FrontPoint Systems Ltd

The Public Accounts Committee report receives wide coverage in the media.

Mr Edward Leigh added: “Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.

“The programme is not looking good. And, four years down the line, the costs and benefits for the local NHS are unclear.”

Committee member Richard Bacon called for the scrapping of Connecting for Health, the agency responsible for the IT programme.

“It is a nightmare organisation and I think the NHS would be better off without it.”

Health minister Lord Hunt criticised the MPs’ report. “This is based on a National Audit Office (NAO) report that is now a year out of date.

“Since then substantial progress has been made and the NAO recommendations have already been acted on.”

If so release current information. Somehow I do not believe you.

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said: “There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.

“The Programme is not looking good. The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the Programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear.

“Given that the total cost of this hugely ambitious project is expected to top £12 billion – and who can be confident that even this massive sum will not be surpassed? – the Department of Health is playing for high stakes indeed.

“Resolute action at this stage by the leaders of the Programme can do much to diminish the risks. The Department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including local NHS organisations, can have more confidence. It must also launch reviews of the ability of the suppliers and local service providers to deliver against their contracts.

“The leaders of the Programme have talked long and loud about the benefits which it will bring to the NHS. The time for talking has ended. If dissident clinicians are to be persuaded, then they will have to see the advanced electronic patient record systems up and running. And if these systems cannot be delivered within the framework of the Programme, then the local NHS should be given greater freedom to look for alternative systems which do work.”

Patients are “unlikely” to see any “significant clinical benefits”.

Richard Bacon in the Telegraph:

They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.

Timetables are fictitious and the programme is now years behind.

Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke.

One expert told our committee: “It was like being in a juggernaut lorry going up the M1 and it did not really matter where you went as long as you arrived somewhere on time. Then, when you had arrived somewhere, you would go out and buy a product, but you were not quite sure what you wanted to buy. To be honest, I do not think the people selling it knew what we needed.”

Sounds very familiar, almost as if it was me saying it, though I did not get called.

A brief mention in the Times.

The Guardian kicks the LSP’s while they are down.

Their report called for an urgent independent review of the performance of three regional contractors - CSC, Fujitsu and BT. A full audit of their work would detail the multimillion-pound payouts and cash advances they have received, the contractual milestones they have missed and what benefits they have delivered.

The Press Association has an overview.

And in the Financial Times:

BT, CSC and Fujitsu, the current suppliers, hold £5bn worth of contracts but were “clearly struggling to deliver”, the Commons public accounts committee said.

The key recommendation - that other suppliers be allowed in - challenges the structure of the programme where BT, CSC and Fujitsu, the so-called local service providers, are charged with supplying, installing and operating the various components of the programme. They use just two software suppliers, Cerner and iSoft, for the core patient record.

Well, it all becomes clear when you read this. Forcing two very different sets of working practices into one straitjacket that fits neither is a route to disaster.

Meanwhile news from across the pond is that New York is to try giving Medicaid practices free medical software with a 19 million buy.

“We will cover half of all the high-volume Medicaid providers in the city, those where over 30 percent of their patient encounters are Medicaid or the uninsured,” said Farzad Mostashari, an assistant city health commissioner overseeing the project.

Over the next two years, the city’s Department of Health and Mental Hygiene will distribute the software to about 1,500 medical practices, from small neighborhood doctors’ offices to large clinics, including the medical offices at the Rikers Island jail. City officials, and makers of patient records software, said they do not believe any state or large local government has tried such a thing.

The department spent months shopping for an electronic records system before awarding a $19.8 million contract to eClinicalWorks, a Massachusetts company that is a sales leader in the field. The medical practices will have to supply the computers. Some already have the equipment. Others that do not might qualify for a state program that awards grants to upgrade medical technology.

Let’s hope they have better luck.

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This entry was posted on Tuesday, April 17th, 2007 at 10:43 am and is filed under EPR, Medical Informatics, NHS, NPfIT, CFH, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

So the Public Accounts Committee report on the NPfIT programme (pdf) from CfH is out today and it has plenty to say (html). I will let the report speak for itself.

1. The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number was 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be a further twenty-two. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. The Department should develop with its suppliers a robust timetable which they are capable of delivering, and communicate it to local NHS organisations who may then have greater confidence as to when systems will be delivered.

