We interviewed Angela Hands and Laura Brackwell who are among the co-authors of a report by the National Audit Office on the NHS’s National Programme for IT [NPfIT]
Angela Hands said: “The Department of Health always knew it was a challenging programme. But I think they’ve realised in recent years it’s on a truly massive scale. They felt it was big but didn’t quite realise how big it was; and how a devolved NHS makes things really complex . There has been progress by the Department but also serious delays in deploying the Care Records Service [CRS] …
“The programme is going to be completed around four years later than initially planned. That will depend on Lorenzo being developed and deployed successfully. There continues to be a huge challenge around the CRS.
“Getting the benefits out of these systems will be the next big step – if clinicians see the benefits their confidence will increase.”
Will it ever work? Will the important releases of Cerner and Lorenzo ever be fit for purpose?
“Going out to trusts and seeing [Cerner’s] Millennium deployed, the trusts were certainly seeing some progress. It’s not a perfect solution and it’s being deployed in trusts on top of legacy solutions. Trusts have different experiences…”
Laura Brackwell said: “There have been issues in some trusts and it’s taking some time to get things to work as intended but we did feel that people were making progress. The vision of the programme is still intact. We did not find evidence to suggest that it would not work. Having said that, the development of Lorenzo is absolutely crucial in terms of the future of the programme and that’s not available yet.
“We came across quite a lot of dissatisfaction over the present position and the systems they have: Millennium and [iSoft’s] iPM.”
She added that some of the concern was because of the systems but some because of “not particularly good communication” within trusts about what they could expect of the technologies being deployed and how they would compare with the systems staff had used before.
Angela Hands said: “The new systems are replacing those that have been developed over very many years. All the edges have been knocked off them. They are being replaced with something that is still being developed. Getting that across to clinicians is very important.” She added that staff should not be led to expect a system they’re not going to get. “Trusts are learning that.”
Honesty is very important, said Hands. She added it was important to have “honesty at national level about what’s reasonable to achieve over say a year and honesty in individual trusts about the fact that this is not the final system”. It’s particularly important, she said, to be clear to NHS staff on exactly what the new system will do and, if appropriate, what it won’t do compared to pre-existing systems.
“Local Service Providers have realised they need to be much clearer about what they are giving to trusts.”
What if Lorenzo doesn’t work?
“That’s speculating about the future.”
Would penalties have to be paid to local service providers if some trusts don’t buy from them?
Laura Brackwell said: “There is a financial incentive for the department to sell the benefits of the NPfIT and make the benefits real so that the trusts do want to take NPfIT systems, which would reduce the potential liability.”
Hands and Brackwell said they accepted there was a risk that the Department of Health would have to pay suppliers for systems that were not deployed.
How well is the NPfIT local ownership programme working?
Angela Hands said: “We did find the NLOP arrangements are still immature. They are not there yet, The SHAs [strategic health authorities] are still learning.”
Why are there hundreds of millions of pounds in advance payments to suppliers?
Hands and Brackwell said the money is in effect repaid when the systems are deployed and accepted by trusts, though there is an outstanding balance from suppliers of about £369m. The payments are because suppliers are incurring significant costs before they are paid for deployment.
Brackwell said: “The department regards it as better value for it to provide advances than suppliers have to borrow and that be included in the contract costs.”
Is the NPfIT feasible?
Hands said: “Lorenzo and Cerner must work if the programme is to be feasible. We are not aware of any other system waiting in the wings to come in.”
She added: “We felt that the early rollout of Lorenzo in the Autumn is quite ambitious. They need to learn the lessons. The big lesson is the connectedness between the trust that has just deployed, and the one that is about to deploy.”
The 2014-15 timeframe for completion of the NPfIT could be extended?
“They may need to look at that,” said Hands.