Category Archives: NHS

MPs to report on £11bn NHS IT scheme on Wednesday

Posted on 31/07/2011 | 1 comment

The House of Commons’ Public Accounts Committee will publish a report on the NHS’s National Programme for IT detailed care records systems on Wedneday 3 August.

The report is likely to be critical of Sir David Nicholson, the Senior Responsible Owner of the NPfIT who told the committee’s MPs that 80% of the total programme has been delivered.

MPs believe that the programme has been a failure, with poor value for money for the systems delivered so far, which have cost about £6bn.

Sir David Nicholson has been overall senior responsible owner of the NPfIT since 2006. He was not responsible for initiating the programme, which happened under the Blair government in 2002, but he accepted responsibility for making the NPfIT a success. He turned down a call by academics for an independent review of the NPfIT.

Detailed care records systems are only part of the NPfIT – but they were the main reason for the programme’s introduction. Staff at the National Audit Office, which has investigated aspects of the NPfIT three times, say they are not convinced that the national programme is under control.

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MPs to publish NPfIT report next week

Posted on 27/07/2011 | Leave a comment

The Public Accounts Committee is expected to publish a report next week on the results of its investigations into the NPfIT detailed care records systems.

The report is likely to be highly critical of the slow progress and high costs of the detailed care records systems. 

It’s possible that the report will criticise Sir David Nicholson who is Chief Executive of the NHS and the Senior Responsible Owner of the NPfIT. He has praised the success of the National Programme to three prime ministers – and before the Public Accounts Committee on 23 May 2011 when he said:

“We spent about 20% of that resource [the £11.4bn projected total spend on the NPfIT] on the acute sector. The other 80% is providing services that literally mean life and death to patients today, and have done for the last period.

“So the Spine, and all those things, provides really, really important services for our patients. If you are going to talk about the totality of the [NPfIT] system … you have to accept that 80% of that programme has been delivered.”

Comment:

One of the NPfIT’s main supplier CSC is negotiating a memorandum of understanding on its £3bn worth of NHS contracts with the Cabinet Office’s Major Projects Group.

The criticisms in next week’s Public Accounts Committee report may make it more difficult for CSC to get the attractive deal it was hoping to sign.  

Indeed the negotiations with CSC are a key test of the Cabinet Office’s mandate from Downing street to stop departments signing deals that are good for suppliers and potentially bad for taxpayers.

On the matter of Sir David Nicholson’s role as senior responsible owner of the NPfIT, we should be urging his continuance in the job until the national programme is at an end. It is usually a good idea for a senior responsible owner to stay with a project from start to finish. But that’s assuming the SRO is independent enough to approach ministers for a complete re-think if necessary.

Several years ago Nicholson rejected calls from academics for an independent review of the NPfIT. He suggested it didn’t need one when clearly it did.

It’s time for fresh SRO eyes to look at the NPfIT. The SRO needs to be the harshest critic on any large IT-enabled change programme, not its PR agent.

We look forward to the PAC report.

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Posted in managing change, NHS, npfit, Uncategorized

Mobile digital dictation in the Cloud targetted to help trusts get on top of their transcription backlog

Posted on 27/07/2011 | 1 comment

By David Bicknell

A recent survey of the technology being considered by NHS trusts includes digital dictation systems which are being used to cut the backlog of transcription files and to help trusts meet their patient discharge targets.

Typically, trusts, although they have experienced secretarial teams, struggle to get on top of the sheer volume of dictation transcriptions channelled in from hospital departments. That volume itself can cause a backlog and delay to the turning around of transcriptions.

One trust, Worcestershire Acute Hospitals Trust, used a solution from V7 Technology to cure its transcripti0n headache, clearing 50% of the backlog from 10 departments in 3 weeks. In 5 remaining departments, where there was the greatest backlog, outstanding transcriptions were reduced by 70% over the same period.

I recently learned that V7 Technology has now created an app-based digital dictation system for BlackBerry smartphones,  which allows users to dictate documents and thoughts in real-time through the Cloud, and have them immediately available for transcription. The system, called Yodal, also allows users to edit the recording and include metadata such as comments, references and instructions.

