Supplier Problems - Others

From Nhs It Info


BT Takes Second Penalty In NHS Programme (4 Oct 2004)

MCN Direct Newswire

"BT's services business, which is the biggest supplier to the programme, admitted the NHS withheld £300,000 in July - around 30% of the monthly payment on the national application service provider contract - because BT failed to meet a target of 99.8% availability for the national data spine."

Secrecy of NHS contracts begins to unravel (10 May 2005)

Computer Business Review

"The UK National Health Service's enormous IT overhaul is beginning to show signs of strain, only 18 months after the NHS signed deals worth a total of GBP6bn ($11bn) with a number of vendors. So far though, it is the suppliers rather than the UK government that are looking decidedly unwell. The companies involved are being gagged by some totalitarian-style privacy rules, but news of problems is beginning to surface. Accenture was forced to reveal earnings shortfalls from its NPfIT (National Future Information Technology) contracts, Tata Consultancy Services blamed delays in its NHS work for its recent revenue shortfall, and a new UK law threatens to expose the details of the deals. . . Controversially, the government has deemed it necessary to demand that suppliers keep secret the details such as delivery deadlines of the contracts, hoping to avoid the bad publicity it has suffered previously. So far, very little is known about the structure of the deals, but this could change. The Freedom of Information Act came into full effect at the beginning of the year, which gives the public greater access to government-held information, and may well be invoked to force the NHS to reveal some of the details of the contracts. In March, a leaked memo revealed that the government has put pressure on NHS executives to refuse requests for information under the act, while it considers publishing some details of the contracts."

BT risks losing NHS contract (13 Jul 2005)


"BT must start meeting its London NHS commitments or risk losing its £996m Connecting for Health (CfH) contract, says NHS IT director general Richard Granger. In an exclusive interview with Computing, Granger acknowledges that there are considerable implementation problems in the capital, and blames the supplier's handling of subcontractor IDX."

Tata blames NHS National Programme for IT for revenue slowdown (22 Aug 2005)

The British Journal of Healthcare Computing & Information Management

"Tata Consultancy Services, a key supplier of data-migration services to the National Programme for IT in the NHS in England (NPfIT), has blamed delays in implementing the National Programme across the whole country for a slowdown in its revenues from its European operations."

ComMedica closes diagnostic imaging business (23 Feb 2006)

North Mersey Connect Portal - I & M T News

"ComMedica Limited, the UK-based developer of Picture Archiving and Communications Software has announced that it is closing its diagnostic imaging software business. The company has announced a 'significant restructuring', including the closure of its diagnostic imaging software business, resulting in over 100 redundancies at its Woking office and elsewhere. ComMedica said the move followed the Department of Health's decision to suspend deployment of CSC's ComMedica/Kodak PACS/RIS reference solution for the North-West and West Midlands region."

NHS trusts pay millions in fines to suppliers of delayed IT system (6 Jun 2006)

The Guardian,,1790952,00.html

"NHS trusts are being made to pay multimillion-pound penalties to computer suppliers because of a clause in contracts for the health service's £20bn IT scheme. Arrangements disclosed today by the magazine Computer Weekly show the government committed trusts to provide 200 staff to work with the computer companies to devise the best possible systems. In southern England the NHS was unable to meet an obligation to second 50 full-time employees to the Japanese-owned Fujitsu Corporation. The trusts will now have to pay Fujitsu £19m."

NHS IT costs hospitals dear: Fujitsu scores £19m compo (6 Jun 2006)

The Register

"More bad news for the UK government's NHS IT programme - cash-strapped health authorities are having to pay millions in compensation to Fujitsu and CSC . When contracts were first set up by central government, NHS trusts promised to provide staff to help work on the new systems. But according to reports, health authorities in the south of England have failed to find enough people so they have to pay Fujitsu $19m compensation. The south of England was supposed to find 50 staff to work at Fujitsu. The Department of Health told the Guardian: 'An agreement has been reached to buy out the liability at a cost of £19m in 2006-07 as NHS trusts have decided not to supply the staff resources.' In the north west and west Midlands, the NHS is contracted to provide 50 staff but is struggling to find enough people. Part of the problem is that NHS staff will be paid their standard salary even after moving. The staff were supposed to go to CSC, which is entitled to £6.9m every year for the 10 year term - or just under £70m. Health trusts are looking at ways to buy their way out of the ageements, according to documents seen by Computer Weekly which has more details here. . . Government IT projects either fail because of overambitious, and under-achieving, suppliers or because of incompetent and feckless civil servants. Rarely do they manage to do such damage to both suppliers and customers before anything is actually delivered." (Response from CfH) (Readers' responses)

Cerner predicted to replace GE in London (13 Jun 2006)

e-Heath Insider

"An analyst report from the US has said that there is a high probability that clinical software firm Cerner will replace GE Healthcare as main the supplier of clinical systems to the NHS in London. If a change does occur it is likely to initially result in further delivery delays to modernising NHS IT systems in the capital, as part of the late running £6.2bn NHS National Programme for IT (NPfIT). BT is understood to have been examining options for a replacement for IDX since the beginning of the year due to the difficulties in delivering the system to NHS trusts in the capital. In the past 30 months BT has implemented the software at just one hospital trust. . ."

Less than 1.5 per cent of electronic prescriptions seamless (23 Jun 2006)

e-Heath Insider

"E-Health Insider has learned that of the 1.6m electronic prescriptions issued by the Electronic Prescription Service, just under 30,000 have been seamlessly sent and received all the way through to dispensing. Out of the 1.6m scripts created electronically by GPs, just 29,386 have then been sent over the NHS spine, received and called down by a local pharmacist for dispensing. Of those called down, 26,676 have been dispensed to patients. This means that less than 1.5% of electronic prescriptions issued are actually being managed electronically end-to-end by the initial version of the EPS -- which still involves the printing of a paper prescription. . . The major efficiency benefits of the national EPS system are only likely to be possible when the majority of scripts generated are entirely electronic. This is a goal that remains a long way off. In a typical week the NHS dispenses 13.7m prescriptions."

Inside the NHS Connecting for Health project (7 Jul 2006)

Computer Business Review

"Richard Granger, director general of IT at the National Health Service, not only hit back at critics of the $10bn Connecting for Health (CfH) project last month, he also claimed that there is an 'essential dishonesty' between IT services vendors and their customers. Granger singled out major NHS contractor Accenture for particular criticism, and said that the project's detractors have failed to appreciate the enormous complexity of the program. . . He added that there remained an, 'essential dishonesty between the IT industry and the consumer, with the IT industry still trying to claim that there's a scientific basis behind its estimations of the costs involved in outsourcing projects, when practical experience shows that there isn't."

NE trust faces clinical systems conundrum (20 Jul 2006)

e-Health Insider

"A mental health trust board formed from three merged organisations has been advised to stop using a clinical information system supplied under the National Programme for IT on part of its new territory and use another single system across the whole trust. Northumberland Tyne and Wear NHS Trust board members received a paper on options for clinical information systems (CIS) which has been leaked to E-Health Insider. Board members were recommended to continue negotiation with CSE-Servelec for its RiO mental health system and to support the development of detailed plans to implement RiO, which is already used in part of the trust. NTW is not alone in its deliberations over strategy to fill the gap between the arrival of national programme solutions and the expiry of existing IT contracts. In December 2005 Norfolk and Norwich NHS Trust, located in the Eastern cluster of the national programme, decided to shelve implementation of an interim PAS system. In the same month Tees and North East Yorkshire NHS Trust, a mental health trust, also postponed an Accenture implementation of iSoft iPM. South West Yorkshire Mental Health Trust has also gone outside the NPfIT programme to procure a new integrated clinical system, as an 'interim solution'."

IMS signs contract with BT for London trust (17 Aug 2006)

e-Health Insider

IMS MAXIMS Plc today announced that it had signed a three year contract with London local service provider, BT, to supply its web-based clinical software to Barking, Havering and Redbridge NHS Trust (BHRT). . . A BT spokesperson told E-Health Insider that the deal for IMS at the east London trust was not long term: 'This is a time limited, interim arrangement The plan is for BHRT to migrate to the strategic solution in due course.' . . . The announcement of the deal further confuses the picture of how the £6.2bn Connecting for Health NHS IT programme is now to be delivered in London. In December 2003 the DH awarded BT a £996m 10-year contract to modernise NHS IT in the capital. To date it has installed core patient administration software at one acute trust - Queen Mary's, Sidcup. BT's clinical software provider is currently GE Healthcare, but the company has made clear its intention to switch to Cerner. A contract has yet to be completed."

When Bill met Tony, seeds of a grandiose scheme were sown (26 Aug 2006)

The Guardian,,1858787,00.html

"When Bill Gates met Tony Blair at Downing Street in 2001 the seeds were sown for the hugely ambitious plan to transform the NHS with the power of computers. Mr Gates, the billionaire software pioneer, had just written a book about how IT could transform economies. The prime minister, determined to reform Britain's public services, was hooked. Just one year later, representatives of Mr Gates's Microsoft empire attended a seminar at No 10 at which the NHS's £12bn IT programme was conceived. A core principle of this grandiose plan was that it should never rely on a single computer contractor and that the work should be carried out by global players. It is a measure of the crisis that these principles have been sacrificed and the NHS finds itself heavily dependent on one contractor, iSoft, a British-based specialist formed only in 2000. . . To create this system, the Department of Health in 2002 appointed Richard Granger, a former management consultant whose last project was the London congestion charge, as IT director at a salary of some £250,000. . . In placing contracts, Mr Granger says that he consciously structured the procurements to attract global players back to the NHS. He divided the NHS in England into five regions: the north-east, the east, north-west with west Midlands, the south and London. Each placed a 10-year contract worth about £1bn with a prime contractor to install standard systems. . . NHS Connecting for Health, the agency set up to run the programme, says that the choice of subcontractor lay entirely with the prime contractors, which carry the risks. . . In this arrangement, the NHS's safety net was always to have a backup supplier if one failed. The first to fail was IDX. In the south of England, Fujitsu has replaced IDX with Cerner. Last month, London followed suit. Hence the importance of iSoft, which although it has so far delivered only the first basic models of its hospital system and has financial troubles, is still seen by the NHS as the star performer, especially in its partnership with CSC. Mr Granger likens his relationship with suppliers to that of a polar explorer with his huskies: he once warned companies that weak performers would be fed to the strong. His problem is that he is rather short of huskies to shoot."

BT gets only £1.3m for two years' NHS work (28 Aug 2006)

The Guardian,,1859650,00.html

"BT has been paid just £1.3m for the first two years of its work introducing new computer systems across GP practices and hospitals in London, despite spending an estimated £200m-plus of its own cash. The company insisted last night it would not be forced to follow competitors and write down the value of the London NHS contract in its accounts. Three years ago, BT announced it had won a £996m 10-year deal as lead contractor to design, deliver and operate next-generation computer systems in the London area as part of the NHS's £6.2bn nationwide IT overhaul. At the time, it was heralded as a landmark deal for BT by chief executive, Ben Verwaayen. He said: 'These wins are BT's biggest ever, and evidence of the new face of BT truly emerging. This is BT taking on world-class competition on its own territory, and winning.' Last month, again, BT chairman Sir Christopher Bland, who received his knighthood for services to the NHS, told investors: 'BT has achieved some notable successes on its NHS National Programme for IT contracts.' But it has emerged that for the first two years of its London contract, BT has been paid by far the least of any of the NHS's lead contractors - just £1.3m. This is believed to reflect the extent to which the NHS thinks BT has met its delivery targets. A spokesman for BT said it was perfectly normal for revenues to be slim at the start of a lengthy contract. 'There is a lot of investment up front, but the profitability comes towards the end.' But the NHS's other lead contractors, operating similar-size projects around the country, have all been paid at least 20 times more than BT over the same period. . . . BT's reputation in London took a heavy blow earlier this year when it emerged that a child health computer system it designed and installed in several primary care trusts had many shortcomings. The system failed to hold correct data on whether babies had routine health checks, vaccinations, visits from health visitors and assessments for special needs. A spokesman for BT insisted many of the problems related to inaccurate paper records and said the trouble had largely been rectified."

BT faces watchdog inquiry into work on NHS computer revamp (29 Aug 2006)

The Times,,9076-2332472,00.html

"BT is facing a fresh inquiry into its work on the NHS's ambitious IT upgrade, amid growing concerns about the £12.4 billion project.The National Audit Office (NAO), the parliamentary watchdog, said yesterday that it may undertake a fresh examination of the mammoth NHS IT upgrade project, on which BT is one of four main suppliers. Another supplier is the troubled software group iSoft. The threat of further scrutiny followed the revelation in a parliamentary answer that BT has been paid just £1.3 million for about two years' work on one £996 million contract. Though the group insisted yesterday that this was in line with its expectation of laying down investment initially with revenues coming through later, some analysts speculated that the tiny size of the payments could reflect delivery failings by BT. The developments will increase pressure on BT to provide further details about the project's progress when it updates investors about its global services division ' the arm that supplies telecoms and IT services to business ' next month. The NHS work, worth in total more than £2 billion over ten years, is one of the biggest contracts in the division."

British Telecom ... And the £1billion con-tract (15-28 Sep 2006)

Private Eye

"Now that the Financial Services Authority (FSA) has decided to investigate one of the companies involved in the multi-billion pound NHS IT project, iSoft, over presenting dodgy figures to the stock market, will it dare take a look at another of the big players, BT? The Eye has already questioned BT's performance on the troubled programme . . . On the largest and most crucial part, its £996m contract for the London region, up to March this year it had received just £1.3m for installing only a fraction of the IT systems it should have, while its expenditure on the deal is likely to have exceeded £200m. Yet its accounts up to 31 March 2006 showed no losses from the project. Then last month BT ditched the software contractor it had been using as it shed all this cash, IDX, casting doubt as to whether its huge costs were, as its accounts would have it, "work in progress" and not money down the drain. . ."

Healthy Competition (11 Sep 2006)

New Statesman

"A more innovative approach to IT could have prevented the NHS records fiasco. The recent announcement that the Financial Services Authority is investigating iSoft, the troubled computer software company charged with delivering a large part of the new, centralised patient records system for the National Health Service, is just another sorry episode in the government's Connecting for Health initiative. In June 2005, Fujitsu, winner of the contract for southern England, changed horses midstream and dumped its software supplier. BT, the national telecoms provider, which owns the London contract, followed suit last month. And in July the Computer Sciences Corporation suffered an outage at its Maidstone data centre that left clinicians in the north-west and West Midlands stranded without computerised patient records for three days. . . Partly why we feel so powerless when our computers crash is that most of us are locked in to services provided by a monopoly supplier. Remarkably, it's the same at state level: familiar company names appear regularly in the news, because governments are flogging the same dead horses. Government IT contracts are often so tight that only huge companies will touch them. In the case of the NHS, the decision to pay on delivery for a highly complex system meant smaller, potentially more innovative producers could not take on the risk of tendering. Rather than nurturing a competitive ecosystem, such practices entrench the position of monopoly suppliers, regardless of actual past performance. The demand for centrally controlled systems is another hurdle. The most successful information pool is the internet - essentially a decentralised network run on open standards - yet governments persist in demanding control from the centre, and allow contractors to keep their standards hidden. If the government used its leverage as the largest spender on IT in the UK to demand that suppliers forfeit their intellectual property rights, they could open their code to smaller innovators. Managed correctly, such a move could change public IT for ever: rivals could salvage botched projects, and smaller producers could develop additional, specialised tools that plug in to the system."

