line that the scheme is a success – although a report of the National Audit Office in May found that the core NPfIT software, a Care Records Service, will finish rolling out at least four years later than first planned.
Baroness Thornton made her comments during a short debate on the NPfIT in the House of Lords. The debate was initiated by a Conservative peer, Baroness Sharples. She pointed out that two suppliers, Accenture and Fujitsu, have quit the national programme.
Baroness Thornton replied:
“The fact that Fujitsu’s contract was terminated is in fact a sign of the programme’s strength. The programme is still on course and our contractors are not paid until they have delivered. In that sense, no money has been lost.”
But her comments about Fujitsu’s departure took no account of the deepening uncertainties facing the boards of NHS trusts in the south of England, where the supplier was contracted in 2004 to be local service provider.
Since Fujitsu’s departure was announced at least one NHS trust has, after repeated postponements, cancelled its go-live of the Cerner “Millennium” system.
A spokesperson for Bath’s Royal United Hospital said the trust “did not did not have sufficient confidence in the level of support that it would receive from the suppliers, at and beyond the go-live period, to proceed with the implementation of Millennium”. The implementation team was stood down.
The months of preparations and training at Bath in anticipation of the go-live are revealed in a paper to the board of the Royal United Hospital. The paper said that a quarter of all phone calls relating to Choose and Book – a central part of the NPfIT – were not answered within five minutes during May.
The board was told that a high turnover of staff handling calls staff has been “exacerbated by the need to support substantial levels of Millennium preparation and training”.
During the debate in the House of Lords earlier this month Baroness Thornton mentioned none of these sorts of difficulties. She continued her defence of the NPfIT saying:
“My Lords, large numbers of clinicians were involved in the original specification. The programme continues to receive high levels of support among front-line and managerial staff. An overwhelming majority say that implementing it is very important. Sixty per cent of clinical support for the initiative is, we think, a reasonable consensus.
“Some clinicians have in the past been resistant to change and are nervous about the new technology, but the key way to change attitudes for the programme is to continue to demonstrate successful delivery and improved services.”
On the summary care record – which includes plans for 50 million people in England to have a basic electronic record – she said:
“We are very confident that, over time, this will roll out as a very successful programme … we are confident that this is moving forward at the right speed”.
And she listed the statistical successes of the NPfIT, as have a succession of other ministers.
“My lords as of the end of June, a typical day in the NHS, saw 320,000 prescriptions transmitted electronically, 25,000 Choose and Book electronic bookings made, more than 50% of NHS referral activity being from GP surgeries to outpatient appointments, two million queries recorded and 1.5 million digital images such as x-rays kept to service NHS patients.”
If the ministers and officials responsible for the NPfIT take heed of today’s advice of Cabinet minister David Miliband it could make quite a difference to the way the programme is perceived. Miliband said:
“When people hear exaggerated claims, either about failure or success, they switch off. That is why politicians across all parties fail to connect.
“To get our message across, we must be more humble about our shortcomings but more compelling about our achievements.”
Baroness Thornton was not at fault for seeing the NPfIT through coloured spectacles. She was giving the government’s line on the NPfIT: that everything on the scheme happens for the best, and if it doesn’t it’s not our fault.
This was the line taken by the NHS’s Chief Executive David Nicholson when he gave evidence on the NPfIT to the Public Accounts Committee in June 2008. Any problems were because of suppliers or the NHS, not Downing Street or the Department of Health.
The comments of Baroness Thornton serve only to show that people are generally right to distrust government statements. Civil servants provide the briefings the ministers expect and sometimes these are no more in touch with reality than the civil service’s “stock-take” to the then Prime Minister Tony Blair on the state of the National Programme in 2007. A confidential Connecting for Health briefing paper to Blair, seen by Computer Weekly, said “….much of the programme is complete with software delivered to time and to budget”.
That was hubris; and Baroness Thornton’s comments show that the orderly presentation of unreality is still the fashion for NPfIT spokespeople.
Before he resigned President Nixon said: “Let us begin by committing ourselves to the truth – to see it like it is, and tell it like it is – to find the truth, to speak the truth, and to live the truth.”
Is this the sort of truth that ministers and senior officials responsible for the NPfIT will continue to hand down to the NHS? Or will Miliband’s advice bring a change in government communications over the NPfIT?
It could just happen: ministers and officials may begin to admit the programme’s shortcomings and stop exaggerating its success. The question is whether the world will last that long.
Full NPfIT debate in the House of Lords – from “Theyworkforyou.com
Baroness Sharples asked Her Majesty’s Government: What is their current assessment of progress made by the agency NHS Connecting for Health?
