Some NPfIT “major issues” - did the PM get a full briefing in 2007?

Some of the major NPfIT issues identified by Helen Bellairs, Chief Executive, Western Cheshire Primary Care Trust, seem at odds with a briefing paper to the prime minister in February 2007

Helen Bellairs is a local senior responsible owner of the National Programme for IT [NPfIT] in the NHS. Under NLOP, the NPfIT Local Ownership Programme, all chief executives of primary care trusts in England have been appointed senior responsible owners. It means they may be held accountable for failures and realising any benefits of NLOP and the NPfIT.

In a briefing paper to the North West Strategic Health Authority NPfIT board, Helen Bellairs outlined what has been achieved locally; and she identified six “major issues” with the NPfIT. Some of the issues have a general significance to the national programme.

The paper referred to the “Lorenzo” product supplied by iSoft – now owned by Australian company IBA health – and CSC, the NPfIT local service provider for the North, Midlands and East of England. Lorenzo is a strategic NPfIT software product, another being Cerner’s Millennium system for London and the South of England.

The seriousness of the issues listed by Bellairs indicate that a presentation by the Department of Health and NHS Connecting for Health to the then prime minister Tony Blair on the NPfIT in February 2007 might have over-optimistic.

The supposedly confidential presentation to Tony Blair – which was entitled “NPfIT Programme Stocktake – Briefing for the Prime Minister 19 February 2007” – blamed poor perceptions of the programme not on delays in the delivery of software or cumbersome Choose and Book systems but on “attitudes”. And the presentation included suppliers in its criticisms.

The briefing paper to the PM said:

“Significant progress has been made…. in applying technological solutions to many of our problems in areas such as infrastructure, digital image processing, Choose and Book and Electronic Prescriptions but challenges remain. The areas for focus for the future are the behaviours and attitudes of NHS staff, patients, suppliers and commentators. .. the key challenges and risks to delivery are now not about the technology to support NPfIT but about attitudes and behaviours which need to be the focus of senior management and ministerial attention as we move forward ….much of the programme is complete with software delivered to time and to budget.”

The major issues identified by Bellairs are listed below, followed by CSC‘s responses. Fujitsu declined to comment on the reference to its NPfIT Natiional Service Desk.

Six of the major issues with the NPfIT as listed in the paper prepared by Bellairs:

– “The continuing delays in the availability of the Lorenzo system, which undermine the credibility of the whole of National Programme for Information Technology. In the meantime, existing suppliers continue to develop their products, which make it even harder to persuade Trusts to move onto Lorenzo.

– “A lack of confidence in how strategic instances are going to work in practice. It is very hard to see how a large database across the whole of Cheshire and Merseyside will work when all hospitals and community settings are on it. This needs to be addressed through strong governance and general interaction between the Local Health Communities.

– “The lack of confidence created by repeated undelivered promises. An example of this would be the recent failed upgrade in Morecambe Bay.

– “The lack of a clear strategy in relation to the sharing of clinical data in relation to i) meeting organisational requirements ii) information governance issues and iii) the technical infrastructure to support it.

– “There is widespread dissatisfaction at the local level with the performance of the National Service Desk (Fujitsu). Despite escalation of these issues, no discernible improvements have been identified. This issue has been addressed to some extent by the formation of the shared Cheshire and Merseyside Service Desk, but this would not have been required if the National Service Desk delivered what they promised.

– “The lack of clinical functionality in the current patient administration system from CSC means that clinicians are disengaging from the programme and looking elsewhere for clinical solutions.

CSC’s responses are below. NHS Connecting for Health, which runs part of the national programme, declined to add to CSC’s comments.

Issue – continuing delays in the availability of the Lorenzo system undermining the credibility of the whole of the NPfIT. Existing suppliers continue to develop their products, which makes it harder to persuade Trusts to move onto Lorenzo.

CSC’s response:

“The Lorenzo development is continuing on plan and we are in the final stages of agreeing the roll-out of this new platform with the first release being available in 2008. The new Lorenzo platform is being delivered in four releases which offers greater flexibility and earlier access to clinical functionality. NHS Connecting for Health have visited the development centre in Chennai and remain pleased with progress. The first release will be deployed to a set of early adopters who have been working with CSC since earlier 2007. These are the local health communities of South Birmingham, Morecambe Bay and Bradford & Airedale. We have been actively demonstrating Lorenzo to clinicians and managers across our regions and have received extremely positive feedback.”

Issue – a lack of confidence in how strategic instances are going to work in practice

CSC’s response:

“Strategic Instances” are simply a shorthand name for multi-organisation instances of our current patient administration system, which we have been running successfully since September 2005. Lorenzo has been architected from the ground up to operate on a regional scale in a multi-organisation environment and will over time replace the existing systems. The need to deliver better healthcare based on multiple agencies is at the heart of the design of Lorenzo.”

Issue – a lack of confidence created by repeated undelivered promises, an example of this would be the recent failed upgrade in Morecambe Bay.

CSC’s response:

“Morecambe Bay is one of our early adopters and this shows confidence in our delivery model. The issues found with the recent upgrade were not related to the product but issues that came to light when in a live production environment where one would expect issues to arise and where problems could be resolved.”

Issue – a lack of clinical functionality in the current Patient Administration System from CSC which means that some clinicians are disengaging from the programme and looking elsewhere for clinical solutions.

CSC’s response:

“The current CSC Patient Administration System is an administrative system and has limited clinical functionality. The first release of Lorenzo next year, will provide clinical functionality.

“We have demonstrated Lorenzo to clinicians both within central Connecting for Health and to many hundreds of clinicians at events throughout our geography. There is a general excitement about the delivery of Lorenzo and the richer clinical functionality that it contains particularly as this will be delivered within the earlier releases.

“The early adopters have an opportunity to influence the development and configuration of the application prior to go live, CSC with its alliance partners have always understood that the delivery of the NHS Care records Service was as much about transforming and improving working practices as about installing systems.

“By working with the early adopters to understand how the IT can support the NHS’s strategic objectives we believe we offer a unique approach which embraces the change management and technological needs of the NHS.”


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