Delays to NHS computer system could cost taxpayers £40bn (1 Oct 2006)

The Observer,,1885133,00.html

"The company charged with rescuing the NHS's troubled IT system has consistently failed to meet its deadlines for introducing the project across the health service, The Observer can reveal. Last week Computer Sciences Corporation (CSC) was awarded a £2bn contract to take on a bigger role in overseeing the implementation of the Connecting for Health system, the biggest civilian computer project in history which is supposed to electronically link all doctors' surgeries and hospitals. But government hopes that CSC will prove the £12.4bn project's salvation have been hit by news that the company has itself experienced huge problems in implementing even the most basic parts of the project. According to its original business plan, obtained by The Observer, CSC was contracted to install new computer systems to 32 acute hospitals by April 2006. However, according to the NHS, only eight of the hospitals had received the basic 'administrative' systems by that date and the company had failed to deliver any working clinical systems - the key part of the project which is supposed to record a person's medical data electronically. . . Critics suggest the eventual cost to the taxpayer of fixing the system's myriad problems will push the total bill for Connecting for Health to in excess of £15 bn. Some have suggested it will rise to as much as £20bn - enough to fund 40,000 nurses for the 10-year lifetime of the contract. . . 'This just replaces one regional contractor with another which has less experience,' said Richard Bacon, a Conservative MP who sits on the Public Accounts Committee. 'By passing the baton to CSC with indecent haste, the government has missed a golden opportunity to think again and to give more control to hospitals locally. I feel very sorry for hospitals who will have to put up with more delays and with systems that just don't work properly.' IT experts predicted the system's delivery could be completed on time and on budget only if it was scaled back. They warned patients' health could suffer unless problems were resolved soon. 'This is about more than taxpayers' money, this is about people's lives,' said Stephen Critchlow, chief executive of Ascribe, an IT company that supplies computer systems to hospitals."

CSC says it will implement iPM at Bradford in six months (18 Oct 2006)

e-Health insider

"Bradford Teaching Hospitals NHS Foundation Trust, which had gone outside the NHS National Programme for IT to procure for a new patient administration system, has come back into the fold. The trust has signed a deal with Computer Sciences Corporation (CSC) to implement iSoft's iPM in just six months, in a deal underwitten by NHS Connecting for Health. Having abandoned its procurement the trust is now dependant on CSC successfully installing iPM more rapidly than it has previously managed. Should this not be achieved NHS Connecting for Health has pledged to meet the extra cost to the trust of paying for continued support of its existing Siemens IRC system. . ."

Fujitsu under spotlight for NHS failures (24 Oct 2006)

The Guardian,,1929770,00.html

"Fujitsu, one of the lead contractors on the NHS's troubled £6.2bn IT upgrade, has installed only three patient-administration systems in two-and-a-half years on the project. It has recently all but frozen further installations while it struggles to fix problems at these sites. Fujitsu's problems are the latest blow for the health service's ambitious IT upgrade, the biggest non-military project of its kind in the world, which has been dogged by delays and contract disputes. Concern about the Japanese consultancy's work has until now been eclipsed by fears over Accenture and iSoft. . . In addition to these other challenges, health service IT bosses have become increasingly concerned about Fujitsu's progress on installing patient-administration systems. In March 2004, having signed a £900m 10-year contract, Fujitsu said it would have the systems up and running in 17 acute trusts, 36 community trusts and eight mental health trusts by this April. But by April Fujitsu had managed only one installation, at Nuffield Orthopaedic, a small acute trust in Oxford. Two months later, Fujitsu promised it would install 12 further systems in acute trusts by the end of this month, but it has added only two more so far and NHS IT bosses now privately admit the target will not be met. Fujitsu's installation programme has been paralysed by problems at the first three trusts to receive the systems. Nuffield Orthopaedic, Fujitsu's first acute trust project, recently said it blamed problems with its computer systems after it lost its top-level three-star performance rating and was assessed as "weak". In a "serious untoward incident" report to the Strategic Health Authority weeks after the Fujitsu system was installed last December, the trust said disruption caused by the installation could have put the safety of patients at risk. Concerns over Fujitsu installations have led to planned "go-live" dates at hospitals across the south of England - the region for which Fujitsu is lead contractor - being repeatedly put back, sometimes with just a few days' notice for staff. A spokesman for Milton Keynes, which has twice had its go-live date delayed, said Fujitsu was "sorting out the odd glitch", but the installation has now been postponed with no new date set. . ."

QMS to ditch IDX for Cerner in 2007 (16 Nov 2006)

e-Health Insider

"Queen Mary Sidcup (QMS), the only London trust to have received a new hospital IT system under the NHS computerisation scheme, will now have to replace it less than a year after the system became fully operational. QMS first switched on IDX's Carecast system after a fraught implementation in November 2005, but it has taken until October 2006 for the system to become fully operational and integrated with Choose and Book. But following the November 2005 implementation, BT, the local service provider for London, stopped work on further hospital PAS installs. For most of 2006 BT has been locked in negotiations with Cerner and GE Healthcare, which in January purchased IDX. Last week BT finally announced that it had replaced GE Healthcare with Cerner and would now offer Cerner's Millennium as its clinical software for the acute sector. Kate Grimes, QMS chief executive, has exclusively confirmed to E-Health Insider that her trust will now replace IDX Carecast with Cerner Millennium in 2007. . . The planned switch will mean that the trust will have had to go through two full PAS implementations in less than two years. Last month Grimes told a health IT conference how disruptive the implementation of IDX has been for the trust, to the point of creating a severe financial risk to her trust. One of the biggest problems for QMS was that following go live last November it took almost another year for Carecast to be become Choose and Book compliant. The system was only finally integrated last month... QMS says that it only learned that Carecast was not Choose and Book compliant last July. . ."

System C issues profit warning as NPfIT slows (18 Jan 2007)

e-Health Insider

"System C Healthcare has issued a profit warning citing a dramatic slowdown in deployments under the NHS IT programme as a result of a three month "hiatus" during the handover from Accenture to CSC. A spokesperson for System C told EHI: "The hand-over from Accenture to CSC caused a significant hiatus in activity for us during that period. With the hand-over now complete, the amount of work is increasing steadily, but we know now that the ramp-up will not be as fast as we expected." They added: "This means that in the time left to us in our current financial year, we won't be able to make up the shortfall in our numbers ' hence the need for profits warning to the City." System C is one of the main companies implementing computer systems as a sub-contractor to the local service providers (LSPs) delivering the £12bn NHS National programme for IT (NPfIT). In its trading statement the company said "System C continues to operate in challenging conditions in our core English market". The firm indicated that the slow down stemmed from the protracted contract wrangles last year between NHS Connecting for Health and one of its prime contractors, Accenture, eventually resulting in Accenture's replacement by Computer Sciences Corporation. . ."

Fitter, healthier, more productive (15 Mar 2007)

The Guardian,,2033496,00.html

"Britain's medical practitioners are making lifesaving technological advances at local level - by effectively ignoring the costly NHS IT programme . . . As you walk into the waiting room of Thornley House Medical Centre in Hyde, Cheshire, the first thing you see is a giant plasma screen inviting you to apply to view your medical records on the web. Meanwhile, at Queen Alexandra hospital in Portsmouth, nurses routinely enter patients' vital signs into handheld personal digital assistants. . . In Hyde, the revolution in healthcare information may have even more profound consequences. It is the first practice in the world to invite every patient to inspect their electronic health record and, if they want, to have it available online. . . Two triumphs of the £14.6bn NHS programme for IT? Hardly. Electronic medical records at Hyde and Portsmouth may be achieving what the national programme, conceived five years ago this spring, is setting out to do. But they are independent efforts, happening not because of the national effort but almost despite it. While Hannan and Smith and other pioneers dotted around the country have patients' full clinical details available at the touch of a button, the much-vaunted NHS programme is only now about to start loading basic clinical details on to the care records "spine". These will contain only the allergies and current prescriptions of patients at a few primary care trusts. Next week the annual Healthcare Computing conference in Harrogate will buzz with accusations that the national programme has held back progress. There are two reasons behind this charge. First, under the £1bn contracts signed early in the programme, hospitals have to replace their administrative systems which record patients' details with systems from centrally chosen suppliers. As this involves considerable local effort for little benefit, progress is painfully slow. The second problem is the potential threat to confidentiality arising from making records available on a national scale. . ."

Update: Fujitsu shock £1.2bn loss driven by problems in UK (20 Mar 2007)

ComputerWorld UK

"Problems at Fujitsu Services, the UK subsidiary of Japanese computer giant Fujitsu, have played a key part in shock forecast losses of £1.2bn for the 2006 financial year. Today's profits warning, made at the end of the business day and ahead of a public holiday in Japan, came after years of problems with Fujitsu Services, which holds a number of high-profile public sector contracts. Fujitsu Services is a lead contractor for the southern region of the NHS's £12.4bn IT programme. It is also an important IT provider to HM Revenue and Customs where its £930m outsourcing contract has been absorbed into the Aspire contract held by Capgemini. The Japanese computer giant, which had earlier forecast profits of £238m, said it now expected to record a loss on devaluation of its stock in Fujitsu Services. . . Fujitsu's relations with the NHS National Programme for IT (NPfIT) were strained last month when Andrew Rollerson, its healthcare consultancy practice lead, spoke out at a conference to discuss implementation of the programme, warning of a 'gradual coming apart of what we are doing on the ground'. The slow progress of NPfIT in the southern region where Fujitsu Services is the lead contractor was recently revealed in a parliamentary written answer that showed the firm had completed just £27m worth of work ' less than 10% of the £287.5 paid out to contractors in the other four regions. . ."

NHS pours £100m into finding additional software suppliers (29 Mar 2007)

The Guardian,,2045089,00.html

"NHS bosses charged with delivering the much-delayed £6.2bn IT upgrade to health trusts throughout England have launched a £100m-plus drive for "additional" IT suppliers to meet "immediate business needs". Separately, the Guardian has learned that the Australian group IBA Health is close to abandoning talks over a potential all-share takeover of cash-strapped software supplier iSoft, which is contracted to provide systems for 60% of the NHS's troubled National Programme for IT (NPfIT). The decision by NHS bosses to seek new suppliers is a significant move away from the troubled NPfIT, which has been running for four years, mired in delays and software setbacks. Concern has been mounting among clinicians and trust executives that the NPfIT has become over-reliant on software sub-contractors iSoft and Cerner and the suitability of their systems. The two firms have been blamed in some quarters for delays. Official tender documents were filed with the European Union yesterday, stating: "The [NHS] anticipates that, as a result of immediate business needs and projects planned, services ... will be procured at an early stage following the establishment of a framework." The framework, the papers said, would "assist with the success and delivery of the NPfIT". However, "it is not intended" that this would conflict with existing NPfIT contracts. Industry insiders and some NHS sources were at a loss to explain how some of the items sought would not come into conflict with contracted NPfIT agreements. They include maternity, A&E and patient administration systems. Richard Bacon MP, a member of the public accounts committee, said: "It is a tacit admission that the current approach is not working. More clarity is needed about ... how fast people in the NHS will actually be able to acquire new systems from these suppliers". A number of trusts have become so disillusioned with the NPfIT delays that they have begun buying their own IT systems outside the programme, forgoing central NHS funding. Meanwhile, it is believed iSoft will remain in talks with at least one other party should IBA end takeover discussions. IBA is thought to have been unable to win the backing of US firm CSC, through which iSoft is a NPfIT supplier."

Atos Origin suspended from NHS contract (13 Apr 2007)

ZDNet UK,1000000308,39286700,00.htm

"Atos Origin has insisted it will continue to work with the Department of Health and the NHS despite the suspension of a key health service contract. Ultrasound and medical imaging services, which were being provided by the IT consultancy, were suspended on 20 March after NHS North West claimed that "operational issues had led to incomplete patient information being included and delays in reporting diagnoses". The crisis deepened last week when it was revealed that there were technical as well as administrative problems with Atos Origin's service. Up to 900 patients from areas including Manchester and Liverpool may now have to be called back to hospital to have their scans repeated. The problems arose during a contract that expired at the end of March. A follow-on contract due to start in April has now been shelved for the time being. A spokesperson for Atos Origin said on Friday that the consultancy had "taken the decision to stop accepting referrals for all diagnostic examinations while a full process review takes place. [Atos Origin, the Department for Health and the NHS] continue to work together in preparation for service delivery scheduled to commence in the coming months". Atos Origin is also developing Choose and Book, the appointments system that is one of the major elements of the National Programme for IT (NPfIT). NPfIT is the largest civilian IT project in the world and will bring together the UK's hospitals and GPs all on one network which shared access to patient information."

NHS chief exec pledges to help resolve CRS issues (5 Jun 2007)

e-Health Insider

"NHS chief executive David Nicholson has told Milton Keynes Hospital NHS Trust that they can count on his full support in resolving the problems they encountered in April after going live with the Millennium Care Records System provided by Fujitsu. In April 79 members of staff from the trust signed a letter outlining their frustrations at the Millennium CRS system, describing the system "awkward and clunky" and stating: "In our opinion the system should not be installed in any further hospitals. Problems cited included incidences of lost records. To help rebuild confidence and get a first hand picture on 14 May NHS chief executive David Nicholson and IT director Richard Granger visited the trust. "Mr Granger and Mr Nicholson gave the Trust their full support resolving issues related to CRS. The Trust is committed to working with CfH to improve CRS," a spokesperson told EHI. NHS Connecting for Health said in April that there had been some "unacceptable problems" with the new system installed at Milton Keynes which "require immediate attention". Prime contractor Fujitsu said there had clearly been "some high impact problems". The trust's finance director Rob Baird was quoted as saying: "The service to our patients in some areas has diminished in this period. At the moment we have quite a confused situation and it's like everyone had started a new job". Since early April Fujitsu and Cerner have had a team working on site at Milton Keynes to resolve the problems. . ."

