Category Archives: npfit

TPP stops gift offers to GPs

Posted on 27/02/2012 | 1 comment

By Tony Collins

IT supplier TPP has stopped offering gifts to GPs while it has talks with NHS Connecting for Health and CSC.

TPP has offered tea at The Ritz, theatre tickets, Marks and Spencer vouchers and chocolates to GPs in return for their hosting demonstrations of its SystmOne  product.

Parts of the NHS have clearly-defined rules on the acceptance of gifts or hospitality, though the rules do not apply to GPs. NHS Sheffield tells its staff:

“All offers of hospitality should be approached with caution. Modest hospitality, for example, a drink and sandwich during a visit or a working lunch is normal and reasonable and does not require approval of a manager. Offers of hospitality relating to theatre evenings, sporting fixtures, or holiday accommodation, or other hospitality must be declined…”

The guidance adds:

“Casual gifts by contractors or others, e.g. at Christmas time, must not be in any way connected with the performance of duties …”

On 30 January 2012 Campaign4Change reported that TPP has offered gifts to tea at The Ritz or two tickets to a West End show to GP leaders in return for helping to organise an event that would give the company a chance to demonstrate its systems.

TPP SystmOne has said in its marketing literature that its systems hold a third of the country’s patient records and have about 100,000 users.

In reply to our questions about TPP’s offers to GPs, the Department of Health said in January that TPP had ceased offering the incentives after a DH intervention.

“We were made aware and asked the supplier about this activity,” said a Department of Health spokesperson. “The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Ten days later Pulse reported that TPP was still offering incentives to GPs. Pulse quoted TPP as saying that it had “momentarily stopped offering the incentives over Christmas but will be resuming during February”.

TPP told Pulse: ‘The incentives were offered only to GPs and practice managers and were completely optional … ‘Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.’

Campaign4Change then questioned whether the DH is powerless to stop TPP offering gifts.

We said that a level playing field for suppliers would mean that all suppliers offered tea at the Ritz or Marks and Spencer vouchers in return for a chance to demo their systems to GPs. Alternatively suppliers could agree that none offers gifts.

Now Pulse has reported that TPP has stopped offering gifts to GP, at least while it has talks with CSC and  NHS  Connecting for Health. TPP is quoted in Pulse as saying:

Obviously TPP would not have begun offering incentives as a thank-you for a GP’s time, if we were not highly confident that we are not doing anything wrong legally or ethically. That remains our position.

However following recent communication with CSC and Connecting for Health we have postponed the sending of marketing material that offers incentives for SystmOne demonstrations, until all parties have agreed a way forward.

There may have been miscommunications in the past about what incentives were offered, when and to whom, but TPP has always been upfront about any promotional incentives that are offered. All parties are now keen to ensure we can agree on ways to advertise and promote our products whilst maintaining our high ethical standards.’

‘In the meantime we will continue to consult with GPs, their staff and any NHS guidelines, in order to gain feedback about the best ways to demonstrate SystmOne to them.

Comment:

Whether or not the talks between TPP, CSC and the Department of Health might have been prompted, in part, by recent publicity over TPP’s offering of gifts, we’re pleased the talks are taking place.

If all IT suppliers to the NHS offered gifts to GPs then some doctors could end up seeing IT demos based in part on the attractiveness of the gifts on offer.

Links:

IT company’s “tea at the Ritz” offer to GPs.

Can officials stop TPP offering gifts to GPs?

Is TPP defying assurance on gifts to GPs? – Pulse

Software firm pulls tea at the Ritz incentives for GPs – Pulse

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Posted in managing outsourced services, NHS, npfit, public sector

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Cerner system “too entrenched to be scrapped”

Posted on 22/02/2012 | 2 comments

By Tony Collins

A report by Deloitte on problematic Cerner installations at some hospitals in Australia calls for the government to appoint a chief medical information officer to oversee computer projects across the State.

The Deloitte report is a reminder that new IT in hospitals can have good – and adverse – safety implications for patients.

Obtained by the Sydney Morning Herald under Australia’s Freedom of Information Act, the Deloitte report is said to accept complaints last year that the system put patients’ health at risk by providing insufficient alerts to clinicians when messages did not reach their destination.  Deloitte found no evidence of harm to patients.

Though the Deloitte report is specific to the Cerner “FirstNet”  system as installed at some emergency departments in New South Wales, the idea of a chief medical information officer is arguably a good one for the UK where the Department of Health’s CIO (currently Katie Davis, interim Managing Director, NHS Informatics) is not responsible for the medical implications of IT go-lives in NHS hospitals.

New systems bypass the sort of regulation that helps protects the public against harm from medical devices. After hospital IT disasters there is no requirement for a genuinely independent investigation, as happens after airline crashes.

The Sydney Morning Herald [SMH] reports Deloitte as saying that the FirstNet system, which was installed to help run emergency departments across New South Wales, is chronically underfunded.

Deloitte was asked to report on the system after some hospital staff last year lost confidence in the software and returned to manual record-keeping.

Despite continuing problems and excessive time spent on data entry, the FirstNet system is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, said Deloitte.

