Will the Government overturn an original NPfIT objective?

The Health Secretary Andrew Lansley has hinted today that he’d prefer a “plurality of information providers” which, if applied to the NPfIT, would indicate a fundamental shift away from the two local service providers BT and CSC.

Between them CSC and BT have LSP contracts worth about £4bn to supply hospital systems to NHS trusts across England, though not throughout the south where work that had been done by the now-departed Fujitsu has been taken up only partially by BT.

When in opposition the Conservatives said they would re-negotiate the LSP contracts.

In a speech today, Lansley – who  in opposition was an informed critic of the NPfIT –  said the government favoured  “action to empower patients through access to information, from a plurality of information providers, with the ability to hold their own patient records, to interact more readily with their clinicians”.

Lansley also said: “As patients, there should be no decision about us,without us”. This could be taken by some GPs as a sign that thegovernment will consider an “opt-in” model for summary care records

Lansleyfurther said he will “disempower the hierarchy, the bureaucracy, thePrimary Care Trusts and the Strategic Health Authorities”.

It is thePCTs that are largely responsible for the roll-out of summary carerecords, and SHAs have a big responsibility for roll-outs of the CareRecords Service that are based on Cerner Millennium and iSoft’s Lorenzosoftware.

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If Lansley opts for a plurality of ITsuppliers to NHS trusts this would overturn an original objective of theNPfIT. The original objectives were outlined in a speech to HealthcareComputing 2002 by the first senior responsible owner of the NationalProgramme for IT, Sir John Pattison.

He told HC 2002 that one aimwould be to set standards, then give the NHS a choice of betweenonly one and five accredited systems.  This objective was clarified in July2002 when the Department of Health published  “Delivering 21st CenturyIT” which set out plans for the NPfIT procurement strategy.

Itsaid:

“A small number of Prime Service Providers who can work… as integration and implementation partners will be procurednationally.”

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Those at the Department of Health who havewritten briefings for ministers on why the NPfIT is a success, contraryto media speculation, would do well to note what was said in theoriginal DH NPfIT documents, which were published in 2002.

Beloware some of the DH messages in the department’s 2002 “21st Century IT” documents that have proved to be hopelessly optimistic – in other wordswrong. The series of DH documents  “21st Century IT” were published tolaunch the NPfIT.

This is some of what they said:

“We will consider radicaloutsourcing options that add pace and value to the programme” [theoutcome of which was the appointment of local service providers whose main software products, Cerner Millennium and iSoft Lorenzo have been delayed by at least four years]

We will improve the leadership and direction given to IT, and combine it with national and local implementation that are based on ruthless standardisation.” [which hasn’t happened]

Phase 2 – January 2006 – December 2007 (Tentative scope)  –  Full National Health Record Service, with core data and reference links to local EPR systems for full record access”. [There is no full national health record service.]

Phase 2 – January 2006 – December 2007 (Tentative scope) National Bookings Service, all patient appointments, implemented [This has only partially happened.]

Phase 2 – January 2006 – December 2007 (Tentative scope)  National Prescriptions Service, with full clinician and patient functionality, 100% implemented [This hasn’t happened.]

Phase 2 – January 2006 – December 2007 (Tentative scope)  EPR  (compliant with new National standard, XML-based specification) systems implemented in all PCTs, all Hospitals [This hasn’t happened.]

Phase 2 – January 2006 – December 2007 (Tentative scope)  Picture Archiving and Communications Systems for all acute Trusts [This has happened.]

Phase 2 – January 2006 – December 2007 (Tentative scope)· Patient / Citizen Portal available via Internet, Digital TV, wireless devices [Portal established and hardly used.]

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Links:

Lansley’s speech – Department of Health website
 
21st Century IT documents – Department of Health website

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Conservative MP Richard Bacon, wrote in Computer Weekly in 2004, that public scrutiny was the key to future public sector IT project success. He said "Bad projects are like anaerobic bacteria. They cannot survive exposure or oxygen but thrive on secrecy and lack of candour".

Successively, a string of Labour Ministers kept NPfIT detail secret and give assurances, albeit occasionally caveated ones, that success would come, but these promises have simply not been fulfilled. The Ministers included Gordon Brown, John Reid, John Hutton, Lord Warner, Liam Byrne, Andy Burnham, Caroline Flint, Tony Blair, Stephen Timms, Lord Hunt & Ben Bradshaw,

Only Geoff Hoon, when Leader of the House, publically recognised the scale of the NPfIT challenge and made no promise that it could be achieved.

But is Andrew Lansley already withdrawing from the clear, if outspoken, views that he expressed in the House of Commons in December 2009 when he said “Rarely have we seen a more abject example of the Government's incompetence. The Government got it wrong and the Treasury is now belatedly putting a stop to the continuing disaster. Let me ask the Secretary of State some questions. Will he now stop the centralised care record system and allow local procurement of care record systems to national standards?

Now Mr Lansley has the opportunity to stop the waste, to eliminate central subsidising of underperforming NHS IT systems, to require NHS bodies to pay for their IT services directly and hence to show that they receive value for money from their IT spend. But, does he have the degree of sound judgement necessary to do so?

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