NHS trusts seek software outside NPfIT (3 Aug 2007)

Computer Weekly

"NHS trusts are going outside the £12.4bn National Programme for IT (NPfIT) to find software to manage patient tests, it has emerged. Computer Weekly has seen board documents from three trusts showing that they are looking outside the programme for software to manage doctors' requests for radiology and pathology tests, a function known as "order communications". Trusts were expecting this functionality to be part of the NPfITs patient administration systems. United Bristol Healthcare now plans to install a third-party system to cover this functionality. The trust will go live with the second version of the Millennium patient administration system next year, but does not plan to use the system for order communications. . . North Bristol NHS Trust said it had bought an alternative product to handle order communications, following delays of more than two years for Millennium. The trust said it expected to go live with R1 next year, but it does not plan to use the system for order communications. Concerns have also been raised by clinicians at Worthing and Southlands NHS Trust about whether the first release of Millennium, known as R0, will support order communications. Despite going live with the first release of Millennium, the trust said it would continue to use manual processes for order communications. . . The Department of Health set the requirement for patient administration systems, and contracted service providers to build these systems with suppliers of their choosing. Fujitsu said it did not believe trusts were seeking an alternative to Cerner for order communications. Steve Isherwood, head of marketing for health at Fujitsu, said that since last year, there had been a lot of discussions over order communications and resolution over how it had been deployed. "R1 and R0 have order communications as part of their functionality. If there are any issues on any areas, we will work with the trusts on these issues. We will identify the issues and provide solutions and resolutions for them," he said. Cerner said the order communications functionality was part of its product, but it declined to comment further. . ."

Contract 'reset' underway in the South (9 Aug 2007)

e-Health Insider'reset'_underway_in_the_south

"The new NHS programme director for the NHS IT programme in the South of England says she is not happy with the core patient administration system delivered so far, and confirmed that a far-reaching 'reset' of contracts has been launched. Sarah Elmendorf took up the new post of programme director at the Southern Programme for IT earlier this summer. Already she has acquired a reputation for straight talking and demanding results in a hurry. In an exclusive interview with EHI she spoke candidly of the problems with Cerner's Millennium patient administration system, as provided by local service provider Fujitsu: 'I am not happy with what has been delivered thus far, but with the focus of Cerner, Fujitsu, the NHS and ourselves, we can get an acceptable baseline PAS.' She added: 'The NHS needs a good PAS and an excellent clinical system quickly. For this to happen the interests of the NHS Fujitsu and Cerner need to be fully in alignment.' Her appointment, the three southern SHA's creation of a Southern NHS IT programme and decision to hit the 'reset' button on contracts are proof power shifting from the centre. But it was the centre, in the shape of Connecting for Health, which originally negotiated local service provider contracts, and remains 'the owner of the contract and the commercials'. To get change through the Southern NHS IT programme will need CfH's co-operation. Only at the end of the current reset period will it be clear whether NPfIT Local Ownership Programme (NLOP) is made of straw or whether the reins have either been surrendered or wrested from the centre. Before taking up the new role in June Elmendorf was the CIO for South Central SHA. Previously she held senior IT positions in telecoms and banking, roles in which she says the focus was always on 'delivery' and staying close to customers and suppliers. She confirmed to EHI that one of the first steps taken by the Southern Programme for IT has been to 'reset' the contract with Fujitsu the culmination of mounting pressures and NHS frustrations over many months. This is a far reaching review of the detail of Connecting for Health's contract with Fujitsu, including revisiting the requirements of what is to be delivered and how and when this is done. Elmendorf suggested the current 'reset' may just be the last opportunity to get NPfIT to work for the NHS. A previous contract 'reset' was completed in November 2006, but failed to draw a line under implementation problems and delays. The difference this time is that it the process is being led by SHAs and trusts. . . Priority areas requiring immediate attention in Millennium include: outpatients, waiting lists, A+E and reporting. . ."

Some NPfIT PAS systems barely used (21 Aug 2007)

e-Health Insider

A number of Connecting for Health funded patient administration systems (PAS), installed in primary care and community trusts, are only being used by a handful of staff months after installation, according to official figures seen by EHI Primary Care. Internal figures, prepared by local service provider (LSP) CSC Alliance, show an average number of monthly users of just one for North Staffordshire, less than 20 for Cambridgeshire PCT, South Essex and Bedfordshire and Hertfordshire health community, and less than 50 for Dudley, Fylde Coast and North Cheshire. Usage figures for PAS systems in the North, Midlands and East Programme for IT show that, in several cases, less than 20 staff are using the CfH supplied PAS system each month. CSC is responsible for delivering new IT systems to three-fifths of the English NHS. Latest CfH figures report that it has installed 99 NPfIT versions of iSoft's iPM PAS system, mostly in its original North West and West Midlands cluster. The majority of the systems have been installed in PCTs, community and mental health trusts. . ."

Future of centralised NHS IT in doubt as BT 'resets' contract (22 Nov 2007)


BT has completed the renegotiation of its £1bn contract to deliver new computer systems to the NHS in London, in another sign that the centrally managed model for the health service's £12.4bn National Programme for IT (NPfIT) has had its day. NHS IT agency Connecting for Health had originally kept a tight central grip on contracts for the huge IT overhaul, under its combative director general Richard Granger. But in July, Granger announced he would quit his post by the end of the year - and the Department of Health has not advertised for a replacement. Instead, the management arrangements of Connecting for Health and NPfIT are being reviewed by NHS chief executive David Nicholson, while the lead contractors for the programme are involved in renegotiating their deals to enable a more locally tailored approach that meets the needs of strategic health authorities and trusts. A BT spokesperson confirmed that the new contract for the London region would establish a "best of breed" approach to the software it supplies rather than a rigid one-size-fits-all model. Negotiations had begun in summer 2006, when BT sought to switch the patient record system it supplied from one supplied by IDX to Cerner's Millennium product, he said. But the new deal had been completed this summer, after the advent of the NPfIT local ownership programme (NLOP) - which transferred responsibility for the delivery of NPfIT from Connecting for Health to SHAs. A Connecting for Health spokesperson insisted that the renegotiation of the BT contract should be described as a "reset", adding: "The contract reset is a normal repeatable commercial process to ensure the detail of the contract reflects the progress to date, current priorities and deployment plans for the future." Another "reset", relating to "changes in development methodology and deployment" was under way with Fujitsu and CSC - lead contractors for the South, and North and Eastern regions - the spokesperson said. But in September Lester Young, NHS account director for Fujitsu, confirmed that his company was expecting to sign a new contract with the NHS and would even be open to changing the original output based specifications for NPfIT set by Connecting for Health in 2003. Changes to the contract - which is ultimately held by the health secretary on behalf of the government - would "deal with the differences" between what strategic health authorities in the southern region want and the requirements set out nationally by Connecting for Health, Young said. It is unclear what the new contracts will mean for the overall cost of the NPfIT programme. The Connecting fro Health spokesperson said: "The original value of the contracts for the same services remain unchanged. However, when additional requirements are identified in conjunction with the NHS then any additional charges will either be funded separately or funded from within the original contract value, depending upon the particular need and the work required."

N Yorks GPs protest over system choice (27 Nov 2007)

e-Health Insider Primary Care

"GPs claim their PCT is acting outside the GP Systems of Choice initiative by outlining a plan to encourage all practices to move onto the local service provider solution TPP's SystmOne. North Yorkshire and York PCT 's IM&T strategy states that the introduction of SystmOne will be "actively promoted and supported by the PCT" giving consideration to the objectives of the strategic health authority, the principles of GPSoC and the best interests of patients. . . The strategy says around 80% of the 102 practices covered by the PCT currently use the GP system EMIS with only four currently using SystmOne but outlines the SHA plan to see 100% of practices in the region on TPP by 2011. Dr Brian McGregor, a GP in York and a director of district's LMC, said the committee first heard about the strategy at a liaison meeting with the PCT at the beginning of this month. It went before the PCT board for approval five days later. He told EHI Primary Care: "First of all we believe it is factually incorrect as it presents SystmOne as the NPfIT solution when our understanding is that this is only an interim solution and the ultimate aim is for practices to move onto Lorenzo primary care. That could mean practices that move to SystmOne having to go through a second change. "We also think it's not for the PCT to promote one system over another which is something for practices to decide for themselves." Dr McGrgeor said the LMC feared that practices would be forced into changing systems against their will and said it was "even more galling" that a local primary and secondary care intranet in the York area, linking EMIS practices with York District Hospital, was already delivering the vision of primary and secondary care linked services that the strategy involved. Dr McGregor said the intranet, set up two or three years ago, now delivers 1000 plus letters sent electronically direct to patient records every day and access to a shared care record was planned soon as well as possible links to the intranet for practices using other GP systems. . . Dr McGregor said GPSoC documents issued to all practices include a statement that those signing up to GPSoC are committing themselves to migrate to the fully integrated LSP solution when that is available. He said the LMC's advice to practices was not to sign the document until that statement had been removed. . ."

NHS records system delays cost CSC £5m (7 Jan 2008)

Computer Weekly

"Services supplier CSC has paid penalties of about £5m following delays in the deployment of patient administration software across several NHS trusts under the National Programme for IT (NPfIT). The disclosure undermines claims by NHS Connecting for Health and the Department of Health in a briefing paper to the prime minister in February 2007 that "much of the programme is complete, with software delivered to time and budget". NPfIT regional minutes seen by Computer Weekly show that CSC has made penalty payments following delays in rolling out software in the North, Midlands and East of England, where it is the NHS local service provider. . . CSC is due to supply NHS trusts with iSoft's Lorenzo patient administration and electronic record system under the NPfIT. CSC has worked with trusts to deploy limited interim versions of iSoft's patient administration systems following delays in the "strategic" Lorenzo releases, which could provide joined-up health systems across England. . ."

Fujitsu may quit NHS National Programme for IT (22 Jan 2008)

Computer Weekly

"The board of an NHS trust has learned of a "significant" risk of Fujitsu ending its £900m contract to supply and implement hospital systems across southern England as part of the National Programme for IT (NPfIT). A withdrawal would add to delays in installations of NPfIT systems, deepen scepticism among doctors over whether the programme is feasible, and could indicate that the NPfIT is in deeper trouble than widely thought. In 2006 Accenture withdrew as a local service provider, making provision for write-offs of about £230m. Fujitsu and NHS Connecting for Health, which runs part of the NPfIT, and the Department of Health are discussing a contract "reset", which involves a renegotiation of large parts of the £896m deal signed in 2004. The contract is not due to finish until 2013. Computer Weekly understands that there are differences of views over the cost of the requested work which amount to tens of millions of pounds. If an agreement over price cannot be reached, Fujitsu has the choice of seeking to reduce the amount of work and risk it is being asked to take on, absorbing any extra costs or withdrawing. The Royal United Hospital at Bath has warned of a series of risks to its planned go-live of NPfIT systems this spring. It has categorised as "significant" a risk of "further delays if Fujitsu ceases to be the local service provider for the South [of England]". The trust's staff are involved in the contract reset. To mitigate risk, the trust would have to establish an effective working relationship with Fujitsu sub-contractor Cerner to "ensure satisfactory continuity in the event of Fujitsu's contract ending", said Richard Smale in a paper to his board, which he wrote as head of information services at Royal United Hospital. Fujitsu is known to be a tough negotiator and, according to a National Audit Office report, it threatened to withdraw from the Libra contract to supply a national case management system for magistrates courts. In the end, the value of Fujitsu's Libra contract was increased from £146m to £232m and it was reduced in scope, with the government's agreement. A spokeswoman for Fujitsu declined to comment on whether it may cease to be the South's local service provider, or that in the contract reset negotiations there are differences of views over the cost of the requested work of tens of millions of pounds. The spokeswoman said, "We cannot comment on ongoing commercial negotiations." NHS Connecting for Health made a similar comment."

Some NPfIT "major issues" - did the PM get a full briefing in 2007?(17 Jan 2008)

Computer Weekly - Tony Collins' IT Projects Blog

"Some of the major NPfIT issues identified by Helen Bellairs, Chief Executive, Western Cheshire Primary Care Trust, seem at odds with a briefing paper to the prime minister in February 2007. Helen Bellairs is a local senior responsible owner of the National Programme for IT [NPfIT] in the NHS. Under NLOP, the NPfIT Local Ownership Programme, all chief executives of primary care trusts in England have been appointed senior responsible owners. It means they may be held accountable for failures and realising any benefits of NLOP and the NPfIT. In a briefing paper to the North West Strategic Health Authority NPfIT board, Helen Bellairs outlined what has been achieved locally; and she identified six "major issues" with the NPfIT. Some of the issues have a general significance to the national programme. The paper referred to the Lorenzo product supplied by iSoft - now owned by Australian company IBA health - and CSC, the NPfIT local service provider for the North, Midlands and East of England. . .

  • The continuing delays in the availability of the Lorenzo system, which undermine the credibility of the whole of National Programme for Information Technology. In the meantime, existing suppliers continue to develop their products, which make it even harder to persuade Trusts to move onto Lorenzo.
  • A lack of confidence in how strategic instances are going to work in practice. It is very hard to see how a large database across the whole of Cheshire and Merseyside will work when all hospitals and community settings are on it. This needs to be addressed through strong governance and general interaction between the Local Health Communities.
  • The lack of confidence created by repeated undelivered promises. An example of this would be the recent failed upgrade in Morecambe Bay.
  • The lack of a clear strategy in relation to the sharing of clinical data in relation to i) meeting organisational requirements ii) information governance issues and iii) the technical infrastructure to support it.
  • There is widespread dissatisfaction at the local level with the performance of the National Service Desk (Fujitsu). Despite escalation of these issues, no discernible improvements have been identified. This issue has been addressed to some extent by the formation of the shared Cheshire and Merseyside Service Desk, but this would not have been required if the National Service Desk delivered what they promised.
  • The lack of clinical functionality in the current patient administration system from CSC means that clinicians are disengaging from the programme and looking elsewhere for clinical solutions. . ."

