Delays and Specification Changes

From Nhs It Info


NHS IT suffering UK-wide delays (27 Apr 2005)


"The first major local system on the timetable is the patient administration system (Pas), but suppliers in all five areas are having trouble meeting schedules. CfH has acknowledged delays in four of the regions, but Computing can reveal that there are also problems in the fifth area, the North West and West Midlands (NWWM). NHS sources say fewer than 300 users in the NWWM area are using Pas systems, out of tens of thousands of potential users. Even at such an early stage this number is significantly below predictions, and is too low to test the scalability and functionality of the new technology."

Annual Audit Letter (2004/2005)

Airedale NHS Trust

"The progress of implementation has been severely limited by national difficulties, particularly delays and shortcomings in delivery of the NPfIT core services by the cluster's LSP. This is beyond the control of the local health community."

Suppliers advised to develop standalone software (26 May 2005)

e-Health Insider

"Connecting for Health (CfH) has confirmed that it is advising its suppliers to develop standalone versions of their applications, not reliant on the NHS Spine, in order to prevent further implementation delays. . . the implementation of the spine, which provides national infrastructure and services such as user authentication, security and data encryption for the Care Records Service, has been experienced serious teething problems and delays. Problems reported at early sites using elements of the spine have included reliability and the basic user log-in and identification process, which takes minutes rather than seconds."

Liverpool trust rejects delayed PACS (17 Nov 2005)

North Mersey Connect Portal

"A leading NHS trust in the North West and West Midlands cluster has been forced to scrap its implementation of a Connecting for Health (CfH) Picture Archiving and Communication System (PACS), due to delays and technical problems with the system."

Leaked e-mails emphasise divide between business goals and technology in NHS plan (22 Nov 2005)

Computer Weekly

"The e-booking part of Choose and Book is considered by the government to be critical to the scheme, and so the software is a key component of the NPfIT. In January 2005, the then health secretary John Reid said e-booking would be fully implemented by 2006, but the scheme is not now due to be fully rolled out until 2007 at the earliest. . ."

The nine projects at the heart of NHS IT (19 Jan 2006),3800010403,39155714-1,00.htm

"Phase one of the [The NHS Care Records Service (CRS)] project, due to be completed in summer 2005, included the booking of outpatient appointments and the ability of health and care professionals to view basic patient information. . . According to the NHS Connecting for Health business plan, the aim was to have 50 per cent of the National Prescription Service in place by the end of 2005. But Connecting for Health told "The target was always going to be a challenging one to meet, especially given its reliance on system supplier and PCT deployment activity." . . . Choose and Book has been subject to long delays - finally coming into service a year later than expected. . . According to the NHS Connecting for Health business plan, the aim was to have 50 per cent of the National Prescription Service is in place by the end of 2005. But Connecting for Health told "The target was always going to be a challenging one to meet, especially given its reliance on system supplier and PCT deployment activity.""

Report to the Board (25 Jan 2006)

West Midlands South Strategic Health Authority

"There will be significant delays to delivery of the strategic Care Record Service solution in the North West / West Midlands Cluster. A delay mitigation plan is being developed which will deliver clinical benefits using existing technology."

NPfIT delays give local NHS trusts a financial planning headache (21 Feb 2006)

Computer Weekly

"Board papers from West Yorkshire Strategic Health Authority reveal how delays to the hospital systems supplied by the programme are making financial planning "extremely uncertain". They specify an allocation for the authority of £6.8m from Connecting for Health (CfH), which runs the programme. Also, £11.4m of the SHA's internal funds were allocated to implement CfH products in financial years 2004/05 and 2005/06. However, delays to the NPfIT mean this funding will need to be stretched over at least one extra year. It was unlikely Leeds Teaching Hospitals Trust would receive suitable systems before the end of 2008, according to board papers. Other hospitals would be in a similar position, they said. "Delays to product delivery have also made forward planning, and therefore any associated financial planning, extremely uncertain... If further funding is not forthcoming then it is possible that the [Leeds] Trust will not be in a position to implement CfH services," said the papers.

NPfIT delays in the south (25 Feb 2006)

Kable Public Sector Research, Publishing & Events

"London and the southern regions of the NHS National Programme for IT (NPfIT) are reviewing the timetable for the infrastructure to support electronic care records. The changed schedule means that the clusters could face a six to eight month delay in implementing parts of the care record."

Implementation schedule slips in South (14 Mar 2006)

e-Health Insider

"The introduction of the NHS Care Records Service in the South of England is set to be delayed following a revamp of the software to introduce new functionality and to address issues identified in the "white knuckle" initial implementation at Nuffield Orthopaedic Centre, Oxford. . . This additional work is understood to address issues around incorporating new clinical codes and the Choose and Book functionality. . . A leading clinician familiar with the issues involved told EHI: 'Whilst I totally support the NPfIT vision, the unrealistic timescales, the lack of local funding, the ongoing problems with delivery, the lack of openess so that lessons can be learnt, the spin and the blame culture are in danger or killing the programme.'"

NHS trust seeks compensation over patient records system delay (21 Mar 2006)

Computer Weekly

"An NHS hospital trust in south west England is seeking compensation for the late delivery of NHS Connecting for Health patient administration systems. United Bristol Healthcare NHS Trust is due to receive the electronic care records service system from Connecting for Health, the government agency running the £6.2bn national programme for IT in the NHS, to replace ageing EDS-supplied systems. Delivery of the Connecting for Health system to hospitals in the region had already been delayed by more than a year before local service provider Fujitsu replaced software supplier IDX with Cerner. A spokeswoman for the trust said it was asking for money from Connecting for Health or its local service provider to pay for the additional support cost from EDS caused by delays.

Summary care record delayed and abridged (25 Apr 2006)

e-Health Insider Primary Care

"The content of the summary record uploaded to the spine will be cut back to include just allergy and prescription information initially, Connecting for Health (CfH) has decided. The decision to significantly abridge the initial content of the record has been made to allay GPs' concerns over the accuracy of their records."

Connecting for Health fails to lead on Contact (26 Apr 2006)

e-Health Insider

"it turns out that CfH is failing to lead by example and continues to run its own Microsoft Exchange email servers. The agency was unable to tell EHI when it plans to fully move to Contact and make savings by switching off local email systems. . . The overwhelming majority of NHS and CfH emails routinely seen by EHI do not carry the tell-tale suffix used by Contact, but instead carry other naming conventions indicating they come from local email systems. CfH failed to identify a single NHS trust that had fully migrated to the web-based system . . . According to CfH there are now 163,000 registered users of Contact, 80,000 of who are described as "frequent users". In a bid to bulk out these registration numbers CfH has announced that all 400,000 members of the Royal College of Nursing working within the NHS, including agency staff, are to be bulk-registered automatically registered on Contact. But while the increased numbers are certain to look good in reports back to ministers, bulk registering staff for a service is very different from getting them to use it."

NPfIT for survival? (May 2006)


"To see the future of the NHS today, go to Salford. There, the care of people with diabetes is being transformed by electronic records shared by doctors, other health workers and patients themselves. . . A breakthrough by the £6 billion National Programme for IT? No. The Salford project is happening in parallel with the National Programme, and is at least a couple of years ahead in making information available where needed. The gap in progress between locally led innovations like Salford's and the slow pace of national projects symbolises a crisis in the world's single civil IT programme as it celebrates its fourth birthday. . . The programme's Head, Richard Granger, Chief Executive of NHS Connecting for Health, says that while enormous progress has been made, the delivery of some crucial systems is behind schedule. . . To try and keep the programme on track, local service providers are deploying a variety of 'interim solutions'. In acute hospitals, the interim solutions are little more than basic patient-administration systems, lacking EPR functions that some hospitals had already installed. Rather than accepting the proposed interim solution, a handful of trusts needing to replace their existing systems urgently for contractual or technical reasons have chosen to procure new systems outside the programme. The latest example is Northumbria healthcare."

Rush to fulfil prime minister's NHS vision tripped up IT programme (23 May 2006)

Computer Weekly's+NHS+vision+tripped+up+IT.htm

"In April 2000, the Public Accounts Committee . . . endorsed the view of the NHS Executive that five types of electronic patient records needed to be built first, before the consolidation of health records could be undertaken. These fives types of electronic patient records addressed the needs of professionals in mental health, acute hospital, GP primary care, community services and social care. . . The prime minister spelt out his vision to the government e-Summit in November 2002. He proposed that 600 million pieces of paper a year could be eliminated from the NHS. Of course, others were left with the task of trying to work out how. The recruitment of the NPfIT team in the autumn of 2002 set the framework for action. . . Forgotten, apparently, was the need for a first stage of five types of electronic patient records – a foundation upon which to build. The NPfIT concentrated right away on putting the national central building blocks in place, signing up a supplier for a national electronic booked appointments database in October 2003, and BT for the national element of the Care Records Service in December 2003."

NHS electronic records are two years late (30 May 2006)

Financial Times

"Plans to give all 50m NHS patients in England a full electronic medical record are running at least two to two-and-a-half years late, Lord Warner, the health minister who oversees the project, has confirmed. He also admitted that the full cost of the programme was likely to be nearer £20bn than the widely quoted figure of £6.2bn. The latter figure covered only the national contracts for the systems’ basic infrastructure and software applications, he said. . . The delays to the electronic care record, which mean it may not be in place until early 2008, come in part because of delays in providing the software, which is being developed by iSoft and other companies. But the record’s introduction is also being stalled by a fierce and unresolved dispute within the medical profession over what should be included on the national medical record, and how patients’ data should be added. Some see it as threatening to “derail” the programme."

Regular check-up with a difference (31 May 2006)

The Guardian,,1786033,00.html

"If you live in Salford and have type 2 diabetes, a regular phone call could keep you out of hospital. Care Call is a new service from Salford primary care trust that involves specially trained advisers keeping in touch with patients in their homes to update their records, advise them on their diet, and remind them to take medication and exercise regularly. It is an example of the kind of innovative service that becomes possible when carers have seamless access to electronic case records. Unfortunately, it is a beacon of excellence in an unjoined-up world. Plans to create electronic case records for both health and social care are falling behind schedule, the Guardian has learned, while a target of joining up the two by 2010 appears to have been quietly dropped. . . The Care Call service is underpinned by an electronic medical record drawing information from a collection of dedicated systems. Joining up information is tricky in long-term care because of the many different people and places involved in any individual's care. "Diabetes is multi-disciplinary and multi-locational," says project manager John Burns. "All information is held at the locality, all in different systems. In diabetes, these might include a podiatrist and an eye clinic as well as the GP and acute trust." The solution is a system from Graphnet, a specialist healthcare IT firm, that takes data from different repositories and presents it in a web format that can in theory be viewed from anywhere, including the Care Call headquarters and, eventually, the patient's own home. . . Salford is not the only local initiative developing electronic health records that share information from across disciplines, but it is one of the most advanced. It is at least two years ahead of the "official" NHS version - the Care Records Service - being developed under the NHS National Programme for IT."

NHS has another stab at records - Going one step at a time after all (20 Jun 2006)

The Register

“A high-powered taskforce has been assigned to tackle problems with the overdue care records system, the core element of the troublesome £12.4bn National Programme for IT. The reputation of the national care records system was undermined in last month's House of Commons Public Accounts Committee on the NHS programme. It found development had been rushed without proper consultation with patients and clinicians. The Department of Health said in a statement yesterday that the task force would address "outstanding issues and concerns" and aid the introduction of the first phase of the care records system in 2007. The last official word on the timetable for care records was given at last month's PAC hearing. Then scheduled for late 2006, they were already running two years late. This had been blamed on suppliers having "difficulty in meeting the timetable" and clinicians wanting to see the system piloted. . . The taskforce is being chaired by Harry Clayton, national director for patients and the public at the DoH. It will consist of two British Medical Association chairs, an executive director of quality at Ealing PCT, and bosses of the Royal College of Nursing, Royal College of General Practitioners, the Terrence Higgins Trust, the college of emergency medicine, an ethics professor from Oxford and a patient advocate.”

