Will minister's NPfIT cuts put future of Lorenzo in doubt?

An IT director at a hospitals trust has questioned the “efficacy” of the NPfIT Lorenzo Regional Care product in the light of ministerial cuts.

The iSoft Lorenzo software is due to be installed by services supplier CSC at hundreds of NHS sites across England – outside of London and the south. Lorenzo is CSC’s main software product under its NPfIT contracts which are worth about £3bn.

But Duncan Robinson, the Associate Director of IT at South Warwickshire General Hospitals NHS Trust, says:

“Statements made during the last quarter by the Health Minister aroundthe need to save £600m from NPfIT have resulted in a number of thefunctional modules planned for the later releases of the LorenzoRegional Care product being removed.

“The original Lorenzo model contained five major release phases.However certain functionality from releases 3 and 4 has now either beenbrought forward or has been axed altogether, bringing the efficacy ofthe product as a whole into question.”

Robinson’s comments may increase Tory anger over plans by the Health Secretary Andy Burnham to sew up new NPfIT deals with CSC and BT by the end of March – weeks before the general election.

Thenew deals would commit CSC to delivering a cut-down version of Lorenzo- even though there are deepening doubts that parts of the NHS would want, orinstall, it.

Some officials want NHS trusts to withdraw from LSP go-lives of Lorenzo and Cerner

The irony of Robinson’s doubts about Lorenzo is that some officials want NHS trusts to withdraw from installing CSC’sLorenzo – and the NPfIT Cerner Millennium Care Records Service, as dueto be installed in London and parts of the south of England by BT.

Thegreater the number of trusts that withdraw from the local service providerinstallations of Lorenzo and Cerner,  the easier it will be for theDepartment of Health to make £600m worth of savings on the NPfIT.

To achieve the cuts, some officials are willing toremove 50% of the planned functionality of Lorenzo and Cerner – butthey also want to reduce the number of planned installations at NHSsites by half.

In London, half of the potential NPfIT sites are expected to drop out of taking the BT-supplied Cerner system.

On the planned cuts, I said in the BBC R4 File on 4 broadcast this week:

“[TheDepartment of Health is] hoping to convince the suppliers to the twomain suppliers to the national programme for IT that they should reducethe cost of the contracts, but from the supplier’s point of view whywould they do that? 

“Now the only reason they would do thatis if you take out of the contracts quite a lot of what we callfunctionality features of the systems that need to be delivered and inreturn, they’ll drop the price of the contract.  Myunderstanding is that a deal is likely to be reached in the next fewweeks but only by taking quite a lot out of the contract.”

BBC presenter: 600 million pounds worth?

Me:  Around a few hundred millions pounds out of the contract.

BBC: And what about the commitments of the suppliers? Would they be reduced by the same amount?

Me:My understanding is that the suppliers will get a a better deal out ofit because they could find over a billion pounds coming out of thecontract in terms of their commitment in order to reduce it by a fewhundreds of millions.

BBC: So they would take out one billion pounds of commitments but take only a few hundreds of millions out of the [overall] cost?

Me:My understanding is that for every £1 that they agree to reduce thecost of the contract, £2 will come out, roughly speaking, in terms oftheir commitment.

BBC: So they [the suppliers] are going to be quids in?

Me: They’ll be very happy [with a contract refresh].

[A podcast of the File on 4 broadcast is here]


Penalising NHS trusts that opt out of the NPfIT 
Tofurther complicate matters, strategic health authorities arethreatening to penalise NHS trusts that don’t take NPfIT preferredproducts as interim solutions.

Robinson told his trust that the maternity functionality of Lorenzo “has been identified as beingde-scoped”, which means that trusts will need to “procure their ownmaternity information systems once their existing systems have reachedtheir end of life”.

South Warwickshire has decided not to take an interim NPfIT maternitysystem. But its Strategic Health Authority [SHA] has “indicated thatthere may be penalties from this stance”.

Robinson adds thatnegotiations are continuing with the SHA to reach a mutually-acceptablesolution.

One reason that SHAs are threatening to penalise trusts that opt out of NPfIT systemsis that the government faces a contractual obligation to pay compensation toCSC or BT if the NHS fails to spend a minimum amount with the suppliers.

A CSC spokeswoman said: “No decisions have yet been madeabout changes to future releases of Lorenzo as a number of options arecurrently being discussed with the local NHS.”


NPfIT executives will stand by Lorenzo  – IT Projects Blog

Bury PCT goes live with iSoft’s Lorenzo Regional Care – BJHC

NPfIT Lorenzo pioneers at NHS Bury – grappling with issues – IT Projects Blog

Lorenzo will stop at Release 2 – E-Health Insider

iSoft was not willing to give up Lorenzo rights in talks with CSC – IT Projects Blog

Unhealthy diagnosis for NHS IT – Canadian EMR