Baroness Thornton (Baronesses in Waiting, HM Household; Labour):
My Lords, the national programme for IT, which is being delivered by the department’s NHS Connecting for Health agency, is delivering front-line systems and services that are bringing major benefits for NHS organisations, staff and patients. The most recent National Audit Office report of May 2008 said: “All elements of the Programme are advancing and some are complete”. However, certain aspects still have some way to go.
Baroness Sharples (Conservative)
My Lords, can the noble Baroness confirm that this IT scheme has already cost £12.7 billion and is five years late? What is the future? Really, I cannot see any. And what about Accenture and Fujitsu leaving?
My Lords, there is a lot of mythology about the cost of the national programme. However, it is not, and has never been, over budget. The recent NAO report confirms that the cost of the original contract at £6.2 billion has not changed, and that the overall programme cost is substantially unchanged from the figure in the earlier NAO report of £12.7 billion.
The fact that Fujitsu’s contract was terminated is in fact a sign of the programme’s strength. The programme is still on course, and our contractors are not paid until they have delivered. In that sense, no money has been lost.
Baroness Prosser (Labour)
My Lords, have the people who are involved in this work–NHS officials, clinicians, and so on–been consulted about the programme and, if so, what were their views?
My Lords, large numbers of clinicians were involved in the original specification. The programme continues to receive high levels of support among front-line and managerial staff. An overwhelming majority say that implementing it is very important. Sixty per cent of clinical support for the initiative is, we think, a reasonable consensus. Some clinicians have in the past been resistant to change and are nervous about the new technology, but the key way to change attitudes for the programme is to continue to demonstrate successful delivery and improved services.
Earl Howe (Shadow Minister, Health; Conservative)
My Lords, the 2004 NHS Improvement Plan said that in 2008, each patient,
“will have access to their own personal HealthSpace on the internet, where they can see their care records and note their individual preferences about their care”.
As at March 2008, just over 150,000 summary care records had been uploaded on to the spine, representing 0.24 per cent of UK medical records. Is that a satisfactory rate of progress?
My Lords, the noble Earl will be aware that the debate about summary care records has been rumbling along. My noble friend Lord Warner concluded that there were many compelling reasons to have a ministerial task force in 2006. So the gradual rollout is in early adopter sites; they are subject to independent evaluation by University College London, which reported on 6 May 2008. NHS Connecting for Health is currently considering the finding that the clinician treating patients should seek consent to view before accessing a summary care record. Patients can choose not to have a summary care record, but evidence from our early adopters is that under 1 per cent of people make that choice. We are very confident that, over time, this will roll out as a very successful programme.
Earl Ferrers (Conservative)
My Lords, I think that my noble friend asked whether that was a satisfactory rate of progress. Will the Minister answer that?
Of course, we could always do better, my Lords, but, with new technology, it is better to get it right.
Lord Broers (Crossbench)
My Lords, large software systems are notoriously difficult to write correctly and impossible if the specifications are not stable. Can the Minister assure us that the specifications are stable?
My Lords, if that is a very technical question, I am probably not in a position to answer it. However, given the amount of consultation that went into the specification, and the time taken to make sure that we get it right and that data security and confidentiality are top priorities, we are confident that this is moving forward at the right speed.
Baroness Barker (Spokesperson in the Lords, Health; Liberal Democrat)
My Lords, does the Minister agree that there is a considerable effect on privacy of medical data when the operating code for the system is not held by the NHS but is retained by the suppliers? If so, what is the department doing to ensure the integrity of private medical information?
My Lords, the IT systems implemented as part of the programme have high standards of security control, requiring a smart card that is issued only to staff providing NHS proof of identity along with a password. All moveable data must be encrypted to protect their confidentiality, and those are the property of the NHS. At local level, NHS trusts are accountable for applying security policies and standards. Where losses occur, they exclusively involve items such as local laptops or paper-based records and are based on human error rather than technical failures.
Lord Elton (Conservative)
My Lords, the noble Lord, Lord Broers, asked a fairly simple question: is the specification stable? That is, are the authorities asking for something different from time to time as the system is developed? Can the Minister assure us that the specification has remained, and will remain, the same?
My Lords, the specification will not remain the same because medical progress happens. Therefore, the specification will have to change from time to time as medical progress takes place.
Lord Haskel (Labour)
My Lords, does my noble friend not agree that this is a hugely ambitious project and that the NHS deserves some credit for attempting it?
My Lords, as of the end of June, a typical day in the NHS saw 320,000 prescriptions transmitted electronically, 25,000 choose-and-book electronic bookings made, more than 50 per cent of NHS referral activity being from GP surgeries to outpatient appointments, 2 million queries recorded and 1.5 million digital images such as X-rays kept to service NHS patients.
Milton Keynes Care Records Service caused “near melt-down” – E-Health Insider
Short NPfIT debate in the House of Lords – July 2008