The recordings can be streamed from anywhere in the world and sent securely – a benefit of the BlackBerry environment – to PAs, secretaries and transcriptionists. Costs for Yodal are £50 per user as part of a fully packaged service that includes including free transcription software. Android and iPhone based solutions are now under development, and the solution is applicable to a range of fee-earning professionals, including accountants, lawyers and surveyors.

As well as Worcestershire Acute Hospitals NHS Trust, which is implementing the Yodal BlackBerry mobile solution,   users also include Top 10 legal aid firm EBR Attridge, which estimates it will save nearly £10,000 in hardware and software costs over three years.

Dr Ian Douglas, consultant in palliative medicine at Princess of Wales Community Hospital said, “Yodal allows me to get as near as possible to making contemp0raneous notes from all settings in which I work, in particular when I am seeing people at home and  on the wards in an acute hospital when access to other existing clinical systems is very difficult due to either the environment o0f the practical difficulties of 3G from people’s homes or my car.  I would recommend this option to other clinicians who are asked to work in a mobile way from multiple sites.”

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Handling change: Could Tesco Bank learn from First Direct – and Govt?

Posted on 26/07/2011 | Leave a comment

By Tony Collins

Tesco Bank has learned the hard way what some government and NHS users have discovered: that the first rule of managing big IT-enabled change is to invest in lots of extra staff to cope with the unexpected.

A spokesman for Tesco Bank said yesterday that its services are back to normal. Customers can access their accounts and the help-desk is answering calls normally. He was not aware of any “issues”.

Not all Tesco Bank’s  customers agree that the service is fully operational.  Some are having problems closing their accounts and when they succeed they are being sent hand-written cheques, which is, perhaps, an archaic practice for an on-line bank. Was this part of the original design?

Martin Bryant who has had a Tesco account since 1997 emailed Campaign4Change to say he was having problems closing his account.

“I’m still waiting for my money, and spend an hour a day on the phone to Tesco’s unbelievably poor helpline.”

Eventually he persuaded Tesco Bank to close his account.

Said Bryant: “The new computer system does not allow me to make transfers to my non-Tesco bank account … The help-desk staff  do not know what they are doing: promises to ring back are not kept, and it took me several hours over three days to close my accounts and get my money transferred to my First Direct account.

“I only succeeded because I rang so often I finally encountered the only member of staff capable of actually doing something –  so thank you Alison.” He said Tesco should “stick to selling cabbages”.

Bryant is among those left unhappy by Tesco Bank’s troubled transfer of about 900,000 accounts from Royal Bank of Scotland systems to its own. These are some of the comments in the past few days on Martin Lewis’ MoneySavingExpert.com website:

“I still don’t have the [new] PIN, and having tried to call Tesco Bank again tonight (three times) i have not managed to speak to anyone as the lines are still too busy. I can’t believe Tesco Bank have the cheek to claim that the issue is somehow resolved. I hope the regulator takes a very good look at Tesco Banks’ conduct …”

**

“One month on and there are still problems. I have been waiting nine days for my temporary PIN. I want to move my money but am unable to do so. No interest from Tesco. You just have to wait 10 working days before we will do anything about it. That’s two weeks with no access to my money… All I want is my money out!”

**

“Still locked out as well – what a shambolic mess. Apparently the temporary PINS that were promised to be sent out on 8th and 9th July were not sent out. The follow-up temporary PIN allegedly sent out 14th July still has not arrived.

They say to allow up to five working days, so tomorrow is my deadline before account closure. Clearly from the conversation today they still have a great many very angry customers, unable to access their accounts after over four weeks.”

**

“I hope the shambles is over for me? After 2 weeks of being messed about I gave up on Tesco. No PIN, no letters, no clue.  Asked to close the account and was transferred through to some one who was clearly becoming a expert at this.

“After security and a call back they will send a cheque……won’t transfer it back to me electronically…mind you with their systems can’t blame them for not taking the risk?

I await the post with baited breath. Still one lesson learnt…Don’t bank with Tesco.”

**

Learning from First Direct – and central government

First Direct is regarded in customer satisfaction surveys as the bank customers would most recommend.