Lengthy delivery for NPfIT maternity systems (26 Jun 2006)

e-Health Insider

"The delivery of new maternity systems as part of the NHS IT programme has stalled, E-Health Insider has learned. Not a single hospital has yet received a new system, and a leading obstetrician has warned that the delays are creating potential “clinical risks” to mothers and children. The lengthy delays to maternity software are causing huge frustrations for NHS trusts that urgently need modern systems to meet the latest statutory reporting and child screening initiatives, and effectively manage their clinical litigation risks. But the Evolution maternity software from iSoft, offered as a stopgap solution in 60% of England under the NHS National Programme for IT (NPfIT), is said to be out-of-date and requiring considerable development before it can be implemented. An NPfIT-compliant version of Evolution that connects to the central NHS data spine was meant to have been provided as an ‘emergency bundle’ from the beginning of 2005 to hospitals across the north west and west midlands, north east and east of England. This had only been intended as an interim solution to meet urgent needs before maternity functionality was delivered by NPfIT as part of an integrated ‘strategic’ clinical systems suite. But no hospitals have received any new maternity systems. The cumulative delays are said to be acting as a deadweight on the modernisation of maternity services, which had previously been considered leaders in using IT to deliver improved patient care."

Implementation dates for hospitals continue to slip (31 Aug 2006)

e-Health Insider

“An investigation by E-Health Insider has found that two-thirds of the 22 NHS acute trusts that were meant to be receiving a replacement patient administration system by the end of October say they will not hit the target. In late June NHS Connecting for Health and its local service providers told Richard Bacon MP, a member of the Public Accounts Committee, that 22 trusts would get replacement PAS systems by the end of October. Two months later, just seven of the trusts named have told EHI they believe the target will be hit. . .”

New setback for NHS computer (3 Sep 2006)

The Observer,,1863760,00.html

“The troubled multi-billion-pound NHS computer system suffered a fresh blow last night when it emerged that two-thirds of the hospital trusts due to have installed an electronic patient administration system for booking appointments with consultants by the end of October will not meet the deadline. The delay has raised concern that the project - already two years behind schedule - may be continuing to overrun. The government believes it will cost £12.4bn but critics fear more delays could mean costs spiralling to more than £15bn. Of the 22 NHS acute trusts supposed to be receiving the new patient administration system by the end of October only seven believe they will now hit the target, according to a survey by E-Health Insider, a specialist online magazine for health professionals. The system is crucial to the entire project as it is the foundation on which all other aspects of the IT system are built. . .”

Choose and Book set to miss 90% referral target (10 Oct 2006)

e-Health Insider Primary Care

"The Department of Health’s target for 90% of referrals to be made through Choose and Book by next March looks almost certain to be missed, as latest figures reveal every strategic health authority is behind schedule. The statistics show that while the average percentage of bookings made through the system is now 27%, many primary care trusts are still in single figures making the achievement of a 90% target by all 150 new PCTs highly unlikely. Figures reported to the September board meetings of the new SHAs show that in the case of the worst performing authorities less than half of the planned bookings had been made through the system during the summer. In South East Coast SHA 12% of outpatient bookings went through Choose and Book in August compared to the projected 28%, and in the East of England 13% of bookings went through Choose and Book, only just over a third of the 35% the SHA said it hoped to achieve by that stage. The figures for August from South East Coast SHA include some trusts that performed well, such as Croydon, which achieved 28% of referrals through the system. However, eight of the 25 old-style PCTs had used Choose and Book for 5% or less of referrals with East Elmbridge and Mid-Surrey PCT referring no patients through the system and East Surrey PCT only 1%."

See also:

Granger compares BMA to the National Union of Miners (13 Oct 2006)

e-Health Insider

"NHS IT boss Richard Granger has compared the British Medical Association to the National Union of Mineworkers, describing the influential doctors’ trade union as a block to change in the NHS. His inflamatory comments came in a New Statesman round table on IT modernisation, in which he spoke of obstacles to the late-running £12bn NHS IT project. “There are some blocks to radical structural change. I have encountered an incredibly powerful union, comparable to the National Union of Mineworkers, and that is the British Medical Association.” Dr Jonathan Fielden, the Chairman of the BMA’s Consultants Committee, told EHI: “I think clearly remarks like that are unhelpful, particularly when the general tenor of relations with the government are good and improving.” . . . Dr Fielden, a consultant intensivist at Royal Berkshire hospital, added the comments were unfortunate given the problems being experienced by the programme. “The CfH agenda needs friends and it needs help right now,” he observed. “The programme is way behind schedule and significantly over budget.” He added, “Richard Granger must be under intense pressure to deliver.” . . . Dr Fielden added that it was a particular “frustration” that CfH had only sought clinical involvement on key issues such as the confidentiality of patient records “late in the day”. Dr Richard Vaughtrey, deputy chairman of the GPC and its lead on IT issues, told EHI that while communication with CfH had improved “There are still times we feel our views are not being taken on board.” He added: “The key area is around the summary record, what it will look like, what it will contain and how it will work in practice.” In a statement CfH told EHI the NHS IT director general’s remarks were not taken from a verbatim transcript and “the full context is therefore missing”. The missing context was not supplied. . ."

HM Treasury unplugged - Government's IT late list (14 Oct 2006)

The Register

"The Conservatives have helped expose, again, the systemic failure of Government IT projects with a seemingly trivial parliamentary question about costs and timescales at HM Treasury. A written answer extracted by Theresa Villiers, shadow chief secretary to the Treasury, discovered that IT projects were running a total of 17 years late at HM Treasury under the leadership of Gordon Brown. . . On 4 September, in answer to a similar question by the Liberal Democrat MP Vince Cable, the Department of Health provided a tally as well. The only project for which the department had no clue of when it started, when it would end and what it might cost was the infamous National Programme for IT, the IT industry's answer to the Millennium Dome. The DoH answer waffled that NPfIT didn't really having a start or end date because it was sort of, well, "substantial", being planned on the fly, "incremental", and "providing increasingly richer functionality over time." . . . NPfIT faltered because it was imposed from above, without reference to the clinicians who were to use it. Connecting for Health, the organisation responsible for NPfIT, admitted that if it had consulted the intended users of the system more widely and included their views in its design, they might have a better idea of what it was doing. It was trying to be too big, too clever, and had tried to impose its world view on too many people. . ."

Newcastle develops options outside CfH (26 Oct 2006)

eHealth Insider

"Newcastle Hospitals NHS Foundation Trust has gone out to tender for key elements of a new Electronic Health Record system, outside the National Programme for IT, to hedge risks created by delays to the Connecting for Health programme growing beyond the current two years. The trust faces an urgent requirement for a new Maternity system, as its existing McKesson system will not be supported beyond next June. The Foundation trust is also seeking a new PAS system, a replacement for which CfH had originally promised to provide by January 2005. Newcastle becomes the latest independent Foundation hospital trust to seek to procure for key systems independently of the late-running £12bn NHS IT upgrade programme. The trust says that it is developing alternatives as the CfH programme is now running two years late, and may be subject to further delays. . . Earlier this year Newcastle issued an OJEU notice for three other key operational systems: order communications, electronic prescribing and theatres. Bids are currently being evaluated by the trust with contracts due to be awarded by February 2007. The trust has now also tendering for a maternity system, an A&E system and patient administration system. The September trust board paper explains why: “The business and operational circumstances as a Foundation trust do suggest there is an urgent need to consider replacement of these systems as matter of priority and outside the national programme.” The paper says “the original Connecting for Health programme is running two years late” with there being “no immediate prospect of system delivery”. It adds: “The Trust had originally planned to implement a replacement PAS on 18 January 2005 as the start of an incremental EPR development.” . . . Newcastle makes clear that it plans to keeps its options open for the time-being and that its OJEU advert could result in more competitive submissions from suppliers yet keeping the trust’s options open if CfH be subject to further delays. . ."

Specialists dispute keyword changes for C+B (25 Oct 2006)

e-Health Insider Primary Care

"A dispute between specialists and the Department of Health over use of keywords for Choose and Book clinic types has led the British Society for Rheumatology (BSR) to recommend that consultants do not populate their directories of services. Dr Andrew Bamji, the society's president, said that he and other members spent the last year drawing up a list of 177 keywords mapped to clinic types after a request by NHS Connecting for Health. He told EHI Primary Care: “We submitted it and we thought we have done a good job there but then discovered by chance that the lists that we had submitted were not the lists that were published.” Dr Bamji claims that another group within CfH, not including specialists, had reviewed the list, cut the keyword list down to 140 and changed some clinic types. He said: “We were taken aback. Our part of CfH had no knowledge that the keywords were being revised by this other group. We have put an enormous amount of time into it and then to have someone else fiddling with it and not even be told about the changes is not helpful.” Dr Bamji says the discovery of the changes led the society to alert other speciality groups who had also drawn up keyword lists mapped to clinic types as part of CfH body called the Specialist Association Reference Group. He added: “They found that they also had had changes put in to their lists that they were not happy about.” Professor Angus Wallace, who leads the specialties on the group, told Hospital Doctor magazine that specialties might pull out of SARG as a result of the problems. . ."

LSPs fail 'acid test' on PAS deployments (30 Oct 2006)

e-Health Insider

"Delivery of the patient administration systems due to form the foundation for future electronic patient records in NHS hospitals has stalled with only a fifth of the systems promised in June actually installed. In June NHS Connecting for Health said that 22 acute NHS trusts would get new PAS systems by the end of October. With just one day left, only four have actually been delivered, and in three of the five clusters none have been installed. Just four months ago NHS Connecting for Health told Commons Public Accounts Committee member Richard Bacon MP that its local service providers (LSPs) would install new PAS systems in 22 hospital trusts by the end of October. London was not included in the October target. Bacon told E-Health Insider that the 31 October PAS target was “a very clear test of the ability of the programme to do what it said it would.” The conservative MP added: “It’s an acid test in terms of what the programme is doing on hospital PAS deployments. We’re not even talking here about clinical deployments.” He said that he had written to Richard Granger, head of CfH in August asking for an update on progress, and had received no response. Bacon told EHI he has now written to Health Secretary Patricia Hewitt asking what deployments have since taken place. . . No acute PAS implementations have occurred for more than six months in three of the clusters: London, the North-east and Eastern. In June BT, the LSP for London, had pledged to deliver new PAS systems to three unspecified acute trusts by the end of December. No new implementations have since occurred and with BT currently negotiating to replace its clinical software supplier it looks like a prediction highly unlikely to be met. Similarly, no new hospital PAS systems are believed to have been delivered in either the North east or Eastern clusters. LSP Accenture had been due to implement four of the iSoft iPM patient administration systems, at Northampton, Airedale, Weston Park and Ipswich. . . The LSP which said it would achieve the most deployments by the end of October was Fujitsu, prime contractor in the South. Having completed its first Cerner implementation in December 2005, it offered a bullish forecast saying it would deliver four implementations by the end of August, rising to 12 by the end of October. In the event just two, Weston and Mid and South Bucks, have occurred since. The remainder of the projects either postponed or delayed at short notice. Milton Keynes has twice had go live dates cancelled at less than a weeks notice. . . CSC committed to implementing six iPM iSoft systems at hospital trusts by the end of October. Since June one hospital, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, has successfully gone live across an entire hospital trust. In addition, North Cheshire Hospitals NHS Trust has received a PAS system, but this is so far only used in physiotherapy and occupational therapy. The other four go-lives that had been predicted have since stalled or been delayed and CSC have confirmed they will not meet their prediction. . ."

More delays as NPfIT overhaul is ordered (27 Nov 2006)

The Register

"The NHS' new chief executive is setting the stage for further delays at the already tardy National Programme for IT (NPfIT), by ordering an overhaul of the entire programme. According to the Financial Times, David Nicholson has told Connecting for Health (CfH) to review both the scope and operation of the programme. NPfIT chief executive Richard Granger has said he wants to focus on getting key aspects of the project done: digital imaging systems, electronic prescriptions, and a new payment system for the NHS. Other aspects of the programme, such as new patient administration systems, will fall even further behind schedule, he said. However, by stepping in now and effectively taking control of the way the project is run, David Nicholson at the very least appears to be undermining Granger's position. The idea is to resolve many of the ambiguities and conflicts about implementation and policy within the project. It could resolve the question of whether or not patients should be able to opt out of having their record stored on the spine, and whether the scheme is currently "too prescriptive" being run centrally. The embattled Granger told the paper that policy questions were being "pinned" on him, but that responsibility for sorting out things like patient consent lay elsewhere in the Department for Health. The paper reports that CfH will become smaller after the review. Staff will be transferred to other posts in the NHS. Granger accepts that this is a necessity, in the face of slipping deadlines."