”With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,” said Deloitte as reported by the SMH.

Nurses and doctors had complained that the system increased the amount of time they spent at a screen and reduced contact with patients. But the Deloitte report said more time spent on data entry ”was essential to realise the eventual benefits of an eventual [electronic medical record]”, such as greater accuracy of test results and medicine orders.

Upgrades were improving safety at some hospitals but needed to be across the state.

The government should appoint a chief medical information officer to oversee computing projects across the state, and pay for continuing development and training for FirstNet, said Deloitte.

The Health Minister, Jillian Skinner, said clinicians did not want to scrap FirstNet because they didn’t “want to start anew”.

The list of hospitals that have had serious problems after IT installations is growing, in part because the increasing use of technology in healthcare. Though hospital staff tend to learn in time to manage new systems, the unanswered question is whether patient care and treatment – and potentially their health and safety – should be damaged in an unregulated way until the problems are solved or mitigated.

Below is the UK list where it is known that the installation of new IT has caused serious disruption.  Any effect on individual patients has gone unreported:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

**

Links:

Does Hospital IT need airline-style certification?

Hospital computer system found lacking – Sydney Morning Herald

Jon Patrick’s essay on the effectiveness and impact of Cerner’s FirstNet system in some hospitals in New South Wales.

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Posted in Cerner, health, health records, IT projects, managing change, managing outsourced services, NHS, npfit, operational issues, Politics, public sector

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CSC may cut 500 jobs after NHS write-off – end of NPfIT?

Posted on 16/02/2012 | 1 comment

By Tony Collins

CSC has confirmed in a statement to Techweekeurope that it may cut 500 jobs on its NHS account.

“We can confirm that, regrettably, we have recently started a formal 90-day consultation process in the UK which could reduce the number of people working on our NHS account by up to a maximum of 500 people,” CSC told TechWeek Europe.

“This action is necessary mainly because we have now substantially completed many key development activities with NHS, and are now moving away from a focus on development work.”

CSC told The Register that it regretted having to take put jobs at risk, but it was necessary because its NHS workload was getting smaller.

CSC has confirmed it is to write-off almost $1.5bn (£957m) as a result of its involvement in the National Programme for IT (NPfIT).

Comment:

CSC is by no means quitting the NHS. Its NPfIT contract is still in force although it remains unrevised, out of date and subject to legal discussions. CSC has large numbers of UK trusts and GP practices as customers, which will need support and upgrades. If it cuts 500 jobs this may indicate the effective end of the monolith that was the NPfIT which will continue in a much diminished, though still expensive, form, largely because of contracts between the Department of Health and BT.

It appears that the dismantling of the NPfIT has begun in earnest, thanks largely to Cabinet Office officials, its Major Projects Group, the Cabinet Office minister Francis Maude, David Cameron and the Department of Health’s Managing Director of NHS Informatics Katie Davis.

The campaign to stop a new deal being signed with CSC was led by the Conservative MP Richard Bacon, a member of the House of Commons’ Public Accounts Committee who was concerned that a new deal would not be good value for money.

It’s to be hoped that CSC will manage to find other work for the 500. The company says it hopes to achieve the job changes through voluntary redundancies and redeploying people within other parts of its business, without the need for compulsory redundancies.

Techweek europe article that includes CSC’s statement.

MP contacts No 10 and Cabinet Office over future of the NPfIT.

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Posted in Campaign4Change, IT projects, NHS, npfit, project management, public sector

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Can officials stop TPP offering gifts to GPs?

Posted on 10/02/2012 | 3 comments

By Tony Collins

On 13 July 2011 CSC gave this written assurance to NHS Connecting for Health at its headquarters in Leeds.

“CSC can confirm that its subcontractor TPP will no longer be sending out letters to practices offering  gifts in return for organising demonstrations of SystmOne.”

TPP has continued to offer gifts, and the Department of Health is now concerned enough to divulge the letters it has sent to CSC.

It can do little more, for GPs are not bound by NHS rules on the acceptance of gifts.

NHS Connecting for Health became involved after TPP sent out a letter in April 2011 offering tea at The Ritz or two tickets to a West End show of the GP choice.

“All we ask for in return is a short slot at your [local practice manager] meeting so we can demonstrate the benefits of SystmOne,” TPP said. “We’re [sic] a proven system and a real alternative to EMIS and Vision. With a third of the country’s patient records and more than 90,000 users, SystmOne is the leader in hosted clinical systems.

“Following recent success in the London area, TPP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will will also receive afternoon tea at The Ritz or two tickets to a West End show of their choice …Don’t wait around for an alternative that might not arrive – SystmOne is available, right here, right now…”

SystmOne is supplied to the NHS by CSC under the National Programme for IT, at a cost to taxpayers that remains confidential under NPfIT contracts. GPs can also buy the system directly under GP Systems of Choice. Some PCTs are said to be putting pressure on GP practices to replace existing systems with SystmOne.

Three months after TPP’s “tea at The Ritz” letter, on 6 July 2011, NHS Connecting for Health’s Programme Director, GP IT, wrote to CSC.