Minister defensive over Cerner NPfIT NHS sites (4 Feb 2008)

Computer Weekly - Tony Collins IT Projects Blog

When advisers to ministers write replies to Parliamentary questions they have no legal duty to be candid. Within reason they can say what they like. So for them answering written Parliamentary questions may be no more challenging than playing tennis with the net down. Indeed, when asked about the NHS's National Programme for IT [NPfIT], ministerial advisers can use Parliamentary replies to make light of the concerns of clinicians and others. And this is what happened when Worthing MP Peter Bottomley put a question about Cerner sites to Ben Bradshaw, who's the latest in a series of ministers to be put in charge of the NPfIT. Cerner's "Millennium" software will be used to help NHS staff administer hospitals and keep records on the care and treatment of patients. It's due to be installed at hospitals across London and the South of England as part of the NPfIT. Bottomley asked Bradshaw what representations he'd received from clinicians in hospitals about Cerner Millennium go-lives. Bradshaw's reply in January 2008 suggested that clinicians are concerned only about things such as the number of keystrokes to carry out certain functions. . . There have been some successes with Cerner go-lives. Barnet and Chase Farm Hospitals NHS Trust, for example, now has near a real-time overview of when beds are vacant and where. The reality, also, is that at some hospitals where Millennium has been installed there have been protracted difficulties, not necessarily through any fault of NHS trusts or Cerner, or the local service providers, Fujitsu and BT. The Audit Commision, in the latest annual audit report on Weston Area Health NHS Trust, referred to the implementation of what it called the Cerner National Care Records System. The Commission said that remedial work continued for months. It said: "Significant problems with the implementation of the Cerner system have resulted in poor data quality and a lack of robust information...Weston Area Health NHS Trust was included within the first deployment of the Cerner National Care Records Service (NCRS) and implemented the NCRS system in October 2006. However, it was soon recognised that the system was not providing the services required by the Trust and that significant remedial work would be required.Over the last nine months the Trust has been working with the suppliers and the SHA to resolve these issues..." Bradshaw's reply gave no hint that an independent organisation such as the Audit Commission had deemed as "significant" problems arising from a Cerner implementation. . . Buckinghamshire Hospitals NHS Trust went live with the Cerner Care Records System on 25 September 2006. More than a year later, in November 2007, the trust's board was told of some of the day to day difficulties. On the matter of keeping track of patients with MRSA and C Difficile, the Care Records System was "not working consistently" although Fujitsu, the supplier of Cerner's Millennium system in the South of England, was working on a fix. . . Avon, Somerset and Wiltshire NHS Cancer Services has said that "Current opinion regarding Cerner is that it will not support cancer data collection and reporting requirements for at least 5 years, possibly nearer 10 years." And NHS South Central reported in November 2007 that "Deployment problems at those sites that have implemented the [Cerner] system has created concern amongst those organisations in the deployment pipeline. Regular communication is now taking place to rebuild confidence and keep organisations up-to-date with progress on the contract reset." . . It has been said before but if ministers and officials continue to play down the problems of NPfIT implementations they'll carry on alienating clinicians and other NHS staff whose support they need to make a success of the programme. Ministers and NHS Connecting for Health, which runs part of the NPfIT, do not need to put the programme in a zoo enclosure marked "Say kind things only - this enclosure is for the worried and nervous". . .

NHS multimillion pound IT: the risks (20 Feb 2008)

Channel 4 News

"It's costing millions but the new NHS computer system in London and southern England poses a risk to patients say some consultants. The new NHS IT system is causing serious concern among clinicians. Last summer, the then boss of the National Health Service IT system, Richard Granger, candidly admitted he was "ashamed" - saying some of the hospital software was "appalling". Seven months on, Channel 4 News has spoken to clinicians who are seriously concerned about the system. NHS bosses insist the software being installed in hospitals to manage all the information on every patient who walks through the door will bring huge benefits. It's a key part of the £12bn NHS computer project, Connecting for Health. With electronic medical records and on-line scheduling of treatment and tests, it's meant to save time and improve efficiency. But the reality for some has been rather different. Consultants we have talked to in a number of trusts paint a disturbing picture. They talk of repeated delays in getting the system up and running. And far from making things more efficient, they say that hundred of thousands of pounds have had to be spent to employ extra staff to make it work. In one hospital they have had to abandon many of the system's functions because they believe it could be putting patients at risk. In southern England and London, the NHS is buying and modifying off-the-shelf software from the US company, Cerner. The new patient information system has already been introduced into 13 hospitals across London and the south. It has not impressed some consultants who've used it. Chris Taylor decided to speak out because of her experience in one hospital. She concluded patients might be at risk after she found the system couldn't do simple things like print labels for blood samples quickly. She said: "It happened on more than one occasion; I was walking around the department with a handful of blood samples in my hand afraid of putting them down because I didn't want to get them mixed up with the samples that others had in their hands which were equally unlabelled because the system couldn't cope. "So if you are asking me whether it puts patients at risk? Yes, it does, because sometimes you must not delay treatment." We put her concerns to Connecting for Health's national clinical director for the new hospital system, who is himself an accident and emergency consultant at a London hospital. Dr Eccles said: "Well that needs to be investigated and interestingly has not been escalated. I am unaware of that. "We do have a very clear escalation policy for any issue that offers risk to patients. It is unacceptable to leave patients at risk and we don't do so." Cerner, who makes the software, told us: "The Cerner Millennium solution has passed all... testing and assurance requirements." As for speed, Cerner said it had conducted performance tests with satisfactory results. Another trust where the Cerner system has run into trouble is at the Royal Free Hospital in north London. The system was due to be up and running at Easter - that's next month - but at the end of January the chief executive wrote to all staff in an email that start-up had been delayed until May. He said: "The trust was not prepared to accept a system that is not yet demonstrated to be fit for purpose." The Royal Free says the delay is frustrating, but not uncommon for programmes of this scale and complexity. They told us it was caused by the need for more testing of computer programs that provide extra clinical functions beyond the basic patient administration system. For some hospitals, too, the new system has led to extra costs. In just three of the 13 trusts with it - Taunton, Worthing, and Winchester - extra staff and other costs add up to around a £1m. The pressure is now on Connecting for Health to show that IT in the NHS brings real benefits. But the opinions of some doctors who've experienced the systems are making that difficult. Chris Taylor added: "Given that the system has been in some form implemented in hospitals for over a year and that there have been entire consultant groups who have raised their concerns, almost protests, it is beyond comprehension that this system, in its current form, is now being implemented. It just really is beyond comprehension. I have no other word for that." The stakes, then, couldn't be higher for the future of the NHS IT programme. Because unless the problems with the new hospital system are resolved soon, the chance of realising genuine longer term benefits of IT in the NHS could be in jeopardy."

Millennium remains a 'challenge' at Worthing (4 Mar 2008)

e-Health Insider'challenge'_at_worthing

"The chief executive of Worthing and Southlands NHS Trust has said in a letter to staff that the Cerner Millennium system installed six months ago by Fujitsu continues "to be a challenge across the trust". In a letter posted on the trust's intranet, Stephen Cass, told staff: "All staff - whether you use the system or not - will be aware that the new care records system - or Cerner - is continuing to be a challenge across the trust." Cass added he was aware of the difficulties staff faced in using the system: "I know the ongoing issues are causing difficulties and adding to your workload." The trust's Millennium R0 was installed by Fujitsu in September 2007. At the time in the months since the go-live has consistently been described as the best implementation yet of Cerner Millennium under the NHS IT programme. In his letter, Cass says that the trust has invested in extra functionality and training resources, to help staff get used to the system. "As an organisation, we have put in additional resources to improve the system's functionality. The trust is also making additional resources available for training and support," he wrote. He stressed that as Millennium is the chosen software for the whole of the Southern NHS the trust had no alternative but make it work: "There is no going back for us - and we are committed to making it [Millennium] work." In February the trust came under scrutiny from Channel 4 News when Dr Patrick Carr said it had been abandoned in the hospital's A&E department: "Every process we used to do by hand seemed to take longer using the Cerner solution." Problems with Millennium are also acknowledged in a letter written by Candy Morris, chief executive of the South East Coast SHA, sent to local MP, Peter Bottomley who had raised questions about problems with Millennium. Morris told the MP that the functionality 'deficiencies' have resulted in Connecting for Health (CfH) asking Fujitsu to explain why implementation dates continue to slip for trusts in the South. "Following the deployment project, whatever the ultimate gains, further deficiencies in functionality have emerged. We are very mindful of these. You may be aware that NHS Connecting for Health with the support of the three SHA chief executives in the South of England has escalated the issue with Fujitsu in relation to their failure to deliver key implementation milestones in their work for the Southern Programme for IT. Negotiations continue, and there are no rose-tinted glasses. We await Fujitsu's remediation plan," she told the MP. EHI contacted staff working at trusts live in the South live with the Millennium R0 solution and found a number were still experiencing difficulties with the software. One anonymous member of the Somerset Health Informatics Service, responsible for Taunton NHS Trust, told EHI: "It's not been as easy an implementation as we hoped it would be. Staff have found the Cerner system difficult and tedious, and there have been a series of complaints arising from the deployment. We have had to bring in outsourced floor walkers to deal with the disruption, and help clinicians get used to the Cerner solution. They added: "We have had a team of people working on this for over two years, testing and retesting the system to make sure that it does what we need it to, and to some extent it is making a difference, but it doesn't surprise me that Worthing are still experiencing functionality deficiencies." A senior nursing staff member at Surrey and Sussex meanwhile told EHI: "Worthing followed our lead in deploying Millennium after the solution was signed off three months after deployment and given a great review in E-Health Insider when they did so. In reality, we have had difficulties and the system isn't the great clinical management asset we needed. It still has some real problems in generating information which nurses need - especially when it comes to printing. The SHA are well aware of our problems and hopefully Mr Bottomley will look to take action on this." In her letter, dated 26 February, Morris told Bottomley the Southern Programme for IT's contract reset with local service provider Fujitsu was still under negotiation. According to health minister, Ben Bradshaw, the next Southern Programme of IT site to get the system will be Bath Royal United Hospital NHS Trust in May, though the trust were unable to confirm this to EHI. . . Cerner and CfH had not responded to questions by the time of publication."

Plans to replace legacy NHS systems put on hold (7 Apr 2008)

Computer Weekly

"Hospital executives have put plans to replace legacy systems on hold after protracted negotiations between the NHS and Fujitsu, its main IT supplier in southern England. Computer Weekly has learnt that several trusts have delayed plans for new systems under the NHS's National Programme for IT (NPfIT). Although training of staff in the systems has continued in some areas, some trusts have been unable to set go-live dates. Fujitsu and the NHS have been negotiating for more than nine months on a "contract reset" to allow for changes in the NPfIT since the 10-year, £896m deal was signed in January 2004. A memorandum of understanding, which allowed the NHS and Fujitsu to operate as if a revised contract were in place, expired on 31 January, and the two sides have reverted to the original deal. The renegotiation of parts of the contract has involved secretary of state for health Alan Johnson and Fujitsu's parent organisation in Japan. Talks on the reset were due to finish last November. They were then expected to be complete by the end of March, but there is still no word on whether a deal has been agreed. Officials working on the NPfIT had announced in 2006 that St Richard's Hospital in West Sussex would go live with an NPfIT care records service in October of that year. But the Royal West Sussex NHS trust confirmed last week that it had been unable to set a date for implementation. The contract reset was one of the uncertainties. The trust's board also wants to learn from a go-live of the Cerner Millennium care records service at Worthing Hospital, where it said there had been "issues concerning functionality". The board of the Southern Programme for IT - part of the NPfIT - has reported that, "The operating plan for the delivery of the care record service deployments for 2008 is being reviewed to take account of local deployment verification and detailed planning, and the current position on contract reset." NHS Connecting for Health, which runs part of the NPfIT, and Fujitsu declined to comment on the contract reset."

All eyes on the NPfIT go-live at Barts? (18 Apr 2008)

Computer Weekly - Tony Collins' IT Projects Blog

"Some staff at the Barts and The London were without their new systems, delivered under the NHS's National Programme for IT, for half an hour on Tuesday during the busy morning period when many patients come into hospital. . . Barts is a particularly complex installation. It's the oldest hospital in the UK, founded in 1123, and is spread over several sites. But that's not the reason its go-live has a potential importance which goes beyond London. It's because of a re-negotiation of parts of a £896m contract signed in 2004 under the National Programme for IT [NPfIT] between the Department of Health and Fujitsu. The so-called "contract reset" leaves ministers with a decision on whether to pay Fujitsu a significant extra sum. It's possible a deal will be done. Or it's conceivable that Fujitsu will quit, gradually handing to a different main supplier for the NHS in the south of England. A Memorandum of Understanding between Fujitsu and the NHS is understood to have been signed, which gives ministers another 90 days to decide what to do. The Department of Health is understood to be seeking to enlist the support of Downing Street and HM Treasury in securing the extra money. But the question is: what will happen after the 90 days? This is why the go-live at Barts has some potential significance. With the help of BT, the local service provider for London, Barts has installed LC0, a version of Cerner's Millennium system, which been tailored for use by the London Programme for IT. There's interest in the NHS in Barts because, if Fujitsu announce a gradual withdrawal from the NPfIT, who would replace it? Just as CSC took over Accenture's contract as an NPfIT local service provider in the north of England, BT could take over Fujitsu's contract as the local service provider to the south. In which case eyes are turned towards BT's challenging installation at Barts. If everything settles down quickly at Barts and Fujitsu quits the NPfIT, BT could slide into position as one of the two remaining NPfIT local service providers for the whole of England, CSC being the other. But serious problems at Barts or at two other London trusts that are planning to go live this side of summer, could affect BT's chances of taking over from Fujitsu. . ."

Worthing says Cerner's functionality 'inferior' (28 May 2008)

e-Health Insider's_functionality_'inferior'

"The chief executive of Worthing and Southlands Hospitals NHS Trust has said the Cerner Millennium care records system is still suffering from 'inferior functionality', leading to 'significant level of discontent among clinicians'. Attempts to install manual and electronic workarounds - where possible - have already cost over £2m of extra spending, with a further £1m now required by the trust. The Cerner CRS system was provided by Fujitsu as part of the £12.7 billion NHS IT programme. Workarounds have had to be installed for nurse handover reports, establishing a separate patient database for A&E and a data warehouse to allow statutory reporting. As a result, Worthing - which had been hailed by Fujitsu as a flagship site - has already had to borrow £2m from West Sussex PCT to cover 'extra expenditure incurred as a result of the Cerner implementation', on extra staff and software, straining the relationship with its main customer. Despite these extra investments Worthing's chief executive has said the trust is "still unable to satisfactorily capture, record and bill all activity", which was "contributing to contractual difficulties" with the PCT. . . Problems with the system include: staff being unable to effectively locate and track patients or case notes, no facility to record A&E procedures or provide fit for purpose discharge summaries, no capability to track and monitor 18-week waits, serious problems with correspondence, no provision for printing and annotating patient lists, and no ability to print off specimen labels. . ."usable.

NHS hit as Fujitsu fired from IT project (28 May 2008)

Financial Times

"The NHS's £12.7bn programme to provide every patient in England with an electronic care record suffered a severe blow on Wednesday as the project fired one of its key suppliers after failing to resolve a wrangle over the contract. Ten months of renegotiations with Fujitsu, which holds the £896m 10-year contract for installing the record across the whole of the south and west of England, have broken down, according to both the company and the NHS. . . The breakdown is a blow to the programme, although its defenders will argue that the contract structure of having an original four big suppliers is likely to work as BT or CSC is likely to step in. But the breakdown can only further delay a programme whose core product - the electronic record - is already running more than four years late. . ."

