Funding delays in London give 'early adopter' sites cold feet

NHS strategic health authorities (SHAs) and trusts in London are reporting concerns about slippage in plans to deploy the core IDX systems to "early adopter" sites.

NHS strategic health authorities (SHAs) and trusts in London are reporting concerns about slippage in plans to deploy the core IDX systems to "early adopter" sites.

The North Central London SHA's board minutes said it was expecting "revised BT Capital Care Alliance deployment dates by end of July". Connecting for Health (CfH) said this had not happened and consultation with trusts and SHAs was currently taking place.

Barts and The London NHS Trust is due to be an early implementer of IDX. Its board meeting in March heard, "Capital Care Alliance, the local service provider for the electronic Care Record Service in inner North East London, had announced a delay in the development of the new computer system, which was due to go live at Barts and The London in autumn 2005."

A spokeswoman for the trust said, "Barts and The London NHS Trust remains on course to be an early implementer of the Care Record Service. In consultation with Connecting for Health and Capital Care Alliance, we are working towards implementing the system in June 2006."

She would not say how the delay had affected the trust's IT support and financing during the interim period.

One London trust has dropped out of the early adopter programme. A spokeswoman for the Royal Marsden NHS Foundation Trust said, "The implementation of the Capital Care Alliance/IDX system has been deferred until later in the trust's IT programme, due to the specialist nature of the trust's needs."

Such is the uncertainty over the delivery and funding of the National Programme for IT (NPfIT) in London that another trust has been reluctant to release local funds to implement it.

In March, St George's Healthcare NHS Trust identified a 1.86m funding shortfall in implementing the NPfIT systems. However, it decided to wait before releasing the funding. Board minutes from the time say, "The cost model [from CfH] for staffing and funding used may be flawed and is unproven. The confidence that the figures are accurate is low. At present no trust has completed the initial implementation so no-one has been able to identify the true costs. The figures and numbers generated are indicative. Moving forward now is effectively signing a blank cheque at a time when the trust is managing a significant financial deficit."

In a statement to Computer Weekly, a trust spokesman said, "We are committed to implementing the national solution. However, we currently face a significant financial problem and we need to carry out a full and thorough analysis of the costs and business benefits of the project before funding can be approved.

"The 1.8m cost of implementing the Carecast package was a projection based on a financial model provided by the NPfIT and we will be looking closely at the experiences of the trailblazer sites to develop a more accurate budget for implementation. In the meantime, we continue to make preparations for delivery of the software."

With no early adopters yet accepting the software, it is not clear when the necessary experiences might be available to the trust. Yet local funding may be critical to the success of the NPfIT. Although the programme has spent 6.2bn on contracts, local trusts and SHAs are still expected to fund some hardware and software, process change management and training.

The issues raised by St George's could be repeated across the country. In May, Anna Walker, chief executive of the Healthcare Commission, highlighted a 500m financial deficit in trusts across the country. In July, research from the Health Service Journal showed a 750m funding shortfall at SHA level in England.

In the context of the budget of the NHS overall and the NPfIT in particular, these might not seem like large amounts, but at trust level they could have a significant impact on the deployment and uptake of national systems.

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