NHS IT makes steady headway

It is more than two years since the £6bn  health service technology deals making up the national Connecting for Health (CfH) programme were signed. And NHS IT director general Richard Granger says significant progress has been made.

The programme includes national applications for bookings, prescriptions and patient records, to be delivered alongside upgraded infrastructure implemented by five local service providers (LSPs), each responsible for a region of England.

The core system is a national smartcard-protected data spine that will give authorised clinicians in any part of the country access to patients' medical history.

According to CfH's first annual report, produced last month, more than 30,000 NHS staff are registered to use the data spine, the first electronic prescriptions have been issued, and take-up of the Choose and Book online referral system is growing.

'We are getting to the point where we can see that the people who said three years ago that computerising the NHS was impossible are demonstrably wrong,' Granger told Computing.

But progress has not been easy. There have been delays across all five regions in implementing the upgraded clinical and administrative systems needed for local health institutions to access the national applications.

And the programme continues to be dogged by questions about escalating costs, resistance from the medical community, and supplier performance.

Granger says although it is true that all five regions are suffering delays, this is a simplistic view.

Alongside major technical additions such as the smartcard security arrangements and national email system, CfH has also had to absorb government policy initiatives such as the choice agenda.

At the procurement stage, CfH was charged with buying a system to manage electronic referrals. With the wider choice agenda, this morphed into a system allowing patients to select from a range of appointment options.

'If you look at what has been delivered to date compared with what was in the schedule, it is apples and pears,' said Granger.

'There is a lot of activity that was not scoped or resourced that was taken on board. Most major programmes have not delivered any user value by this point, but we have about 350,000 people using things we have shipped in the past year.'

How well the programme is doing depends on which region of the country you are in, says Granger.

'It is a function of local NHS capacity and competence, and supplier capacity and competence,' he said. 'If you compare CSC in the North West with BT in London, there has been a very different story in the past few months.'

In the three months from March to May, CSC installed 16 of the next-generation patient administration systems (Pas) critical for local health institutions to access the national applications. In London there is only one such upgraded system in place.

According to the original contracts, BT and Fujitsu, the LSPs for London and the South, were to share a common Pas provided by sub-contractor IDX. But last month Fujitsu dropped IDX over performance issues, and BT is coming under pressure to consider a similar move.

'BT has substantial problems and I do not believe it has effectively managed IDX,' says Granger.

Because of the way the CfH deals are structured, and the strict adherence to the principle of payment-on-results, BT will not be paid until there are working systems in London. Similarly, Accenture posted financial results in April showing losses of up to $150m (£86m) on the company's NHS deals, a situation not expected to be reversed until 2006 at the earliest.

'You can see what complete bunkum it is to say that the contracts have increased five-fold in values because the statutory listings show Accenture's revenues are actually less,' said Granger.

'The value of the contracts is unchanged in any material sense, and the key suppliers' cash receipts are, in general, reduced at the moment.'

Fujitsu's switch from IDX to Cerner in the South is a vindication of both the financial pressure built into the contracts and also of the CfH's multi-supplier approach, says Granger. Rather than giving the NHS programme to a single supplier or consortium, CfH uses competition to give the NHS more power to force the results it wants from its suppliers.

In the north of England, for example, LSPs Accenture and CSC are using iSoft software, so CSC's initially strong performance could be used to motivate better results from Accenture, says Granger.

'We have a competitive market position in the NHS because we have multiple application suppliers and multiple prime contractors,' he said.

A key priority for the coming months is to continue with the system deployments and work with NHS staff now keen to engage with the programme.

'The equanimity with which people accept things not working on a local basis contrasts with a total lack of tolerance when things provided centrally are not working,' said Granger.

'There is a tendency to say that any problems must be CfH; sometimes they are, and we must take that on the chin, but equally sometimes they are not.

'The trusts making most progress are those that are the most accepting of the imperfections of the things we deliver, and those that recognise how much better it is than when we tried to do things locally.'