NHS wrestles with erratic demand for IT

A confidential paper has revealed that the level of demand for BT's services under the national programme for IT may be different...

A confidential paper has revealed that the level of demand for BT's services under the national programme for IT may be different from what has been anticipated

The Department of Health is in danger of not meeting commitments made to BT under its £996m contract to modernise healthcare in London, a confidential paper has revealed.

The document highlights the successful work achieved so far and the problems faced by the Department of Health and BT in timetabling the roll-out of new IT-based services to clinicians.

The paper sets out BT's obligations under a 10-year contract as local service provider for London to help modernise the capital's health services under the government's national programme for IT in the NHS.

The programme has five local service providers and two national systems providers across England, with BT having the largest share of the contracts.

One of BT's first obligations after winning the London local service provider contract in December 2003 was to set out its plans for modernising the capital's health services.

It conducted a survey of trusts to assess their state of readiness for new systems and what they would require from the company. The results were compiled in a BT paper, London LSP Project - Detailed Implementation Plan, which is marked "confidential and commercially sensitive".

Among its disclosures is the existence only five months into the deal of "material contractual issues". These were detailed in Computer Weekly last week.

The paper also revealed that far fewer hospital trusts and general practices in London have ordered new systems in the first year of the deal than the contract envisaged.

The NHS/BT contract provides a number of remedies if trusts and general practices order fewer products and services from BT than the deal specifies. These specific remedies do not apply to the first year of the contract.

However, the BT paper gives an early indication of the difficulties that will be faced by the health service as it seeks to meet its commitment to local service providers. The documents show that compliance with the contracts is in many ways at least as onerous for the NHS as it is for the contractor. This is because the Department of Health has made contractual commitments on behalf of trusts, but is not always in a position to force them to comply. On the other hand, BT, as a private company, has control over its own share of obligations in the contract.

An especially challenging commitment for the Department of Health is an undertaking to, in effect, pay contractors for systems that are not necessarily needed if the amount of business falls below predefined levels.

The BT paper referred to "bundles" which the health service described as "units of services" which are bought from suppliers to support NHS staff. Core bundles will support the recording of clinical notes and the generation of clinical correspondence.

BT's paper said, "Analysis of the information currently provided from the trusts indicates that the nature of demand for bundles is different from that set out in the agreement between the contractor and the authority."

It added that demand from trusts for phase one, release one, of BT's services is "considerably lower than anticipated during the bid phase" which was 19 bundles requested against 86 anticipated.

The paper lists the demand for a Care Records Service portal, a service that will allow trusts to link into a national data spine of medical records and the electronic booking of hospital appointments.

As from 31 March 2004, the demand for access to the Care Records Service portal in the first year of BT's contract was only seven against 73 specified when the deal was signed. Demand for an early electronic patient record was one against 14 in the contract.

These figures will have changed by now, as Department of Health officials seek to increase demand in the first year. However, the national programme declined Computer Weekly's invitation to update the figures.

The consequences of a failure by the NHS to meet a minimum value of services which the government is obliged to buy in any particular year is set out in the contracts of the local service providers.

It said that if the health service does not take up the required level of core bundles, it must purchase other bundles or services "to a value sufficient to bring the cumulative spend to the minimum committed value". If the NHS fails to so, it is "obliged to pay the minimum commitment regardless".

The BT paper disclosed that demand for bundles in the financial year 2005/06, in which the systems on offer promise much greater functionality than in the initial release, is "considerably above that anticipated in the agreement".

It added, "A total of 141 bundles have been requested versus 50 in the agreement. Clearly this level of demand is undeliverable without a massive, and perhaps unsustainable, spike in activity and resource input by both the authority [the health service] and the contractor [BT]."

The paper said work is continuing to prioritise excess work in the second year, but IT executives in trusts fear this could leave BT unable to meet the demand in some hospitals for new systems.

The difficulty for some trusts is that there is already an urgent need to replace old systems, which, in the case of pathology equipment, may be in danger of not meeting safety standards. However, the local service provider may have its hands full delivering systems as part of the national programme.

Despite the contractual and other challenges, officials on the national programme are confident it will be a success.

A spokesperson for the national programme, when asked whether demand from trusts for new systems should have been ascertained before contracts were signed with local service providers, said the information in the BT paper was "well out of date".

The spokesperson added, "There have been tens of iterations in the London cluster and further iteration is ongoing. When the final drafts are concluded, a summary will be published.

"A key underpinning principle of the programme is not to accept technologies until they have been fully implemented and positive benefits have been achieved for the NHS. The contractual terms and minimum volume commitment fully supports this principle."

Tim Smart, chief executive of BT Syntegra, the local service provider for London, said the paper was an internal document which was circulated widely across stakeholders. "It seeks feedback and represents work in progress," he said.

He added, "There are more than 7,000 detailed requirements in the contract we agreed with the national programme for our work in London... and yet, as the programme advances, issues are identified, discussed, clarified and resolved in agreement with our customer. This was anticipated and is how it works in any complex programme." He underlined BT's commitment to making the London project a success.

Implementation of systems under the  national plan for IT       

Dependency

Current 

Impact

Complete W3 domain scoping report (EBS, PDS, LRS)  Complete EBS/LRS still outstanding We have made further assumptions and if they are wrong, there may be further delays to the programme
Complete W5 detailed communication    Complete EBS still outstanding     
Complete NASP interface requirements    V5 received 19/3 but still missing detail
Complete HL7 message definition specifications Several drafts received with considerable changes; areas of PDS, EBS late Design proceeding on assumptions       
Interim GP solution deployment strategy not complete with respect to data migration    Need closure with the authority on requirements for data migration and to ensure that can completed in timescales If we do not identify the migration needs and receive the migration plan, it will be difficult to meet the interim GP deployment plan


Source: London LSP Project - Detailed Implementation Plan

EBS - electronic booking service, the first service to go live
PDS - personal demographic service (required for data spine information)
NASP - national application service provider for the national programme for IT in the NHS
HL7 - messaging standard

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