In 2011, as in other years, the UK Customer Service Index, which surveyed 26,000 people, put First Direct top of the UK banks.

Like Tesco Bank, First Direct unwittingly locked customers out of their accounts when implementing large-scale change. It happened in 2007.

First Direct got away with the problems without damage to its reputation largely, it seems, because it had enough extra service desk staff talking through with thousands of callers the steps they needed to take to update their browser. Some browser versions were incompatible with First Direct’s upgraded system.

In contrast Tesco Bank was caught short and customers had to wait an hour or more before getting through on the helpline – or giving up. It also appears that when people did get through, some of the extra staff Tesco Bank belatedly drafted in did not have access to customer accounts.

NHS Trusts and the NPfIT local service providers BT and CSC have learned the hard way that large-scale IT implementations require extra staff at go-live, and several weeks after, to cope with system and software bugs, work-rounds and end-users not understanding new ways of working.

It’s a trap one would have thought Tesco Bank would have avoided.  You can’t cut staff before large-scale IT-enabled change – and perhaps not soon afterwards either.

Links:

Lessons from an IT crisis – Tesco Bank.

Waitrose apologises to website customers.

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Did officials tell MPs the whole truth on NPfIT payments to CSC?

Posted on 15/07/2011 | 2 comments

By Tony Collins

Conservative MP Richard Bacon wrote to the NHS Chief Executive Sir David Nicholson yesterday warning that a failure to disclose information to the Public Accounts Committee was a “very serious matter”.

Bacon, a long-standing member of the Public Accounts Committee, wrote to Nicholson about advance payments to CSC under the NHS National Programme for IT.

The MP is concerned that the Department of Health did not mention a £200m advance payment to CSC at a hearing of the Public Accounts Committee on the NPfIT detailed care records systems on 23 May 2011; and the payment wasn’t mentioned in the Department’s subsequent memo to the committee.

Said Bacon in his letter:

“I understand that the advance payment of £200m to CSC was made in April 2011 but the Department of Health’s memo of 7 June 2011 doesn’t mention it. 

“The failure to disclose to the PAC an advance payment of £200m is a very serious matter.  The fact that the payment appears to have happened after 31 March 2011 is scarcely the point.

“What is going on? … 

CSC declared the £200m advance payment in regulatory announcement

CSC has told regulatory authorities in the US that on 1 April 2011, pursuant to the NPfIT contract, the “NHS made an advance payment to the Company of £200 million ($320 million) related to the forecasted charges expected by the Company during fiscal year 2012”.

The payment was reported by E-health Insider last month.

It appears that the Department decided to give the committee details of advance payments to CSC up until 31 March 2011. The undisclosed £200m payment to CSC was made the next day, 1 April.

As the Department of Health wrote to the committee on 7 June there is no clear reason for its choice of 31 March as the cut-off date for informing MPs of advance payments to CSC.

It would not be the first time the Department has withheld the latest information on the NPfIT from what it regards as outsiders, such as Parliament and the media.

When the National Audit Office was investigating the NPfIT several years ago it was not told of the latest Ipsos MORI survey on NHS perceptions of the National Programme.

The Department instead gave the NAO an older and more positive Ipsos MORI survey. The NAO confirmed to me it had not seen the latest survey [which had some negative findings on the NPfIT].  

Today some in the Cabinet Office are exasperated at the disdain with which some officials at the Department of Health – not all – treat outside supervisory organisations such as the NAO, the Public Accounts Committee and the Cabinet Office.

It appears that some in the Department regard these organisations as necessary by-products of democracy that must be tolerated but not encouraged.

Comment:

Major change is unlikely to happen in Whitehall or at least within the Department of Health and NHS Connecting for Health if officials are allowed, with ease, to dismiss their scrutineers with a wave of their hand.

The culture of allowing the DH to withhold the truth about the NPfIT needs tackling. All credit to Bacon and the Cabinet Office for trying to do just that. It’s likely that Katie Davis, the interim health CIO, will also seek to make the DH less introspective and defensive, at least in terms of the NPfIT and health informatics generally.   