Fujitsu's £896m NHS IT contract to be terminated (28 May 2008)

e-Health Insider

"NHS Connecting for Health is to terminate the £896m contract with Fujitsu to upgrade NHS IT systems across the South of England after the IT services giant withdrew from contract re-set negotiations. Negotiations to 'reset' the Fujitsu local service provider contract have been underway since July 2007. Senior NHS staff in the South of England were told of the news today, after last ditch attempts to broker a deal failed last Friday with a final unsuccessful effort made on Tuesday. By withdrawing from the contract re-negotiations Fujitsu placed itself in breach of the original contract signed. In a statement NHS CfH told E-health insider: "Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice." In a statement to EHI Fujitsu said: 'Fujitsu Services can confirm that we have now taken the decision to withdraw from the National Programme for IT (NPfIT) contract re-set negotiations with NHS Connecting for Health as we did not feel there was a prospect of an acceptable conclusion. The NHS has advised us that they intend to end the contract early by issuing a notice of termination. The Fujitsu statement added: "For the moment our work on the contract reverts to the terms of the original programme. We will work closely with the NHS to provide a smooth transition to the new arrangements.' CfH has begun a crash programme of working up contingency arrangements. The agency said it acknowledged the work Fujitsu had done and "commitment to smooth transition arrangements", but stressed it had to "protect the interests of the taxpayer and preserve the basis of contracts which ensure payment on delivery. Gordon Hextall, the chief operating officer and interim director of programme and systems delivery for CfH, said in a letter today to trust chief executives in the South: "There are no immediate implications for live sites and Fujitsu Services Ltd will continue to support these Trusts to current service levels in line with the contract. We are working co-operatively and constructively with Fujitsu Services and the NHS to review the overall arrangements for providing systems to the sites that have not yet gone live with Cerner Millennium."

Fujitsu's departure from NPfIT leaves project floundering, experts say (29 May 2008)

Computer Weekly

"The National Programme for Information Technology, the NHS's flagship project to produce a national networked information infrastructure for patient care, could become the government's biggest IT disaster yet, experts have said. Their comments came after Fujitsu walked away from negotiations on a "more flexible" contract to supply an electronic patient record system to hospitals in the south and west of England. Martyn Thomas, who represents the UK Computing Research Committee (UK CRC), a policy committee for computing research in the UK that consists of computer science professors at 23 leading universities and an expert witness in IT-disaster court cases, described the national programme as "a train wreck in slow motion". Speaking in response to the news, Thomas said UK CRC had warned the parliamentary select committee on health several years ago that the NPfIT "was exhibiting signs of failure" and called for an independent review to identify ongoing risks and ways to manage them. Thomas said Richard Granger, then head of the NPfIT, and his successor, David Nicholson, had accepted the comments, but had been overruled by ministers. MP Richard Bacon, who sits on parliament's Public Accounts Committee, said Fujitsu's refusal to sign a renegotiated contract was an opportunity to give back to local trusts the right to buy what they liked. "The original approach of handing over monopolies to a handful of local service providers was never going to work and has been shown not to work," he said. Bacon warned against handing Fujitsu's contract over to the other two main suppliers on the project, CSC and BT. It was a way to screw things up completely, he said. "This whole thing was built on the detailed patient record system. We have not seen much yet, but we are already four years late and £4bn in." Bacon and Thomas both noted that the successes claimed for the programme, such as the ability to send digital X-rays over IT networks, were not part of the original NPfIT, and in fact preceded it. Thomas said the X-ray system was part of the argument for the programme made to the then prime minister, Tony Blair. . ."

Where now for NHS National Programme after Fujitsu exits? (29 May 2008)

Computer Weekly

Only 10 days ago a deal aimed at rescuing the NHS's National Programme for IT in the south of England seemed imminent. Officials and Fujitsu had spent nearly a year negotiating changes to a 10-year contract worth £896m, signed in January 2004. The two sides had agreed a deal in principle. Papers were ready for signing by David Nicholson, the chief executive of the NHS, who is also the predominant senior responsible owner of the £12.7bn National Programme for IT (NPfIT). But at what one NHS official said was the "59th minute of the eleventh hour" Fujitsu informed Nicholson that it was withdrawing from the negotiations. The NHS responded decisively, by terminating Fujitsu's contract. The NHS had threatened to terminate the contract even during the "contract re-set" negotiations. Nevertheless, the way Fujitsu withdrew has taken many in the NHS by surprise. . . Why did a proposed deal collapse? NHS officials believe that Fujitsu's board in Japan decided to intervene. The board was concerned that Fujitsu's potential losses on its NPfIT work, as one of three local service providers to the NHS, could be much greater than its directors had thought at first. Fujitsu is the monopoly supplier of Cerner's Millennium care records service, which is mandated to be the main hospital system for the south of England. Now that Fujitsu is withdrawing as the local service provider for the South, and trust boards do not have the freedom to buy elsewhere, uncertainty has been piled onto uncertainty for the boards of NHS trusts. Some in the NHS say this is a characteristic of the NPfIT as a whole. "We are into a period of turmoil. There are the exit arrangements with Fujitsu to manage, especially for the early-adopter sites, and there will probably be some months of discussion about what we should do. There is no uniformity of view within the NHS on that," one official said. There are several options. One is for the government to give trusts the freedom to buy care record systems from other suppliers, under Connecting for Health's Additional Supply Capability and Capacity (ASCC) framework, which came into force recently. This would give trust boards in the south of England the option of buying the Millennium system directly from Cerner - rather than from Fujitsu as the middle-man. Or they could choose to buy from another accredited Care Records Service supplier. Most IT executives in the NHS are expected to favour this option, particularly if the software is funded centrally irrespective of what ASCC choice the trust makes. Other options include passing Fujitsu's work to one or both of the two other local service providers, CSC and BT. But both of these suppliers have had serious difficulty delivering a national strategic system to the NHS. Some NHS staff believe that Cerner can be made to work across the UK. It is a successful product in the US and elsewhere. But others are concerned that Millennium is a client-sever system rooted in the 1990s. NHS staff need extensive training to use it. It is not as intuitive as, say, an online banking system. There are also wider concerns among some officials that the NPfIT itself is dated in concept as well as practice. Since the programme was announced, trusts have become subject to competition for patients from private companies and even within the health service, particularly foundation trusts. They want IT to give them a competitive edge, which makes them less inclined to favour systems chosen for them centrally. . ."

NHS bosses may not replace contractor after Fujitsu's walkout (30 May 2008)

The Guardian

"NHS bosses may not appoint a replacement for Fujitsu as one of three regional contractors leading the health service's troubled £12.7bn IT systems overhaul following the Japanese firm's decision this week to walk away. This is being called for by disaffected trusts across the south of England who want to pick their own suppliers. It would be a big blow for BT which had been seen as favourite to replace Fujitsu because it is already lead contractor for the neighbouring London region and is deploying the same software package, Cerner Millennium. BT has said it wants the Fujitsu contract, but many medics and IT workers within the NHS remain deeply sceptical about the suitability of Millennium, a US product, for Britain's hospitals. NHS Connecting for Health, the body which oversees the National Programme for IT, was last night weighing up whether to go with BT or to allow trusts to select their own suppliers. . . A report this month by the National Audit Office revealed that just 13 Millennium systems had been deployed in acute trusts, nine of them in the southern region. In several cases trusts have withheld payment, something they are only supposed to if systems are not working properly. The Lorenzo software package, earmarked by CSC for the Midlands and the north of England, remains in development phase. It was originally supposed to start being rolled out in trusts from April 2004, but the development schedule has slipped repeatedly. Early versions of Lorenzo are now promised to go live in some hospitals this summer, but many experts believe that deadline will also be missed. Despite its considerable success building an IT "spine" and nework designed to link National Programme systems across the country, BT has had a mixed track record running the care records services contract for London. By the end of March it had deployed just four patient administration systems in acute hospital trusts out of 32 in total. Last month it added Barts to the list, but this deployment is already believed to be suffering serious data collection and reporting problems. A spokesperson for Barts last night denied there were serious concerns. "The system is largely working as intended and gradually becoming embedded into normal operations." Proceeding without a lead contractor for the southern region would mark an end to the original vision of a centrally orchestrated programme - the largest non-military IT project in the world - which the NAO this month confirmed was already running at least four years late. . ."

Leading article: Another tragedy of errors (30 May 2008)

The Independent

"In almost any enterprise, the news that management has plans to install a new computer system tends to be greeted as a threat rather than a promise. Nowhere, though, are there more grounds for IT apprehension than in the public sector, where one project after another has been dogged by severe overruns in time and budget, and the end product invariably falls some way short of being, in that celebrated phrase, fit for purpose. The latest example, or rather the latest episode, in the long-running tragedy of errors that is the NHS electronic database concerns the computerising of patient records for the whole of southern England. Government negotiations with the supplier, Fujitsu, have broken down and the contract has now been terminated. The overall project, currently running more than four years late, is likely to be further delayed. What with penalties for terminating the contract and the extra expense of finding a new supplier, the final cost to the taxpayer, at present estimated at almost £13bn, looks set to rise another notch. Why should it be that ministers stumble so predictably over big computer projects? Other countries have experienced problems, to be sure, but our government seems to have a particularly lethal touch. From the ill-fated Child Support Agency onwards, it is hard to think of any major public-sector IT project that has been delivered on time and on budget and done everything it was required to do. One explanation may be that too many people and interests are involved in drawing up the specifications; another is that because the Government came to computerisation relatively late, it was unrealistic about what a single system could accomplish and its aspirations were over-centralised. It has also been suggested that the qualities of senior civil servants are not necessarily those required to commission, or oversee the commissioning of, IT systems. Yet, surely, in the time since the CSA debacle, something should have been learnt - if not from mistakes here, then from successful projects overseas. . . If the Government is having so much trouble computerising patient records, the chances for a trouble-free introduction of ID cards must range from slender to nil."

Bad software bursts £1bn NHS bubble (2 Jun 2008)

The Inquirer

"Fujitsu escapes to reality: A KEY ELEMENT of the UK's gargantuan health IT scheme was exposed as a fallacy yesterday when Fujitsu, one of four original suppliers of patient systems, dumped its £1bn contract, becoming the second supplier to have jumped ship. The IT industry has taken Fujitsu's resignation as evidence that both its £1bn contract with Connecting for Health (CfH), the UK health IT quango, and the original aims of the National Programme, had become untenable. Fujitsu's contract had another six years to run and, according to sources close to the firm, had only been paid half of the £300m to £400m it had spent doing the work. When Fujitsu signed the 10-year deal in 2004 (then for £896m) it was under the assumption that the £12.7bn National Programme for IT, the grand NHS IT scheme, would force all 86 local health trusts in its patch to use the software it provided, guaranteeing income and justifying the infamously stringent contractual terms it signed up to. Crucial changes in the Programme have since left Fujitsu in a position were it can can no longer guarantee its income under the original deal. It is said to have bailed out after failing to secure, after 10-months of negotiations to reset the contract with CfH, a position that would recover its costs, with an asking price of £1.2bn. CfH was expecting Fujitsu to accommodate moving goal posts without charging any more money, but the moving goal posts made it a more costly exercise for the supplier. What has changed is the perception that the Programme could force legally autonomous trusts to take its software; and the idea that a centrally-designed system could be suitable for all trusts alike. The facade of the centrally-dictated national scheme crumbled over the last year, revealing an NHS which looked little different to before the Programme started, said NHS IT advisor Murray Bywater of Silicon Bridge. NHS IT has reverted to a market-led structure in which CfH is only one competing supplier with software that the National Audit Office said this month was still four years from being completed. "The original contracts were awarded on the mistaken premise that the National Programme would be able to force everyone down the route they envisaged. That was part of their pricing algorithm," said Phil Sissons, former supplier liaison manager for the Programme. . . The writing appeared on the wall for the national scheme last April when CfH devolved responsibility for the programme on Strategic Health Authorities, by which it recognised that it had no right to foist its systems on their health trusts. That left Fujitsu and other contractors in the position of having to go out and convince the trusts to use the software they were selling under the auspices of the Programme. This would have added a 10 per cent cost of sale to their balance sheet, said Bywater, and that in addition to ballooning development costs. This situation was clarified further last week when CfH finalised the contracts under its Additional Systems Capacity and Capability (ASCC) contract framework, which lets the LSPs off the hook by helping trusts do what they had always done, which is choose their own software. . . Roger Wallhouse, who chairs a number of health IT firms including one that was already offering a fully-fledged PAS to the UK market before the Programme kicked them all out, said Cerner was trying to charge an "outrageous" amount of money for its unfinished software. "The NHS could buy those systems from UK suppliers for 30 per cent of the £900m that Cerner wants," he said. "You could get them faster than Cerner could deliver and that's always been the case," he said. . ."

Royal Berkshire 'may walk' from NHS IT programme (3 Jun 2008)

e-Health Insider'may_walk'_from_nhs_it_programme

"The chairman of the Royal Berkshire NHS Foundation Trust has said the trust "may walk" from the NHS IT Programme, to ensure it gets the IT systems required. Speaking last Thursday, the day after Fujitsu had its £1.1 billion NHS IT contract for the South terminated, Colin MacLean the chairman of Royal Berks said it was "very worrying" the NHS IT programme had ground to a halt in the region. Royal Berks has experienced repeated delays in receiving an electronic patient record system - or Care Records Service - from Fujitsu under the £12.7bn NHS IT programme. With Fujitsu no longer leading the programme in the South the trust now has no immediate prospect of getting a new patient IT system. As a result the chairman said the Foundation Trust (FT) was now working up a Plan C based on going it alone. Foundation Trusts are strongly encouraged to take NPfIT systems but their independent status means they are not required to. "Plan A was to try to work with the national programme, Plan B was to start propping up our own IT systems and to continue working with the national programme, and just over six months ago we were made aware that we needed to start thinking about a Plan C to go out on our own," MacLean was quoted as saying. . . Trust board papers from Royal Berks show that contingency planning for delays to the NPfIT CRS were begun in January 2007, when the trust was also suffering significant delays. It had hoped to begin implementation by November 2007 at the latest."

