Category Archives: npfit

NHS “Wachter” digital review is delayed – but does it matter?

Posted on 13/07/2016 | 3 comments

By Tony Collins

The Wachter review of NHS technology was due to be published in June but has been delayed. Would it matter if it were delayed indefinitely?

A “Yes Minister” programme about a new hospital in North London said it all, perhaps. An enthusiastic NHS official shows the minister round a hospital staffed with 500 administrators. It has the latest technology on the wards.

“It’s one of the best run hospitals in the country,” the NHS official tells the minister, adding that it’s up for the Florence Nightingale award for the standards of hygiene.

“But it has no patients,” says the minister.

Another health official tells the minister,

“First of all, you have to sort out the smooth running of the hospital. Having patients around would be no help at all.” They would just be in the way, adds Sir Humphrey.

In the Wachter’s review’s terms of reference (“Making IT work: harnessing the power of health IT to improve care in England“)  there is a final bullet point that refers, obliquely, to a need to consider patients. Could the Wachter terms of reference have been written by a satirist who wanted to show how it was possible to have a review of NHS IT for the benefit of suppliers, clinical administrators and officialdom but not patients?

The Wachter team will, according to the government,

• Review and articulate the factors impacting the successful adoption of health information systems in secondary and tertiary care in England, drawing relevant comparisons with the US experience;

• Provide a set of recommendations drawing on the key challenges, priorities and opportunities for the health and social care system in England. These recommendations will cover both the high levels features of implementations and the best ways in which to engage clinicians in the adoption and use of such systems.

In making recommendations, the board will consider the following points:

• The experiences of clinicians and Trust leadership teams in the planning, implementation and adoption of digital systems and standards;

• The current capacity and capability of Trusts in understanding and commissioning of health IT systems and workflow/process changes.

• The current experiences of a number of Trusts using different systems and at different points in the adoption lifecycle;

• The impact and potential of digital systems on clinical workflows and on the relationship between patients and their clinicians and carers.

Yes, there’s the mention of “patients” in the final bullet point.

Existing systems?

nhsSome major IT companies have, for decades, lobbied – often successfully – for much more public investment in NHS technology. Arguably that is not the priority, which is to get existing systems to talk to each other – which would be for the direct benefit of patients whose records do not follow them wherever they are looked at or treated within the NHS.

Unless care and treatment is at a single hospital, the chances of medical records following a patient around different sites, even within the same locality, are slim.

Should a joining up of existing systems be the main single objective for NHS IT? One hospital consultant told me several years ago – and his comment is as relevant today –

“My daughter was under treatment from several consultants and I could never get a joined-up picture. I had to maintain a paper record myself just to get a joined-up picture of what was going on with her treatment.”

Typically one patient will have multiple sets of paper records. Within one hospital, different specialities will keep their own notes. Fall over and break your leg and you have a set of orthopaedic notes; have a baby and you will have a totally different set of notes. Those two sets are rarely joined up.

One clinician told me, “I have never heard a coroner say that a patient died because too much information was shared.”

And a technology specialist who has multiple health problems told me,

“I have different doctors in different places not knowing what each other is doing to me.”

As part of wider research into medical records, I asked a hospital consultant in a large city with three major hospitals whether records were shared at least locally.

“You must be joking. We have three acute hospitals. Three community intermediate teams are in the community. Their records are not joined. There is one private hospital provider. If you get admitted to [one] hospital and then get admitted to [another] the next week your electronic records cannot be seen by the first hospital.  Then if you get admitted to the third hospital the week after, again not under any circumstances will your record be able to be viewed.”

Blood tests have to be repeated, as are x-rays; but despite these sorts of stories of a disjointed NHS, senior health officials, in the countless NHS IT reviews there have been over 30 years, will, it seems, still put the simplest ideas last.

It would not cost much – some estimate less than £100m – to provide secure access to existing medical records from wherever they need to be accessed.

No need for a massive investment in new technology. No need for a central patient database, or a central health record. Information can stay at its present location.  Just bring local information together on local servers and provide secure access.

A locum GP said on the Pulse website recently,

“If you are a member of the Armed Forces, your MO can get access to your (EMIS-based) medical record from anywhere in the world. There is no technical reason why the NHS cannot do this. If need be, the patient could be given a password to permit a GP to see another Surgery’s record.”

New appointments

To avoid having patients clog up super-efficient hospitals, Sir Humphrey would have the Wachter review respond to concerns about a lack of joined up care in the NHS by announcing a set of committees and suggesting the Department of Health and NHS England appoint a new set of senior technologists.

Which is just what has happened.

Last week NHS England announced  “key appointments to help transform how the NHS uses technology and information”. [One of the NHS appointments is that of a Director of Digital Experience, which is not a fictional title, incidentally. Ironically it seems to be the most patient-facing of the new jobs.]

Said the announcement,

“The creation of these roles reflects recommendations in the forthcoming review on the future of NHS information systems by Dr Bob Wachter.

“Rather than appoint a single chief information and technology officer, consistent with the Wachter review the NHS is appointing a senior medical leader as NHS Chief Clinical Information Officer supported by an experienced health IT professional as NHS Chief Information Officer.

“The first NHS Chief Clinical Information Officer will be Professor Keith McNeil, a former transplant specialist who has also held many senior roles in healthcare management around the world, including Chief Executive Officer at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust and Chief Executive Officer at the Royal Brisbane and Women’s Hospital in Australia.

“The new NHS Chief Information Officer will be Will Smart, currently Chief Information Officer at the Royal Free London NHS Foundation Trust. Mr Smart has had an extensive career in IT across the NHS and in the private sector.

“The NHS CCIO and NHS CIO post-holders will act on behalf of the whole NHS to provide strategic leadership, also chairing the National Information Board, and acting as commissioning ‘client’ for the relevant programmes being delivered by NHS Digital (previously known as the Health and Social Care Information Centre).

“The roles will be based at NHS England and will report to Matthew Swindells, National Director: Operations and Information, but the post-holders will also be accountable to NHS Improvement, with responsibility for its technology work with NHS providers.

“In addition, Juliet Bauer has been appointed as Director of Digital Experience at NHS England. She will oversee the transformation of the NHS Choices website and the development and adoption of digital technology for patient ‘supported self-management’, including for people living with long term conditions such as diabetes or asthma. Ms Bauer has led delivery of similar technology programmes in many sectors, including leading the move to take Times Newspapers online…”

Surely a first step, instead of arranging new appointments and committees, and finding ways of spending money on new technology, would be to put in place data sharing agreements between hospitals?