**

Bacon’s letter to Sir David Nicholson

This is Bacon’s letter dated 14 July2011 to Nicholson, copied to the head of the National Audit Office Amyas Morse, the chair of the Public Accounts Committee Margaret Hodge, and the Cabinet Office. 

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I do not seem to have received a reply to my email of 27 June below.

Making advance payments of any kind at all is wholly at variance with the Department of Health’s long-stated boast that the NPfIT contracts “only pay for delivery”, but let us leave aside this basic point for the moment.

I understand that the advance payment of £200 million to CSC was made in April 2011 but the Department of Health’s memo of 7 June 2011 doesn’t mention it.  The failure to disclose to the PAC an advanced payment of £200 million is a very serious matter.  The fact that the payment appears to have happened after 31 March 2011 is scarcely the point.

What is going on?  Please reply to my email below with its various questions without further delay.

Yours sincerely

Richard Bacon MP for South Norfolk, Member of the Public Accounts Committee

Bacon’s earlier letter to Nicholson, dated 27 June 2011

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I am writing following the hearing of the Public Accounts Committee on Monday 23 May 2011, to follow up on two important issues that were raised during your evidence:

1.       ADVANCE PAYMENTS TO SUPPLIERS

In your supplementary memorandum to the PAC following the hearing you gave a total of advance payments made up to 31 March 2011, in respect of all contracts over the whole period of the Programme, of £2,532m of which suppliers have retained £1,328m. You also identified a further £119 million of advance payments to be earned or refunded.  Since the memorandum was received by the PAC, it has been reported that the NHS made an advance payment of £200 million to CSC in April 2011. http://www.ehi.co.uk/news/acute-care/6971/nhs-made-£200m-april-advance-to-csc

I should be most grateful if you would let me know the answers to the following questions:

1.       Is this report accurate?

2.       Why was this payment was not reported to the PAC, either during the hearing or in the subsequent memorandum?

3.       What was the justification for this payment and what value does it represent to the NHS?

4.       What will happen in respect of this payment if a new memorandum of understanding is not in fact signed with CSC?

5.       I would also be grateful if you would comment on the CSC filing with the US Security and Exchange Commission, which states that in the opinion of the company, if the NHS were to terminate the current contract “for convenience” it would owe fees totalling less than the $1 billion asset value CSC now has on its books for the contract.   How is this consistent with the claim at the PAC  hearing by Ms Connelly that the cost of terminating the CSC deal could “potentially leave us exposed to a higher cost than if we completed as it stands today”?

2. THE COST OF DEPLOYING CERNER MILLENNIUM AT NORTH BRISTOL

Second, I would be grateful if you could comment on the cost of deploying Cerner Millennium at North Bristol, reported in your memorandum as £21 million, including service for 56 months, and on the current expected go-live date.  Specifically:

6.       Can you explain why the delivery date agreed with BT at the contract “reset” was 4th June 2011?

7.       Why it was then revised to 2nd July 2011?

8.       And why it now appears that there is no agreed delivery date at all?

9.       Can you also give your best comparison of the cost of deploying the Cerner Millennium system at North Bristol, with the cost to University Hospitals Bristol of deploying the System C Healthcare Medway system outside the National Programme?  It would appear from media reports that this latter contract includes deployment of functionality including PAS, Accident and Emergency, maternity, theatres, clinical data collection, and a data warehouse and reporting system, as well as integration of third party and current Trust applications.  According to the National Audit Office, the average cost for each new site under the BT South contract is £28.3 million, but the cost of the Medway system to UHB has been reported as £8.2 million over seven years. (http://www.guardian.co.uk/healthcare-network/2011/may/19/university-hospitals-bristol-foundation-trust-awards-e-patient-contract)   What is the justification for this apparent difference?

10.   As the Senior Responsible Owner for the National Programme, can you give your explicit undertaking that the North Bristol contract represents value for money for taxpayers?

I look forward to receiving your reply.

With many thanks

Yours sincerely

Richard Bacon

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Posted in Campaign4Change, improving communications, NHS, npfit, outsourcing, public sector, public services, supplier relationships, Uncategorized

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Employee-led mutuals: should the public services white paper have gone further?

