New hospital battles to implement care component of health service's IT upgrade

Richard Granger and Robert Naylor have something more in common than senior NHS roles: they are running high-risk IT programmes...

Richard Granger and Robert Naylor have something more in common than senior NHS roles: they are running high-risk IT programmes which could end in renowned success.

Granger is director general of IT for the NHS and senior responsible owner of the world's largest civil IT scheme, the national programme for IT in the NHS (NPfIT).

Naylor is chief executive of University College London Hospitals NHS Foundation Trust, which he hopes will begin a full roll-out next month of a customised version of one of the NPfIT's main products: Carecast, from US-based company IDX.

Naylor's project has run into trouble - it has been delayed four times - but he has control over the implementation team and his trust's contract with IDX: he chairs his trust's project board for the introduction of electronic patient records.

Granger's national programme has also run into delays and he has a large degree of control over the scheme's suppliers and contracts. But over other aspects of the project he has less direct influence: he cannot force doctors and nurses to work differently to make best use of new national systems. Between him and local implementation teams are layers of NHS organisations: the Department of Health, clinical groups, clusters, strategic health authorities, primary care trusts and local hospitals.

In comparison, Naylor's programme, although problematic, seems simple. Strictly speaking UCLH is outside the NPfIT: the trust signed a contract with IDX in September 2003. Months later, the NPfIT agreed a separate contract with local service providers BT and Fujitsu, both of which will help install new national systems, including Carecast, in trusts in London and southern England.

Some trusts are hampered in dealing directly with IDX because the NPfIT's contracts are between the suppliers and the Department of Health. This distance between the suppliers and trusts is of concern to some NHS executives. For example a paper dated 24 February 2005, to the board of the Bristol South and West Primary Care trust, said, "No NHS staff in the southern cluster have been allowed by the NPfIT to see the contracts the NPfIT have signed with FJA [Fujitsu Alliance, the region's local service provider]."

In contrast, Naylor is grateful he can deal directly with IDX. He told Computer Weekly, "The contract we have with IDX is an entirely separate contract from the national programmeÉ Because our contract is directly with IDX we have engaged with the company on a one-to-one basis, whereas the London contract is through BT."

Naylor has another advantage over the chief executives of other trusts: the trust is moving into a new 18-storey hospital in Euston Road, London.

Naylor said, "I think we have a major advantage over the rest of the health service, because for the past five years the clinicians have been expecting a completely new hospital. Therefore, they are all expecting to work differently. So it has not been difficult to get them motivated and thinking about the use of new technology in this new environment."

IDX's proven "Lastword" product was due to go live within UCLH last summer, which would have allowed at least eight months for the product to stabilise before it was introduced into the new hospital. But UCLH decided to buy a newer product from IDX, Carecast, which has led to far more Anglicisation of software than initially expected.

IDX "seriously underestimated the effort needed", according to UCLH. What began as an implementation scheme has turned into a software development project, said UCLH in a board paper last October.

In response, Robert Baker, managing director of IDX Systems UK, said, "Some delays are to be expected in return for the benefits of a new solution."

A risk for Naylor is that Carecast will run into serious problems when the new hospital starts admitting patients. But the risks are mitigated by taking on patients gradually along with a stepped introduction for the system.

Since February a trial of Carecast at the Hospital for Tropical Diseases, the smallest of UCLH's sites, has gone well and Naylor is reasonably confident of success.

But he and his team have confronted many difficulties on a scheme in which they have direct control over the supplier, the contract, the implementation and the change management programme. Their experiences underline the scale of the task for Granger and other trusts in making a success of the much more labyrinthine national programme.

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