Fresh trouble for NHS IT system (5 Jun 2008)

The Guardian

"The loss of Fujitsu puts growing pressure on the NHS computerisation scheme, which is still waiting on essential software. Losing a major contractor is a serious problem for the largest ever non-military IT project. But the Guardian has established that the £12.7bn NHS computerisation scheme has growing troubles besides the decision last week by Fujitsu to abandon the project. Besides being four years behind schedule after five years' work (according to the government spending watchdog, the National Audit Office), and having seen consultant Accenture jump ship two years ago, the National Programme for IT now has another difficulty. The Lorenzo patient administration system, which is earmarked for hospital trusts across the midlands, east and north of England, is no longer expected to meet its already much-delayed release date of October. Instead, senior NHS directors are talking about Lorenzo "release 1" being ready by autumn. This would be a toe-in-the-water clinical system, software far short of a patient administration system - the core building block on which all clinical systems will eventually sit. . . Last week, the project was dealt another body blow. Fujitsu quit, becoming the second of the original "big four" contractors to depart, after Accenture two years ago. The move is expected to cost the Japanese firm hundreds of millions of pounds and its reputation will be damaged around the world. No matter, said Fujitsu. The £1.1bn contract was no longer worth the candle. All of a sudden, the NAO's estimate for completion of the electronic care records project by 2014-15 begins to look very optimistic. On June 16, NHS chief executive David Nicholson and Gordon Hextall, the health service's most senior IT boss, will appear in front of the MPs' public accounts committee to give a progress update. Given the slew of bad news in recent weeks, they can expect a tough reception. Questions will undoubtedly centre on the loss of Fujitsu and the uncertainty this has created. It remains to be seen which firm, if any, will be chosen as a replacement within the south of England contract being abandoned by the Japanese firm. The NHS is believed to be weighing up whether to take the quick and easy option of transferring the contract to BT or CSC, or to permit trusts to chose from an accredited list of alternative suppliers. The latter option would be popular with many disaffected trusts. Grassroots demand for fresh suppliers follows repeated broken promises on delivery dates for Lorenzo in the midlands, east and north, and by a scepticism about the suitability of rival patient administration system Millennium, which is being rolled out in London and the south. . ."

Fujitsu may lose southern NHS PACS deal (16 Jun 2008)

e-Health Insider

"Fujitsu may not have its contract renewed to provide Picture Archiving and Communications Systems (PACS) services to NHS trusts in the south of England. The development comes two weeks after Fujitsu had its £1.1bn contract as local service provider (LSP) for the region terminated on 28 May, following its withdrawal from contract re-negotiations. Fujitsu had previously been expected to get the lucrative PACS deal renewed. When the LSP contract was terminated, the linked PACS contract was also ended, leaving NHS trusts across the south with systems that were not covered by formal support contracts. E-Health Insider has been told that as a result, key clinical systems in the region - including PACS, Radiology Information Systems (RIS), child health, Map of Medicine and Cerner Millennium - are only covered by a "promise" of support from the ex-LSP. EHI has learned that NHS Connecting for Health (NHS CfH) originally indicated that it would renew its contract with Fujitsu to provide PACS services after terminating Fujitsu's LSP contract. . . In a 28 May letter to NHS chief executives in the south about the ending of Fujitsu's LSP contract, Gordon Hextall, head of NHS CfH said: "However, the PACS and RIS contracts are not expected to be affected by this outcome." The agency now appears to have reversed its position and to be proceeding on the assumption the terminated PACS contract will not be renewed. . ."

UK: NHS still looking for Fujitsu replacement (2 Jul 2008)


"More than a month after the National Health Service (NHS) announced the termination of Fujitsu Services' £996 million contract to deliver electronic patient records to the South of England, the future of these services in the Southern Programme for IT (SPfIT) is still unclear. For NHS Connecting for Health (NHS CFH), the agency in charge of England's £12 billion+ National Programme for IT in the NHS (NPfIT), the most pressing issue is finding a replacement for Fujitsu Services. News late last month that 700 or more Fujitsu employees could be made redundant as a result of the contract termination brings home the importance of resolving the situation quickly and putting an end to the uncertainty surrounding SPfIT. The longer the programme is in limbo, the more likely it is that skilled staff will be lost to other sectors; that clinicians will lose any remaining confidence in the programme in the South; and that the deployment of acute patient record systems in the South will be further delayed. BT has confirmed it is in talks with NHS CFH to take over responsibility for the eight trusts in the South that have already received Cerner's Millennium software from Fujitsu. However, it is likely to be the end of July before any take-over arrangements can be finalised. This is a sensible course of action that should add further NHS coins to BT's coffers. However, the future for trusts in the South that have yet to receive Millennium is far from clear. In testimony to the Public Accounts Committee (PAC) last month Gordon Hextall, COO and Interim Director of Programme and Systems Delivery for NHS CFH, stressed that the decision on an alternative supplier was up to the NHS in the South and that the process could take 'a few months'. He implied, however, that systems were more likely to be provided by existing LSPs (BT or CSC ) - who have extant contracts offering known products at a known price - than by a new LSP contracted through the ASCC procurement framework, a process which 'would take time'. While the former route certainly has advantages - notably the known price and potentially a quicker deployment (since it avoids a fresh procurement process), it would seriously damage suppliers' confidence in ASCC, a framework for which many bid assuming it would be used in a situation like this. Should BT and/or CSC be called upon to provide services in the South, they will need to scale up quickly (good news for those about to be made redundant by Fujitsu) and make full use of their partners. This would undoubtedly benefit the likes of System C Healthcare (an implementation partner for CSC) and Perot Systems (a key partner to BT in London), as well as specialist application providers that are already subcontracted to either BT or CSC, such as mental health system suppliers CSE-Servelec and SystmOne. Whichever supplier - or combination of suppliers - does eventually take over from Fujitsu, it will face many of the same challenges that led the Japanese firm to part company with SPfIT. The biggest challenge will be striking the right balance between local demands for the tailoring of software and the ideal of standard systems across the NHS in the South. As Fujitsu found, without a certain level of standardisation, upgrading and integrating systems becomes more difficult and costs escalate. Any supplier bidding to replace Fujitsu should be doing so with their eyes wide open and will expect to be suitably compensated."

Health trust abandons NHS care record upgrade (22 Jul 2008),3800010403,39262815,00.htm

"Uncertainty sees Bath jump ship: A health trust serving more than 500,000 people said it has pulled out of the national NHS IT electronic care record programme because it has lost confidence in the project following the departure of key supplier Fujitsu. The Royal United Hospital Bath NHS Trust (RUH) has stopped the deployment of the Cerner Millennium electronic care records system - part of the £12.7bn national NHS IT modernisation programme. The Trust said it terminated the implementation because it had lost confidence in the delivery of the system following Fujitsu's exit as the provider delivering the National Programme for IT (NPfIT) in the south of England. Fujitsu will continue to deliver the system in the south until it departs in November and health authorities are now in negotiations with Bath about whether it will use its own provider to implement the Millennium care records system or turn to other NPfIT providers, BT or CSC. The RUH provides acute treatment and care for a catchment population of around 500,000 people in Bath, and the surrounding towns and villages in north east Somerset and western Wiltshire. . ."

Milton Keynes' CRS caused 'near melt down' (29 Jul 2008)

e-Health Insider'_crs_caused_'near_melt_down

"The deployment of a national programme care records system at Milton Keynes Hospital NHS Foundation Trust "developed into an untenable situation which resulted in near melt down of the organisation." According to papers from the CRS project board, obtained by E-Health Insider under the Freedom of Information Act, the trust experienced a far from smooth go-live of the Cerner Millennium system. The CRS project team described it as "eight weeks of extreme pressure and operational issues to the acute trust." Board papers from the CRS project board, dating from July 2005 to June 2007, show a turbulent journey before the system finally went live on 24 February 2007. Milton Keynes was an early implementer site for the local service provider, Fujitsu, and the acute trust urgently required a new patient administration system to replace its existing legacy system, which was considered obsolete. An initial go-live was scheduled for 16 June 2006. The system was meant to include basic PAS, clinical noting and order communications, maternity, A&E, theatres and information for analysis functionality. . . When EHI reported on Milton Keynes's implementation, which also covered the community hospitals run by Milton Keynes Primary Care Trust, Fujitsu said it had benefited from the experience gained from earlier implementations. However, the minutes from the CRS project board show problems being continuously identified and go-live dates continuing to slip. In two years of planning, the go-live date changed seven times. The cost of the slippages was almost £800,000. . . The green-light to go ahead with the deployment was only given three weeks ahead of the actual go-live. However, post-go-live, doctors began to identify a series of problems, resulting in the "near melt down" described by the project board. The board papers suggest that problems at this stage included bed availability not displaying correctly, notes for clinics going missing, patient appointments not displaying on lists, reports not printing correctly, GP labels being unavailable, clinic rebuilds being necessary, back office help being unavailable, printers not working and passwords being forgotten. . ."

NHS faces £700m legal action over IT project (30 Aug 2008)

The Independent

"The NHS is facing an unprecedented £700 million legal action from a Japanese computer firm over a failed project to store electronically the health records of millions of Britons. Fujitsu's contract with the NHS was terminated in May after negotiations between the company and health officials broke down. The Independent has now learnt that the Japanese firm is seeking to recoup the bulk of the £896m it would have been paid for the entire computer system. Neither the company nor the NHS was prepared yesterday to comment on the precise details of the compensation figure, but sources close to the negotiations said Fujitsu was ready if necessary to go to court to press its £700m claim. The development is the latest setback in the troubled history of NHS computing, which has been beset by cost overruns, defective systems and late deliveries. The cancelled contract was part of the £12.7bn Connecting for Health programme to modernise NHS computers and provide every patient in England with an electronic health record. It it ran into difficulties when the NHS tried to renegotiate the terms. Health officials wanted Fujitsu to provide a more localised records system for southern and western England, but the company said this would increase its costs substantially and asked for more money up-front. When the NHS refused to stump up, Fujitsu walked away from the negotiations - which caused the Government to terminate the contract. Now Fujitsu is gearing up for a major confrontation with the Government with what could be the biggest compensation claim against the NHS in its 50-year history. Asked whether it could end up in court, a company spokesman said: "At the moment we're in dialogue with the NHS and we hope to come to a satisfactory outcome." It is understood that only a small amount of the £896m has been paid to Fujitsu in upfront costs for the computers and software development. Some industry analysts estimate the company has spent about £300m since it secured the contract in 2004. Fujitsu's deal was one of the biggest of the four regional contracts awarded by the NHS as part of the 10-year Connecting for Health programme, which is already four years late in terms of its overall implementation according to a report by the National Audit Office (NAO). By last March, Fujitsu had supplied just nine out of 41 acute hospitals in southern England, and the systems were working so badly that the company had not been paid for most of them, according to the NAO. . ."

Hospitals: London health trusts plot legal action over new IT system (1 Sep 2008)

The Guardian

"Some of London's largest hospital trusts are drawing up claims for compensation relating to the disastrous performance of computer systems installed by BT under the government's controversial £12.7bn overhaul of NHS IT systems in England. Board minutes from the Royal Free Hampstead NHS Trust show members discussing who is to blame for shortcomings in a patient administration system, additional spending required to cope with the crisis, and the possibility of legal action. Minutes dated August 28, seen by the Guardian and Computer Weekly, describe trust chief executive Andrew Way outlining his view of who is to blame. "With regard to compensation, Mr Way reminded members that the contract was with the Secretary of State and that currently it was considered the NHS as a whole was failing to deliver more substantially than BT." The papers show the board also noted one other trust - not named - was known to be seeking compensation. The Royal Free board has instructed staff to log "all problems ... encountered to be used in the event that a claim proves possible". In 2003 BT Global Services won a £993m 10-year contract to build a care records service throughout the NHS in London. BT has given no indication its London NHS contract is under pressure. But two out of its three fellow NHS IT contractors in other regions in England - Fujitsu and Accenture - have withdrawn from similar contracts. Work on the BT London contract has been mired in difficulties, particularly around administration systems produced by US software sub-contractor Cerner. Cerner's system has been installed by BT in four London acute trusts. In each case, trust board minutes detail a litany of glitches, bugs and system failures. The latest minutes from Barts record: "Clinics were reduced in some areas and issues with bookings meant that some clinics and operating theatres were not operating at their usual capacity." Hospitals earn income from primary care trusts for the patients they treat, so reduced activity is expected to hit Barts' income. As a result of "data quality issues" from BT's implementation of Cerner systems, Barts is forecasting "an under-performance of £3m for the year". At Barnet 14,000 patients contacted the trust with concerns about their treatment compared with 5,500 in 2006. . ."

NPfIT Cerner: a user writes (30 Sep 2008)

Computer Weekly - Tony Collins' IT Projects Blog

Gordon Caldwell, a UK consultant in endocrinology and diabetes, writes to the IT Projects blog about a few of the practicalities of trying to make Cerner work. He says that its use in hospitals may require extra staff (which is the experience of trusts so far). Cerner's software is due to be rolled out across London and the south of England as part of the NHS's £12.7bn National Programme for IT [NPfIT]

Is the NHS IT programme weighing down BT? (9 Nov 2008)


BT Global Services has until very recently been a shining star of the telecoms giant, and even after its shock profit warning last week, the division still accounts for £9bn of the group's £20bn revenue. In all the recrimination, resignation and share price falls since the financial announcement, one potential aspect of Global Services' problems has been little discussed. I've heard a few people wondering how much of the division's troubles are down to its involvement in the NHS National Programme for IT (NPfIT). BT is one of only two major contractors still involved, along with CSC. Accenture and Fujitsu have already pulled out due to concerns over potential losses, and BT had been expected to pick up the region ceded by Fujitsu's departure. Former NHS IT director general Richard Granger negotiated some tough terms and conditions for the key suppliers to the programme - in particular, that payments would be made on delivery of finished product. This is great news for the NHS - now that key parts of the project have been delayed, it doesn't have to worry about the costs of software and services that are not yet fully operational. This was a big factor in Accenture's withdrawal as the supplier saw its costs increasing and its revenue being pushed further into the future. In the early days of NPfIT, former BT chief executive Ben Verwaayen was asked by reporters about the impact on the firm's bottom line, and he proudly explained that BT had not budgeted for a profit from the programme for some time ahead, seeing it as a long-term investment. A wise move - but one now wonders exactly when those profits were expected. The core part of NPfIT -electronic patient records - is an area BT is most exposed to, and is the area most delayed. Recent reports suggested that many NHS trusts are refusing to implement software until they can see it working elsewhere. Considering that one of the BT pilot sites, the Royal Free Hospital in London, has just revealed it lost £7.2m due to the project, it isn't looking promising. BT meanwhile, is funding development and providing services to implement software and try to make it work - essentially without getting paid for it. There has been no official word from BT one way or the other, but observers cannot help but speculate that the troubled National Programme may be a factor in Global Services' current struggles. And if it is, and BT feels it has to reconsider or renegotiate its involvement, then the risks to the NHS IT scheme would be significant.