A former trust chief executive told me,

“In primary care, GPs will say the record is theirs. Hospital teams will say it is our information and patient representative groups will say it is about patients and it is their nformation. In maternity services there are patient-held records because it is deemed good practice that mums-to-be should be fully knowledgeable and fully participating in what is happening to them.

“Then you get into complications of Data Protection Act. Some people get very sensitive about sharing information across boundaries: social workers and local authority workers. If you are into long-term continuous care you need primary care, hospital care and social care. Without those being connected you may do half a job or even less than that potentially. There are risks you run if you don’t know the full information.”

He added that the Summary Care Record – a central database of every patient’s allergies, medication and any adverse reactions to drugs, was a “waste of time”.

“You need someone selecting information to go into it [the Summary Care Record]so it is liable to omissions and errors. You need an electronic patient record that has everything available but is searchable. You get quickly to what you want to know. That is important for that particular clinical decision.”

Is it the job of civil servants to make the simple sound complicated?

Years ago, a health minister invited me for an informal meeting at the House of Commons to show me, in confidence, a one-page civil service briefing paper on why it was not possible to use the internet for making patient information accessible anywhere.

The minister was incredulous and wanted my view. The civil service paper said that nobody owned the internet so it couldn’t be used for the transfer of patient records.  If something went wrong, nobody could be blamed.

That banks around the world use the internet to provide secure access to individual bank accounts was not mentioned in the paper, nor the existence of the CHAPS network which, by July 2011, had processed one quadrillion (£1,000,000,000,000,000) pounds.

Did the briefing paper show that the civil service was frightened by the apparent simplicity of sharing patient information on a secure internet connection? If nothing else, the paper showed how health service officials will tend, instinctively, to shun the cheapest solutions. Which may help to explain how the (failed) £10n National Programe for IT came into being in 2002.

Jargon

Radiation_warning_symbolNobody will be surprised if the Wachter review team’s report is laden with  jargon about “delays between technology being introduced and a corresponding rise in output”. It may talk of how new technology could reduce the length of stay by 0.1528 of a bed day per patient, saving a typical hospital £1.8m annually or 7,648 bed days.

It may refer to visions, envisioning fundamental change, establishing best practice as the norm, and a need for adaptive change.

Would it not be better if the review team spoke plainly of the need for a patient with a fractured leg not having to carry a CD of his x-ray images to different NHS sites in a carrier bag?

Some may await the Wachter report with a weary apprehension that its delay – even indefinitely – will make not a jot of difference. Perhaps Professor Wachter will surprise them. We live in hope.

Wachter review terms of reference.

Review of IT in the NHS

Another NPfIT IT scandal in the making?

Hunt announces Wachter review

What can we learn from the US “hospitalist” model?

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Posted in Campaign4Change, change management, CIO, consultants, data sharing, Department of Health, e-health, ERP, health, HSCIC, LPfIT, MoD, National Audit Office, NHS, npfit, open standards, SPfIT, Summary Care Record

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Another NPfIT IT scandal in the making?

Posted on 09/02/2016 | 8 comments

By Tony Collins

Jeremy Hunt may have forgotten what he told the FT 2013, as reported in the paper on 2 June 2o13.

Referring to the failed National Programme for IT [NPfIT] in the NHS he said at that time,

“It was a huge disaster . . . It was a project that was so huge in its conception but it got more and more specified and over-specified and in the end became impossible to deliver, but we musn’t let that blind us to the opportunities of technology and I think one of my jobs as health secretary is to say, look, we must learn from that and move on but we must not be scared of technology as a result.”

He added, “I’m not signing any big contracts from behind [my] desk; I am encouraging hospitals and clinical commissioning groups and GP practices to make their own investments in technology at the grassroots level.”

Now the Department of Health (and perhaps some large IT suppliers) have encouraged Hunt to find £4bn for spending on technology that is (again) of questionable immediate need.

Says Computing, “A significant part of the paperless NHS plans will involve enabling patients to book services and order prescriptions online, as well as giving them the choice of speaking to their doctor online or via a video link.”

The £4bn, if that’s what it will cost, is much less than the cost of the NPfIT. But are millions to be wasted again?

[NPfIT was originally due to cost £2.3bn over three years from 2003 but is expected to cost £9.8bn over 21 years, to 2024.]

Yesterday (8 February 2016) the Department of Health announced a “review of information technology in the NHS”. Announcing it Hunt said.

“Improving the standard of care patients receive even further means embracing technology and moving towards a fully digital and paperless NHS.

NHS staff do incredible work every day and we must give them and patients the most up-to-date technology – this review will tell us where we need to go further.”

The NPfIT was supposed to give the NHS up-to-date technology – but is that what’s needed?

A more immediate need is for any new millions of central funding (for the cost would be in the tens of millions, not billions) to be spent on the seemingly mundane objective of getting existing systems to talk to each other, so that patients can be treated in different parts of the NHS and have their electronic records go with them.

This doesn’t need a new national programme for IT. Some technologists working in the NHS say it would cost no more than £150m, a small sum by NHS IT standards, to allow patient data to reside where it is but be accessed by secure links anywhere, much as secure links work on the web.

But the review’s terms of reference make only a passing reference to the need for interoperability.

Instead the review will have terms of reference that are arguably vague – just as the objectives for the NPfIT were.

The Department of Health has asked the review board, when making recommendations, to consider the following points:

  • The experiences of clinicians and Trust leadership teams in the planning, implementation and adoption of digital systems and standards;
  • The current capacity and capability of Trusts in understanding and commissioning of health IT systems and workflow/process changes.
  • The current experiences of a number of Trusts using different systems and at different points in the adoption lifecycle;
  • The impact and potential of digital systems on clinical workflows and on the relationship between patients and their clinicians and carers.

The head of the review board Professor Wachter will report his recommendations to the secretary of state for health and the National Information Board in June 2016.

