By Tony Collins
NHS Minister Simon Burns gave MPs a series of statistics this week in defence if the NHS IT scheme – and went further by suggesting that systems installed under the National Programme for IT are more critical to patients than IT installed by the NHS outside of the NPfIT.
The NPfIT statistics he gave to the House of Commons indicate that the Department of Health’s ministers are content to follow the practice of Labour ministers who gave MPs regular updates of statistics on what has been achieved by those running the National Programme for IT.
Burns criticised top-down approach of the NPfIT, said that the Conservatives would not have started such a scheme, and promised that £1.3bn – 18% – would be cut from the “forecast” costs of the programme.
Much of his speech during a debate on the NPfIT in the House of Commons was, however, in praise of what the programme has achieved. He cited some of the achievements of the two main NPfIT suppliers CSC and BT, and was supportive of the controversial Summary Care Record scheme.
Far from being at an end, or dead, as some headlines suggested last year, the NHS IT scheme has the full commitment of the Department of Health’s CIO Christine Connelly, the NHS Chief Executive Sir David Nicholson and the minister. It’s not so clear, though, whether the Prime Minister David Cameron is so enthusiastic; and it’s possible that MP Richard Bacon, a member of the Public Accounts Committee who initiated this week’s debate, will seek to have control of NPfIT contracts transferred from the DH to the Cabinet Office which is now reviewing CSC’s £3.1bn worth of NPfIT contracts.
These are extracts from Burns’ speech this week:
“… Regarding national infrastructure, there is the spine, which is the core service that connects all other systems at both national and local level and handles, among other things, more than 11 million daily queries made on the personal demographics service.
“N3, the secure network that links all NHS organisations to each other, to outside data centres and to the internet, has almost 50,000 connections.
“The NHS internal e-mail service handles 2 million e-mails every day.
As for national applications, every day, choose and book processes about 30,000 appointments, the electronic prescription service sends about 660,000 prescription messages and about 2,000 records are transferred electronically using the GP2GP system.
“On the summary care record, as a result of the two reviews that I commissioned last summer, we now have agreement on the core data to be held and the approach to roll-out. More than 30 million patients have been contacted about the summary care record…”
He said the systems “implemented by the programme are making a difference to patients’ experiences and to clinical efficiency, safety and effectiveness”. He cited as examples of success three NHS trusts that have had particular problems with installations of NPfIT systems:
– University Hospitals of Morecambe Bay NHS Trust [which installed Lorenzo 1.9 from CSC]
– Barts and The London NHS Trust [which installed Cerner Millennium from BT]
– Royal Free Hampstead NHS Trust [which also installed Millennium from BT]
Burns said that at Morecambe Bay infection prevention is “now fully electronic, using the Lorenzo system”.
At St Barts, London, “clinicians are alerted to all patients carrying MRSA through the [Cerner] Millennium system”.
The Royal Free hospital in Hampstead has “also used Millennium to create safety procedure information, including for endoscopy data and bleeding guidelines”.
Burns went on to say that “BT has delivered community and mental health systems to all trusts in London and the south that requested them, and the Cerner Millennium system to “just over half the London trusts that require it”.
CSC, said Burns, has “delivered to 83 acute trusts in the north, midlands and east of England using upgraded interim systems”. CSC has also “delivered iSoft’s Lorenzo e-patient record system to 10 trusts and completed delivery of 137 prison health IT systems across the country”.
And “all but 14 of the more than 8,000 GP practices in England have a system supplied by either the national programme or the GP systems of choice scheme, which has allowed us to maintain several small and medium suppliers in the market”.
In giving MPs the latest statistics on the NPfIT Burns follows Labour ministers who included Lord Warner, Caroline Flint, Lord Hunt, John Reid, Andy Burnham, Ivan Lewis, Liam Byrne, Hazel Blears, David Lammey, Rosie Winterton and Ivan Lewis.
This was what Labour NPfIT minister Caroline Flint told the House of Commons on 6 June 2007:
“Thousands of NHS staff and many thousands more patients are already benefiting from the national programme for IT… Connecting for Health systems are already used by 645 GPs and 335 pharmacists. To date, more than 20,000 direct bookings have been made through choose and book in his area, which is already benefiting from the picture archiving and communications system. Our ambition is that all NHS staff and the public throughout England will gain from the enormous benefits that the national programme for IT is enabling.”
Are NPfIT installations more critical than non-NPfIT sites?
In his support for what the NPfIT has achieved, Burns went further than Labour ministers. He suggested that NPfIT systems are more critical than those installed outside the programme, and so need more money spent on disaster recovery arrangements.
Burns said that “because NHS systems are so critical, they need to be far more robust and stable than those outside the programme”.
He said: “We invest a great deal of money in ensuring that if systems go down, each and every component can be automatically recovered.
“Should a whole system fail, it can be recovered and made available for clinicians to use within two hours. Of course, such a level of disaster recovery does not come cheaply, which helps explain differences in price between some systems in the programme and similar systems procured by some trusts outside the programme.”
But Burns’s Conservative colleague Richard Bacon made the opposite point: that when an NPfIT data centre crashes it can cause more disruption than when a single trust’s systems fail.
Bacon said that when a CSC data centre at Maidstone was hit by a power failure, followed by restarting problems, it was “the largest computer crash in NHS history”.
“The back-up systems did not work, and data held in the centre could not be accessed. That meant that, for four days, 80 NHS trusts could not use their patient administration systems and had to operate as best they could with paper systems,” said Bacon who, in the debate, gave an excoriating critique of the NPfIT and its history.
Bacon remains concerned that trusts with NPfIT systems will face sharply increasing IT costs when the local service provider contracts end in 2014/15.
Nothing Bacon says, however, is likely to dent Burns’ spirited enjoyment of the programme’s achievements and commitment to its future.