Posted on 14/07/2011 | Leave a comment

By David Bicknell

Some commentators believe that the Government could and should have gone further with the publication of the Open Public Services White Paper.

Writing in the Guardian, Colin Cram, the former chief executive of the North West Centre of Excellence, makes some constructive suggestions. He argues that publishing the white paper is “a bold step. It is an attempt to create a coherent and different approach to providing public services. My feeling is that the consultation will be genuine, which will provide an opportunity for criticisms to be addressed and the government to back off from impracticable ideas or change its approach. The risks for the government are that the rhetoric looks likely to exceed the scale of delivery and it could be easy for the parliamentary opposition and the electorate to hold it to account.

Under the sub-heading ‘Making a Change’, Cram makes the following points:

“The white paper places much emphasis on consultation and facilitating change rather than directing. A weakness is that many proposals are projects or programmes and should be subject to the established public sector controls such as “starting gate” and “gateway”. These are not bureaucratic, help identify what should not go ahead, whether the necessary success factors are in place at each stage of the project and whether there need to be changes. These robust approaches save time and money and greatly increase chances of success. The white paper should have provided assurance about applying these disciplines.

“The paper argues that the public sector should be a commissioner of services rather than a provider, yet appears to run out of ideas on where this might operate, focusing mainly on social care and to a lesser degree the hackneyed “back office services”. The government is attracted by employee-led mutuals, but suggests that these will be created voluntarily.

“The potential contribution of the private sector to the diversity of service providers is scarcely mentioned. Lib Dems 3, Conservatives 0? However, local government will increasingly outsource front and back-office services, and we can expect the NHS to continue to do so.”

“Critics might argue that the white paper represents little more than bringing together government policy announcements in a coherent form: health and wellbeing boards, strengthening the powers of local government over the NHS, removing excessive monitoring and oversight by central government, community budgets and retention of business rates. However, it does provide a narrative and context.”

“Absent from the paper is how one might manage the anticipated increasing diversity of service providers. The wider public sector has not been good at this, hence the Southern Cross debacle. Integrated commercial management of markets and suppliers throughout the public sector is vital.

“New commercial models include incentivising suppliers to deliver successful outcomes and assigning the risk to them, though I would question whether payments to suppliers under the work programme will be “based primarily on the results they achieve” unless the bar is set very low. Risk sharing would rule out many social enterprises.”


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Posted in Campaign4Change, mutuals, NHS, outsourcing, public sector, public services

What the FireControl disaster and NPfIT have in common

Posted on 01/07/2011 | 1 comment

By Tony Collins

From today’s National Audit Office report on FireControl project which wasted at least £469m:

“FiReControl was flawed from the outset because it did not have the support of the majority of those essential to its success – its users”

Were the Fire and Rescue Service’s FireControl project and the National Programme for IT in the NHS launched to discover all that can go wrong with a large IT-based project?

One could be forgiven for thinking so. The two projects were conceived in the early part of the new millennium as national, centralised schemes which, in the main, did not have any support from the people who would be using them.

The schemes were launched by civil servants and ministers with good intentions and little or no experience in the many IT-related project disasters that went before.

The projects that had failed since the late 1970s and early 1980s went wrong for similar reasons. As early as 1984 the Public Accounts Committee met to question civil servants on the common factors in a succession of “administrative computing” failures.

Since then every department has come to its IT-based projects and programmes with little understanding – and very little interest – in the lessons from history; and it’s said that those who don’t learn from history are destined to repeat past mistakes.

The FireControl system, which is the subject of an NAO report today, and the NPfIT, had something striking in common: the fact that the system users were the ones with the control of money and decisions on how they spent it – and they did not want technology imposed on them by civil servants in London. That was clear from the start. But it did not stop either the NPfIT or FireControl going ahead.

Indeed a Gateway Review by the Office of Government Commerce in April 2004, after the FireControl project had been approved, found that the “extraordinarily fast pace” of the project was introducing new risks to its delivery, and was escalating the risks already identified. The review concluded that the project was in poor condition overall and at significant risk of failing to deliver.