Members of the National Advisory Group on health IT in England (the review board) are:

  • Robert Wachter, MD, (Chair) Professor and Interim Chairman, Department of Medicine,University of California, San Francisco
  • Julia Adler-Milstein, PhD, Associate Professor, Schools of Information and of Public Health, University of Michigan
  • David Brailer, MD, PhD, CEO, Health Evolution Partners (current); First U.S. National Coordinator for Health IT (2004-6)
  • Sir David Dalton, CEO, Salford Royal NHS Foundation Trust, UK
  • Dave deBronkart, Patient Advocate, known as “e-Patient Dave”
  • Mary Dixon-Woods, MSc, DPhil, Professor of Medical Sociology, University of Leicester, UK
  • Rollin (Terry) Fairbanks, MD, MS, Director, National Center for Human Factors in Healthcare; Emergency Physician, MedStar Health (U.S.)
  • John Halamka, MD, MS, Chief Information Officer, Beth Israel Deaconess Medical Center; Professor, Harvard Medical School
  • Crispin Hebron, Learning Disability Consultant Nurse, NHS Gloucestershire
  • Tim Kelsey, Advisor to UK Government on Health IT
  • Richard Lilford, PhD, MB, Director, Centre for Applied Health Research and Delivery, University of Warwick, UK
  • Christian Nohr, MSc, PhD, Professor, Aalborg University (Denmark)
  • Aziz Sheikh, MD, MSc, Professor of Primary Care Research and Development, University of Edinburgh
  • Christine Sinsky, MD, Vice-President of Professional Satisfaction, AMA; Primary care internist, Dubuque, Iowa
  • Ann Slee, MSc, MRPharmS, ePrescribing Lead for Integrated Digital Care Record and Digital Medicines Strategy, NHS England
  • Lynda Thomas, CEO, MacMillan Cancer Support, UK
  • Wai Keong Wong, MD, PhD, Consultant Haematologist, University College London Hospitals; Inaugural chair, CCIO Leaders Network Advisory Panel
  • Harpreet Sood, MBBS, MPH, Senior Fellow to the Chair and CEO, NHS England and GP Trainee

Comment

Perhaps egged on by one or two major suppliers in behind-the-scenes lobbying, Hunt has apparently found billions to spend on improving NHS IT.

Nobody doubts that NHS IT needs improving.  But nearly all GPs have impressive systems, as do many hospitals.  But the systems don’t talk to each other.

The missing word  from the review board’s terms of reference is interoperability. True, it’s difficult to achieve. And it’s not politically aggrandizing to find money for making existing systems interoperable.

But at present you can have a blood test at the GP, then a separate blood test at the local hospital and the full results won’t go on your electronic record because the GP and hospital are on different systems with no interoperability between them.

If you’re treated at a specialist hospital for one ailment, and at a different hospital 10 to 20 (or say 100) miles away for something else, it may take weeks for your electronic record to reflect your latest treatment.

Separate NHS sites don’t always know what each other is doing to a patient, unless information is faxed or posted between them.

The fax is still one of the NHS’s main modes of cross-county communication. The DoH wants to be rid of the fax machine but it’s indispensable to the smooth running of the NHS, largely because new and existing systems don’t talk to each other.

The trouble with interoperability – apart from the ugliness of the word – is that it is an unattractive concept to some of the major suppliers, and to DoH executives, because it’s cheap, not leading edge and may involve agreements on data sharing.

Getting agreements on anything is not the DoH’s forte. [Unless it’s an agreement to spend more money on new technology, for the sake of having up-to-date technology.]

Last year I broke my ankle in Sussex and went to stay in the West Midlands at a house with a large ground floor and no need to use stairs. There was no communication between my local GP and the NHS in the West Midlands other than  by phone, post or fax, and even then only a summary of healthcare information went on my electronic record.

I had to carry my x-rays on a CD. Then doctors at my local orthopaedic department in Sussex found it difficult to see the PACS images because the hospital’s PCs didn’t have CD players.

A government employee told me this week of a hospital that gave medication to a patient in the hope she would not have an adverse reaction. The hospital did not have access to the patient’s GP records, and the patient was unsure of the name of the medication she’d previously had an allergic reaction to.

Much of the feedback I have had from those who have enjoyed NHS services is that their care and treatment has been impeded by their electronic records not moving with them across different NHS sites.

Mark Leaning, visiting professor, at University College, London, in a paper for health software supplier EMIS, says the NHS is “not doing very well when it comes to delivering a truly connected health system in 2016. That’s bad for patient outcomes.”

That GPs and their local hospital often cannot communicate electronically  is a disgrace given the billions various governments have spent on NHS IT.  It is on interoperability that any new DoH IT money needs to be spent.

Instead,  it seems huge sums will be wasted on the pie-in-the-sky objective of a paperless NHS by 2020. The review board document released today refers to the “ambition of a paper- free health and care system by 2020”.

What’s the point of a paperless NHS if a kaleidoscope of new or existing systems don’t properly communicate?

Congratulations, incidentally, to GP software suppliers TPP and EMIS. They last year announced direct interoperability between their core clinical systems.

Their SystmOne and EMIS Web systems hold the primary care medical records for most of the UK population.

And this month EMIS announced that it has become the first UK clinical systems provider to implement new open standards for interoperability in the NHS.

It says this will enable clinicians using its systems to securely share data with any third party supplier whose systems comply with a published set of open application programme interfaces.

The Department of Health and ministers need to stop announcing things that will never happen such as a paperless NHS and instead focus their attention – and any new IT money – on initiatives that are not subconsciously aimed at either political or commercial gain.

It would be ideal if they, before announcing any new IT initiative, weighed up diligently whether it is any more important, and any more of a priority, than getting existing systems to talk to each other.

Review of information technology in the NHS

EMIS implements open standards

 

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Posted in Campaign4Change, change management, consultants, culture, Department of Health, Government IT, health, health records, HSCIC, IT-related failures, NHS, npfit, PACS, supplier relationships

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Yet another NHS IT mess?

Posted on 09/07/2015 | Leave a comment

By Tony Collins

Last week the National Audit Office reported on the failure of the GP Extraction Service. Health officials  had signed off and paid for a contract even though the system was unfit for use.

The officials worked for organisations that have become part of the Health and Social Care Information Centre.

An unapologetic HSCIC issued a statement on its website in response to the Audit Office report. It said, in essence, that the problems with the GP Extraction Service were not the fault of the HSCIC but rather its predecessor organisations (ignoring the fact that many of the officials and contractors from those defunct organisations moved to the HSCIC).

Now it transpires that the HSCIC may have a new IT-related mess on its hands, this time one that is entirely of its own making – the e-Referral Service.

Last month the HSCIC went live with its e-Referral service without testing the system properly. It says it tested for thousands of hours but still the system went live with 9 pages of known problems.

Problems are continuing. Each time in their routine bulletins officials suggest that an upgrade will solve e-Referral’s problems. But each remedial upgrade is followed by another that does not appear to solve the problems.

The system went live on 15 June, replacing Choose and Book which was part of an earlier NHS IT disaster the £10bn National Programme for IT.

Problems more than teething?

Nobody expects a major new IT system to work perfectly first time but regular outages of the NHS e-Referral Service may suggest that it has more than teething problems.

