NHS IT programme is a question of faith

The National Programme for NHS IT (NPfIT) is like religion – either you are a believer, or you are not.

Last month the furore was over a second-tier supplier, iSoft, and its delayed software, wobbly finances and uncertain future. This month speculation centres on Accenture. The company is the local service provider (LSP) for two of the five regions into which the £6bn plan is divided, and one of two prime contractors, with CSC, reliant on the beleaguered iSoft.

All five LSPs have had problems, and all five regions are behind schedule. But Accenture’s problems have already led to its putting aside $450m (£280m) of profits ‘against future losses’. And when CSC signalled its support for iSoft with an agreement guaranteeing £153m of NHS business, a similar statement from Accenture was notably absent.

Even global consultancies’ pockets are not bottomless, and given the government’s refusal to renegotiate the contracts, the programme is nearer than it has ever been to losing a major supplier.

Debate focuses on either the political fallout or the financial penalties and consequences for the reputation of the supplier. But the more important question is the impact on the NHS.

One school of thought says Accenture’s woes are part of a much wider picture – serious delays across the entire programme, under-performance from nearly all the major suppliers, continuing uncertainty over iSoft, capacity issues, and so on. In this context, the departure of a major supplier would be momentous: the latest and most serious indictment of a programme causing increasing dissatisfaction and accusations of central mismanagement among local NHS IT staff.

The other perspective is that such changes would have less effect on the NPfIT itself than the likely media firestorm might suggest. iSoft says it will be 2008 before its next-generation software will be fully developed, so there is already some leeway. And because the new deals would most likely go to existing LSPs, it would be a question of scaling up existing operations rather than starting from scratch.

Accenture is expected to clarify its position with the publication of its end-of-year results at the end of this month – although there is speculation that the decision has already been made.

However the issues are handled, it will largely come down to individual faith as to whether the outcome looks like evidence of the effective contract policy of the NHS programme, or just one more totter before collapse.

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