In an interview before he announced he was leaving his job as Director General of NHS IT, Richard Granger is reported to have criticised some early installations of software from Cerner, a US-based health software supplier.
In CIO Magazine Richard Granger referred to Cerner whose “Millennium” software is scheduled to be deployed by NHS trusts across Southern England and in London as part of the £12.4bn National Programme for IT [NPfIT].
Fujitsu, the local service provider to the NHS in Southern England, has chosen Cerner as its main software subcontractor.
Richard Granger was quoted as saying:
“Sometimes we put stuff in that I’m just ashamed of. Some of the stuff that Cerner has put in recently is appalling. It really isn’t usable because they have been building a system with Fujitsu without listening to what the end users want. They have taken some account but they then had to take a lot more. Now they’re being held to account because that’s my job.”
We asked for a comment from NHS Connecting for Health, whose chief executive is Richard Granger. We put it to CfH that a number of hospital trusts were preparing to implement to Cerner’s systems and were already, before Richard Granger’s reported comments, concerned about the risks of failure and the uncertainties over how well Cerner’s Millenium product could be adapted for widespread use in the UK. We asked whether such concerns may be deepened by the reported comments about Cerner.
An official at NHS Connecting for Health did not play down Richard Granger’s remarks.
He said that NHS Connecting for Health expects high standards of performance and delivery from all its suppliers.
The spokesperson added that Richard Granger had expressed his views on a small number of sites where difficulties have been experienced with Cerner Millennium.
“As in any situation where standards and service delivery experience difficulty NHS Connecting for Health is committed to work through those with the supplier concerned. Our ultimate objective is to continue delivering the best patient benefits for a modern NHS.”
Cerner declined to comment. But Fujitsu’s response was enlightening.
Peter Hutchinson, Managing Director, Public Sector, Fujitsu Services, appeared to sympathise with NHS trusts that did not like standardised systems. He said:
“What we are finding is that standardised solutions are disliked in some parts of the NHS. Fujitsu Services is working closely with the NHS to adopt a more flexible approach to local requirements.”
The phrase “ruthless standardisation” has been the motif of the NPfIT since the early days of the scheme.
One of the documents that set the NPfIT in motion was 21st Century Support for the NHS, a document published by the Department of Health in early 2002.
It mentioned three times the need for “ruthless standardisation”.
“We will improve the leadership and direction given to IT, and combine it with national and local implementation that are based on ruthless standardisation.”
It was this command that left some trust IT directors and local NPfIT programme managers with the task of explaining to their boards the quest for ruthless standardisation. One trust board paper in January 2004 on the NHS’s Care Records Service – a plan to give 50 million patients in England an online medical record – said:
“The effective deployment of NHS Care Records Service in particular will rely on ruthless standardisation across each Cluster. There are 156 Trusts within the Southern Cluster and it would be impossible for the Local Service Provider to implement the new systems if all Trusts were implementing them differently.”
Now it’s all change, it seems. Ruthless standardisation is to be replaced with “standardisation where possible”. It’s a practical way forward. Some trusts are installing NPfIT patient administration systems that may at some point exchange files with other local NPfIT patient administration systems – but not, perhaps, with other patient administration systems further afield.
Some observers of the national programme have said all along that a one-size-fits-all approach would never work, that every trust was different, and that some were of the size and complexity of large businesses, and they would not take kindly to uniform technologies being foisted on them.
But where does this apparent departure from ruthless standardisation leave the National Programme for IT? It was founded in part on the Henry Ford principle of “any colour as long as it’s black”.
It could be argued that the departure from the conveyor-belt approach is another sign that the NPfIT is to some extent facing a future that’s distinctly indistinct. For standardisation-where-possible, without large funds to support the principle, was one the guiding torches of NHS IT before the advent of the NPfIT.