It’s a common factor in IT-based project failures that those responsible have commissioned tests for many hours but with inadequately designed tests that did not always reflect real-world use of the system. They might also have underestimated loads on the available hardware and networks.

This means that after the system goes live it is brought down for regular hardware and software fixes that don’t solve the problems.  End-users lose faith in the system – as many GPs did with the Choose and Book system – and a misplaced optimism takes the place of realism in the thinking of managers who don’t want to admit the system may need a fundamental redesign.

On the day the e-Referral Service launched, a Monday, doctors had difficulties logging in. Software “fixes” that day made little difference. By the next day HSCIC’s optimism has set in. Its website said:

“The NHS e-Referral Service has been used by patients and professionals today to complete bookings and referrals comparable with the number on a typical Tuesday but we were continuing to see on-going performance and stability issues after yesterday’s fixes.

“We suspend access to the system at lunchtime today to implement another fix and this improved performance and stability in the afternoon.”

The “fix” also made little apparent difference. The next day, Wednesday 17 June, the entire system was “unavailable until further notice” said the HSCIC’s website.

By early evening all was apparently well. An HSCIC bulletin said:

“The NHS e-Referrals Service is now available again. We apologise for the disruption caused to users and thank everyone for their patience.”

In fact, by the next day, Thursday 18 June, all was not well. Said another bulletin:

“Yesterday’s outage enabled us to implement a number of improvements and hopefully this is reflected in your user experience today.

“This morning users reported that there were ongoing performance issues so work has now taken place to implement changes to the configuration to the NHS e-Referral Service hardware and we are currently monitoring closely to see if this resolved the issue.”

About 2 weeks later, on 30 June, HSCIC’s officials said there were ongoing problems, because of system performance in provider organisations that were processing referrals.

Was this HSCIC’s way of, again, blaming other organisations – as they did after the NAO report’s on the failure of the GP Extraction Service project? Said a statement on the HSCIC’s website on 30 June 2015:

“Since transition to the NHS e-Referral Service on Monday 15th June, we have unfortunately experienced a number of problems… Although most of the initial problems were related to poor performance of the system, some residual functional and performance issues persist and continue to affect some of our colleagues in their day-to-day working.

“Most of these on-going problems relate to the performance of the system in provider organisations that are processing referrals, though this does of course have a knock-on effect for referrers.

“Please be assured that the team are working to identify root causes and fixes for these issues.”

By last week – 2 July 2015 – HSCIC warned that it will require a “period of planned downtime on the NHS e-Referral Service tonight which is currently scheduled for between 21:00 and 23:00 for some essential maintenance to fix a high priority functional Incident.”

The fix worked – or did it? HSCIC told Government Computing: “An update was applied to the system overnight from Thursday (July 2) into Friday (July 3) which was successful.”

But …

Monday 6 July 2015 4.15pm. HSCIC e-Referral Service bulletin:

“We would like to apologise for the interruption to service between 13:15 and 13:54 today.  This was not a planned outage and we are investigating the root cause.  If any remedial activity is required we will give notice to all users. Once again please accept our sincere apologies for any inconvenience this caused.”

Why was testing inadequate?

Did senior managers go live without testing how the system would work in the real world, or did they select as test end-users only IT enthusiasts?

Perhaps managers avoided challenging the test system too much in case it gave poor results that could force a redesign.

We probably won’t know what has gone wrong unless the National Audit Office investigates. Even then it could be a year or more before a report is published. A further complicating factor is that the HSCIC itself may not know yet what has gone wrong and may be receiving conflicting reports on the cause or causes of the problems.

An IT failure? – change the organisation’s name

What’s certain is that the NHS has a history of national IT project failures which cause organisational embarrassment that’s soon assuaged by changing the name of the organisation, though the officials and contractors just switch from one to the next.

NHS Connecting for Health, which was largely responsible for the NPfIT disaster, was blended into the Department of Health’s informatics function which was then blended into the HSCIC.

Similarly the NHS Information Centre which was largely responsible for the GP Extraction Service disaster was closed in 2013 and its staff and contractors blended into the HSCIC.

Now, with the e-Referral Service, the HSCIC at least has a potential IT project mess that can be legitimately regarded as its own.

When will a centrally-run national NHS IT-based turn out to be a success? … care.data?

New SRO

Meanwhile NHS England is looking for a senior responsible owner for e-Referral Service on a salary of up to £98,453.

Usually in central government, SROs do the job as an adjunct to their normal work. It’s unusual for the NHS to employ a full-time project SRO which the NAO will probably welcome as a positive step.

But the job description is vague. NHS England says that the SRO for NHS e-Referrals programme will help with a switch from paper to digital for 100% of referrals in England by March 2018.

“The SRO … will have responsibility for the strategic and operational development of the digital journey, fulfilment of the patient and clinical process and the performance of the service. Plans to achieve the strategy will be underpinned by the delivery of short to medium term objectives, currently commissioned from HSCIC and other third party suppliers.”

Key aspects of this role will be to:-

– Ensure the strategy is formulated, understood by all stakeholders and is delivered utilising all available resources efficiently and effectively.

– Ensure the development and management of plans.

– Ensure appropriate system and processes are in place to enable the uptake and on-going use of digital referrals by GP’s, hospitals, patients and commissioners.

– Proactively manage the key risks and issues associated with ensuring appropriate actions are taken to mitigate or respond.

– Monitor and establish accountability on the overall progress of the strategy to ensure completion within agreed timescales.

– Manage the budgetary implications of activity.

– Avoid the destabilisation of business as usual.

– Manage and actively promote the relationships with key stakeholders.

The job will be fixed-term until 31/03/2017 and interviews will be held in London on the 20th July 2015.

The big challenge will be to avoid the destabilisation of business as usual – a challenge beyond the ability of one person?

Government Computing. 

Another fine NHS IT mess

Why was e-Referral Service launched with 9 pages of known problems?

National e-Referral Service unavailable until further notice

 

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Posted in Agile, Campaign4Change, consultants, e-health, e-Referral Service, Government IT, HSCIC, IT-related failures, National Audit Office, NHS, npfit, operational issues

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Another fine NHS IT mess

Posted on 02/07/2015 | Leave a comment

By Tony Collins

Today the National Audit Office reports on the General Practice Extraction Service, an IT system that allows patient data to be extracted from all GP practices in England.

The report says that Department of Health officials – who were then working for the NHS Information Centre – signed off and paid for a contract even though the system was unfit for use. The original business case for the system grossly underestimated costs.

And the system was developed using the highest-risk approach for new IT – a combination of agile principles and traditional fixed-price contract.

