Having made it through the Public Accounts Committee hearing relatively unscathed, the £6bn National Programme for NHS IT (NPfIT) faces tests with far greater implications.
The data centre failure that knocked out patient admin systems in 80 hospitals this month raises serious questions, not least because backup systems also failed.
But they are only ripples on the surface; two far deeper currents are stirring.
The first is the doctors. Progress is already being delayed by disputes with the government over reform plans, with the Connecting for Health (CfH) agency running NPfIT over lack of consultation, and between different clinical groups over who owns what data. While discussions are cloaked by concerns such as confidentiality and security, there is more than a hint of politics, and of a turf war over who is the first and final arbiter of the relationship with the patient.
The second vital area will be the suppliers.
CfH director general Richard Granger was specifically hired from the private sector to broker hard-nosed, commercial deals. He did a good job. The NPfIT contracts pay only on delivery of working systems, and include punitive fines for under-performance and the scope to swap out the weak at any time.
Granger’s jealous guard over taxpayers’ money is commendable, but the cracks are widening.
One second-tier software supplier, IDX/GE, has already been dropped, at considerable cost to prime contractors Fujitsu and BT and with a knock-on effect on rollout.
Accenture, another major supplier responsible for two of the five regions, announced in April that it was holding back £260m of its profits against ‘slower and lower future demand’ on its NHS deals.
And iSoft, the other second-tier contractor, has serious problems – delays, management and accounting issues that have led to profit warnings, resignations and, last week, the suspension of two more senior executives.
An optimist might say the suppliers’ financial issues are evidence that the contracts are working. But private sector pockets are not bottomless, and only a fantasist would say that implementation delays – and therefore payment delays – will catch up in the coming year.
Much will come down to Granger’s ability to confound his reputation for uncompromising pugnacity. While CfH can do little to arbitrate the politics of the clinical community, constructive relations with its suppliers may be the only way to avoid a crisis far more serious than whether rollout meets its arbitrary timetable.
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