That review was, at the time, as with similar reviews on the NPfIT, kept secret, so those outside the project, including MPs and the media, were unable to challenge the projects with a credibility that could have influenced decisions on the future of the schemes.

New gateway reviews are still kept secret today, despite the coalition’s promise of openness and transparency.

The good thing about the FireControl project and the NPfIT is that the Cabinet Office has taken control. A Cabinet Office Major Projects Review Group in in July 2010 concluded that negotiations should begin to terminate the FireControl contract – and indeed a settlement with the supplier EADS was reached successfully and amicably in December 2010. The Cabinet Office’s Major Projects Authority is now  reviewing the future of CSC’s £2.9bn worth of NPfIT contracts.

The bad thing is that the FireControl scheme has wasted at least £469m, according to today’s report of the National Audit Office. The NPfIT may have lost a great deal more.

NAO’s conclusion on FireControl

This was the NAO’s conclusion on the FireControl project. Much the same could be said of the NPfIT:

“This is an example of bad value for money. FiReControl will have wasted a minimum of £469m, through its failure to provide any enhancement to the capacity of the control centres of Fire and Rescue Services after seven years.

“At root, this outcome has been reached because the Department, without sufficient mandatory powers, decided to try to centrally impose a national control system on unwilling locally accountable bodies, which prize their distinctiveness from each other and their freedom to choose their own equipment.

“At the same time, it tried to rush through key elements of project initiation and ended up with an inadequate IT contract, under-appreciating its complexity and risk, and then mismanaged problems with the IT contractor’s performance and delivery.”

 Links:

FireControl project a comprehensive failure.

The failure of the FireControl project – NAO report.

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NHS IT supplier “corrects” Health CIO’s statements

Posted on 30/06/2011 | 3 comments

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.

Connelly said:

“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.

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MP questions why IT costs at two nearby hospital trusts are vastly different for similar systems

Posted on 28/06/2011 | 4 comments

By Tony Collins

A Conservative MP has asked the NHS Chief Executive Sir David Nicholson to explain why an NHS trust is deploying a centrally-chosen Cerner patient record system at more than twice the cost of a similar but non-NPfIT system at a nearby Foundation trust.

University Hospitals Bristol NHS Foundation Trust is deploying the Medway system from System C  (now owned by McKesson] at a reported cost of £8.2m over seven years. The acute trust is one of the largest in the country.

With support for less than five years, the nearby North Bristol NHS trust is taking the Cerner Millennium patient record system under the NPfIT at a cost of £21m from BT – and the go-live date in June has slipped to July.

Now Richard Bacon, a member of the Public Accounts Committee, has written to Sir David Nicholson asking for an explanation of why the two trusts are paying vastly different amounts for systems that do similar things. Bacon has also asked Nicholson whether he believes the higher sum is value for money.

The average cost of BT Cerner go-lives under  the NPfIT is £28.3m according to the National Audit Office.

Bacon’s letter is part of evidence which suggests that continuing NPfIT contracts is costing hundreds of millions of pounds more than necessary.

The coalition government, despite its plan to cut public sector IT costs, may spend a further £3bn to 4.bn with the NPfIT’s two major suppliers, BT and CSC, though the Cabinet Office’s Major Projects Authority is reviewing CSC’s £2.9bn worth of contracts.

Bacon’s letter also questions advance payments to CSC, and whether a recent hearing of the Public Accounts Committee was told the full truth.

An unwavering defender of the NPfIT, Nicholson is likely to defend the cost of the North Bristol implementation, and the advance payments to CSC. On costs, he will argue that North Bristol’s systems have better resilience than at non-NPfIT sites.

If that were true – and there is no evidence it is – the extra costs of having a “hot”, or real-time standby data centre, may not justify a doubling of a rival’s prices. 

This is Bacon’s letter to Sir David Nicholson:

Chief Executive, National Health Service, Department of Health, Richmond House, London SW1A 2NS

27 June 2011

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I am writing following the hearing of the Public Accounts Committee on Monday 23 May 2011, to follow up on two important issues that were raised during your evidence:

ADVANCE PAYMENTS TO SUPPLIERS

In your supplementary memorandum to the PAC following the hearing you gave a total of advance payments made up to 31 March 2011, in respect of all contracts over the whole period of the Programme, of £2,532m of which suppliers have retained £1,328m. You also identified a further £119 million of advance payments to be earned or refunded.  Since the memorandum was received by the PAC, it has been reported that the NHS made an advance payment of £200 million to CSC in April 2011.