Some of the officials involved appear to be those who worked for NHS Connecting for Health – the organisation responsible for what has become the UK’s biggest IT-related failure, the £10bn National Programme for IT (NPfIT).

As with the NPfIT it is unlikely anyone responsible for the latest failure will be held accountable or suffer any damage to their career.

The NAO says officials made mistakes in the original procurement. “Contract management contributed to losses of public funds, through asset write-offs and settlements with suppliers.” More public money is needed to improve or replace the system.

Labour MP Meg Hillier MP, the new chairman of the Public Accounts Committee, sums up today’s NAO’s report:

“Failed government IT projects have long been an expensive cliché and, sadly for the taxpayer and service user, this is no exception.

“The expected cost of the General Practice Extraction Service ballooned from £14m to £40m, with at least £5.5m wasted on write-offs and delay costs.

“GPES has managed to provide data for just one customer – NHS England – and the data was received 4 years later than originally planned.

“While taxpayers are left picking up the tab for this failure, customers who could benefit, such as research and clinical audit organisations, are waiting around for the system to deliver what they need to improve our health service.”

Some GPs who do not want patient data to be extracted from their systems – they believe it could compromise their bond of confidentiality with patients – may be pleased the extraction system has failed to work properly.

But their concern about patient confidentiality being compromised will not make the failure of the extraction service any more palatable.

The NAO says it only learned of the failure of the extraction system through its financial audit of the Health and Social Care Information Centre. It learned that the system was not working as expected and that HSCIC had agreed to pay additional charges through a settlement with one of the main suppliers, Atos IT Services UK Ltd.

An NHS Connecting for Health legacy?

Work on the GP Extraction Service project began in 2007, first by the NHS Information Centre, and then by the HSCIC.

The NHS Information Centre closed in 2013 and responsibility transferred to the HSCIC which combines the Department of Health’s informatics functions – previously known as NHS Connecting for Health or CFH – and the former NHS Information Centre.

What went wrong 

The original business case said the extraction service would start in 2009-10, but it took until April 2014 for HSCIC to provide the first data extract to a customer.

Meanwhile other potential users of the system have found alternative sources of patient data in the absence of the HSCIC system.

The NAO says that officials changed the procurement strategy and technical design for the GPES extraction systems during the project. “This contributed to GPES being unable to provide the planned number and range of data extracts.”

The NHS Information Centre contracted with Atos to develop a tool to manage data extraction. In March 2013, the Centre accepted delivery of this system from Atos.

But officials at the HSCIC who took over the system on 1 April 2013 found that it had fundamental design flaws and did not work. “The system test did not reflect the complexity of a ‘real life’ data extract and was not comprehensive enough to identify these problems”.

To work in a ‘real life’ situation, the GPES query system needed to communicate accurately with the four separate extraction systems and other systems relying on its data.  The test officials and Atos agreed was less complex. It did not examine extractions from multiple extraction systems at once.

Nor did the test assess the complete process of extracting and then passing GPES data to third-party systems.

Fixed price and agile – a bad combination

Officials began procuring the GPES query tool in April 2009, using a fixed-price contractual model with ‘agile’ parts. The supplier and officials would agree some of the detailed needs in workshops, after they signed the contract.

But the NAO says there was already evidence in central government at this time that the contractual approach – combining agile with a fixed price – was high risk.

The NAO’s report “Shared Services in the Research Councils”reviewed how research councils had created a shared service centre, where a similarly structured IT contract failed.

In the report, Fujitsu and the shared service centre told the NAO that: “the fixed-rate contract awarded by the project proved to be unsuitable when the customers’ requirements were still unclear.”

The court case of De Beers vs. Atos Origin highlighted a similar failure.

To make matters worse officials relied too heavily on contractors for development and procurement expertise.  And 10 project managers were responsible for GPES between 2008 and 2013.

Once health officials and Atos had signed the query tool contract, they found it difficult to agree the detailed requirements. This delayed development, with Atos needing to start development work while some requirements had yet to be agreed. Officials and Atos agreed to remove some minor components. Others were built but never used by HSCIC.

A Department of Health Gateway 4 review in December 2012 found that difficulties with deciding requirements were possibly exacerbated by development being offshore.

They raised concerns about the project management approach:

“The GPET-Q [query tool] delivery is being project managed using a traditional ‘waterfall’ methodology. Given the degree of bespoke development required and the difficulties with translation of requirements during the elaboration parts of R1, the Review Team considers that, with hindsight, it might have been beneficial to have adopted an Agile Project Management approach instead.”

General Practice Extraction Service – an investigation. NAO report. 

Latest healthcare IT disaster is a reminder of how vital government digital transformation is.

 

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Posted in Atos, Campaign4Change, Department of Health, Government IT, India, IT projects, IT-related failures, Major Projects Authority, National Audit Office, NHS, npfit, project management

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What do Ben Bradshaw, Caroline Flint and Andy Burnham have in common?

Posted on 18/06/2015 | 1 comment

By Tony Collins

Ben Bradshaw, Caroline Flint and Andy Burnham have in common in their political past something they probably wouldn’t care to draw attention to as they battle for roles in the Labour leadership.

Few people will remember that Bradshaw, Flint and Burnham were advocates – indeed staunch defenders – of what’s arguably the biggest IT-related failure of all time – the £10bn National Programme for IT [NPfIT.

Perhaps it’s unfair to mention their support for such a massive failure at the time of the leadership election.

A counter argument is that politicians should be held to account at some point for public statements they have made in Parliament in defence of a major project – in this case the largest non-military IT-related programme in the world – that many inside and outside the NHS recognised was fundamentally flawed from its outset in 2003.

Bradshaw, Flint and Burnham did concede in their NPfIT-related statements to the House of Commons that the national programme for IT had its flaws, but still they gave it their strong support and continued to attack the programme’s critics.

The following are examples of statements made by Bradshaw, Flint and Burnham in the House of Commons in support of the NPfIT, which was later abandoned.

Bradshaw, then health minister in charge of the NPfIT,  told the House of Commons in February 2008:

“We accept that there have been delays, not only in the roll-out of summary care records, but in the whole NHS IT programme.

“It is important to put on record that those delays were not because of problems with supply, delivery or systems, but pretty much entirely because we took extra time to consult on and try to address record safety and patient confidentiality, and we were absolutely right to do so…

“The health service is moving from being an organisation with fragmented or incomplete information systems to a position where national systems are integrated, record keeping is digital, patients have unprecedented access to their personal health records and health professionals will have the right information at the right time about the right patient.