Hospitals reluctant to embrace systems (27 Nov 2006)

Financial Times

"The National Health Service's financial troubles and delays in getting the right software are blamed by Richard Granger, head of the NHS's information technology programme, for hospitals' reluctance to install key parts of the new technology. Many hospitals need a new patient administration system, or PAS, to allow the full electronic care record to operate when it becomes available, Mr Granger told the Financial Times.But only 19 systems have been installed out of 43planned to be in place at the end of November. Hospitals are increasingly reluctant to take them, he says. This is in part due to problems with the software. Of the two versions of software available, Cerner's provides extra clinical benefits but does not easily provide reports on patients' appointments in a format preferred by hospitals that enables them to claim money from primary care trusts, he says. Isoft's product does that, but as yet offers few clinical gains. Neither does "everything that people want" and in addition, "it is not a great time to ask people to take new computer systems. Money is tight, targets are tight, these systems are disruptive and there is not an enormous amount of benefit to trusts at the moment". Staff have to be taken off achieving NHS targets to be trained, and hospitals "have to go through a laborious data cleansing exercise" before the system goes in. That, he says, is throwing up duplicate records, hospitals are discovering patients who have breached the government's waiting time targets, and discrepancies are showing up over the payments made by primary care trusts. "You never find good news when you do data cleansing," he said. . ."

NHS IT schemes 'under-funded and over-ambitious', trust board is told (5 Dec 2006)

Computer Weekly

"A confidential paper issued to the board of the UK’s largest NHS trust says that new initiatives under the £12.4bn National Programme for IT (NPfIT) are “invariably under-funded and over-ambitious”. It adds that the pressure on central Whitehall budgets has increased the transfer of costs to the NHS. The paper to the board of Leeds Teaching Hospitals NHS Trust, obtained by Computer Weekly under the Freedom of Information Act, also includes praise for the NPfIT. It says that the electronic transfer of prescriptions to pharmacies and a broadband network are among key elements that are progressing well. But the most important part of the NPfIT – a national care record which puts medical information on 50 million people in England onto central systems – has been scaled back, says the paper. The central system now “essentially covers only allergies and recent GP prescribing”. . . The lack of new patient administration systems means many trusts “will be unable to meet national e-booking targets and will struggle to meet other national policy requirements”. E-booking is a top ministerial priority for the NHS. The aim is to allow patients and doctors to book hospital appointments online during a visit to the GP. The paper, by the trust’s director and deputy directors of informatics, also says that, since core software has been delayed, trusts are “increasingly looking to procure new patient administration systems outside the National Programme”. With the creation of several large contractor conglomerates, “smaller often more innovative companies have struggled to survive”, it adds. . ."

Great Ormond Street gets single sign on (6 Dec 2006)

e-Health Insider

"Great Ormond Street Hospital (GOSH) is set to use a single sign on system that will not only cut the number of passwords clinicians need to access patient information, but also give them a converged view of data from different applications. The system will be deployed initially at the hospital to enable access to a core set of applications, including those used for electronic prescribing, medication administration, medical imaging, pathology results and e-mail. Additional applications will be added into the system, supplied by Sentillion, later. David Bowen, GOSH’s electronic patient record project manager, told E-Health Insider: “However many applications you have got open you always know you don’t have to worry that you are going to look at somebody else’s record.” The search for a suitable solution for the internationally-renowned London children’s hospital dates back to 2002. Bowen explained that the hospital faced a choice between going for a heterogeneous model with applications drawn from different sources or a more homogenous HISS-type [hospital information support system] approach. . . GOSH’s plan diverges significantly from the route mapped by the National Programme for IT for the NHS in England, but Bowen said that all along Connecting for Health had recognised the hospitals’ particular circumstances and been supportive of the approach taken."

Concern over slow progress in acute sector (11 Dec 2006)

e-Health Insider

"A board paper written for the largest NHS trust in England says that its region of the National Programme for IT does not have a roadmap for delivering an electronic care record. The report, submitted to Leeds Teaching Hospitals NHS Trust, by director of informatics, Brian Derry and his deputy, Alastair Cartwright, in October says: “Other than PACS (digital radiology), there are no strategic clinical systems on offer in Yorkshire and the Humber. “CFH is increasingly announcing ad hoc developments, for example blood tracking and oncology e-prescribing systems, not least as a means of increasing clinician engagement in the national programme. However, such initiatives are invariably under-funded and over-ambitious.” The paper makes plain that the LTHT technology team is aiming to stay self-sufficient in IT while working in a ‘new landscape’ of slow progress nationally in acute trusts. . . Summarising the CfH position at the beginning of the paper - which was obtained under the Freedom of Information Act by Computer Weekly - Derry and Cartwright say the implementation of GP systems has generally been a success and good progress has been made with community and child health systems. They add however that little has been achieved in providing strategic systems for secondary care (acute and mental health) – especially in the North East and East of England. In particular, they say patient administration system replacements for several West Yorkshire trusts are running at least two years late. . . In another damning paragraph, they say: “LSPs and their sub-contractors are not keeping up with the scale and complexity of the national programme. Existing supplier offerings are obsolescent, as major policy initiatives – notably the 18 weeks waiting times target and Choose and Book – arrive with inadequate DH allowance for the significant informatics and associated change management consequences.” There is also concern about the future of iSoft, the clinical systems sub-contractor to the North East and a supplier used independently by LTHT. . ."

2006 - a curate's egg for Connecting for Health (21 Dec 2006)

e-Health Insider

"2006 may well be seen as the year Connecting for Health (CfH) and its prime contractors failed to deliver on their promise of next generation integrated clinical record systems that would provide a rich, detailed local record and summary national record. During the course of the year not a single implementation of such a next generation system occurred, and it remains unclear when and whether such systems will now be delivered. . . The consequences of this fundamental failure have been huge, both on the NHS, CfH and its suppliers. In the absence of the next generation CRS systems CfH has only been able to offer existing systems. For the trusts that had little this has been a boon, but for those with more advanced IT, especially in the acute sector, the programme still offers them little. . . Given the problems on local CRS the focus has moved, rather conveniently, to the summary care record which at times is now spoken of as 'the record' rather than as one component of it. . . Meanwhile a storm rages around whether patients should have to give explicit consent for their details to be uploaded to the new service, rather than the qualified implied consent favoured by the Department of Health. . . In the absence of strategic next generation solutions, CfH and its prime contractors became increasingly desperate to deploy something, anything, which would be of use to NHS customers and enable them to get paid. Existing system suppliers – many of them recently told they had no future in the market - have been courted and in many cases provided solutions through LSPs. . . Having first been due to be implemented by the end of 2005, then the end of 2006 Choose and Book is now meant to be 90% in place by the end of March 2007. Despite generous incentive payments to GPs this target looks extremely unlikely to be met. As 2006 ended the system, which failed entirely last Christmas during an upgrade, was still being dogged by technical problems that routinely make it unavailable to some staff or too slow to use. . . Like Choose and Book the Electronic Prescriptions Service is proving slower than originally intended: phase 1 has been widely deployed, but phase 2 appears to be running badly late. . . The pledge to deliver on giving GPs a choice of systems has become like Father Christmas: comes round once a year and some people get very excitable, but few take it seriously. . ."

PCTs fail to reach halfway point on choose and book (1 Feb 2007)

Health Service Journal

"No strategic health authority is on track to hit the government target to make 90 per cent of outpatient bookings through choose and book by the end of March. Figures from the last round of SHA board papers show that primary care trusts are up to 50 per cent behind planned levels of the system in some parts of the country. Even NHS North East, which had the highest choose and book take-up in the country, achieved less than 40 per cent of outpatient appointments through the system in November - nearly 40 per cent below its target for that month. Despite being identified by several SHAs as one of six 'big tickets' to concentrate on, papers suggest a combination of IT problems, lack of engagement from GPs, and a failure by acute trusts to provide appointment slots through the system have left PCTs struggling. In the worst-performing area, NHS East of England, just 20 per cent of appointments had been arranged through choose and book in November and the SHA reported that there had been a 'widening gap' between actual and planned performance. All PCTs in the SHA have now been instructed to produce 'recovery plans' in an attempt to hit March's target. Other SHAs, including South Central, have also ordered PCTs to produce recovery plans, and some are monitoring booking statistics on a weekly basis to put pressure on PCTs and acute trusts. NHS South East Coast achieved only 24 per cent of referrals in November, well under half of its target for that month of 59 per cent. The SHA acknowledged that the number of choose and book slots made available by acute trusts 'remains a concern', and trusts are being monitored to ensure they follow guidance on making appointment slots available. North West SHA, which achieved 30 per cent of choose and book appointments in November, also accepts that March's target will almost certainly be missed."

Millennium delays creating financial risks, trust warns (1 Feb 2007)

e-Health Insider

"A report by Worthing and Southlands Hospital NHS Trust on delayed plans to deploy Cerner Millennium warns that current reporting difficulties with the system "could have an impact on all remaining Cluster R0 go-live dates". The trust board paper seen by EHI warns that should delays to the availability of a system that meets requirements continue, it will risk local financial turn around plans. Worthing and Southlands is attempting to turn around a £6m deficit in 2006. . . A telephone survey carried out this week by E-Health Insider of ten trusts in the South found there is now a growing backlog of trust's waiting to receive a new deployment date from local service provider (LSP) Fujitsu, and Connecting for Health, to receive their new Cerner Patient Administration System (PAS). All the sites now queuing now appear to be waiting for the next two Millennium implementations, due to be in Milton Keynes and Winchester. . . Fujitsu originally told the Commons Public Accounts Committee that Release Zero systems would be deployed at these trusts by the end of October 2006. Only three trusts currently have a Millennium Care Records System – Weston, Nuffield Orthopedic and Mid & South Bucks. . ."

Picture this: an NHS data project that everybody loves (8 Feb 2007)

The Guardian,,2007594,00.html

"If you slip on an icy pavement this winter and land up in casualty, take heart. The chance of your x-rays turning up when they're needed is probably the best in the NHS's history. Digitally displayed radiological images, using a technology known as Pacs (picture archiving and communications system) are the big success of the £12bn programme to computerise the NHS. Pacs stormed into hospitals because nearly everyone sees advantages. The images are available immediately, anywhere on site, so fewer appointments are cancelled due to films going astray. And there's a tangible business case, too - immediate savings on expensive x-ray films. Unfortunately, at the moment Pacs generally extends only as far as each hospital's no-smoking zone. Five years after the government decided to chuck money at a central initiative to modernise the NHS with information technology, the dream of multimedia records available anywhere remains remote. For some parts of the health service, that dream is more remote than it was five years ago, thanks to the scale of the programme and the furore it has provoked. "Don't panic," says Richard Granger, the NHS's IT boss. "We have spent the past few years putting in the basic pipes while grabbing quick wins such as Pacs." The exciting stuff is now coming together. After many delays, the first basic extracts of medical records are due to be loaded on to the national system this spring. This will be an important step. But the programme has a long, long way to go. In large parts of the country, the process of installing basic hospital systems has ground to a halt because cash-strapped managers see no point. Controversy still surrounds the uploading of sensitive data on to the system. This was stirred further this week by revelations that hospital staff are routinely sharing system logins. Just how far we have to go was revealed a couple of weeks ago by the NHS's new overall boss, David Nicholson. He admitted that if the IT programme is to work, the NHS will have to "own, love and understand" it in a way that it has not done up to now. That means giving local organisations more say in where they go with the programme. And, while turning down calls for a fundamental review, Nicholson suggested that the programme may be doing too much on "far too big a waterfront". This implies that some fundamental rethinking is under way. . ."

NPfIT's Evolution maternity dropped by Royal Shrewsbury (13 Mar 2007)

e-Health Insider

"The NHS trust that was meant to be the pilot site for the National Programme for IT version of iSoft’s Evolution Maternity Information System, has given up waiting for its delayed NPfIT system and implemented an alternative system bought off the shelf. Royal Shrewsbury Hospital NHS Trust, Shropshire has been waiting for almost two years for its local service provider Computer Sciences Corporation to implement iSoft's Evolution MIS. The trust has now deployed the Eclipse system from Huntleigh Diagnostics in a bid to save up to £0.5m annually through reduced clinical negligence liability costs. . ."

