Contract problems hit £1bn London NHS plan

BT document reveals that milestones have been "adversely affected"

BT document reveals that milestones have been "adversely affected".

BT's £1bn contract to build and operate NHS IT systems in London has run into contractual issues only five months after the deal was signed.

A leaked BT document marked "confidential and commercially sensitive" that has been widely circulated to NHS executives in London, gives an insight into the strengths and weaknesses of one of the UK's most ambitious computerisation programmes.

It sets out plans by BT for rolling out new systems to the hospitals and GP practices in the capital, as part of the government's IT-based modernisation programme for the NHS.

BT's implementation plan reveals that there are "a number of material contractual issues" over the "detailed definition of requirements and practical deployment not envisaged at the Effective Date of the Agreement".

It highlights a series of gaps in specifications and uncertainties which some IT specialists say could jeopardise the successful take-up of new systems. For example, the paper says there are "numerous issues to be resolved" in the area of legacy systems some of which will need to be integrated into the national projects.

The paper, which went through six drafts before it was issued last month, reported that system designs have proceeded on the basis of assumptions, and that some specifications and products not due to be supplied by BT have been late or outstanding. It referred to "inconsistencies within contract schedules," and ambiguity and uncertainty in requirements.

One conclusion of the report is that there have been "delays in requirements definition and solution design" which have "adversely affected the interim milestones".

BT said in the report that if its assumptions are proved wrong it may lead to "further delays in the programme". In explaining the position on key dates, it said that requirements workshops had occurred later than planned.

The Department of Health and BT are working to ensure that key milestones are met and the document states that significant progress has been made towards some programme goals. It emphasises BT's aim of moving forward with its plans for London, "without prejudice to each party's position with respect to the unresolved contractual issues".

The overwhelming majority of NHS IT specialists support the aims of the national programme, which involves up to 10,000 people working on software development. The Department of Health hopes that teething problems and initial criticism of the programme will be countered by success with early adopter sites.

A spokesman for the national programme questioned whether Computer Weekly should publish details of the paper, saying it was an "out-of-date draft of a document that is work in progress". However, senior London NHS IT staff have told not allow ourselves to be diverted from the very important work we are undertaking and our commitment to make it a success."

The national programme's spokesman said, "The national programme is confident that it has robust contracts in place for the effective delivery of systems and services that will support improvements in patient care.

"It is not surprising when managing a major programme that there will be issues to discuss. It was always anticipated that the drafting of implementation documentation would raise issues that would need debating and resolving. The national programme continues to be on track to deliver benefits for the NHS, clinicians and patients alike."

However, MP Richard Bacon, who sits on the Commons Public Accounts Committee, criticised the rush to sign contracts. "The evidence suggests that the time spent in preparation is rarely wasted," he said.

He feared that the desire to sign contracts quickly was "possibly at the expense of getting things right to start with". Computer Weekly it is the latest version distributed to them.

Tim Smart, chief executive of BT Syntegra, which is responsible for the London contract, did not seek to downplay the importance of the paper.

He said, "Although an internal document, this plan was developed in conjunction with the London Care Communities and it has been circulated widely across all our stakeholders in London. It seeks feedback and represents work in progress."

As the programme advances, issues are identified, discussed, clarified and resolved in agreement with the customer, said Smart. "This project is so important for the people of London that it is bound to attract interest, sometimes criticism but also suggestions and encouragement. We take note of everything but cannot allow ourselves to be diverted from the very important work we are undertaking and our commitment to make it a success."

The national programme's spokesman said, "The national programme is confident that it has robust contracts in place for the effective delivery of systems and services that will support improvements in patient care.

"It is not surprising when managing a major programme that there will be issues to discuss. It was always anticipated that the drafting of implementation documentation would raise issues that would need debating and resolving. The national programme continues to be on track to deliver benefits for the NHS, clinicians and patients alike."

However, MP Richard Bacon, who sits on the Commons Public Accounts Committee, criticised the rush to sign contracts. "The evidence suggests that the time spent in preparation is rarely wasted," he said.

He feared that the desire to sign contracts quickly was "possibly at the expense of getting things right to start with".

BT's part in the NHS programme     

BT is the main supplier to the national programme with contracts worth more than £2bn. As a local service provider, it has produced a detailed implementation plan of the new systems and when they can be expected.  

The plans provide for a web-based gateway, based on a BEA Weblogic portal environment running on clustered Sun hardware. This will help book hospital appointments electronically and will provide access to a central database of up to 50 million medical records. 

One of BT's main systems is based on an innovative US-based product, Carecast, which will need to be adapted to the UK market, instead of Last Word which has an established user base in London.

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