“As the Health Committee has recognised in its report, the roll-out of new IT systems will save time and money for the NHS and staff, save lives and improve patient care.”

[Even today, 12 years after the launch of the National Programme for IT, the NHS does not have integrated digital records.]

Caroline Flint, then health minister in charge of the NPfIT,  told the House of Commons on 6 June 2007:

“… it is lamentable that a programme that is focused on the delivery of safer and more efficient health care in the NHS in England has been politicised and attacked for short-term partisan gain when, in fact, it is to the benefit of everyone using the NHS in England that the programme is provided with the necessary resources and support to achieve the aims that Conservative Members have acknowledged that they agree with…

“Owing to delays in some areas of the programme, far from it being overspent, there is an underspend, which is perhaps unique for a large IT programme.

“The contracts that were ably put in place in 2003 mean that committed payments are not made to suppliers until delivery has been accepted 45 days after “go live” by end-users.

“We have made advance payments to a number of suppliers to provide efficient financing mechanisms for their work in progress. However, it should be noted that the financing risk has remained with the suppliers and that guarantees for any advance payments have been made by the suppliers to the Government…

“The national programme for IT in the NHS has successfully transferred the financing and completion risk to its suppliers…”

Andy Burnham, then Health Secretary, told the House of Commons on 7 December 2009:

“He [Andrew Lansley] seems to reject the benefits of a national system across the NHS, but we do not. We believe that there are significant benefits from a national health service having a programme of IT that can link up clinicians across the system. We further believe that it is safer for patients if their records can be accessed across the system…” [which hasn’t happened].

Abandoned NHS IT plan has cost £10bn so far

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Posted in BT, Campaign4Change, Cerner, change management, Choose and Book, CSC, Department of Health, e-health, Fujitsu, Government IT, health, health records, IT-related failures, LPfIT, npfit, procurement, project management, SPfIT

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New national e-Referral Service “unavailable until further notice”

Posted on 17/06/2015 | Leave a comment

By Tony Collins

The NHS e-Referral Service which launched nationally on Monday was “unavailable until further notice”, the Health and Social Care Information Centre said at 9.30am today.

“Due to issues experienced overnight the NHS e-Referral Service is unavailable until further notice while essential maintenance is performed. If you have local business continuity processes available, we recommend that you consider invoking them,” says the HSCIC on its website.

“We are working hard to resolve these issues as quickly as possible and to keep disruption to a minimum… We apologise for the disruption caused to some users and thank everyone for their patience.”

Late yesterday afternoon the Health and Social Care Information Centre warned GPs and other users of its e-Referral Service that technical problems were continuing.

The difficulties have aggravated cynicism in the GP community about the ability of centrally-based officials to implement national IT systems.

Is it too soon to question whether e-Referrals is the first IT disaster of the new government? There is also the question of whether GPs have been used as guinea pigs to test for problems with the new system.

Until the service went down GPs were in any case unable to log in or were experiencing long delays in arranging referrals. Some reverted to sending letters by post – or always did use the post and avoided the NPfIT Choose and Book system which e-Referral is replacing.

Fewer than 60% of GPs used Choose and Book to hospital appointments for patients.

On its website at 17.30 yesterday the HSCIC said:

“PLEASE PASS THIS ON TO COLLEAGUES WHO USE THE NHS e-REFERRAL SERVICE

“The NHS e-Referral Service has been used by patients and professionals today to complete bookings and referrals comparable with the number on a typical Tuesday but we were continuing to see on-going performance and stability issues after yesterday’s fixes.

“We suspend access to the system at lunchtime today to implement another fix and this improved performance and stability in the afternoon.

“We are continuing to monitor the service and will implement further fixes if required. If users notice any further issues they should log them with their local service desk in the usual way…

“We apologise for the disruption caused to some users and thank everyone for their patience.

Update 14.00 17 June

The Health and Social Care Information Centre said the e-Referral Service was still down.

“HSCIC are completing the final stage of testing a number of fixes to the NHS e-Referrals Service. It is hoped that the service will be available again later today. A further update will be issued at 15:00 today.”

Update 18.00 17 June

Said the HSCIC:

“The NHS e-Referrals Service is now available again. We apologise for the disruption caused to users and thank everyone for their patience.

Update 15.00 18 June – ongoing problems

“Yesterday’s outage enabled us to  implement a number of improvements and hopefully this is reflected in your user experience today,” said HSCIC’s website.

“This morning users reported that there were ongoing performance issues so work has now taken place to implement changes to the configuration to the NHS e-Referral Service hardware and we are currently monitoring closely to see if this resolved the issue.”

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Posted in Agile, Campaign4Change, e-health, e-Referral Service, Government IT, IT-related failures, Major Projects Authority, NHS, npfit, open source

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Why was NHS e-Referral service launched with 9 pages of known problems?

Posted on 17/06/2015 | 2 comments

By Tony Collins

Were GPs guinea pigs for live testing of the new national NHS e-Referral Service?

Between 2004 and 2010 the Department of Health marked as confidential its lists of problems with national NPfIT systems, in particular Choose and Book.

So the Health and Social Care Information Centre deserves praise for publishing a list of problems when it launched the national “e-Referrals” system on Monday. But that list was 9 pages long.

The launch brought unsurprised groans from GPs who are used to new national systems going live with dozens of known problems.

The e-Referral Service, built on agile “techniques” and based on open source technology, went live early on Monday to replace “Choose and Book” for referring GP patients to hospitals and to other parts of the NHS.

Some GPs found they could not log on.

“As expected – cannot refer anything electronically this morning. Surprise surprise,” said one GP in a comment to “Pulse” on its article headlined “Patient referrals being delayed as GPs unable to access e-Referrals system on launch day.”

A GP practice manager said: “Cannot access in south London. HSCIC debacle…GPs pick up the pieces. Changing something that wasn’t broken.”

Another GP said: “I was proud never to have used Choose and Book once. Looks like this is even better!”

Other GPs said they avoided using technology to refer patients.

“Why delay referral? Just send a letter. (Some of us never stopped).”

Another commented: “I still send paper referrals – no messing, you know it has gone, no time wasted.”

Dr Faisal Bhutta, a GP partner in Manchester, said his practice regularly used Choose and Book but on Monday morning he couldn’t log in. “You can’t make a referral,” he said.

The Health and Social Care Information Centre has apologised for the disruption. A statement on its website says:

“There are a number of known issues, which are currently being resolved. It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks. We have published the list of known issues on our website along with details of how to provide feedback .”

But why did the Centre launch the e-Referral Service with 9 pages of known problems? Was it using GPs as guinea pigs to test the new system?