I should be most grateful if you would let me know the answers to the following questions:

Is this report accurate?

Why was this payment was not reported to the PAC, either during the hearing or in the subsequent memorandum?

What was the justification for this payment and what value does it represent to the NHS?

What will happen in respect of this payment if a new memorandum of understanding is not in fact signed with CSC?

I would also be grateful if you would comment on the CSC filing with the US Security and Exchange Commission, which states that in the opinion of the company, if the NHS were to terminate the current contract “for convenience” it would owe fees totalling less than the $1 billion asset value CSC now has on its books for the contract.  

How is this consistent with the claim at the PAC  hearing by Ms Connelly that the cost of terminating the CSC deal could “potentially leave us exposed to a higher cost than if we completed as it stands today”?

2. THE COST OF DEPLOYING CERNER MILLENNIUM AT NORTH BRISTOL

Second, I would be grateful if you could comment on the cost of deploying Cerner Millennium at North Bristol, reported in your memorandum as £21 million, including service for 56 months, and on the current expected go-live date.  Specifically:

Can you explain why the delivery date agreed with BT at the contract “reset” was 4th June 2011?

Why it was then revised to 2nd July 2011?

And why it now appears that there is no agreed delivery date at all?

Can you also give your best comparison of the cost of deploying the Cerner Millennium system at North Bristol, with the cost to University Hospitals Bristol of deploying the System C Healthcare Medway system outside the National Programme?  It would appear from media reports that this latter contract includes deployment of functionality including PAS, Accident and Emergency, maternity, theatres, clinical data collection, and a data warehouse and reporting system, as well as integration of third party and current Trust applications.  According to the National Audit Office, the average cost for each new site under the BT South contract is £28.3 million, but the cost of the Medway system to UHB has been reported as £8.2 million over seven years. (http://www.guardian.co.uk/healthcare-network/2011/may/19/university-hospitals-bristol-foundation-trust-awards-e-patient-contract)   What is the justification for this apparent difference?

As the Senior Responsible Owner for the National Programme, can you give your explicit undertaking that the North Bristol contract represents value for money for taxpayers?

I look forward to receiving your reply.

With many thanks

Yours sincerely

Richard Bacon

MP for South Norfolk, Member of the Public Accounts Committee

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NHS users should require mutuals to deliver more benefits than in-house, says NAO

Posted on 24/06/2011 | Leave a comment

By David Bicknell

The National Audit Office (NAO) has highlighted risks to value for money associated with the Department of Health’s programme aimed at enabling its staff to take the lead in leaving the NHS – or ‘spinning out’ – to set up health social enterprises or mutuals.

The NAO’s  Report recognises that, at this early stage of the ‘Right to Request Programme’, it is too early to assess its costs and benefits. But it makes the point that the Department of Health has not set measurable objectives specifically for the Right to Request Programme against which to evaluate its success. PCTs expect social enterprises or mutuals to deliver more benefits than other providers, but did not generally contract for them to deliver savings or any other additional benefits.

The NAO’s report points out that many risks and liabilities still reside with the PCTs and will need to be managed if value for money is to be achieved. In the last resort, the trust or its successors will be responsible for ensuring that essential services continue to operate. For a time, social enterprises will be highly dependent on work and cash flow from their respective PCTs. They will also be operating in an ‘increasingly competitive market’ owing to changes in health legislation currently going through Parliament. So PCTs or their successors will need to have a clear idea of how they will react if enterprises run into financial difficult or fail.

Amyas Morse, head of the National Audit Office, said, “There are many risks to be managed if the Department is to get value for money from the £900 million contracts awarded to social enterprises. The Department needs to reassess its approach, when contracting with social enterprises, of not requiring efficiencies over and above what would have been achieved if the services had remained within the Department.”

You can access the full report here

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