IT delays contribute to NHS trust deficits (20 Mar 2007)

e-Health Insider

"Delays in implementing the National Programme for IT are listed by the influential Commons public accounts committee today as a factor leading to some NHS trusts plunging into the red. The PAC’s inquiry into financial management in the NHS found that in 2005/06 14 trusts asked the Department of Health for money to cover “costs incurred as a result of delays in the implementation of the National Programme for IT”. None was paid. The report does not name the trusts. It says: “The department reports that information on how much has been claimed by each trust is not available as the requests include a mixture of one-off costs, ongoing costs, alternative interim solutions and unspecified amounts.” The information was winkled out of the Department of Health by Richard Bacon, Conservative MP for South Norfolk and a constant thorn in the DH’s side on matters relating to the national programme. . ."

Missed 90% C+B target to remain for PCTs (3 Apr 2007)

e-Health Insider Primary Care

"The target for 90% of referrals to be made through Choose and Book is to remain for the NHS, even though the latest deadline has been missed by some way. Final figures are not yet available for use of Choose and Book to March 31, but it is clear the NHS will have fallen well short of the 90% mark which was one of six key targets set by the Department of Health for 2006/67. Statistics seen by EHI Primary Care for the week ending March 22nd suggest the figure was then closer to 40%, with the highest number of bookings, 909774, made by GPs in the North West and West Midlands cluster. According to NHS Connecting for Health officials approximately 16,000 Choose and Book appointments are being made a day. In an interview with EHI Primary Care, Dr Mark Davies, CfH's medical director for Choose and Book, said the picture was very variable around the country. He said: “Some PCTs will meet the 90% target, there are a significant number in the 50-80% bracket where the majority of referrals are going through Choose and Book and some PCTs are struggling with this. The point is that whatever the national figure is there are 150 stories out there and it’s very different from one PCT to another.” However Dr Davies said despite the variable performance the 90% target would remain. . ."

PCTs still only half way to choose and book target (5 Apr 2007)

Health Service Journal

"Strategic health authorities are planning measures - from a radio campaign to crisis support squads - in an effort to make up lost ground in implementing choose and book. Primary care trusts were tasked with referring 90 per cent of patients through the choose and book system by the end of last week, but latest SHA figures suggest that PCTs are barely half way to the target. It is one of six key goals for SHAs. Even the best-performing SHA, NHS North East, was still referring fewer than 50 per cent of patients through choose and book, according to the most recent figures available. And the worst performer, NHS East of England, saw just 22 per cent of patients referred through CAB. SHAs cite technical problems as a key reasons for falling so far short of the target, with a number of acute trusts still unable to accept direct booking via CAB. This includes eight of London's 32 acute trusts, five of them foundation trusts. Some are waiting for the national IT programme to deliver a CAB-compliant patient administration system, said NHS London. The number of booking slots offered by acute trusts has also caused difficulties. . ."

New national IT setback as devolution is delayed (12 Apr 2007)

Health Service Journal

"The national programme for IT is facing another setback as it emerges that plans to enhance the role of strategic health authorities have been delayed. NHS Connecting for Health and SHAs are still working through the details of the local ownership programme (NLOP) a fortnight after the 1 April deadline for transfer of the main responsibilities passed. The process, which will devolve parts of the national IT programme to SHAs, has entered a 'transition period' and now looks unlikely to take place in full before July. A 'transition assurance review' is being carried out to assess the risks the delay might pose to the successful delivery of the IT programme. . . CfH will continue to take responsibility for areas such as commercial strategy and contracts with suppliers. The SHAs, working with trusts and PCTs, are to take over local delivery and implementation of products. . . But there have been concerns over whether NLOP will provide genuine local control or just shift accountability away from CfH. Although SHAs took on this extra accountability on 1 April as planned, their full responsibilities are yet to be confirmed. . ."

Delays continue on NPfIT local ownership programme (25 May 2007)

e-Health insider

"A review is underway to establish new priorities and additional requirements for the NHS National Programme for IT Local Ownership Programme (NLOP) with the results due to be reported to the NHS Management Board in June, E-Health Insider has learned. The review – known as the Butler Review - is being carried out to identify and prioritise new requirements to be delivered by the programme, based on the priorities identified by local strategic health authorities. It forms part of the wider National Programme for IT (NPfIT) Repositioning Programme, which includes the late-running NLOP, first due to have been implemented by the end of April, and now projected to occur in July. SHA board papers seen by EHI indicate that NLOP is facing further delays and will only offer limited freedom to local NHS organisations to set IT priorities, instead chiefly making them responsible for implementing nationally-determined systems. . . An indication of the extent of the very limited scope for local flexibility within the constraints of the national programme comes from a May East of England SHA board paper: ""Whilst the existing contractual arrangements with suppliers allow for substantial variations, the degree of change is effectively constrained by cost and commercial considerations." The same paper makes clear that while a central objective remains to not lose "the advantages of having a national IT approach and benefits of a national procurement led by a single agency in NHS Connecting for Health" the scope for local freedom will be limited. "The maintenance of these benefits necessarily limits the freedom of action of individual SHAs of trusts to make significant changes, in the shorter term, in products, services and deployment plans". Another major question mark exists over whether they will have the capacity and expertise to undertake design, build and test of CRS, together with deployment and implementation responsibilities? . . ."

Trust steps ahead of NPfIT (8 Jun 2007)

Computer Weekly

"Guy's and St Thomas' NHS Foundation Trust is embarking on a major integration programme to link 650 medical applications. The move will bring together financial, corporate and clinical data, together with voice, video and images. The initiative is one of several undertaken by a group of research hospital trusts including St James in Leeds, and Coventry and Warwickshire, which are not prepared to wait for systems to be developed under the NHS's National Programme for IT (NPfIT). Speaking at the IT Directors Forum on board the cruise ship Arcadia this week, Richard Storey, head of IT and solutions delivery at Guy's and St Thomas', said that the highly innovative programme was not working against the NPfIT. "We will not step outside the National Programme, but what we are doing is one step ahead. We are well ahead of the NPfIT and we will not do anything to compromise it, but we will not be held back," he said. The programme will use service oriented architecture with a heavy focus on interoperability. Data is shared using an enterprise service bus and is converted to the medical data sharing standard, HL7 standard version 3.0. This allows Guy's to link to developments taking place in the other hospitals using open standards. Benefits will include single sign on and a contextualised portal, with a core scheduling system and clinical images available on the desktop. Because of Guy's central location, Storey is targeting City IT professionals to work on the project. . ."

London delays due to 'lots of factors' says BT chief (8 Jun 2007)

e-Health Insider

"BT Health’s managing director has told MPs that ‘lots of factors’ are the root cause of delays in implementations at London's acute hospitals, but that the National Programme for IT’s (NPfIT) work in the capital should be completed by 2009 with full integration of systems a year later. Patrick O’Connell was giving evidence to the Commons Health Select Committee’s third session on the electronic patient record. Quizzed by the chairman, Kevin Barron for exact reasons why acute patient administration system (PAS) deployments under the London Programme for IT (the new term for the work) were running late, O’Connell said it was a result of ‘lots of factors’. Asked to expand on that, he said: “It is not just one thing [delaying implementations] but a multiple set of factors, such as re-prioritisations, change of schedules and an attempt for synergy that did not work.” He added: “This is a large programme. We start with timescales, they get reshuffled, things are added and some are implemented on time and some things go out of schedule. More importantly though, we are making progress and rollout should start in the summer.” O’Connell was asked to explain why BT had made promises when bidding to be a supplier, which it appeared it couldn’t meet. It was suggested that this was so that BT would win the contract, but O’Connell flatly denied the accusation, saying delays were due to a lack of understanding. “It takes three communities to make this programme a success: the user community, the buyer community and the supplier community. Working together, the programme would work on schedule, but all three groups are not uniformly bonded together, so there is often not a complete understanding upfront. There needs to be a coming together of groups and this lack of understanding makes all the difference between implementing on day one (on time) and day two (late).” To help London achieve the objectives of NPfIT, O’Connell said that BT had revised its strategy and chosen just three suppliers whom it considered ‘best of breed’. . . He said that BT had technical pathways ready to implement the Detailed Care Record, but no actual specification was confirmed for this. He felt that the system would evolve over years, comparing it to the internet, which he couldn’t see the point of in 1990 but couldn’t live without in 2007. . ."

BT claims successful NPfIT shift in London (8 Jun 2007)

Kable's Government Computing

"BT has claimed its revised strategy for London is helping to get the National Programme for IT (NPfIT) back on track in acute trusts. The Commons Health Select Committee heard on 7 June 2007 that BT's revised strategy to deliver services under the NPfIT to acute hospitals is "proving a success". BT is the national programme's local service provider for London. Although it has made reasonable progress in some areas, particularly primary care trusts and mental health trusts, delivery to acute hospitals had fallen behind schedule. To remedy this, the company agreed with Connecting for Health, the agency responsible for delivering the programme, to make changes to its subcontractors. This included the replacement of IDX with the Cerner Millennium solution. BT said that half of all London's mental health trusts now had new IT systems installed. Newham and Homerton trusts upgraded to Cerner systems late last year and there are plans to go live at Barnet and Chase Farm this summer. Two further deployments are planned later this year. A key element of BT's revised strategy has been to install products initially as "standalone" deployments and then to integrate them with the cluster-wide solution. . . The MPs got a less sanguine view of the programme from Professor Naomi Fulop of King's College London. Fulop, co-author of a study on the implementation of NPfIT published last month in the British Medical Journal, said the e-patient record had been deeply problematic and is seriously behind schedule. "The detailed record is now two and a half years late. By next year it will be three and a half years late," she said. There was a growing risk to patients' safety associated with delays to the programme, according to Fulop. Also, local NHS managers are unable to prioritise implementation of the NPfIT because of competing financial priorities and uncertainties about the programme."

Conservatives announce NHS IT review (8 Jun 2007)


"The Conservatives have said that they intend to carry out a review of the NHS IT programme. Much criticism has been levelled at the scheme for its spiralling costs and lengthy delays and the review is being launched in response to a lack of similar investigation by the government, shadow health minister Stephen O'Brien said. He stated: 'The programme is two years late, so by the government's own admission the consequences of its incompetent implementation are the thousands of lives the government told us the NHS IT system would save.' The announcement comes shortly after the House of Commons' public accounts committee published a report suggesting that government IT projects need to benefit from better skills at the highest management levels in order to succeeed. This week, the NHS IT project hit the headlines again following uncertainty over the future of iSoft, one of the companies involved in the scheme. The firm is currently suffering from financial difficulty and is the takeover target of a number of other technology companies - one of which is also working on the project."

Connecting for Health briefing claims much of NHS NPfIT complete (11 Jun 2007)

Computer Weekly

"A confidential Connecting for Health briefing paper for the prime minister has claimed that much of the NHS's £12.4bn National Programme for IT (NPfIT) is complete - although an integrated national care record system has yet to materialise, and software delivered under the scheme has been criticised by some trusts as not yet fit for purpose. The paper, dated 19 February 2007, said, "Much of the programme is complete, with software delivered to time and budget," though, "some deployment is progressing more slowly than we would wish for and is dependent on legacy IT suppliers and NHS preparedness." The paper was included in a Connecting for Health document presented to a health care technical standards conference in Canada. It said, "Key challenges and risks to delivery are now not about the technology to support NPfIT but about attitudes and behaviours, which need to be the focus of senior management and ministerial �attention as we move forward." The paper's findings come despite a Public Accounts Committee report in April which found that significant clinical benefits were unlikely to be delivered by the end of the contracts in 2013/2014. Connecting for Health, which runs the NPfIT, said, "We stand by the data contained within the presentation including the working calculations for the percentage completion data as provided as all this information has been independently verified." The paper put the progress towards a life-long health record service at about 35%, although a national electronic health record system is still only at the trial stage. It also said that "procurement processes had saved £4.5bn", but this figure has not been independently audited and represents a projection of savings based on existing installations. During a debate in the House of Commons last week, MP Richard Bacon praised Accenture for its honesty in admitting its losses of hundreds of millions of dollars. He said that, in his view, local service providers BT, CSC and Fujitsu had "not done anything to try to account for the losses that must have been made". These losses could run into hundreds of millions of pounds, Bacon believed. "The government ought to be aware of that now, as it has consequences for the behaviour of local service providers in trying to claw back money because they did not make any on the contracts," he said."