Comment

The Health and Social Care Information Centre is far more open, less defensive and a better communicator than the Department of Health ever was when its officials were implementing the NPfIT.

But is the HSCIC’s openness a good thing if it’s accompanied by a brazen and arrogant acceptance that IT can be introduced into the NHS without a care whether it works properly or not?

In parts of the NHS, IT works extraordinarily well. Those who design, test, implement and support such systems care deeply about patients. In many hospitals the IT reduces risks and helps to improve the chances of successful outcomes.

But in other parts of the NHS are some technology enthusiasts – at the most senior board level – who seem to believe that all major IT implementations will be flawed and will be improved by user feedback.

The result is that IT that’s inadequately designed, tested and implemented is foisted on doctors and nurses who are expected to get used to “teething” troubles.

This is dangerous thinking and it’s becoming more and more prevalent.

Many poorly-considered implementations of the Cerner Millennium electronic patient record system have gone live in hospitals across England with known problems.

In some cases, poor implementations – rather than any faults with the system itself – have affected the care of patients and might have contributed to unnecessary deaths when records needed urgently were not available, or hospitals lost track of urgent appointments.

A CQC report in March 2015 said IT was a possible factor in the death of a patient because NHS staff were unable to access electronically-held information.

In another incident a coroner criticised a patient administration system for being a factor in the death of three year-old Samuel Starr whose appointment for a vital scan got lost in the system.

Within NHS officialdom is a growing cultural acceptance that somehow a poor IT implementation is different to a faulty x-ray machine that delivers too high a dose of radiation.

NHS officials will always brush off IT problems as teething and irrelevant to the care and safety of patients. Just apologise and say no patient has come to any harm.

So little do IT-related problems matter in the NHS that unaccountable officials at the HSCIC have this week felt sufficiently detached from personal accountability to launch a national system knowing there are dozens of problems with the use of it.

Their attitude seems to be: “We can’t know everything wrong with the system until it’s live. So let’s launch the system and fix the problems as GPs give us their feedback.”

This is a little like the NHS having a template letter of regret to send to relatives and families of patients who die unexpectedly in the care of the NHS. Officials simply fill in the appropriate name and address. The NHS can then fix the problems as and when patients die.

It’s surely time that bad practice in NHS IT was eradicated.  Board members need to question more. When necessary directors must challenge the blind positivism of the chief executive.

Some managers can learn much about the culture of care at the hospitals that implement IT successfully.

Patients, nurses and doctors do not exist to tell hospital managers and IT suppliers when electronic records are wrong, incomplete, not available or are somebody else’s record with a similar name.

And GPs do not exist to be guinea pigs for testing and providing feedback on new national systems such as the e-Referral Service.

e-Referral Service “unavailable until further notice”

Hundreds of patients lost in NPfIT systems

Hospital has long-term NPfIT problems

An NPfIT success at Croydon? – Really?

Physicians’ views on electronic patient records

Patient record systems raise some concerns, says report

Electronic health records and safety concerns

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Posted in Agile, Campaign4Change, change management, Choose and Book, Department of Health, e-health, e-Referral Service, Government IT, health, health records, HSCIC, IT successes, IT-related failures, LPfIT, NHS, npfit, open source, open standards, operational issues, procurement, project management

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After billions spent on NHS IT, a carrier bag to transfer x-ray images

Posted on 26/05/2015 | 12 comments

By Tony Collins

After fracturing my angle (slipping on a slope while mowing the lawn) I’ve been surprised how well parts of the NHS work – but not when it comes to the electronic transfer of records and PACS x-ray images from one trust area to another.

The minor injuries unit at one trust wasn’t able to send its PACS images to another trust’s orthopaedic department because it used a different PACS.  [The NHS has spent more than £700m on PACS ]

“Can’t we email the images?” said a senior nurse at the minor injuries unit. In reply the clinician looking at my x-rays gave a look that suggested emailing x-rays was impossible,  perhaps for security and cost reasons. [PACS images are sometimes tens of MBs.]

In the end the minor injuries unit (which within its own sections shared data electronically) had to download my x-rays onto CD for me to take the other trust’s orthopaedic department.  The CD went into a carrier bag.

The next day, at a hospital with an orthopaedic department, after 4-5 hours of waiting in a very busy A&E, I gave a doctor the CD. “I don’t think we can read that,” he said. “We don’t have any computers which take CDs.”

After a long search around a large general hospital the tired doctor eventually found a PC with a CD player. Fortunately the minor injuries unit had downloaded onto the disc a self-executing program to load the x-rays. Success. He gave his view of the fracture.

Even then he didn’t have my notes from the minor injuries unit.

Comment

My care was superb. What was surprising was seeing how things work – or don’t – after the NHS has spent more than £20bn on IT over the past 20 years.

The media is bombarded with press releases about IT innovations in the NHS. From these it’s easy to believe the NHS has the most up-to-date IT in the world. Some trusts do have impressive IT – within that trust.

It’s when records and x-rays need to be transferred outside the trust’s area that the NHS comes unstuck.

As a nurse at my GP’s practice said, “Parts of the NHS are third-world.”

Since 2004 billions has been spent on systems to create shareable electronic patient records.  But it’s not happening.

Within those billions spent on IT in the NHS, couldn’t a little bit of money be set aside for transferring x-rays and patient notes by secure email? That’s the real innovation the NHS needs, at least for the sake of patients.

In the meantime the safest way for x-rays and notes to be transferred from one trust to another is within the patient’s carrier bag.

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Posted in Campaign4Change, data sharing, Department of Health, e-health, Government IT, Institute for Government, NHS, npfit, operational issues, PACS, technology

Secrecy is one reason gov’t IT-based projects fail says MP

Posted on 25/07/2014 | Leave a comment

By Tony Collins

The BBC, in an article on its website about Fujitsu’s legal dispute with the Department of Health, quotes Richard Bacon MP who, as a member of the Public Accounts Committee, has asked countless civil servants about why their department’s IT-based change projects have not met expectations.

Bacon is co-author of a book on government failures, Conundrum, which has a chapter on the National Programme for IT [NPfIT] in the NHS.

In the BBC article Bacon is quoted as saying that the culture of secrecy surrounding IT-based projects is one of the main reasons they keep going so badly – and expensively – wrong.

He says it has been obvious to experts from an early stage that the NPfIT, which was launched by Tony Blair’s government, would be a “train wreck” because the contracts were signed “in an enormous hurry” and contained confidentiality clauses preventing contractors from speaking to the press.