Government plans for London NHS IT in tatters (19 Nov 2008)

Computer Weekly

"Health officials in London are working with BT, Cerner and IT specialists to rescue plans for integrated e-health records in the capital amid signs that the government's one-size-fits-all approach is disintegrating, Computer Weekly has learned. The original plan which was announced in 2002, in a document "Delivering 21st Century IT Support for the NHS", was for the National Programme for IT [NPfIT] in the NHS to deliver "ruthless standardisation". In London a single database to support electronic health records for eight million people was to be rolled out to all trusts and other NHS sites. That plan turned out to be too ambitious - and was watered down when officials and the NPfIT local service provider in the capital, BT, decided to install different releases of the US-based Cerner "Millennium" system to support e-records in NHS trusts. Now that plan, too, has run into trouble, Computer Weekly has learned. BT, NHS IT specialists and Cerner have ended up customising the standardised smartcard-based Cerner system for one London trust, the Royal Free, after it ran into serious problems. In June 2008 the Royal Free Hampstead NHS Trust became the first trust to install the London Configuration Release 1 [LC1] of Cerner Millennium Care Records Service. It was the first installed Cerner system in England where users had smartcard access to electronic records. Three other London trusts are using the earlier LC0 of the Cerner system. But because of continued problems with the LC1 installation, the Royal Free Hampstead NHS Trust, BT, Cerner and the London Programme for IT have put in place a 90-day rescue plan of the trust's systems, which began on 6 October. The plan involves setting up on site what the Royal Free calls a "full systems and support team". The trust says the team is working on a software build directly for the Royal Free and is "thus changing the London programme model of one build appropriate for all trusts". Health officials and BT had hoped to start rolling out LC1 to other trusts and NHS sites in London - but work has been halted. It is unclear when - and if - it will restart given the Royal Free's problems and the customisation of its software. The Royal Free's staff have had to cope with system crashes, delays in booking patient appointments and data missing in records. Some health IT experts say the problems at the Royal Free and other London trusts could end up with BT delivering a non-standard system to NHS sites in the capital. This would wipe out some of the cost savings of having standard software which could be upgraded easily across NHS sites in the capital. It would also mean an end to the NPfIT vision of fully integrated IT systems across England. . ."

Evidence mounts for NPfIT review (28 Nov 2008)

Computer Weekly

"It is often said that good results on IT-related projects and programmes rely on good communications. This helps to explain why the NHS's £12.7bn National Programme for IT (NPfIT) is such a good case study - an exemplar of how poor communications corresponds with poor results. The point is underlined by the details which have emerged this week on the confusing and, as it turns out, overly optimistic public and internal communications over the go-live of the Cerner R0 e-records system at Weston Area Health Trust. . . The Department of Health's public communications over Weston began in 2006, when it tried to use the trust for political advantage. This backfired. In a memo in 2006 to MPs of the Public Accounts Committee, who were sceptical about the claimed successes of the NPfIT, the Department of Health quoted Weston as being particularly satisfied with its installation of the Cerner system. In fact Weston came to regard its Care Records Service as disruptive and "never going to deliver what the NHS needed", according to a paper this year to the trust's board of directors. All trust boards need to report externally on how many patients they are treating, for what, and how quickly. Patient administration systems such as Cerner Millennium should provide this information, at least to ensure that trust boards are paid for treating people. But in the 18 months since its go-live, Weston was never sufficiently certain of its management information from the system to know it would get paid. A deleted section of a draft report of Weston's Audit and Assurance Committee said in February 2008, "The fact remains that the trust is still not at a stage, despite 18 months of work, of having the certainty that we are able to communicate on activity [treating patients] and charge for all the work undertaken". The Department of Health also miscommunicated when giving an assurance to the Public Accounts Committee that mistakes from an earlier go-live of the Cerner system at Nuffield Orthopaedic Centre would not be repeated. Weston repeated some of the mistakes at Nuffield. Both Nuffield and Weston - and other trusts since - have had difficulties producing external statutory reports on their care and treatment of patients. What has happened at Weston could answer the question so many in the NHS are asking: how is it that mistakes are unknowingly replicated every time a trust goes live with the Care Records Service? The answer, from the facts at Weston, is that the board of a trust which is due to go live with Cerner is assured that problems at other trusts have been solved. But the team going live find out only too late that the problems are still there. It is arguably time for the Department of Health to come clean about the NPfIT. Trust after trust has gone live with Cerner only to find that problems have not been fixed. It is uncomfortable for Computer Weekly to criticise the NPfIT in this way. Many thousands of people are working on the programme, or have a stake in its wished-for success. They want it to work. So do doctors. Paper-based records that go missing can cause lives to be lost unnecessarily. E-records make unequivocal sense. But the NPfIT is demonstrably not the best vehicle to deliver e-records. We say again, but now with more evidence in our possession, that there needs to be a thorough, independent published review of whether the NPfIT will meet the needs of NHS trusts. Meanwhile, money continues to be poured into the programme - before anyone really knows whether the money is being well spent or wasted on archeologically excavating ground which has little or nothing worthwhile beneath the surface."

NPfIT future in question as BT reviews contract (23 Jan 2009)


"One of the two remaining main suppliers for the £12.7bn National Programme for IT, BT Global Services, said on Thursday it expects to take a £340m writedown on earnings from 15 of its 17 largest contracts due to poor "cost controls". BT chief executive Ian Livingstone warned another writedown of "some hundreds of millions" of pounds more on the remaining two contracts, which are still being reviewed, could be on the cards. A £1bn contract to link up and standardise all of the NPfIT computer systems in the London area, due to run until 2013, is thought to be among these final two, according to director of analyst house TechMarketView, Richard Holway. Under the deal, BT is replacing an ageing patchwork of 5,000 different NHS computer systems with a nationwide infrastructure connecting more than 100,000 doctors, 380,000 nurses and 50,000 other health professionals. Holway said the NHS must renegotiate less ambitious and more rewarding terms with BT for its NHS contract or risk the vendor walking away as previous suppliers Fujitsu and Accenture have. "Clearly a huge question-mark hangs over the future of the NHS IT programme. I believe there is a great deal of contract renegotiation going on behind the scenes," he said. . . A spokesman for BT told ZDNet UK's sister site,, that a "handful" of the 17 contracts have become "loss-making" but that it is too early to say whether BT will walk away from them. "We cannot rule anything out at this stage," he said. . ."

Worthing decides to switch off Cerner (16 Feb 2009)

e-Health Insider

"Worthing and Southlands Hospitals NHS Trust has agreed plans to switch off its Cener Millennium electronic records software and move back to its old Sema-Helix software. As first reported by E-Health Insider on 26 January, the trust has been examining whether to move from its current Cerner Millennium system back to its old Sema-Helix patient administration system as part of a merger with neighbour Royal West Sussex (RWS). The new NHS trust, to be created in April from the proposed merger of RWS and Worthing and Southlands Hospitals (WaSH), will adopt the Helix Patient Administration System to ensure the continued safe management of medical records across the three sites. The future IT plans will still have to be ratified by the board of the newly merged trust, but had previously been described as one of several options. The Helix system is currently in use at RWS and was also used at WaSH prior to the introduction of the Cerner Millennium Care Records Service (CRS) software in September 2007. The trust says it remains committed in the long-term to adopting a National Programme solution to implement a Sussex-wide CRS. E-Health Insider understands that the Worthing and Southlands trust board decided to switch back to Sema-Helix following an options appraisal exercise. EHI has learned that the WASH board decided it was more sensible to transfer to a familiar system still being used at RWS, than to move RWS to an entirely new platform - one unsupported by an LSP - on a temporary basis."

The road not taken (6 Mar 2009)

Health Investor

"Some parts of the National Programme for IT (NPfIT), the NHS's ££12.7 billion computer system overhaul, are so late and working so badly that hospital trusts are beginning to look elsewhere. . . Rotherham, Worthing & Southlands and Newcastle-upon-Tyne trusts are all going off-piste in their attempts to get working systems. Each is a special case, however, and Connecting for Health, the government body which oversees the NPfIT, is keen to stress the trusts are looking for interim solutions - which implies eventually they'll be brought back into the fold. But it's by no means sure that will ever happen. MPs are so disillusioned with the care records element of the programme, in particular, that they called on the Department of Health (DH) to give the scheme just six more months to get better. Unless the position "improves appreciably," says the Commons public accounts committee in its new report, "the department should assess the financial case for allowing trusts to put forward applications for central funding for alternative systems compatible with the objectives of the programme". All three of the trusts currently looking for alternatives to the NPfIT have foundation status, giving them control over their own financial affairs. They aren't obliged to take what the national programme offers. But David Nicholson, chief executive of the NHS, told the public accounts committee in July 2008 that they would have to show pretty good reasons why they were treading their own path. "They have to have a business case which sets out the benefits or otherwise of taking something alternatively, and I think it is a very difficult thing for them to be able to prove," he said. "In fact, I have not seen one that has done it yet." Rotherham invited tenders for its patient administration system because the current TotalCare system won't be supported by supplier McKesson after 2010. TotalCare is already over 24 years old and a spokeswoman for the trust describes it as "an antique in computing terms". The trust had expected that its local service provider, CSC, would install iSoft's Lorenzo software system in its place in 2006-07 - but there's still no word on when it might be ready. In the words of the public accounts committee, "given the continuing delays and history of missed deadlines, there must be grounds for serious concern as to whether Lorenzo can be deployed in a reasonable timescale and in a form that brings demonstrable benefits to users and patients". It adds that "pushing ahead with the implementation of Lorenzo before trusts or the system are ready would only serve to damage the [national] programme". The shortlisted providers for Rotherham are understood to be Meditech, SystemC and the University of Pittsburgh Medical Center (UPMC) working with Cerner. This would not be the same 'Millennium' product which Cerner provides to trusts under the national programme. That's plagued by implementation problems, including at Worthing & Southlands trust which is getting ready for its merger with the Royal West Sussex trust, Chichester, in April. Millennium was installed at Worthing & Southlands Hospitals (WaSH) in September but was dumped last month in favour of a return to the previous system, the 20-year-old Sema-Helix software which Chichester still uses. A spokeswoman for WaSH said: "Continuing with separate systems until the proposed deployment of the new national programme system was not considered a viable option as the timetable for this has not yet been finalised. Running parallel systems would also be more time-consuming and less efficient than switching to a common one." Eventually, says a spokesman for Connecting for Health, the organisation may well take a NPfIT system, but in the interim, "it is more sensible for Worthing to transfer to a familiar system used by Chichester, than for Chichester to move to an entirely new system on a temporary basis. NPfIT is happy to help with these arrangements to support a smooth transition to a new larger organisation." Newcastle also opted to bypass its local service provider, CSC, and has entered a joint venture with UPMC. Not only is the joint venture going outside the programme, it also hopes to sell systems itself to other NHS organisations. . .

BT faces multimillion pound writedown on NHS computer upgrade (12 April 2009)

The Guardian

"BT Group will next month become the third major contractor in as many years to take a multimillion pound writedown on its work with the government's crisis-stricken £12.7bn overhaul of the NHS computer system. The writedown at BT's struggling Global Services division is expected to be accompanied by news that thousands more jobs will be lost as BT is forced to slash costs. Some reports have suggested that more than 10,000 jobs could go, though BT described the figure as "speculation". . . The National Programme for IT - the largest non-military computer project on record - has already lost two of its four regional contractors, Accenture and Fujitsu. Both quit contracts similar to BT's work in the London region, writing off hundreds of millions of pounds. A poor-performing BT contract to install NHS computer systems in the capital will be the main element in a £1bn-plus package of writedowns when the company reports full-year results next month. Global Services last year announced a £336m provision against 15 of its 17 contracts, but the two remaining deals - widely believed to be the NHS and Reuters - are thought to be the most troublesome. The NHS-related writedown comes despite BT two weeks ago winning highly lucrative bolt-on deals, including a contract to manage IT systems at eight hospital trusts across the south of England installed by Fujitsu before the Japanese firm quit. Without this additional work, as well as a low-profile deal to reset the existing London contract, BT's writedowns may well have been substantially larger. NHS IT bosses had been aware for years that BT's work in London - started in 2003 as a 10-year £996m contract - had not been going well, but are eager to ensure another regional contractor does not leave. Until it struck the new or revised deals with the NHS at the end of March, it is understood that BT was considering whether to quit the project. Since its London contract began BT has installed just four patient administration systems (PASs) in acute hospital trusts - at the Royal Free; Barnet & Chase Farm; Queen Mary's Sidcup; and Barts & The London. In many cases the systems deployed were blamed by the trusts for a series of IT problems which cost them millions of pounds in financial penalties. . ."

CfH on the brink of new deals with CSC and BT (14 Apr 2009)

e-Health Insider

"NHS Connecting for Health is on the cusp of signing renegotiated deals with both of its two main regional contractors, Computer Sciences Corporation and BT. CfH says "agreement has been reached" with both suppliers. But while the final 'Penfield agreement' with CSC" has been signed, the agreement with BT is understood to be a non-binding Memorandum of Understanding. The two deals are intended to ensure that the struggling local service providers can successfully deliver iSoft's Lorenzo and Cerner's Millennium electronic record software to a significant number of hospitals by the end of the year. Extra money appears to have been found, functionality scaled back in some areas, previous release schedules ditched, and the central concept of single shared system sacrificed in a final attempt to achieve delivery through the LSP model ahead of a 2010 general election. The deals cover the three LSP contracts CSC holds for the North, Midlands and East of England and BT's LSP deal in London. Termed 'Contract Change Control Three', they are the third major renegotiation of the LSP contracts since they were signed in 2003. . . E-Health Insider understands the renegotiation of the three CSC deals focuses on reworking the Penfield delivery strategy for the Lorenzo software and concentrating resources on implementations of the initial versions of the software now in use on a small scale in South Birmingham, Morecambe Bay and Bradford. EHI has learned that development work with NHS trusts has been suspended for later versions of Lorenzo, which was set to include clinical modules such as maternity and theatres from release three onwards. CSC will also continue to provide trusts with versions of older iSoft software, where required. In London, the new LSP contract is understood to focus on moving to a new delivery model for NPfIT, which focuses resources on a series of stand-alone acute implementations of Cerner Millennium, with more local configuration at a much higher cost than originally planned. In London, BT is also understood to have negotiated a deal that will see it hand back responsibility for providing new GP systems out of a hosted data centre. The LSP will, however, continue to offer CSE-Servelec's RiO community system. BT Group is reported to have examined all options in London, including quitting the LSP contract, unless it could agree a new delivery model. The exit of BT would have left the NHS with just one surviving LSP out of the original four appointed; Accenture and Fujitsu having already departed. But a clear indication that deadlock had been broken came at the end of March, when BT was awarded a lucrative deal to support eight existing Cerner sites in the South. The eight sites have been in limbo since Fujitsu exited as LSP for the south last May. BT's beleagured Global Services Division last year announced a £336m write-down against 15 of its 17 contracts; one of the remaining two is thought to be NHS London. Originally signed in 2003, the deal is worth £996m. The company is expected to announce further write-downs against the London NHS deal next month. BT Global Services has already slashed thousands of contractor jobs, with further cuts expected. . ."