Millennium problems at Taunton condemned by consultant (3 Jul 2007)

e-Health Insider

"Taunton and Somerset NHS Trust have delayed deploying Cerner Millennium software due to ‘severe security problems’, the BMA’s Annual Representative Meeting heard. The software had been due to go live the weekend beginning 29 June. Calling for a public inquiry into the National Programme for IT (NPfIT), David Wrebe, consultant obstretician and gynaecologist, told the meeting last week: “We have had greater then a dozen go-live dates. I’ve just been told that 30 June has again been cancelled because there remain three to six absolutely outstanding and severe security problems with the software.” He explained the problems were which were causing Taunton to delay deployment of the patient administration system: “Namely, if I put my name in to get my patient data you get all the health information of my entire family. There are 50 P2 problems. The maternity programme they originally showed us collected 10% of the data that was required from the old theme driven computer system and we now have to buy an entirely new maternity system to get the Millennium module to work.” In a statement, the trust confirmed that the go-live had been postponed, but refused to elaborate on the reasons for this. “Taunton and Somerset NHS Trust has postponed go live of Cerner Millennium, the foundation release of the NHS Care Records Service planned for 30 June, in order to allow time for remaining final issues to be resolved. . . Wrebe, a member of the BMA's Central Consultant and Specialist Committee (CCSC), added that pressure was being applied to the trust to take the NPfIT solution and not purchase another, by its strategic health authority. . . Wrebe told the audience: “We should have a public inquiry. The people who made the original Cerner contract should be brought to book and as Cerner Millennium R0 is not fit for purpose under any kind of consumer legislation we should throw it back in the face of the suppliers and tell them if they want the money, they can take us to court.” The motion was carried by the meeting, despite claims that an inquiry was unnecessary from other members. . ."

Project overruns 'costing billions' (13 Jul 2007)

The Guardian,,-6776329,00.html

"Poorly-managed Government projects are costing taxpayers tens of billions of pounds in budget overruns, a campaign group for lower taxes has claimed. Publicly-funded programmes are running up bills one-third higher, on average, than their original projections, the TaxPayers' Alliance said. Its analysis of more than 300 projects from the past two years found that the net overrun came to £23 billion above initial estimates. This was the equivalent of £900 for every household, the group calculated. Having looked at 305 schemes, including roads, hospitals, science facilities, IT systems, art galleries and defence systems, it said the biggest overruns were the NHS National Programme for IT by £10 billion, the 2012 Olympics by £6.95 billion and the Astute Class Submarine by £1.1 billion. The TaxPayers' Alliance said its figures were probably an under-estimate because departments often disguised overruns by scaling back orders and moving funds around. As well as simply failing to work out the proper costs in advance or setting prices in stone, it said many overruns were caused by lack of know-how among officials and politicians. . ."

NHS Choose and Book gets new chief as uptake stalls (7 Sep 2007)


"NHS Connecting for Health has appointed a new head for its Choose and Book programme - the second senior appointment in two months as new figures show uptake of the hospital appointment booking system has virtually stalled. Guy Dickie, formerly e-prescribing programme manager and prison health IT programme manager at Connecting for Health, will now head work on Choose and Book - a flagship component of the NHS's £12.4bn National Programme for IT (NPfIT). . . September figures show that Choose and Book was used for 'over 40%' of NHS referral activity from GP surgery to first outpatient appointment. In July, Connecting for Health put the figure at 'nearly 40%' - up from 37% in April, but still less than half the Department of Health's 90% target. . ."

Choose and Book fails to achieve key targets (23 Oct 2007)


"Choose and Book has failed to win over GPs and is 'struggling to deliver' on patient choice, a damning report from the Healthcare Commission warns. The commission's annual health check found only 2% of PCTs hit targets on convenience and choice - a result described as 'by far the worst level of performance for any of the existing national targets'. 'The challenge of persuading independent practitioners to adopt the new system has been far harder than anticipated,' the report said. Meanwhile, new figures from the Government's bimonthly tracking poll on patient choice showed a fall for the first time in the number of patients who recalled being offered a choice of hospital. The latest National Patient Choice Survey found 44% of patients recalled being offered a choice for their first outpatient appointment in May, down from 48% in March. A Connecting for Health spokesperson admitted encouraging GPs to use Choose and Book had been 'a key challenge' but insisted the programme was 'here to stay'. He added that 43% of first outpatient referrals were now made through Choose and Book. BMA chair Dr Hamish Meldrum said there was a lot of evidence to show imposed referral management schemes and problems with the Choose and Book IT system had worked against patient choice. 'The BMA has urged the Government time and time again to work with doctors before rolling out expensive software systems, but unfortunately this has not happened,' he said. As details of the scheme's poor performance emerged, Peterborough PCT become the latest trust to refuse to accept paper referrals from GPs. A PCT spokesperson confirmed mandatory use of Choose and Book would be phased in next year. Pulse last week revealed that Eastern and Coastal Kent PCT is due to begin phasing out paper referrals in December. Dr Rob Sadler, chair of Kent LMC, said the decision had caused 'significant disquiet' among local GPs, many of whom have doubts over Choose and Book. 'Some doctors in East Kent have not engaged at all with Choose and Book because of the workload issue,' he said. 'We have all these issues which haven't been properly thought through before imposing these arbitrary deadlines.' The Healthcare Commission blamed poor progress on the lack of contractual obligations on GPs to use the system, teething problems with the system itself and patient unfamiliarity with the concept of being offered choice."

N3 dominates NHS IT savings (14 Mar 2008)


"The N3 broadband network produced nearly all the savings generated by the NHS National Programme for IT to March 2007, according to the government. The Department of Health said that of savings totalling £208m, N3 generated £192m, with digital imaging and scanning saving a further £14m and software licensing and hardware maintenance contributing £617,000. The figures were published a part of a benefits statement on the NHS National Programme for IT (NPfIT) released by the department on 13 March 2008, covering the period from NPfIT's start in 2004 to the end of March 2007. On the basis of ongoing annual cost reductions, the cumulative savings will total £1.14bn by 2014. . . The statement also reported that NPfIT had underspent by 47%, costing just £2.4bn by March 2007 compared with its 2004 forecast of £4.5bn by that date. This included £1.3bn on the programme's core contracts, less than half the £2.8bn planned in 2004. Jeavons said this showed that the contractors are paid only when they deliver. "Delivery has been slower than the original plan," he said, particularly on electronic care records. However, he said he was confident that Lorenzo, the much-delayed patient administration and record system, will be delivered in the next few months. . ."

IT overhaul benefits just one in five trusts (19 Mar 08)

Healthcare Republic

"Report on National Programme for IT shows many NHS trusts have still to implement the scheme. Only a fifth of acute trusts and PCTs have reported benefits from the NHS National Programme for IT (NPfIT), according to a DoH report. The remaining 80 per cent have failed to implement NPfIT plans sufficiently enough to give feedback. Last week, the DoH published the report, which estimates that NPfIT will deliver £1.14 billion worth of savings by 2014. The estimated final cost, however, is £12.4 billion. To date, the scheme has delivered a total of £208 million in cash savings, but it has cost £2.4 billion since its 2002 launch. The DoH report also shows that due to delayed roll-out, the programme is under budget by about £1 billion. This data was published in response to a National Audit Office request for a statement on the scheme's progress. Dr Steven Millar, medical director for the Choose and Book programme and a GP in north London, said the scheme was 'half way to where we wanted to be at this stage'. While health minister Ben Bradshaw joked that he was still receiving letters about Choose and Book, Dr Millar admitted that GPs were being put off the scheme because of pressure to use it from PCTs. Despite 98 per cent of GP practices being enabled to use Choose and Book, only half of all referrals are done through the computerised system. Nevertheless, the directed enhanced service that encourages GPs to use it is being scrapped this year. . ."

Care records rollout hit by chaos, delays and GP pullout (8 Apr 2008)


The rollout of the Summary Care Record has been hit by massive delays and fresh controversy over patient confidentiality, Pulse can reveal. The first pilot to introduce the electronic patient records system has begun in chaos, and is lagging far behind schedule, according to confidential papers seen by Pulse. A report from Bolton PCT's Summary Care Record project board, released under the Freedom of Information Act, reveals just in four patients have had their records uploaded. Connecting for Health had pledged not to begin rollout to unscheduled care - which has now begun - until 60% of records were uploaded. The third wave of the rollout among Bolton GPs has been delayed for at least four months, after three practices backed out at the last minute, while uploaded records themselves had been used on just 167 occasions by the end of last month. Bolton LMC said a new poll conducted among its committee members found they were still opposed by a two to one ratio to the care record plans. News of the delays comes as a serious blow to Connecting for Health, ahead of an independent evaluation of the early adopter pilots due next month before the system's rollout across England. Dr Gillian Braunold, director for the Summary Care Record and a GP in Kilburn, north London, admitted the rollout had been 'slower than we would have liked' and said additional evaluation of the early adopter sites was now being commissioned, beyond the University College London evaluation due this summer. 'We're not rolling out rapidly because we're doing very, very careful safety checking of the product,' she said. But opponents of the Summary Care Record said the delays were shocking. Dr Paul Thornton, a GP in Kingsbury, Warwickshire, said: 'This is neither a blip nor a stalling, but a complete breakdown and four punctures on the starting grid.' A second document prompted new confidentiality fears after revealing receptionists at Royal Bolton Hospital's A&E department were to be given access to the care record, contrary to explicit guarantees given to local patients and GPs. Minutes of a meeting in February show the PCT has backtracked on the pledge, and now plans to give receptionists access if they ask patients directly. A spokesperson for Bolton PCT this week said it was 'the most practical way forward' but insisted 'a final decision has not been made'. But Dr Neil Bhatia, a GP in Yateley, Hampshire, who first obtained the documents, said records should not be accessed by non-clinical staff. 'If I was a Bolton GP, I'd be furious.'

Huge delay for care record evaluation (16 Apr 2008)


The Summary Care Record will remain under review for at least two years in a move which casts a shadow over the future of the programme, Pulse can reveal. University College London had been expected to produce its final evaluation next month, but a crippling series of delays, IT problems and fears over security have forced Connecting for Health to order a major extension to the timeframe. It is a huge blow to Government IT chiefs, who had planned to roll out the record nationally by the end of this year. Pulse revealed last week that just one patient in four in Bolton, the first early adopter area, has so far had Summary Care Records uploaded. Other early adopter areas, including Dorset, Bradford and Airedale and South West Essex, have yet to upload any records at all. The additional evaluation, which will also be carried out by the UCL team, headed by Professor Trisha Greenhalgh, will continue to look at the early adopter areas, as well as neighbouring PCTs which are expected to comprise the next wave. It will cost just over £700,000 and is due to report in May 2010. Dr Gillian Braunold, clinical director of the Summary Care Record and a GP in Kilburn, north London, said she expected the interim report from UCL next month to be 'illuminating', adding: 'It may well be that it strengthens quite a lot of what we're doing that we've had to be quite defensive about � maybe we'll be able to be a bit more robust.' But Dr Paul Cundy, chair of the GPC IT subcommittee, said: 'It's rather odd to be hearing about further evaluation before the results of the first evaluation.'

