NHS was warned over BT performance in London four years ago

Gateway review reveals widespread concerns over BT's delivery of care records system that later led to major delays and £1.2bn write-off at the supplier

Electronic patient records have been badly delayed

The NHS was warned of “poor supplier performance” in the London rollout of electronic patient records as early as 2005 – problems that later led to severe delays to the project and contributed to a £1.2bn write-off at prime contractor BT.

The release of the Gateway project reviews for the £12.7bn NHS National Programme for IT has revealed the depth of concern over BT and its sub-contractors at the earliest stages of the Care Records System (CRS) implementation in London.

“Delivery of CRS has been a major disappointment so far due in the main to poor supplier performance,” said the “Gateway review 4 – readiness for service” report, produced in July 2005.

“Repeated slippage of milestones and the failure to deliver a core CRS product have resulted in significant tensions and losses in confidence and trust between both the NHS and the suppliers and the NHS and CfH.”

CfH is Connecting for Health, the NHS agency tasked with implementing the National Programme.

In November last year, the lead site in London for CRS, the Royal Free Hampstead NHS Trust, reported a £7.2m deficit as a result of problems with the rollout. The trust’s chief executive Andrew Way was forced to apologise to staff for the “heartache” caused by the system.

The previous month, all CRS implementations in London were halted pending improvements to the software after NHS trusts expressed reluctance to continue after seeing so many problems at early adopter sites.

And in May this year, BT admitted that it was forced to write-off £1.2bn because of problems on two major contracts – one of which was the London CRS deal.

But doubts about BT were being expressed a long time ago.

“Although the NHS in London remains committed to the CRS vision for the capital we have observed significant scepticism amongst members of the care community regarding how and when that vision will be delivered. Much of this doubt has been directed at the suppliers, BT and their principal sub-contractor IDX,” said the Gateway review.

IDX was replaced in 2006 by Cerner as the provider of CRS software to BT.

“Milestones have repeatedly been missed and re-set,” the document also reveals.

“Whilst there will have been many reasons for these delays, the management team believes that the principal root causes have been an under-estimation of the scale and challenge of the task by the suppliers (particularly the work required to ‘anglicise’ an American software product) and ineffective project management on the supplier side,” it continued.

“Given the problems the programme has encountered since its launch, the repeated slippage of milestones and the failure so far to deliver core product, our view is that the stakes for this next immediate phase are very high indeed.”

There were repeated warnings in the Gateway review over the need to improve supplier performance.

“The matter of supplier capacity must remain a critical risk to the forward programme... Until evidence of an improved performance becomes apparent, it would be appropriate to ensure that rollout plans are cautious in their expectations otherwise there is every prospect that the development phase experience of repeatedly missed milestones will be repeated during deployment,” said the report.

The review highlighted issues over the “customer-supplier relationship” and concerns over “trust and a desire to co-operate for the common good”.

“We recommend that the Cluster gives thought to the way in which a more partnering-based relationship with the LSP [local service provider – BT] might be developed, when conditions make this possible, in order to lay a stronger and more effective foundation for the longer term programme,” it said.

The NHS has published 31 separate Gateway project reviews for the National Programme for IT. Gateway reviews are designed to test the business case for projects at various different stages of their lifecycle.