Health check: NHS IT nears the first delivery deadlines

With all the supplier contracts signed in record time, implementation of the £2.3bn National Programme for NHS IT is well underway.

The first major delivery deadlines are looming, with early adopters due to go live on the first release of the ebooking application early this summer.

Computing talked exclusively to NHS IT director general Richard Granger about the current challenges he faces.

BT

The programme has also experienced its first problems. BT is facing six-figure fines for missing some of the milestones in its roll out of the N3 broadband infrastructure. The company won three of the major deals making up the programme - N3 rollout, development of the 'spine' to underpin national electronic care records, and local implementation in the London area.

'We think they've missed two milestones in the N3 contract,' Granger told Computing.

'But we will work with them to sort out what form of recompense we receive, recognising the other things BT may do - so they might supply good and services rather than money.

'On the spine contract for the care records system BT continues to work bloody hard. We are in the real world. This is about getting the job done. It's a substantial job and BT are pulling all the stops out to do it.'

Backfill

The Local Service Providers (LSPs) contracted to deliver the programme on the ground have started their work, developing , plans for where each of their area's health trusts fits in the implementation schedule.

But NHS staff have expressed continuing concerns about where the money for training is going to come from. The major issue is the need for 'backfill' - that is, sufficient funding to pay for cover while clinicians take time off to be trained.

Granger says some extra funding will be needed in the short term, but the benefits provided by the new systems will free up the necessary resources.

'Undoubtedly the IT programme will generate the need for some backfill, but what we are trying to do is deploy systems which have minimal training requirements because they are well-designed,' he said.

'Clinicians won't need to be trained for weeks on how to use the systems because they will be modern, clean, fresh systems with contextual help.'

The National Programme has provided some central funding for training, which will be augmented by re-prioritising other NHS spending, says Granger.

'We've handed over £84m this year, and there are £1bn-worth of local IT budgets, some of which won't need to be spent as a consequence of the national systems. There will be benefits received as consequence of the things we are doing that will free up resources,' he said.

Granger says there will be a short period in which the programme will have to 'pump prime' - use up investment while waiting for the benefits to flow.

'But as they do we will get into a virtuous circle in which savings being made by local trusts free up more resources,' he said.

An example is the time saving benefits of electronic patient records, he says.

'The result will be enormous efficiency savings once we stop clinicians' wasting their time chasing records around,' he said.

Granger expects to see a comparable sum to the £84m provided by the National Programme coming from those re-aligned budgets and from existing funds available to bodies such as the Modernisation Agency.

'This is about the NHS aligning resources around the programme,' he said.

Smartcards

Some of the finer details of how the National Programme applications will work in practice are to be worked through with the early adopters. One possibility to be investigated as the first wave of online booking users go live this summer is around the use of smartcards to authenticate access to patient records.

'Our ebookings early adopters are going to use smartcards as part of range of access control and confidentiality assurance technologies,' said Granger.

'We're following the principle that, to access a record, you have to know something - a password - and you have to have something - a smartcard - and obviously you would also have to have a user ID.

'That structure is a good way of controlling access and you would only get to become an authorised user when you could demonstrate your identity through provision of a passport or similar relevant documents,' he said.

The plan is to control access to all records and create exception reports for access to records for which there is no obvious relationship - if the clinician is hundreds of miles from a patient's home address, for example.

The details of how the smartcard system could work are in the process of being hammered out centrally through the Design Authority set up early last year to oversee development of technical standards.

'Smartcards are probably part of the armoury but we need to make sure the technology is right for use in a clinical setting and look at what the unintended consequences might be,' said Granger.

'We need to look at all the eventualities of locums, lost cards, name changes and so on and we will work through that through the early adopters in the piloting exercises to check this really is the right approach.

'We also need to work through the process of having an identity checked because sometimes it can be quite difficult, for a 16-year-old for example who doesn't have a driving licence, utility bill or passport,' he said.

These are all issues which must be worked through in practice because what makes sense on paper may face different issues on the ground.

'You can sometimes specify something to the "nth degree" and then experience reality on the ground with real users and unforeseen consequences and factors around deployment,' said Granger.

'I have been trying to engender in my team the need to specify to the right level of detail and be humble about the fact that some things that are the optimal technical solution may not be the optimal usable solution for end users in the real world,' he said.

Recent Developments in the NHS National Programme

• BT
  

  BT is liable for a six-figure sum for missing two of the 56 milestones it has faced in the rollout of the N3 broadband infrastructure

• Clinical systems
  

  A proposal for BT in the London area and Fujitsu in the South to develop a joint solution using clinical systems from IDX was key to Fujitsu's low-priced winning bid. The details of the scheme are now being finalised and it is set to go ahead as planned, says Granger.

  'In the London cluster we will next clear the heads of agreement between BT and Fujitsu regarding the consolidated solution using IDX for London and the South,' he said.

  Accenture, LSP for the North-East and East regions, has finalised its agreement for IDX-rival iSoft for clinical systems across its areas.

• IBM
  

  One of the most conspicuous losers in the National Programme procurements last year was IBM. But the company has just won the deal for technical and project assurance resources across the programme.

  'IBM is providing that intensive supplier management and will be reviewing suppliers' progress, plans and technical products on behalf of the NHS,' said Granger.