The Summary Care Record: What's gone wrong? (16 Apr 2008)


"Delays are not uncommon for Government IT projects, but even by the tardy standards of the National Programme for IT, this is a big one. When Connecting for Health officially launched the Summary Care Record in March 2007, the plan was for a rapid early adopter rollout, with the rest of the country to follow in short order. The first early adopter area, Bolton PCT, confidently predicted that within three months 'the majority of patients in Bolton will have a Summary Record'. More than a year later, the project is stuck in the mire, as internal papers obtained by Pulse reveal. The first flagship pilot, it turns out, has been beset by technical glitches, confidentiality concerns and a series of crippling delays. Just one in four patients have had their records uploaded and records have been used just 167 times. But the bad news for Connecting for Health is not confined to Lancashire. We can reveal that in other pilot areas the project has also slowed to a crawl. Bury PCT, the second early adopter, still hopes to have all the records in early adopter practices uploaded 'by the end of the summer'. But the fifth pilot, at Bradford and Airedale PCT, has yet to upload a single record four months after its launch. The Bolton minutes have also raised fresh fears over confidentiality. Project leaders had initially said that in A&E healthcare assistants, but not receptionists, would be given access to records - itself a controversial move, but one intended to mollify GPs who had told their patients only clinicians would use the records. But minutes of a meeting in February reveal that the PCT subsequently back tracked, and now plans to give receptionists access so long as 'they ask the patient directly.' By the PCT's own admission, this explicitly contradicts a guarantee to patients that non-clinical staff 'will not have access to your records'. . . The early adopter rollout has also been struck by severe software compatibility problems with the major suppliers. So far just two, InPractice and iSoft, are online, with the most widely used, EMIS, not going into testing until the end of this month. Getting GP buy-in to an the unpopular project has proved even harder. A poll last October by Bolton LMC found two thirds of the town's GPs opposed the care record rollout and a similar poll last month of committee members showed nothing had changed. . . So stung was Connecting for Health over adverse publicity it attempted to impose a media blackout, refusing for months to reveal the location of the sixth early adopter pilot - which Pulse finally revealed in February to be South West Essex PCT. It too has yet to upload a single record. University College London's independent evaluation of the early adopter projects, which was due to make a final report next month, has now been told to continue its evaluation for a further two years. . . There is some good news for Government IT bosses. With the uploading of care records for more than 150,000 patients now completed in early adopter practices, there has still been no catastrophic security breach. . . Yet despite the time and extraordinary amounts of money lavished on it, the next three months could prove make or break the Summary Care Record project. As well as the now-interim report from UCL next month, a National Audit Office progress report into the National Programme for IT due at the end of May and Lord Darzi's Next Stage Review in June will help determine the shape and scale of the wider rollout. The BMA, meanwhile, is having to decide whether to come off the fence. Despite rank-and-file members at last year's annual representatives meeting voting to 'advise all members not to cooperate with centralised storage of medical records as this seriously endangers confidentiality', the body has adopted a cautious approach. . . Dr Paul Cundy, chair of the GPC IT subcommittee, savages the Bolton project, warning patients have been 'effectively deceived' over receptionists being given access to records. 'The BMA's absolutely fundamental view is that explicit patient consent should always be the gold standard, and that's unchanged,' he says. Back in the early adopter practices, some GPs are doggedly pushing ahead. The Kearsley Medical Centre in Bolton has begun uploading 'full' or 'enhanced' Summary Care Records, with a far greater level of information beyond medications and allergies. But uploading a full record requires a patient's explicit consent, and reception so far has been mixed. While most new patients now have one, just one in three of patients with chronic illness contacted have so far opted in. . ."

NPfIT software implementation may stretch to 2016 (21 May 2008)

Kable's Government Computing

"Further delays have beset the implementation of a key feature of the NHS National Programme for IT According to a paper released online by the North West Strategic Health Authority, NHS Connecting for Health and local service provider CSC are preparing a new schedule for installation of the Lorenzo software within health service trusts, which extends to 2016. Lorenzo will provide the core clinical information system for hospitals in the north and east of England and the Midlands. This is at odds with a National Audit Office report released on 16 May, which said the implementation of electronic care records, the core of the national programme, had been delayed to 2014-15, making it four years late. The paper, signed by Alan Spours, chief information and knowledge officer of the SHA and dated 29 April, said that the University Hospitals of Morecambe Bay trust is scheduled to become the first trust in the country to deploy the Lorenzo in June. It added that the revised contract would include improvements such as interoperability between the Lorenzo software and GPs' systems, and mentioned that this was expected to be signed by 6 May. However, CSC and Connecting for Health said on 20 May they are still in negotiations over the contract. North West SHA said it was not able to comment on the document, given the continuation of negotiations."

Lorenzo likely to be further delayed (12 Jun 2008)

e-Health Insider

"The deployment of Lorenzo release 1 to three early adopter sites is likely to be further delayed, E-Health Insider has learned. University Hospitals of Morecambe Bay NHS Trust was scheduled to deploy the first release of iSoft's key product this weekend. But the trust, its local strategic health authority and NHS Connecting for Health all refused to say that this would happen when contacted by EHI this week. . ."

Leaked report for NHS reveals full extent of Lorenzo slippage (19 Jun 2008)

The Guardian

"Lorenzo, the much-delayed software package earmarked for a central role in the NHS's �£12.7bn IT overhaul, remains mired in development glitches and is still struggling to get out of the technical design phase, according to a confidential document seen by the Guardian. The document paints a very different picture to the one given earlier this week by the NHS chief executive, David Nicholson, and his interim head of IT, Gordon Hextall, when they appeared before parliament's public accounts committee. Asked why, after so many disappointments, trusts should have faith in the latest set of delivery promises, Nicholson said: "We are in a position now where Lorenzo actually has a product and it would be ridiculous now to just dump that." But a confidential report, seen by the Guardian and Computer Weekly, makes clear delivery deadlines slipped several months ago - though the delays were not made public. The report was produced by CSC, the US consultancy firm delivering Lorenzo in the north, Midlands and east of England. The document in part blames delays on serious staffing issues at IBA, the firm behind Lorenzo. It also flags as "red" concerns that resources have been diverted in order to meet the first milestone deadline for Lorenzo release 1, a less complex piece of software providing clinical functionality. This has slowed progress on release 2, the patient administration system that forms the core of the care records service. With developers struggling to get the relatively small release 1 ready at three pilot sites, CSC believes the more substantive release 2 is unlikely to get much beyond early stage tests by the end of the year. Officially it is scheduled to be live in hospitals by October. Previous delays to Lorenzo contributed to the near-collapse of the Manchester-based software firm iSoft, but the business was rescued by a smaller Australian rival, IBA, which took it over last summer. Lorenzo had initially been due to be rolled out from March 2004 and has missed a series of revised delivery dates since. Two years ago, an earlier internal CSC progress report on Lorenzo was leaked to the Guardian. It said: "There is no well-defined scope and therefore no believable plan for releases." Officially, Lorenzo release 1 was due to go live at Universities of Morecambe Bay Trust at the start of this week, but was delayed. "It will go live when the quality is right," Nicholson told the committee of MPs on Monday. "The software is actually in the trust and is being tested." Meanwhile, Nicholson and Hextall were surprised to learn from one committee member, Richard Bacon, that CSC had been offering some trusts an alternative system not owned by IBA. Asked if they were aware the US consultancy firm had two months earlier been "hawking around" the Portuguese system Alert at a healthcare IT conference in Harrogate, the men appeared baffled. "I was not aware of that," said Hextall."

Lorenzo stalled at Morecombe Bay (21 Oct 2008)

e-Health Insider

"The latest deadline for the implementation of Lorenzo at University Hospitals of Morecambe Bay NHS Trust has passed and there is currently no go-live date. Health minister Ben Bradshaw indicated that Morecambe Bay would become the first large NHS hospital to use the first version of iSoft's Lorenzo electronic patient record by the end of the summer. However, there is no published timetable for the key National Programme for IT in the NHS software to go live in its first acute reference site. The software is eventually due to be used across three-fifths of the English NHS. The latest delays to the first version of Lorenzo will innevitably push back the planned schedule for adding key clinical functionality to the software in three further releases, under a programme known as Penfield. This, in turn, raises doubts over the achievability of the current 2012 completion date for Lorenzo. . . "

Doctors aren't using the new Choose and Book system as much Connecting for Health has hoped. (24 Oct 2008)

IT Pro

"The National Health Service (NHS) has admitted only 50 per cent of hospital outpatient referrals are made through its new electronic appointment booking system. The government has wanted GPs to put at least 90 per cent of such appointments through the Choose and Book system by the time it was delivered by contractor Atos Origin last March. Then, only 37 per cent of outpatient referrals were booked through the system, but GP usage levels have remained static lower than targets ever since, according to Connecting for Health (CfH), the agency responsible for the NHS's National Programme for IT (NPfIT). It did say, however, that every hospital and 93 per cent of GP practices in England were now using the Choose and Book system overall, where some primary care trusts offering financial incentives to participating GPs. CfH stated that the 90 per cent target remains, although it has no deadline by which to achieve it. . ."

NHS records project grinds to halt (27 Oct 2008)

Financial Times

Progress on the £12bn computer programme designed to give doctors instant access to patients' records across the country has virtually ground to a halt, raising questions about whether the world's biggest civil information technology project will ever be finished. Connecting for Health, the ambitious plan to give every patient a comprehensive electronic record, has faced a series of problems over its size and complexity since it was first launched in 2002. In May this year, the National Audit Office said the project was running at least four years late but still appeared "feasible". Since then, however, just one of the scores of acute care hospitals due to install the underlying administration system required in order for the patient record to work has done so. The hospital, Royal Free NHS Trust in London, continues to have difficulties getting it to operate properly. In addition, the contractor originally hired to build the patient record system for the whole of the south of England, Fujitsu, has been fired. And BT, one of the two key remaining contractors, has been unable to agree a price for taking over the work Fujitsu had begun. Health ministers originally promised the long-delayed first installation of patient record software in the north of England would finally take place in June at Morecambe Bay on the Lancashire/Cumbria border. But four months on, the system has still not gone live and neither Morecambe Bay nor Connecting for Health can give a date when it might. CfH's most recent published plans for the next three months do not include a single installation of a patient administration system into any acute hospital trust. And while NHS Trusts in the south Fujitsu's former area - are being given a choice of working with BT, the supplier for London, or CSC, the supplier for the north, none has yet signed up with either. Jon Hoeksma, editor of the e-health insider website which has tracked the CfH programme from its start, said other parts of the £12bn project are continuing to make progress. "But this key part seems to be simply stuck. It has ground to a halt. And that is not just affecting deployments that should be happening now. It will have a knock-on effect on those that are meant to be going live two or three years down the line." Hospital chief executives, he said, did not want to take a new system "until they have seen it put in pretty flawlessly elsewhere". Frances Blunden, the IT policy specialist at the NHS Confederation, the body that represents NHS Trusts, said: "It is a little bit too early to pronounce the programme dead." She said there were "undeniable" problems, but "to say everyone is walking away from it is a bit premature, probably". She said the health department had promised earlier this year to address hospital complaints that the system was too standardised and could not be adjusted to take account of local needs. "But we haven't seen the implementation document to put flesh on the bones of that." A spokesman for Connecting for Health acknowledged that BT, which covers London, was "taking stock" given the difficulties encountered. The spokesman said it was more important to get the quality of installations right rather than promise delivery on a particular date. Talks with suppliers were under way to ensure "a smooth transition" in the south, after Fujitsu's departure.

NHS defers 2008 e-record go-lives - and FOI disclosures (29 Oct 2008)

Computer Weekly - Tony Collins's IT Projects Blog

"NHS trusts have deferred plans to go-live this year with electronic record systems under the £12.7bn National Programme for IT [NPfIT]. The deferral of major roll-outs of the Care Records Service comes after calamitous introductions of the system at hospitals in London and the south of England. Some observers will see the halting of e-record plans as a further sign of the slow demise of the NPfIT. But officials at NHS Connecting for Health, which runs part of the NPfIT, see the delays as a chance to understand thoroughly what has gone wrong at trusts which have implemented the Care Records Service. NHS Connecting for Health insists that trusts in London have not postponed go-lives indefinitely. A spokesman said: "Meetings will be taking place over the next couple of weeks with the London trusts to discuss the implementation dates and NHS London and those trusts hope to have revised dates as soon as possible." The cancellations of plans have added millions of pounds in extra costs for trusts which have recruited NPfIT specialists and trained thousands of NHS staff for go-lives which have not happened. Documents obtained by Computer Weekly under the Freedom of Information Act give an insight into some of the extra costs, problems and risks which face NHS trusts whose boards have taken decisions to become an "early adopter" of the Care Records Service. St Mary's Hospital in London, which is part of Imperial College Healthcare NHS Trust, has released the documents. It was due to become an early adopter of the problematic Cerner "Millennium" system which has been installed at Barts and The London, and the Royal Free Hospital, Hampstead. St Mary's has cancelled several go-live dates this year, the latest in August 2008. It is among several NHS trusts that have delayed plans to implement the Care Records Service until next year at the earliest. No major implementations under the NPfIT are expected this year, contrary to undertakings given to Parliament by NPfIT minister Ben Bradshaw. The documents released under the Freedom of Information Act say that senior executives at St Mary's in Paddington regarded an implementation under the NPfIT as carrying "huge risks". The "private" minutes of a St Mary's executive meeting said: "There were huge risks to implementation as experienced in other trusts such as Barts and The London and The Royal Free... the situation [when to go-live] was being dealt with on a day to day basis. The delay would mean that the project costs were likely to exceed the budget by £1m with the actual amount depending on the new date." The papers highlight the difficulties of producing comprehensive statutory reports from the system. They describe this as "one of the Care Records Service showstoppers". There was also concern about the possibility of a go-live having an undue effect on the health and care of patients. For example there was a risk that a failed merger of tens of thousands of duplicate files could end up with the wrong records being given to clinicians when they came to see patients. . ."