Barts' waiting list worst in country as it struggled with IT (7 Jul 2009)

Computer Weekly

"Hundreds of Londoners have waited longer than they should have for their first hospital appointment, as staff at Barts and The London NHS trust struggle to keep track of patients on their IT systems. The waiting list delays during March at Barts and The London were the worst in the country. The Government has set a target that all patients should see a consultant or doctor within 13 weeks of a referral by a GP. Most trusts in England reported to the Department of Health "zero" patients in March who had waited longer than 13 weeks for their first outpatient appointment. But the latest papers presented to the Board of Barts and The London said that it had 834 patients who were still waiting in March - and 675 of these had been waiting more than 17 weeks. The number of patients waiting was higher than all the trusts in England put together. Computer Weekly understands that some of the patients have shown up incorrectly on the waiting list - they had duplicate e-records and were actually seen but not recorded as being seen on their duplicate file. Other patients gave up waiting and were referred by their GP to another trust. Still, hundreds of Barts' patients were still waiting for their first appointment after a GP referral, for weeks and sometimes months beyond the Government's 13-time limit. Staff at Barts and The London have struggled to keep track of patient appointments since implementing the Cerner Millennium "Care Records Service" last April. Their difficulties have been compounded by inefficient management information systems. Last year Barts reported that patients with suspected cancer were not receiving urgent appointments to see specialists within the government's two-week target. The trust said this was "directly attributable to the erroneous migration of outpatient clinics [data] at the change-over to [the] Care Records Service". For Barts, one challenge has been to attune management processes and train staff to work differently since the introduction of the Care Records Service. The trust's board says it is of "extreme concern" that Barts has been unable to report on the number of patients who have or have not been treated within 18 weeks of being referred by a GP. The trust is having trouble keeping track on its systems of patients who are due to be treated and by when. The problems at Barts have hit the performance ratings of London primary care trusts - particularly Tower Hamlets - which pass their patients to Barts for care and treatment. . ."

FSA starts criminal proceedings against former iSOFT directors (6 Jan 2010)

Computer Weekly

The Financial Services Authority (FSA) has begun criminal proceedings against four former directors of the healthcare software supplier iSOFT Group plc. The directors face charges over the offence of conspiracy to make misleading statements, contrary to the Financial Services and Markets Act 2000 and the Criminal Law Act 1977. Patrick Cryne, Stephen Graham, Timothy Whiston and John Whelan have been summonsed to appear at City of Westminster Magistrates Court on 29 January 2010. At the time the four were directors of iSOFT, it was a major supplier to the £12.7bn National Programme for IT (NPfIT), as a subcontractor to services supplier CSC, which is not involved in the criminal proceedings and faces no accusations. iSOFT has faced Parliamentary scrutiny and allegations of financial irregularities in its accounts. It has since been taken over by an Australian company, which continues to supply iSOFT products as part of the NPfIT. In a separate announcement, iSOFT said today that it welcomes the FSA's decision to discontinue its investigation into the company. Australian company IBA Group, which renamed itself iSOFT Limited, acquired the UK-based iSOFT Group plc in October 2007, after the events that were the subject matter of the FSA investigation. iSOFT said it has "cooperated fully with the FSA throughout the investigation, which involved former management of iSOFT Group plc and had no bearing on any of the current management or employees of iSOFT Group Limited". . .

NPfIT cuts put future of Lorenzo in doubt (5 Mar 2010)

Computer Weekly

Ministerial plans to cut £600m from the NPfIT have put the usefulness of the Lorenzo software, which is due to be installed at NHS sites across large parts of England, in doubt. Supplier CSC is delivering the iSoft Lorenzo Care Records Service under an NPfIT contract worth more than £3bn. Though delayed by four years, the Lorenzo system is due to be installed at NHS sites in England, outside of London and the south. But the usefulness of Lorenzo is under threat now that officials are negotiating fresh deals with the two NPfIT local service providers, CSC and BT, to reduce the overall cost of their contracts by hundreds of millions of pounds. A cut in the planned functionality of Lorenzo will bring the product's whole efficacy into question, said Duncan Robinson, associate director of IT at South Warwickshire General Hospitals NHS Trust. In South Warwickshire trust's latest board papers, Robinson said, "Statements made during the last quarter by the health minister around the need to save £600m from NPfIT have resulted in a number of the functional modules planned for the later releases of the Lorenzo Regional Care product being removed. "The original Lorenzo model contained five major release phases. However, certain functionality from releases 3 and 4 has now either been brought forward or has been axed altogether, bringing the efficacy of the product as a whole into question." Robinson's comments are likely to increase Tory concerns that health minister Andy Burnham wants to sew up new NPfIT deals with CSC and BT before a general election. The deals would commit CSC to delivering a cut-down version of Lorenzo even though there are deepening doubts that parts of the NHS would want it. A CSC spokeswoman said, "No decisions have yet been made about changes to future releases of Lorenzo as a number of options are currently being discussed with the local NHS."

Bacon says 'prove value of NPfIT deals' (24 Mar 2010)

eHealth Insider Primary Care

A leading member of the Commons Public Accounts Committee has written to NHS chief information officer Christine Connelly, questioning how negotiations to ‘descope’ the two remaining local service provider contracts will deliver value for money. In an interview with E-Health Insider, Richard Bacon said it was essential that civil servants leading the contract renegotiations were clear that the deals would deliver clear value for money and provide the NHS with working systems. . . Two new, cut down local service provider deals - that dramatically cut the amount of functionality and slash the number of hospitals to get new systems - are thought to be on the brink of being signed. Both involve up-front payments to remaining LSPs, BT and CSC. The new CSC deal hinges on a successful go-live of Lorenzo at University Hospitals of Morecambe Bay NHS Trust. Bacon is concerned that the new LSP deals will fail to deliver systems urgently needed by NHS hospitals. "I remain very concerned about the acute hospital care record systems that are at the heart of the national programme," he said. . . E-Health Insider has learned that up to 18 London hospitals trusts are thought to have withdrawn from the LSP upgrade programme, out of an original total of 32. Seven of these are existing iSoft sites. . . . The latest date for a go-live at Morecambe Bay of Lorenzo Regional Care Release 1.9 appears to be 2 April. However, Bacon points out that: "Over the last seven years, the Lorenzo PAS [patient administration system] has missed deadline after deadline. We were expecting it in 2004-05; and then in 2008 Mr Nicholson told us that it was ready to deploy; and I understand that it is about to miss the March 2010 drop dead date which you set last year." Bacon told EHI that he his current information was that over 100 bugs still exist with Lorenzo at Morecambe Bay, indicating the software is not ready. . .

Is CSC 'on brink of dismissal' from NHS IT delivery? (1 April 2010)

Computer Weekly

CSC, which has £3bn worth of contracts under the NHS IT programme, is "on the brink of being fired from a key part of its contract after failing to meet a deadline to install systems at hospitals in the north-west", according to the Financial Times. The Department of Health had given CSC a deadline of 31 March 2010 to go live successfully with the iSoft Lorenzo 1.9 Care Records Service at Morecambe Bay University Hospitals NHS Trust, which is an ardent advocate of the National Programme for IT (NPfIT) Lorenzo system. Had a go-live happened successfully, the Department of Health and its agent, NHS Connecting for Health, would have paid CSC tens of millions of pounds, in recognition that Lorenzo 1.9 had proved itself capable of being rolled out across other NHS trusts. But the deadline passed yesterday without a go-live, and although officials had been willing to put back the deadline to this month, a go-live in April now seems highly unlikely as well. The failure to go live means that Connecting for Health has been unable to sign a memorandum of understanding with CSC, which would have set out a schedule for the delivery of new systems to NHS trusts under a new government. CSC will now put forward a new deadline for going live at Morecambe Bay, which will have to be agreed with the Department of Health's CIO, Christine Connelly. She told the FT that if progress is not made, the Department of Health has the option of cancelling CSC's contract to install the systems in acute hospitals, which is worth about £1bn. Connelly could end up allowing hospitals to choose from other suppliers. Connelly said that CSC has to be given time, under its contract, to propose a fresh deadline for deployment at Morecambe Bay. The Department of Health will then assess the credibility of the new deadline and decide whether to agree it. "We have to walk through this step by step," Connelly told the FT. "In a contract as large and complex as this we cannot just set a deadline and say that is it. We have to act responsibly and not expose the department and the taxpayer to risk." The Department has signed a new memorandum of understanding (MOU) with BT, the NPfIT local service provider in London and parts of the South of England. The deal means £112m will be cut from BT's £1bn local service provider contract and BT will need to deliver the Cerner Millennium system to about half of the trusts in London. Originally it was contracted to supply all of them. A Department of Health statement said: "We made clear last year that it is important to improve the certainty of delivery of NHS IT in the acute sector while ensuring that any innovation matches the changing needs of the local NHS. We want trusts to be able to choose how National Programme for IT products can work with local systems that remain fit for purpose. "This new flexible framework is the basis of our MOU with BT and will be the basis for an MOU we expect to sign with CSC once University Hospitals of Morecambe Bay NHS Trust goes live with Lorenzo. "While we are disappointed that we have not been able to agree both MOUs, we are expecting our current review with CSC of delivery plans to achieve significant savings, while building on the gains already made for patients, clinicians and managers."

Officials nervous over Morecambe Bay's planned go-live (27 May 2010)

Computer Weekly Tony Collins IT Projects Blog

NHS staff and executives at University Hospitals of Morecambe Bay NHS Trust are planning for an important go-live of iSoft's Lorenzo system this Bank Holiday weekend. A spokeswoman for the Trust said this morning (27 May 2010) that she was unaware that any definite decision for a go-live had yet been taken, but all the signs are that the Trust wants it to happen this weekend. Not all officials at Richmond House, the headquarters of the Department of Health, share Morecambe Bay's conviction that a go-live this weekend is a good idea. A smooth go-live - if signed off by the Trust as successful - would in theory give the supplier CSC and its subcontractor iSoft tens of millions of pounds. But would a coalition government that is sceptical of the NPfIT want to pay CSC such a large sum at a time when it wants to prove it is serious about cutting the national debt? This is one of the problems facing the DH CIO for health Christine Connelly who has recently travelled to Morecambe Bay in Cumbria. Does she want a go-live at Morecambe Bay that would help CSC and iSoft climb several rungs of the NPfIT ladder, when the government wants to remove most of the top rungs of the same ladder? Even if Morecambe Bay goes live this weekend many other trusts in CSC's local service provider area may not want to take Lorenzo 1.9. So CSC could end up being paid tens of millions pounds for having proved the feasibility of a system many other trusts won't install. . .
Update: Morecambe Bay's press office told me this afternoon [27 May 2010] that the Trust's directors want any journalists inquiring about the planned go-live this weekend to be referred to NHS Connecting for Health in London. This is unusual advice, because trusts are independent organisations, and CfH does not answer for what Morecambe Bay does or doesn't do. NHS trusts have their own press offices, separate from the press offices that are run by CfH and the Department of Health. I have now asked CfH for a comment on Morecambe Bay's planned go-live this weekend. I have also asked CfH who would be responsible if a new system at Morecambe Bay contributed to an avoidable injury or fatality. Would the responsibility lie with Morecambe Bay or CfH? I haven't yet had an answer.

Govt IT scheme 'set NHS back 10 years' (16 Jun 2010)


The chief executive of an NHS trust that opted out of the Government's National Programme for IT has slammed the scheme, labelling it "Not Fit For Purpose IT". Brian James, chief exec of the Rotherham NHS Foundation Trust, told delegates at yesterday's Smart Healthcare Live conference in London that the National Programme for IT had "put back the contribution of IT in the NHS by more than ten years". Rotherham became one of the first NHS trusts to ditch the Government's NPfIT scheme. Executives at the trust expressed their concern that plans for an electronic patient record system were slipping behind schedule. The trust rejected the NPfIT's Lorenzo system, provided by much-criticised supplier CSC, and instead opted for the Meditech v6.0 system from FileTek in a project that cost the trust £40 million. CSC came under fire earlier this year after missing a March deadline to roll out a pilot Lorenzo to the Morecambe Bay Primary Healthcare Trust. The project eventually went live on 1 June. "We are one of the bad boys who left NPfIT," James said of the trust's decision. "But we think we have a unique and completely fit-for-purpose solution that will deliver between eight to ten per cent return on our investment." James told delegates: "We were promised NPfIT products in 2005 that didn't appear, and our supplier said it would withdraw from the healthcare market in 2010 anyway." The Rotherham healthcare chief told the conference that the decision hasn't been easy. "This has also been a complex programme to manage by ourselves, with complex negotiations to make our supplier adapt and Anglicise the system... as well as stiff project management issues all round. But we feel we have delivered something that will really benefit us nonetheless." The ailing NPfIT scheme's prognosis is still uncertain. A spokesperson for the Department of Health told THINQ that, following the recent change of government, they were still waiting for policy direction.  

MP seeks NAO inquiry into BT £546m NHS deal

ComputerWorld - Tony Collins Blog

Was BT paid to stay in the £12.7bn NHS IT programme? An MP on the Public Accounts Committee is seeking an investigation by the National Audit Office into a deal in which officials promised BT £546m of extra payments under the NHS IT scheme. Richard Bacon, a Conservative MP who has followed the NHS's National Programme for IT [NPfIT] for much of its eight-year existence, questions whether the Department of Health has paid a premium of hundreds of millions of pounds to BT, partly to dissuade it from leaving the NPfIT after the departures of Fujitsu and Accenture. Had BT withdrawn from the £12.7bn NPfIT - Whitehall's single largest IT investment - the scheme would have been left with only one of the original four local service providers, CSC, a limitation which would have jeopardised the programme's existence. Bacon's request for an investigation will be welcomed by many within and outside the NHS who were surprised by the size of the Department's deal with BT in 2009. The MP has written to Amyas Morse, the head of the National Audit Office. The NAO reports regularly on the results of its value-for-money investigations to the Public Accounts Committee. Bacon says in his letter that £400m of the £546m agreed with BT has not been properly accounted for and so raises questions about the proper use of public money. The £546m was for BT to take over work from Fujitsu which withdrew from the NPfIT in 2008. Bacon says he recognises that Fujitsu's withdrawal from the NHS IT scheme left the Department of Health and its NPfIT agent, NHS Connecting for Health, in a difficult position. They needed to find a supplier to take over the support of eight NHS trusts where Fujitsu had already installed Cerner "Millennium" systems under the NPfIT. Bacon's letter questions whether the payments to BT were £400m more than necessary. "It seems to me that it would have been reasonable, indeed generous, to have paid BT £100m for taking on the local service provider work from Fujitsu. I cannot see how £546m was justified unless the Department of Health was willing to pay BT any sum to keep it within the National Programme for IT," says Bacon. . .

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