He says the urge to cover things up means that “we never learn from our mistakes because there is learning curve, but when things go wrong with IT the response is to keep it quiet”.

Citing the example of air accident investigations, which are normally conducted in a spirit of openness so lessons can be learned, he says “It is the complete opposite in IT projects, where everyone keeps their heads down and goes hugger-mugger.”

Fujitsu versus Department of Health

Fujitsu sued the Department of Health for £700m after the company was ejected six years early [2008] from a 10-year £896m NPfIT contract signed in January 2004.  The case went to arbitration – and is still in arbitration, largely over the amount the government may be ordered to pay Fujitsu.  Bacon says the amount of the settlement will have to be disclosed.

“I don’t know how the government can honestly keep this number quiet. It simply cannot do it. It is not possible or sensible to keep it quiet when you are spending this much money,” says Bacon.

The BBC article quotes excerpts from a Campaign4Change blog

Government ‘loses £700m NHS IT dispute with Fujitsu’ – BBC News

 

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Posted in Campaign4Change, change management, Department of Health, e-health, excessive secrecy, Fujitsu, Government IT, health, health records, IT-related failures, NHS, npfit, public sector, public services, supplier relationships

Has Fujitsu won £700m NHS legal dispute?

Posted on 24/07/2014 | 6 comments

By Tony Collins

The Telegraph reports unconfirmed rumours that Fujitsu has thrown a party at the Savoy to celebrate the successful end of its long-running dispute with the NHS over a failed £896m NPfIT contract.

Government officials are being coy about the settlement which implies that Fujitsu has indeed won its legal dispute with the Department of Health, at a potential cost to taxpayers of hundreds of millions of pounds.

Fujitsu sued the DH for £700m after it was ejected from its NPfIT contract to deliver the Cerner Millennium system to NHS trusts in the south of England.

At one point a former ambassador to Japan was said to have been involved in trying to broker an out-of-court settlement with Fujitsu at UK and global level.

But the final cost of the settlement is much higher than any figure agreed, for the Department of Health paid tens, possibly hundreds of millions of pounds, more than market prices for BT to take over from Fujitsu support for NHS trusts in the south of England. The DH paid BT £546m to take over from Fujitsu which triggered a minor Parliamentary inquiry.

A case that couldn’t go to court?

The FT reported in 2011 that Fujitsu and the Department of Health had been unable to resolve their dispute in arbitration and a court case was “almost inevitable”.

But the FT article did not take account of the fact that major government departments do not take large IT suppliers to an open courtroom. Though there have been many legal disputes between IT suppliers and Whitehall they have only once reached an open courtroom [HP versus National Air Traffic Services] – and the case collapsed hours before a senior civil servant was due to take the witness stand.

Nightmare for taxpayers

Now the Telegraph says:

“Unconfirmed reports circulating in the industry suggest that a long-running dispute over the Japan-based Fujitsu’s claim against the NHS for the cancellation of an £896 million contract has finally been settled – in favour of Fujitsu.”

It adds:

“Both Fujitsu and the Cabinet Office, which took over negotiations on the contract from the Department of Health, are refusing to comment. The case went to arbitration after the two sides failed to reach agreement on Fujitsu’s claim for £700 million compensation. Such a pay-out would be the biggest in the 60-year history of the NHS – and a nightmare for taxpayers.”

The government’s legal costs alone were £31.45m by the end of 2012 in the Fujitsu case.

Francis Maude, Cabinet Office minister, is likely to be aware that his officials will face Parliamentary criticisms for keeping quiet about the settlement. The Cabinet Office is supposed to be the home of open government.

Earlier this week the National Audit Office reported that Capgemini and Fujitsu are due to collect a combined profit of about £1.2bn from the “Aspire” outsourcing contract with HM Revenue and Customs.

Richard Bacon, a Conservative member of the Public Accounts Committee is quoted in the Telegraph as saying the settlement with Fujitsu has implications across the public sector. “It should be plain to anyone that we are witnessing systemic failure in the government’s ability to contract.”

What went wrong?

The Department of Health and Fujitsu signed a deal in January 2004 in good faith, but before either side had a clear idea of how difficult it would be to install arguably over-specified systems in hospitals where staff had little time to meet the demands of new technology.

Both sides later tried to renegotiate the contract but talks failed.

In 2008 Fujitsu Services withdrew from the talks because the terms set down by the health service were unaffordable, a director disclosed to MPs.

Fujitsu’s withdrawal prompted the Department of Health to terminate the company’s contract under the NHS’s National Programme for IT (NPfIT).

Fujitsu’s direct losses on the contract at that time – which was in part for the supply and installation of the Cerner “Millennium” system – were understood to be about £340m.

At a hearing of the Public Accounts Committee into the NPfIT,  Peter Hutchinson, Fujitsu’s then group director for UK public services, said that his company had been willing to continue with its original NPfIT contract – even when talks over the contract “re-set” had failed.

“We withdrew from the re-set negotiations. We were still perfectly willing and able to deliver to the original contract,” he said.

Asked by committee MP Richard Bacon why Fujitsu had withdrawn Hutchinson said, “We had tried for a very long period of time to re-set the contract to match what everybody agreed was what the NHS really needed in terms of the contractual format.

“In the end the terms the NHS were willing to agree to we could not have afforded. Whilst we have been very committed to this programme and have put a lot of our time, energy and money behind it we have other stakeholders we have to worry about including our shareholders, our pension funds, our pensioners and the staff who work in the company. There was a limit beyond which we could not go.”

The termination of Fujitsu’s contract left the NHS with a “gaping hole,” said the then chairman of the Public Accounts Committee Edward Leigh.

Thank you to campaigner Dave Orr for drawing my attention to the Telegraph article.

Comment 

In an era on open government it is probably not right for officials and ministers at the Cabinet Office and the Department of Heath to be allowed to secretly plunge their hands into public coffers to pay Fujitsu for a massive failure that officialdom is too embarrassed to talk about.

Why did the DH in 2008 end Fujitsu’s contract rather than renegotiate its own unrealistic gold-plated contract specifications? Should those who ended the contract be held accountable today for the settlement?

The answer is nobody is accountable in part because the terms of the dispute aren’t known. Nobody knows each side’s arguments. Nobody even knows for certain who has won and who has lost. Possibly the government has paid out hundreds of millions of pounds to Fujitsu on the quiet, for no benefit to taxpayers.

Is this in the spirit of government of the people, by the people, for the people?

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Posted in BT, BT Health, e-health, excessive secrecy, Fujitsu, Government IT, health records, IT-related failures, legal disputes, NHS, npfit, supplier relationships

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