The 10 projects at the heart of NHS IT (10 Nov 2008),3800010403,39328119,00.htm

"It's the world's largest health IT project, its projected cost has doubled in its lifetime to £12.7bn, and parts of it are running four years late: welcome to the National Programme for IT (NPfIT). While the NHS's NPfIT has already outlasted several heads of IT, its chequered track record is not surprising given the ambitious scale of the project: replacing an ageing patchwork of 5,000 different computer systems with a nationwide infrastructure connecting more than 100,000 doctors, 380,000 nurses and 50,000 other health professionals. The NPfIT faced considerable scrutiny since its inception. A National Audit Office report in May this year highlighted serious delays in introducing the electronic care records system at the heart of the scheme due to technical challenges, while suppliers Accenture and Fujitsu pulled out of delivering the system and one trust halted implementation of the care records service. . . Paul Cundy, former chairman of the British Medical Association's IT Committee, believes the project has overall been a mixed blessing for UK healthcare. "It is a real mixed bag - those projects that worked very well have been clearly defined as delivering the best benefits to users, where the users have had input and where there has been political support for them. The ones where there is bad political interference, where there is no user input into design or are doing things that users do not want, those are the ones that predictably fail," Cundy told "The key is to ask people what they want." first put the core NHS IT projects under the microscope in early 2006. Much has changed since then, however, and has decided the time is ripe to revisit each of the major projects in the programme to get the latest on their highs and lows, and find out just how far away the NHS is from its interconnected dream. . . The deployment of the CRS is four years behind schedule and is not likely to be implemented across every NHS health trust in England and Wales until 2014 or 2015 according to a report by the National Audit Office. Progress has been hindered by technical problems and disagreements over how patients are asked for their consent for their medical records to be digitised. Five "early adopter" primary care trusts, Bradford and Airedale, Bolton, Bury, Dorset and South Birmingham, were chosen to create summary care records for patients and upload them to The Spine. Delays to the summary care records rollout have meant that only two of the five early adopter sites, Bolton and Bury, have uploaded their records to the Spine. Currently, patients in Bolton and Bury St Edmunds are able to view their own records using the NHS personalised site HealthSpace while patients in the other three early adopter trusts - Bradford and Airedale, Dorset and South Birmingham - will have access to their records over Healthspace once their care records have been uploaded. Meanwhile, the remaining 375 primary care, hospital and mental health trusts in England are rolling out patient administration systems (PAS). These PAS will initially handle more electronic admin records - containing details such as patients' names and addresses - and share them within parts of the local trust. A later date, the PAS will be upgraded to handle summary care records as well. Further problems in rolling out PAS means that six years into the National Programme for IT only 130 PAS have been deployed in 380 health trusts while delays to the deployment mean the majority of these systems are interim solutions, to be replaced by the Lorenzo software system at some point in the future. Trusts deploying a fully-fledged PAS have a choice of two systems, Cerner and Lorenzo. To date only 14 Cerner Millenium PAS software systems and just two Lorenzo system have been deployed. While Cerner release one users have the ability to connect to the Spine and upload summary care records, trusts using Lorenzo release one will need to upgrade their PAS system before enjoying the same functionality. Both Accenture and Fujitsu have pulled out of delivering the Care Records Service, leaving only BT and CSC left as the service suppliers. Some hospital trusts in the south are without any dates for when the PAS system will be implemented since Fujitsu's departure and Bath Royal United Hospital NHS Trust recently terminated its implementation of the Cerner system. Barts and the London NHS Trust reported that problems with the introduction of Cerner system had delayed the treatment of 11 cancer patients and The Royal Free Hampstead Hospital has had problems with data entry errors and other issues which contributed to a £7.2m deficit at the trust. These problems culminated in the NHS London Primary Care Trust halting any futher deployments of the Cerner PAS while it resolves issues with trusts already using the system. . ."

National Summary Care Record rollout finally begins (12 Jan 2009)


"The national rollout of the Summary Care Record is finally to begin next week, almost two years after the launch of the first pilot site. Documents posted on Connecting for Health's website reveal details of the first wave of the rollout, which will be fully underway by the end of March. Five 'fast follower' trusts are to start writing to patients in Lincolnshire, Stoke-on-Trent, Medway, Brighton-and-Hove and the Isle-of-Wight almost immediately, while a further nine have also indicated they may take part. LMCs have in some cases yet to be informed of the rollout, which comes even though records have been uploaded for only a small proportion of patients in the six existing early adopter areas, and with some early adopters yet to upload any at all. Some 12,000 patients at three practices in Stoke-on-Trent will begin receiving letters telling them about the Summary Care Record early next week. An NHS Stoke-on-Trent spokesperson insisted local LMC leaders were 'fully behind' the plans. But LMCs elsewhere warned local GPs had been left in the dark. Dr Nigel Watson, chief executive of Wessex LMCs, said: 'We have not been consulted about the Isle of Wight. We don't know anything about it.' Dr Neil Bhatia, a GP in Yateley, Hampshire and an IT campaigner, added: 'Connecting for Health simply want to roll this out as widely as possible, without alerting the public too much, in the hope that there will be no turning back.' Asked whether LMCs had been consulted, a Connecting for Health spokesman said: 'Any fast follower that has a confirmed status will have gone through appropriate governance approval within the PCT.' A letter sent in October and seen this week by Pulse from Dame Deidre Hine, chair of the BMA's Working Party on IT, called on Connecting for Health bosses to go slow, trailing the 'consent to view' model and reviewing its public communications strategy first. The letter warned: 'Once agreed, the new model should be carefully piloted with a limited number of practices before any wider rollout.' But a spokesman for the BMA said this week that it was not opposed to the first wave rollout going ahead, insisting it would involve only a 'small number' of practices."

London trust apologises to patients for IT-related delays (27 Jan 2009)

Computer Weekly

Barts and the London NHS Trust has apologised to 442 patients who were not seen within maximum government waiting limits because of inadequate management systems. The patients waited an average of six weeks longer than the 13-week waiting time national standard for an outpatient appointment. The trust said the delays were caused by inadequate management systems within the Outpatient Appointment Office. The trust has launched a "serious untoward incident" investigation to identify the root cause of the issue and why management systems did not alert the organisation to delays sooner. In a statement the trust said that no patient had come to "direct" clinical harm as a result of the delays. Last April Barts and The London NHS Trust installed the Cerner Millennium Care Records Service as part of the NHS's £12.7bn National Programme for IT. After the go-live last year it had difficulty gaining an overview of which patients had been treated for what. Some patients with suspected cancer had their appointments delayed. Of the latest incident to come to light of delays in the appointments for 442 patients, the trust said matters appear to have been "compounded by the inflexibility of the Care Record Service computer system". This inflexibility was "combined with the complexity of the trust's clinic structure, which meant that some appointments could not be made during the initial phone call, even though slots were available in specialist clinics". The trust added, "The issue was also exacerbated by increased pressure on appointment slots arising from the reduction in the maximum waiting time for outpatient appointments." The trust tackled the delays by increasing capacity in its clinics and by senior clinical staff contacting patients by telephone. Staff also wrote to patients to apologise and to arrange a suitable time and date for their outpatient appointment. . . Meanwhile, E-Health Insider has reported that Worthing Hospital may ditch the Cerner Millennium system it bought under the NPfIT.

Spend on NHS NPfIT of £5.1bn exceeds initial budget (7 Apr 2009)

Computer Weekly

"Taxpayer spending so far on the NHS's National Programme for IT (NPfIT) has risen to ££5.1bn, which is more than the scheme's original total lifecycle cost. The programme is in its seventh year and is not due for completion until 2014/15 at the earliest. Computer Weekly is publishing for the first time the Office of Government Commerce's Project Profile Model for the national IT programme. The Department of Health expunged the Project Profile Model from the official version of "Delivering 21st Century IT Support for the NHS", the document which, in 2002, marked the launch of the NPfIT. The "secret" document is to be published on the IT Projects blog. Richard Bacon, an MP on the Public Accounts Committee who has followed the NPfIT for several years, says he is astonished that £5.1bn has been spent on what he says is so little. The government revealed the figures in reply to a Parliamentary question by Tory shadow health spokesman Stephen O'Brien. One of the main products of the NPfIT - an e-records database for 50 million people - has yet to materialise. Originally it was envisaged that an electronic health record, what was then called a "Life-long National Health Record Service", would be in place by the end of 2005. Richard Bacon said: "It is depressing to think that this much money has already been spent and yet so little has been delivered. For £5.1bn an enormous amount should have been achieved in the NHS." NPfIT minister Ben Bradshaw said the latest figures include the original costs of NPflT contracts but also include "new and additional requirements that have been added, supported by separate business cases and funding, as reported by the National Audit Office". Proof that the government planned for the NPfIT on the basis it would cost ££5bn in total is in a document called the "Project Profile Model" which the Department of Health concealed. Computer Weekly is publishing the document for the first time. The Project Profile Model is dated March 2002. It put the total whole-life project costs of the NHS IT programme at £ Project Profile Models were used at that time to assess the risks of projects. The one for the NPfIT gave the scheme a score of 53 out of a possible 72. Any score over 40 put the project into the "high risk" category. The Project Profile Model was removed from the published version of Delivering 21st Century IT Support for the NHS, a Department of Health document which marked the launch of the NPfIT. The £5.1bn spent on the NPfIT to date excludes capital charges and the bulk of the local costs of NPfIT implementations which have not yet been measured. NHS Connecting for Health made no comment."

Health trust dodges NPfIT with £2.4m iSoft deal (23 April 2009),3800010403,39423082,00.htm

Heatherwood and Wexham Park Hospitals NHS Foundation Trust has rejected the National Programme for IT in choosing a supplier for the refresh of its patient administration system (PAS). Under the National Programme for IT, health trusts in the southern cluster - where Heatherwood and Wexham is located - are due to be upgraded to the Cerner Millennium PAS. Heatherwood and Wexham Park Hospitals NHS Foundation Trust, however, has selected a PAS from health software company iSoft instead. The system will cost the trust £2.4m over five years and will see the organisation take on iSoft's i.Patient Manager PAS as well as refreshing the installation of iSoft's i.Clinical Manager, which is already in use at the hospital. The trust opted to go with iSoft rather than wait for a PAS update through the National Programme for IT (NPfIT). The rollout of PASes to health trusts has been beset by delays and the NPfIT contract with Fujitsu to install the systems for the southern cluster fell apart last year. While BT has taken over upgrade work for some of the trusts, the remainder have yet to be allocated a new supplier.

