An IT supplier to the NHS has written to MPs to “correct” statements made by Health CIO Christine Connelly.
The implications of the supplier’s corrections are that Conservative MP Richard Bacon might have been right all along: that the Department of Health may be paying BT as much as £200m more than necessary to install the “RiO” patient record system at 25 trusts in the south of England.
The corrections by CSE Healthcare Systems – supplier of RiO – call into question some of the Department of Health’s justifications for the high costs of NPfIT versions of RiO.
RiO is an electronic patient record system that is supplied to mental health trusts and community service organisations. Trusts can buy directly from CSE Healthcare or via its partner BT Global Services which is the local service provider to London under the National Programme for IT.
Through the NPfIT, BT is installing RiO at 25 trusts in the south of England under a £224.3m NPfIT deal – £8.9m per site, compared with £500,000 to £1.5m per site if supplied to the NHS directly by CSE outside of the national programme.
At a hearing of the Public Accounts Committee on 23 May 2011, Conservative MP Richard Bacon asked Connelly to explain why RiO costs so much more when it is supplied by BT.
Connelly told the Committee that the Department of Health had investigated the RiO costs at Bradford District Care Trust, which is a mental health trust.
Bradford bought RiO outside the NPfIT, using the ASCC framework contract, which enables trusts to buy systems directly from suppliers without going through NPfIT local service providers.
The total cost of RiO at Bradford was £1.3m, which Connelly said was for a 59‑month contract.
She told MPs:
“So the comparison: in terms of the services that we provide, there are a whole set of services that are not within that £1.3m that are inside the Local Service Provider contract.
“Earlier somebody said, ‘Well, doesn’t everybody have disaster recovery.’ Well, actually, no, and at this Trust only 25% availability is provided in their local arrangements, which are not included in these costs.
“So we have a cost in terms of the BT LSP in the South for the same period, which includes the hardware, the support, the disaster recovery at 100%, the Spine connectivity, all of which are not supplied inside this Bradford system.
“If we looked at those costs through BT’s cost profile, it would be valued at £2.5m.”
Bacon pointed out that £2.5m was still much less than £8.9m being charged by BT. He wanted the difference explained.
“So first there is the period. So we need to take a look at the average period that you would expect to be there, because we pay a one‑off deployment charge and then we pay a monthly charge. So in terms of the figure that you quote, it is generally for about a four-year period, and the figure we quote is generally for about a six-year period, sometimes a little more. I think what we get is 24/7 support.
“We get full disaster recovery. I think it is fine to say, “Oh, anybody has that.” The cost of full disaster recovery is significant, when you look at the costs that BT have; we invited an external auditor to go look at the cost build-up, and they have audited these costs. We looked at BT’s profit margin, and they have taken a significant reduction in their profit margin between the original contract and the contract that we have today…”
To which Bacon replied: “But it is not the taxpayer’s fault if BT has unbelievably high costs.”
Bacon said that one reason the costs are so high is that CSE cannot talk directly to NHS trusts and must go through BT. “That is the problem with this structure,” said Bacon. “It is like having you over here, and the customer over there, and an enormous thicket, a forest of lawyers, in between.”
Connelly replied that a change to the programme means that suppliers of RiO are now on site “talking to Trusts themselves”. In London and the South, for RiO, a new user group brings together all the Trusts. Cerner, the supplier of NPfIT patient administration systems in London and the south of England, also deals directly with trusts rather than through BT, said Connelly.
Taking issue with Connelly’s comments about Bradford, this was CSE’s written statement to the Public Accounts Committee:
“During the evidence presented by Ms Christine Connelly, one of our contracts for RiO, Bradford Mental Health Trust was referenced.
“Ms Connelly’s statement was that Bradford is receiving a lower standard of service than provided by BT in London and hence the lower price charged by CSE Healthcare Systems to Bradford.
“CSE Healthcare Systems wishes to correct the evidence given.
• Ms Connelly stated that the service is NOT 24*7 hours – the service is a 24*7 service.
• Ms Connelly stated that Disaster Recovery (DR) was NOT included in the service – a DR service is included.
• There was no mention of Facilities Management – we provide remote Facilities Management
• The service contract is for five years – not four years as stated.
• Ms Connelly implied that the system only had 25% availability – our records demonstrate that this is not true; the system is architected to achieve an availability of over 99%.”
Another NHS IT supplier Maracis has provided evidence that RiO costs several times more under the NPfIT than outside the programme, for similar levels of service, disaster recovery, availability and support periods.
On its website CSE Healthcare says its system is compliant with the NPfIT data “spine” and supports established standards for interoperability such as HL7 and XML.
The Public Accounts Committee is finalising a report on the NPfIT detailed care record systems. Its findings will be based on its questioning of Connelly and other witnesses, written evidence from CSE and others, and a report of the National Audit Office in May.
Connelly, who is Director General of Informatics, has announced she is leaving at the end of this month, after three years. She is being replaced in the interim by Katie Davis, who is from the Cabinet Office.