The crucial questions after Accenture quits

Doctors and IT experts query key elements of NHS programme

The decision by Accenture to walk away from its original £2bn contracts to deliver IT systems to the health service in the North East and East of England has raised important questions about the NHS National Programme for IT (NPfIT).

Accenture's work will be taken over by CSC, which already has a £973m contract to deliver systems in the North West and West Midlands.

Accenture will continue to supply profitable x-ray picture archiving and communications systems, which were added as a core NPfIT service in September 2004.

Health minister Lord Warner said there would be "no significant delays" as a result of Accenture's decision, adding that it was "nonsense" to suggest that Accenture's move was a major blow to the project.

However, questions being raised by health practitioners, IT professionals and politicians include:

●How will Accenture's withdrawal affect the confidence of doctors and nurses in the programme? The support of clinicians is vital if they are to make good use of new systems.

● Does the NPfIT have an architecture that is likely to work? Core medical records systems have been delayed by at least two years and an outage at CSC's datacentre, which brought down services to dozens of trusts, has raised questions about the resilience of the specifications.

● What assurance is there that the standalone systems being installed as interim solutions will share key clinical information? This was one of the principal reasons for launching the national programme.

Ministers are also likely to face questions about how CSC could be awarded a contract worth nearly £2bn without a specific open competitive tender, and about the terms under which Accenture has withdrawn.

The ability to rapidly replace Accenture with CSC is likely to reduce delays caused by the contract switch. But CSC's new deal is worth about £2bn - the price of the contracts signed with Accenture nearly three years ago, and Accenture has since made thousands of deployments.

CSC's European president Guy Hains last week expressed confidence about his firm's ability to deliver in three of the five NHS cluster areas in England. Yet few acute hospitals have gone live with CSC's early releases of patient administration systems.

Accenture has absorbed heavy losses, and it has only had to repay the NHS £63m in full and final settlement of its legal obligations under the contract. This is a long way short of the damages Whitehall executives could in theory demand from suppliers for an early exit. Without a settlement, the government faced a long legal dispute with the supplier and, possibly, enforced disclosures about the programme.

Questions about Accenture's withdrawal are fuelling demands for the government to publish the reviews it has commissioned into the NPfIT. There have also been renewed calls for an independent review of the project.

Tom Brooks of the Parliamentary IT Committee said the withdrawal made an independent review of the NPfIT more important.

"Accenture's withdrawal could produce a challenge for chief executives of trusts in the North East and Eastern clusters. If they consult with their lawyers, they are likely to be told they are under no obligation to hold to any promises made to take a service from Accenture."

Steve Webb, Liberal Democrats shadow secretary for health, said, "This suggests that Accenture may have spotted something coming down the track. There is so much political credibility resting on this project that I wonder whether, even if the programme is going off the rails, the government will simply continue to pour money into it."

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