There is still an unwillingness to accept the failures inherent in the current approach. an honest re-evaluation is needed.

2. The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. Total expenditure on the Programme so far is over £2 billion. The Department should publish an annual statement outlining the costs and benefits of the Programme. The statement should include at both a national and local level original and current estimates of total costs and benefits, costs and benefits to date, including both cash savings and service improvements, and any advances made to suppliers.

Hopefully the claims made by Richard Granger that the work done by the suppliers is “at risk” is sound. But as witnessed in the case of Acccenture, getting them to actually pay up is going to be a different matter due to all the cock-ups from CfH.

3. The Department’s investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost. The main justification for the Programme is to improve patient services, and the Department put a financial value on benefits where it could. The Department should also quantify non-financial benefits, even if they are not valued, to better inform decision making and to provide a baseline for work after implementation to ensure that the intended benefits are being fully realised. The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.

The procurement was truly woeful but not much different from other recent contracts. The quality of purchasing by the DoH is shameful.

4. The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. The Department should review with suppliers their capacity to deliver, and use the results of this review to engage, or to get suppliers to engage, additional capacity where required. It should also regularly review suppliers’ performance for any signs of financial difficulties potentially affecting their ability or willingness to discharge their obligations. In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.

I could say a lot about the quality of resourcing by both CfH & the industry but it is a waste of time when people who do not know healthcare IT are running the show. Incompetence is the key word.

5. The Department needs to improve the way it communicates with NHS staff, especially clinicians. The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. It should ask the heads of the clinical professions within the Department, such as the Chief Medical Officer, to review the extent of clinical involvement in the specification of the systems, and to report on whether they are satisfied that the systems have been adequately specified to meet the needs of clinicians.

There needs to be a period of re-evaluation. The goals are far too important to be treated like this.

6. We are concerned that leadership of the Programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change. The frequent changes in the leadership of the Department’s work to engage NHS organisations and staff have damaged the Programme and convey that the Department attaches a low priority to this task. The Department should avoid further changes in the leadership of this work, beyond those necessary to improve its links with clinicians, and strengthen the links between the Programme and the improvement of NHS services that the Programme is intended to support.

I would argue for a change of leadership as there is too much sunk capital for them to accept their mistakes.

7. The Department should clarify responsibility and accountability for the local implementation of the Programme. At a time when many changes are taking place in the configuration of the local NHS and a range of other initiatives require implementation, it is essential that Chief Executives and senior managers in the NHS understand the role they need to play in the implementation of the Programme. The Department should make clear to Chief Executives and senior managers their objectives and responsibilities for local implementation, and give them the authority and resources to allow local implementation to take place without adversely affecting patient services.

Local implementation should be governed by strategy, not expedience & there need to be clinical personnel at the helm who understand IT.

8. The use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition. In addition, the fact that the Programme has lost Accenture, Commedica and IDX, three key suppliers, is running late and is having difficulty in meeting its objectives raises doubts over whether the contracts will deliver what is required. The Department should seek to modify the procurement process under the Programme so that secondary care trusts and others can if they wish select from a wider range of patient administration systems and clinical systems than are currently available, provided that these conform to national standards. This approach could have the benefit of speeding up the deployment of new systems and of making it easier to secure the support of clinicians and managers. We are concerned in particular that iSOFT’s flagship software product, ‘Lorenzo’—on which three fifths of the Programme depends—is not yet available despite statements by the company in its 2005 Annual report that the product was available from early 2004.

See comments above about the procurement process & my previous posts about the belief in “big is beautiful”.

9. At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. As a matter of urgency the Department must define precisely which elements of functionality originally contracted for from the Local Service Providers will be available for implementation by the end of the contract period and in how many NHS organisations it will be possible to have this functionality fully operational. The Department should then give priority to the development and deployment of those systems of the greatest business benefit to the NHS, such as local administration and clinical systems.

So pretty much nothing I can seriously disagree with. A look at the full report will happen when there is more time.

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This entry was posted on Tuesday, April 17th, 2007 at 9:19 am and is filed under EPR, Medical Informatics, NHS, NPfIT, CFH, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.