Blame issue hounds NHS implementers

When £6bn-worth of NHS IT contracts were signed in 2003, the ?challenging? delivery timetables had two key focuses.

One was political: quick wins in time for New Labour?s 2005 election campaign to focus on improved public services and tangible benefits from the extra billions poured into the service. The second was a newly Draconian approach to IT contracting. In a marked departure from the likes of the disastrous Libra magistrates courts deal ? where the supplier was paid more and more money as it became less and less successful ? suppliers that signed up to NHS contracts and did not deliver would first be penalised and then dumped.

As it turned out, the election campaign was rather quiet on the NHS. Notwithstanding the media being sidetracked by the legality of the Iraq war and the trustworthiness of the Prime Minister, even the official campaign barely mentioned health service technology. This should come as no surprise, because the so-called quick wins are proving more difficult and less quick than anticipated.

The 10-year NHS Connecting for Health (CfH) IT programme is to develop national electronic bookings, prescriptions and patient records systems, to run over a central ?data spine?.

As part of the modernisation, and to interface with the spine and its related applications, local clinical and administrative systems across the NHS are also to be upgraded.

Following last month?s acknowledgement that these implementations are also starting to slip, one of the prime regional contractors ? Fujitsu Services in the south ? is replacing its electronic patient records supplier, IDX, with a rival (NHS cuts key supplier from IT programme, 2 June).

This constitutes the first test of the efficacy of the government?s strong-arm approach. And the implications of where responsibility for the problems lies are central to the changing environment of public sector IT.

The NHS IT plan is mammoth in its complexity: consider the scale of deciding which trust or hospital should have which system in which order, in relation to which kind of systems they have now, how long their current contracts have to run and where new hospitals are being built.

As CfH is quick to point out, the technology is all very new and the delays are not surprising. Looked at in a prudential light, the sacking of IDX is not a sign of impending disaster, but the first evidence of NHS IT director general Richard Granger?s much-vaunted commitment to ?hold suppliers? feet to the fire until the smell of burning flesh is overpowering?.

Interestingly, it is CfH?s commitment to no-nonsense contracts that comes under fire from NHS IT professionals. They have some tough questions for Granger. If IDX is not up to the job, why has it taken so long to find out? And what was the contractual process about, if not to establish suppliers? ability to deliver?

And they claim the problems with IDX would have been evident from the start, had CfH focused less on penalty clauses and more on the technical details of the proposal.

This criticism strikes at the heart of the question facing government IT.

Were a Whitehall department buying a car, it would not conduct detailed analyses of how the engine works, because that is the garage?s responsibility. So should it be CfH?s job to assess whether the system proposed by prospective suppliers is technically viable?

It is a slightly facetious analogy but the point holds. Technology procurement is changing, just as the automotive industry eventually moved away from a world where every driver was also a mechanic.

Without doubt, CfH shares responsibility for the problems. There are serious questions to be answered in the wake of IDX?s sacking, not least how long the delays will be and how much will be added to the famously low price of Fujitsu?s original ?shared implementation? local service provider bid. It is Granger?s job to answer them.

But the industry cannot pretend forever that it is up to the customers to know IT suppliers? business.

And with CfH being eagerly watched across the public sector, whatever the outcome of the liability tussle, the ripples will certainly be wide.