National Summary Care Record rollout finally begins (12 Jan 2009)


"The national rollout of the Summary Care Record is finally to begin next week, almost two years after the launch of the first pilot site. Documents posted on Connecting for Health's website reveal details of the first wave of the rollout, which will be fully underway by the end of March. Five 'fast follower' trusts are to start writing to patients in Lincolnshire, Stoke-on-Trent, Medway, Brighton-and-Hove and the Isle-of-Wight almost immediately, while a further nine have also indicated they may take part. LMCs have in some cases yet to be informed of the rollout, which comes even though records have been uploaded for only a small proportion of patients in the six existing early adopter areas, and with some early adopters yet to upload any at all. Some 12,000 patients at three practices in Stoke-on-Trent will begin receiving letters telling them about the Summary Care Record early next week. An NHS Stoke-on-Trent spokesperson insisted local LMC leaders were 'fully behind' the plans. But LMCs elsewhere warned local GPs had been left in the dark. Dr Nigel Watson, chief executive of Wessex LMCs, said: 'We have not been consulted about the Isle of Wight. We don't know anything about it.' Dr Neil Bhatia, a GP in Yateley, Hampshire and an IT campaigner, added: 'Connecting for Health simply want to roll this out as widely as possible, without alerting the public too much, in the hope that there will be no turning back.' Asked whether LMCs had been consulted, a Connecting for Health spokesman said: 'Any fast follower that has a confirmed status will have gone through appropriate governance approval within the PCT.' A letter sent in October and seen this week by Pulse from Dame Deidre Hine, chair of the BMA's Working Party on IT, called on Connecting for Health bosses to go slow, trailing the 'consent to view' model and reviewing its public communications strategy first. The letter warned: 'Once agreed, the new model should be carefully piloted with a limited number of practices before any wider rollout.' But a spokesman for the BMA said this week that it was not opposed to the first wave rollout going ahead, insisting it would involve only a 'small number' of practices."

NPfIT Lorenzo - £57,500 per user so far (30 Oct 2009)

Computer Weekly Tony Collins' IT Projects Blog

The NPfIT minister Mike O'Brien revealed in a Parliamentary reply yesterday that there are 174 regular users of the Lorenzo 1 system at five NHS trusts. The Lorenzo system is supplied by services company CSC and software supplier iSoft under the National Programme for IT [NPfIT]. This number of users will increase when NHS Bury goes live with Lorenzo next month. But MPs are still likely to consider the number very low given the cost to taxpayers of the system. Taking O'Brien's figure of 174 together with £2m as a conservative figure for the cost per site of installing the Lorenzo system, the cost per user of the system is about £57,000. If you take the cost per concurrent user - 19 according to the minister - the cost per user rises to about £526,000. It may also be worth bearing in mind that two of the five trusts have been live with Lorenzo for more than a year. About £4bn in total has been spent centrally on the NPfIT and ministers have trumpeted the Care Records Service as the main aim of the programme. Lorenzo is one of two main NPfIT Care Records Service products to be delivered to trusts in England, the other being Cerner's Millennium. Lorenzo was due to have been delivered several years ago under the NPfIT. A typical NHS trust has about 1,000 to 5,000 users of its hospital administration system. . .

Insider View: Jon Hoeksma (5 Nov 2009)

e-Health Insider

E-Health Insider editor Jon Hoeksma reflects on a busy couple of weeks for news about the National Programme for IT in the NHS and says the sudden flurry of activity can mean only one thing - those November deadlines matter and judgement day is coming for NPfIT. There is nothing like a deadline to sharpen the mind, and finally the National Programme for IT in the NHS and its main suppliers are now working to deadlines that count. They fall in November. And chief among them is to successfully deliver both versions of the 'strategic' electronic patient record software purchased by the programme. Word has it that the Department of Health's chief information officer, Christine Connelly, has a three line whip from NHS chief executive David Nicholson to meet her commitment to get a problem free Cerner Millennium installation in London (Kingston) by the end of the month and to be "on track" to deliver iSoft's Lorenzo across a big acute trust (Morecambe Bay) by the end of March. It's against this background that the DH's newly published criteria for judging whether "significant progress" has been achieved have been published. For both Millennium and Lorenzo they begin with "does the product exist?" To have to even ask the question seems remarkable six years into the NPfIT programme. Otherwise, the criteria focus on reliability and scalability. They do not exactly raise the bar; rather they are the bare minimum the NHS might expect. Yet in an interview with E-Health Insider, Connelly declined to be drawn on whether she thought they would be met. It would be nice to hear the DH CIO saying that such basic hurdles will be cleared with ease. That said, the fact that NHS Bury went live with a version of Lorenzo containing some PAS-style functionality this week is a big step forward; even if going live across Morecambe Bay will require a much bigger leap. Who gets to make the call on success, and what happens next, promises to be extremely interesting. In her interview, Connelly stressed the decision will ultimately be taken by the NHS Management Board and Secretary of State for Health. Sources indicate that Nicholson and ministers have all but lost faith with the national programme, and have been pushing the November deadlines hard with little expectation of them being met. The option said to fast be gaining favour is systems of choice within a framework of interoperability and a radically reworked version of the LSP contracts. Also on Connelly's big 'to do' list by the end of November is to sort out interoperability with NPfIT systems; provide trusts in the South with a route out of the post-Fujitsu mire; and complete a new deal in London that will allow locally-configured delivery of Cerner while meeting the new requirements of polyclinics. . . Incredible though it may seem, six years after contracts were awarded, the world's largest civilian IT programme is still poised on a razor's edge between success and failure. With a Herculean effort, it may scrape over its November hurdles, making far-reaching changes unlikely - this side, at least, of a general election.

NPfIT aims in London won't be achieved, says a top health official (9 April 2010)

Computer Weekly

A senior health official has told all London NHS chief executives that savings on the £12.7bn NHS IT programme mean that "it will no longer be possible to provide a comprehensive solution that was anticipated in 2003". The letter by Ruth Carnall, who is chief executive of NHS London, the strategic health authority for the capital, is confirmation that the National Programme for IT [NPfIT] in London will not deliver to trusts in the capital a single standardised hospital system. One of original purposes of the NPfIT had been to achieve economies of scale by having one local service provider - BT - deliver a common, unified systems to all trusts in London. Carnall's letter explains the cuts in services and systems that will be made because of the government insistance that BT's £1bn contract as the NPfIT local service provider in London is reduced by at least £100m. The letter says: "The £100m reduction in the available funding, inevitably, means a reduction in the scope of the Programme. It will no longer be possible to provide the comprehensive solution that was anticipated in 2003." BT will no longer have to supply systems to about 1,400 GP practices in London. The Cerner and Rio electronic patient record systems "will now not be available to all organisations", says Carnall. BT is also excused from delivering an ambulance solution. Conservative MP Richard Bacon, a member of the House of Commons' Public Accounts Committee, said that the new deal with BT represents an extraordinarily good deal for the company and an extraordinarily bad one for taxpayers. Carnall says that a new IT strategy for the NHS in London will be drawn up which will help "address the IT challenges emerging from the reconfiguration of services".

NPfIT's Summary Care Records system suspended (19 Apr 2010)


One of the most controversial elements of the NPfIT, the Summary Care Records (SCR) system, has been suspended following industry criticism of a rushed implementation. The SCR system was criticised by the British Medical Association (BMA) last month in a letter to health minister Mike O'Brien. The letter said there were some privacy concerns around the scheme and that patients should be able to "opt out" if they wanted. Dr Grant Ingrams, chairman of the BMA's GP IT committee, said that the move to suspend the SCR system was a positive one. "We welcome the decision to suspend uploads. Summary Care Records have the potential to improve healthcare for patients if implemented appropriately. We will work with government in future to ensure that the many concerns of patients and doctors are listened to and addressed." The Department of Health (DoH0 said the rollout would be delayed until there was better awareness of the scheme. Separately, the government recently signed an NPfIT contract with BT locking the next government into a contract that will see the delivery of the NPfIT reduced in scale. Chief executive of NHS London Ruth Carnall said: "The deal means [the NPfIT] will no longer provide the comprehensive solution anticipated in 2003." BT will be paid about £900m, the original contract had been for £1bn. Public sector analyst for Ovum Mike Davis explained that the contract actually affords flexibility. "NHS trusts in London can now choose their own software and an alternative supplier if they want to," he said. Although choosing their own provider will cost individual trusts money upfront, some, such as Ipswich, have opted to choose their own software and system integrator to implement an Electronic Patient Records (EPR) system because they believe it would be more cost-efficient in the long run. The EPR means that the region's hospitals' billing systems are more efficient, thereby guaranteeing payment from their Primary Care Trust. Although the Tories have said they would look to dismantle the NPfIT, Ovum's Davis argued that in reality there will be no official dismantling of the NPfIT because so many parts are up and running – however, elements of it may begin to start unravelling over time as more trusts begin to choose their own software and system integrator. "My advice to any new government is to leave the NHS and the NPfIT alone. Coping with the changes [caused by the NPfIT] has been incredibly difficult for the health service – there are so many fiefdoms and hierarchies within the NHS that change has to be managed very carefully."

Summary Care Records scheme "at risk" - confidential draft report (20 Apr 2010)

Computer Weekly Tony Collins IT Projects Blog

The Summary Care Records scheme has yet to gain Treasury approval, which puts the future funding of the project at risk. SCRs are central to the success of the £13bn National Programme for IT in the NHS [NPfIT]. SCRs were launched in March 2007 when patients in Bolton became the first in England to receive information telling them about the introduction of the new electronic Summary Care Record. Since then, GP practices and primary care trusts have uploaded more than one million patient records onto a central Oracle database run by BT under an NPfIT data "spine" contract; and the Department of Health has paid financial rewards to dozens of primary care trusts for undertaking a public information programmes on the Summary Care Records scheme before March 2010. The Department of Health has told me several times over the past month that the business case for the SCR scheme is "in the process of being approved". But a confidential draft report on the SCR reveals that the scheme has been operating for three years without the Treasury's approval of the business case. The draft report by researchers at University College London, says that the non-approval of the business case is seen as the "biggest risk" to the programme by NHS Connecting for Health. The UCL report was commissioned by Connecting for Health. Ministers have decided not to publish it until later this year although it was due originally to have been published before the general election next month. The Treasury approves business cases when the full costs have been identified and justified, when there is proven support from stakeholders, and the benefits are clear, though the Treasury allows for some assumptions to be made. Last week the Department of Health announced that uploads of summary patient information will be halted in areas where the roll-out had been accelerated. No clear reasons were given for the suspension: the Department of Health said the roll-out would be delayed until there were better awareness of the scheme. The Department's spokesperson told me that the suspension had nothing to do with the Treasury's lack of approval so far for the SCR business case. . .

Government plans new model for Summary Care Record (21 Jun 2010)


Exclusive: The Government is planning to switch to a scaled back, 'patient-held' electronic care record, severing central control over the controversial programme, but stopping short of scrapping it altogether. A senior Government source told Pulse of moves to substantially reform the Summary Care Record after researchers found it had spectacularly failed to deliver a raft of promised benefits to patients and doctors. The official evaluation, by researchers at University College London, concluded the programme's problems were so deep routed they could not be solved, and claimed senior IT managers had deliberately rushed the rollout in the run-up to the election to save it from the axe. The Department of Health's signal that it plans a more patient-focused approach to the care record came as it emerged that almost 90% of nearly 9 million patients who have been mailed information may have given consent without realising it. A senior source said the Government was 'profoundly, deeply troubled' by the rollout and planned major changes including axing IT bureaucracy and switching to a simpler system based on patient control at a local level, including a back-up system for vulnerable patients. Connecting for Health had claimed the Summary Care Record would make GP out-of-hours telephone calls and visits 15% shorter, cut time spent on A&E and walk-in centre consultations by a third and make mental health crisis intervention encounters 60% shorter. Yet, the 250-page report, based on three years of data and costing £1m, said: 'When the care record was accessed by doctors, consultations were significantly longer.' The report, published in shorted form by the BMJ, did find a 'rare but important' impact on medication errors, but warned some records contained 'incomplete or inaccurate data,' including failing to list medication or listing allergies the patient probably didn't have. It also claimed a revised consent model brought in by Connecting for Health after huge pressure from the BMA, requiring clinicians to ask patients for consent each time they entered one of 1.2m records created as of March this year, was routinely ignored. Connecting for Health is accused of deliberately ramping up the speed of the rollout and reducing consultation with GPs, in an attempt to reach a critical mass of record use before the general election. Study leader Professor Trisha Greenhalgh, now professor of primary health care at Queen Mary's University, London, told Pulse: 'I cannot see how they are going to solve the problems we have found. The whole idea of a shared summary record sitting on a shared database is problematic.' Professor Greenhalgh added: 'If the Government ignores this report it will be a disgrace. If we'd found out there were real benefits to health, that it saved lives, them maybe we'd think it was worth it. But it hasn't.'

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