MP calls for closure of "nightmare" NHS computer agency

Richard Bacon MP said today (Tuesday 17 April 2007) that the health service would be better off without Connecting for Health, the Department of Health agency responsible running the national programme for IT in the NHS.


Bacon was speaking as the Commons’ Public Accounts Committee published a damning report on the £12.4bn programme. The report concludes that “at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period”.

He has called for the agency to be wound up, with most of its budget handed over to local hospital bosses and any remaining functions handled by the Department of Health.

Bacon, a member of the committee, said: “Connecting for Health has produced exceptional anger and frustration among doctors, nurses, and hospital managers. It is a nightmare organisation and I think the NHS would be better off without it”.

He added: “The bulk of the programme should be handled by local hospital chief executives in consultation with their own clinicians, who all have a direct interest in delivering IT that works. Local hospitals should have freedom to buy from a wide range of suppliers whose technology conforms to national standards. Functions such as setting common standards could be transferred to the Department of Health. There is no need for an expensive separate agency.

“This is a truly grim tale. The NHS IT programme has already cost over £2 billion, with five times more than that in the pipeline, and yet the programme is unlikely to deliver significant clinical benefits by the end of the contract. There have been six bosses in five years. The programme has left doctors, nurses and hospital managers spitting with rage.

“Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier, iSoft, which is under investigation by the Financial Services Authority and whose flagship software product, ‘Lorenzo’, does not yet exist even though the company said it was available three years ago, and which in the meantime has been merrily selling old software which pre-dates the national programme. You just couldn’t make this up.

“The limited deployment of administrative systems which has taken place so far has caused havoc in various hospitals, leading to significant delays in providing inoculations to children, waiting list breaches, missing patient records, extended shut downs of some systems and the inability to report activity statistics”. [PAC report page 14, paragraph 13].

“The central problem arises from a set of huge contracts which were signed in great haste, before either the government had understood properly what it wanted to buy or the suppliers had understood what it was they were expected to supply. It is impossible to avoid the conclusion that this project has been an expensive failure. It will continue to fail unless there are drastic changes”.

The report calls on the Department of Health to commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.

In view of the slippage in the deployment of local systems, the MPs also recommend that the Department of Health should commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.

Bacon’s press release continues as follows:

Below there are references in the PAC Report to the following topics:

Clinical benefits unlikely to be delivered by end of contract.

No firm dates for development of patient clinical record.

Clinicians not persuaded of benefits.

Frequent changes of leadership.

High costs yet no detailed record of overall expenditure.

Concern over of software supplier iSoft, which is under investigation and which is selling old software which pre-dates the Programme.

MPs call for independent assessment of business case for the Programme.

MPs recommend urgent independent review of the performance of Local Service Providers against their contractual obligations.

1. CLINICAL BENEFITS UNLIKELY TO BE DELIVERED

At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. PAC report page 6, paragraph 9

No published plans exist for implementing shared electronic patient clinical records in line with the original vision for the Programme. PAC report page 13, paragraph 10.

The report notes that the delivery of phase 1 of the programme, the least important from a clinical point of view because it contains mainly administrative functionality, is already late with no published dates for its completion; and concludes that the implementation of phases 2 and 3, which are the key to the delivery of clinical benefits and which were the core of the business case for the high cost contracts, may scarcely have begun by the time the Local Service Providers were originally contracted to have implemented completely all three phases to all hospitals and Trusts in England. PAC report page 22, paragraph 34

2. NO FIRM DATES FOR PATIENT CLINICAL RECORD

The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number was 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be a further twenty-two. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. PAC report page 5, paragraph 1.

3. CLINICIANS NOT PERSUADED OF BENEFITS

The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. PAC report page 6, paragraph 5

4. FREQUENT CHANGES OF LEADERSHIP

The frequent changes in the leadership of the Department’s work to engage NHS organisations and staff have damaged the Programme and convey that the Department attaches a low priority to this task. PAC report page 6, paragraph 6.

Leadership in securing support from NHS staff and organisations has changed several times over the life of the Programme: at the time of our examination, responsibility for this task had passed between six Senior Responsible Owners. PAC report page 20, paragraph 26.

5. HIGH COSTS YET NO DETAILED RECORD OF EXPENDITURE

The National Programme has already cost taxpayers at least £2.074 billion PAC report page EV 82 and pages 14 and 15, paragraph 16

The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. PAC report page 5, paragraph 2.

Note that £20 billion was quoted by Lord Warner in an interview with the Financial Times on Tuesday 30 May 2006, although the £20 billion figure was later qualified. Connecting for Health has separately acknowledged that costs could rise to £15 billion.

The Department of Health has paid at least £639 million in advance payments to suppliers despite its supposed approach of payment only on successful delivery. PAC report page 14, paragraph 15.

6. CONCERN OVER ISOFT

The company is now under investigation by the Financial Services Authority, while its former directors and former auditors are under investigation by the Financial Reporting Council’s disciplinary body, the Accountancy Investigation and Discipline Board. Although iSOFT has received loan support from its banks, there is a continuing risk to the National Programme if it is overly dependent on the future stability of a small number of suppliers. PAC report page 15, paragraph 18

We are concerned in particular that iSOFT’s flagship software product, ‘Lorenzo’–on which three fifths of the Programme depends–is not yet available despite statements by the company in its 2005 Annual report that the product was available from early 2004. PAC report page 6, paragraph 8.

At the time of our hearing in June 2006, some 13 acute Trusts had had their Patient Administration System (PAS) replaced, which itself provides no care record functionality beyond what they already had. In those regions where iSOFT is the main software supplier, the replacement has been an old iSOFT PAS which pre-dates the Programme because the PAS element of the new system, Lorenzo–which is being developed for the Programme and which the company stated was available from early 2004 — is not yet available. PAC report page 13, paragraph 10.

Also iSoft Group PLC 2005 Annual Report and Accounts, page 6 paragraph 2 where it states that the Lorenzo software system was “available from early 2004”

There are five regional clusters each with a main regional contractor or ‘Local Services Provider’. iSoft is the main software supplier for three of the five main clusters. See below for the five clusters and their main suppliers:

REGIONAL CLUSTER LOCAL SERVICE PROVIDER MAIN SOFTWARE SUPPLIER

North West &

West Midlands CSC iSOFT

North East

CSC (previously Accenture) iSOFT

Eastern

CSC (previously Accenture) iSOFT

London BT Cerner (previously IDX)

Southern

Fujitsu Cerner (previously IDX)

7. CALL FOR INDEPENDENT ASSESSMENT OF BUSINESS CASE

The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date. PAC report page 5, paragraph 3

8. URGENT REVIEW OF CONTRACTORS’ PERFORMANCE AGAINST CONTRACTUAL OBLIGATIONS

In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations. PAC report page 5, paragraph 4.

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