Board minutes of the North East London Strategic Health Authority (SHA), which is building a 200m hospital in Romford, show the complexity of the project and give an insight into the uncertainty around implementing the IT systems to be delivered under the NHS's National Programme for IT (NPfIT) across England.
David Welbourn, chief information officer of North East London SHA, told his board in May, for example, "It has been assumed the [IT system for the new hospital] would be met by the national project."
But it is not clear whether Connecting for Health (CfH), the part of the Department of Health that is implementing NPfIT, will provide the full funding. Nor is it clear whether the new hospital, which will open next year, will have the advanced technology its staff would expect.
The authority's May board minutes discuss the possibility of invoking contingency plans for IT so the hospital can open on time.
North East London SHA is not the only health organisation thrown into uncertainty by delays in the delivery of core systems from the NPfIT's local service providers. CfH has sanctioned the replacement of IDX by Cerner in southern England and warned of short-term delays to rollouts.
Capital Care Alliance, the service provider in London, has admitted there are delays delivering its core IDX product. There are also reports of delays in the other three "clusters" in England.
The replacement of IDX in southern England, and recent warnings to suppliers by CfH leaders, shows that Whitehall officials are holding suppliers to account, and demonstrates the robustness of the contracts signed by the NPfIT.
But it is the trusts and health authorities that will pay the price for any delays. They face more uncertainty and revised or cancelled plans, and increased costs.
David Wiltshire, Head of ICT at North East London SHA, told Computer Weekly about the impact of these delays on the new Romford hospital.
"It is of the utmost importance that Barking, Havering and Redbridge NHS Trust have a workable ICT solution for the new Romford hospital in November 2006. An interim solution has been agreed between Capital Care Alliance and CfH that will provide the necessary clinical functionality for Barking, Havering and Redbridge NHSTrust to open their new hospital on time," he said. Wiltshire added that any interim solution would be part of the national project and funded as such.
The impact of the delays in London is not limited to a single hospital. They have forced North Central London SHA to consider using interim systems. Its board meeting minutes from 14 July said, "To reduce the delays BT Capital Care Alliance has proposed an approach that is being used in other clusters, ie the deployment of interim systems already in use elsewhere in the NHS, which will subsequently be replaced once IDX's Carecast is fully developed.
"There are potentially additional cost implications for trusts in deploying two systems: the interim and later IDX's Carecast."
Computer Weekly understands that the interim systems being put forward are not the core IDX patient administration system, but departmental modules, such as maternity or pathology, that in some trusts require urgent replacement.
Although Richard Granger, director general of NHS IT, has said that the health service will not pay for supplier failure, CfH could not say who would meet the cost of successive upgrades to departmental systems resulting from the delays to IDX in London.
In a statement it said, "NHS Connecting for Health does not intend to pay twice for the cost of upgrading. However, this is the subject of continuing discussions between NHS Connecting for Health and Capital Care Alliance."