NPfIT Lorenzo - is the cost per user frightening?

MP Richard Bacon, a member of the Public Accounts Committee, is, any day now, expecting answers to his Parliamentary questions on the number of Lorenzo users at five “early” adopter trusts.

He asked for the number of users at these trusts: Five Boroughs Partnership, Bradford Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay, Hereford Hospitals and South Birmingham.

The cost per user may be high, Bacon warned the House of Commons during a debate on the work of the Public Accounts Committee last week.

Lorenzo is supplied by services company CSC in England [north of Oxford], and by iSoft directly in the south. 

Bacon told MPs:

“I tabled a question yesterday about the number of hospital trustswhere Lorenzo has been partially deployed, asking how many users – howmany concurrent users – of Lorenzo there are.

“I look forward to the answer, but the Exchequer Secretary will notneed to consult the written answer that has not yet been written toknow that the answer is not very many. It is literally just a handful,which means that the cost per user is not what one would expect.

“Deploying a software system in an acute hospital with 3,000 to 4,000workers, one might expect that the cost per user would be a few hundredpounds per user per year”. But the cost could be hundreds of thousands ofpounds per user said Bacon. [He may not be wrong when a small portion of the central costsassociated with the Care Records Service are taken into account].

He continued: “How is that consistent with …the Treasury saying thatit does not accept that the programme fails to provide value formoney?”

He said it is not just that Lorenzo that is not working. “The othersystem produced by the other main company involved – the CernerMillennium system – has also caused absolute havoc where it has beendeployed”.

Bacon’s questions on Lorenzo users:

“To ask the Secretary of State for Health, what his latest estimateis of the number of users of the Lorenzo software system at (a) FiveBoroughs Partnership NHS Trust, (b) Bradford Teaching Hospitals NHSFoundation Trust, (c) University Hospitals of Morecambe Bay NHS Trust,(d) Hereford Hospitals Trust and (e) South Birmingham Primary CareTrust.

“Mr Richard Bacon: To ask the Secretary of State forHealth, what his latest estimate is of the highest number of liveconcurrent users of the Lorenzo software system across English NHStrusts (a) at any one time and (b) on any one day.


NHS Connecting for Health (a name which is slowly going out of fashion] and the Department of Health are right to go slowly and carefully with Lorenzo.

But slow and cautious is one thing. Implementing the system with a tiny number of users just to show ministers that the NPfIT is working is the sort of thing politicians enjoy – more misshapen statistics – and a waste of time and money for the NHS which has more important things to do and, arguably, better IT to spend its money on.


NPfIT executives will stand by Lorenzo – IT Projects Blog

Three more early-adopters for Lorenzo – E-Health Insider

“Alert” over NPfIT Lorenzo – IT Projects blog

House of Commons debate on the work of the Public Accounts Committee – Commons

iSoft and Lorenzo – the good news keeps on coming? – IT Projects Blog

BT, FOSS and the national programme – Fox on software

iSoft forecasts 10% growth – TechMarketView

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What is really worrying me is the desire to introduce Lorenzo Regional Care as the SSEPR (Single Shared Electronic Patient Record) across the whole local health economy: hospital(s), community, mental health etc - *and including general practice*.

If you look at the requirements, they differ fundamentally.

General practice EPRs (the only sort really in existence!) are cradle-to-grave records, used for everyday management of multiple problems in the same patient.

Changes over time are inevitable - and needed.

Other records - especially acute trust records - deal with single episodes of care, and need to be immutable.

Take medication - a very dangerous area for patients if not well managed.

The hospital record will show what was administered in the hospital as part of the immutable record: the GP record will have a combination of repeat prescriptions - which will change over time - and acute prescriptions such as antibiotics which are a course of medication - and need to be removed from view if the record is to be usable.

Just look at the RCGP report (SRPG Shared Record Professional Guidance )for an idea of the problems.

How is the problem tackled in Lorenzo?

Is it capable conceptually of handling cradle-to-grave records - which could need to last over a hundred years and be used, all that time, for the care of one individual?

You have a point Mary: has the SSEPR been thought through?

It seems not. As you point out the GP record is one thing, the hospital record another.

Could you ever combine them without losing important information, and if you did combine them, would'nt you be giving the hospital doctor much more than he/she needs to know or would have the time to discover? Some hospital patient records run to more than 100 pages.

Take a high-level view of the NPfIT - the hopes, the output-based specifications and the objectives - and it all seems such a good idea.

Consider, though, some of the detail - which hasn't been worked out even today, seven years on, and you get the feeling that some trusts are implementing NPfIT systems as some Chinese parents had the feet of their female children painfully bound: because it was the fashion.

The good news, perhaps, is that Labour, in the run-up to an election, may want to take actions which put the NPfIT on a proper course - rather than leave as a legacy an NHS IT disaster which the Tories can claim credit for turning around.