Dear Sirs

GPSoC [GP Systems of Choice] Marketing Activity by Subcontractor (TPP)

It has come to the attention of the Authority [Connecting for Health/Department of Health] that TPP have been sending letters to practices which include offers of gifts in return for organising meetings of practice managers  during which SystmOne would be demonstrated. The gifts on offer include tea at The Ritz, two tickets to a West End show and £50 of Marks and Spencer vouchers.

The activities being carried out by TPP state that they are in relation to the provision of SystmOne through GP Systems of Choice. As the Supplier of SystmOne under the Framework Agreement, the Authority requests that CSC review these activities and provides a response to the Authority, by no later than 13 July, to advise whether TPP, as their subcontractor, will be continuing with such activity.”

CSC’s Primary Care Product Executive replied on 13 July:

“CSC was not aware of such activities being undertaken by TPP and immediately entered into dialogue with TPP.

CSC can confirm that its subcontractor TPP will not be sending out letters to practices offering gifts in return for organising demonstrations of SystmOne.”

In December 2011 Campaign4Change learned that TPP was offering £25 Marks and Spencer vouchers to GPs in return for a “short slot at your meeting so we can talk to you and demonstrate the benefits of SystmOne”. By that time TPP put the number of its users at more than 100,000.

We asked the Department of Health in December 2011 whether it approved of TPP’s incentives. It replied:

“We were made aware and asked the supplier about this activity. The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Then we learned of a TPP offer of Hotel Chocolat chocolates.

“Happy Christmas and a Happy New Year from TPP.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration…”

This month, February 2012, TPP sent out this message:

TPP sponsorship for your practice meeting

“TPP are looking to sponsor your practice manager meeting! We’ll provide lunch and refreshments for all of your attendees. As a thank-you, the organiser of the meeting will also receive £25 Marks and Spencer vouchers! All we ask for in return is a short slot at your meeting so we can talk to your attendees and demonstrate the benefits of SystmOne to those practices not yet using it. Anyone that books a SystmOne demonstration on the day of the meeting will also recieve £25 Marks and Spencer vouchers!

“You already know all the great reasons to move to SystmOne, why not share them with other practices in your area? The more practices that move to SystmOne, the more benefits you’ll see.

“To arrange sponsorship for your next meeting and take advantage of this great offer, just contact us on the number below or reply to this email.”

We asked DH why it had suggested that the gift offers had ceased when they hadn’t. Its reply:

“The Department contacted CSC (as the GPSoC supplier) about this activity by their subcontractor TPP. CSC confirmed that TPP would cease offering gifts to GPs in return for organising demonstrations of SystmOne. We have contacted CSC about TPP’s position which is not in line with the assurances previously provided.”

We also asked the DH why it was concerned about the gifts. It did not reply directly but sent us copies of the letter it had sent to CSC, and CSC’s reply.

Is the DH powerless to stop TPP offering gifts?

TPP told Pulse this week:  “We momentarily stopped offering the incentives over Christmas but will be resuming during February … The incentives were offered only to GPs and practice managers and were completely optional.

“Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.”

CSC has made no comment.

Pulse reports that the GP Systems of Choice framework agreement prohibits software providers from offering gifts to any servant of the authority or a PCT. The ban does not include GPs because they do not sign the framework. Suppliers can offer gifts to GPs without breaching the framework agreement says Pulse.

It quotes Dr Charlie Stuart-Buttle, a former chair of the EMIS user group and a GP in Tonbridge, Kent, as saying the incentives were an unacceptable way of going about things. It also quotes Dr Trefor Roscoe, a GP in Sheffield and former medical IT consultant, as saying the incentives were not a problem as long as the GPs felt the system in question was worth demonstrating in the first place.

Comment

Some will say that GPs are bombarded with offers of freebies from drug companies. So why does it matter if an IT company offers gifts?

Another argument is that drugs are different. GPs can stop offering drugs that become too expensive. They cannot simply stop using a GP system. It’s a big decision for any GP practice to choose a new system even with subsidies from the Department of Health under GP Systems of Choice GPs, while the GPSoC framework lasts. Any new GP system is likely to be a long-term commitment because of the disruption of changing.

GPs should surely choose their IT supplier on the basis of the facts and after shortlisting suppliers.

We dislike the expression “level playing field” but if applied here it would mean that GPs chose new systems only after demos at which all shortlisted suppliers offered tea at the Ritz or Marks and Spencer vouchers to certain GPs.

Alternatively the suppliers could agree that none offers gifts.

IT company’s tea at The Ritz offer to GPs.

Pulse article on TPP incentives

Are PCTs putting GPs under pressure to switch to SystmOne?

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Posted in change, Government IT, health, health records, managing outsourced services, NHS, npfit, outsourcing, Politics, procurement, supplier relationships

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NPfIT Cerner go-live at Bristol – Trust issues apology

Posted on 31/01/2012 | 4 comments

By Tony Collins

North Bristol NHS Trust has issued an apology on its website after problems with the implementation of a Cerner Millennium patient record system under the National Programme for IT.

Some Bristol consultants had regarded the software as installed at the Trust as “potentially dangerous”.

The Trust went live on 9 December 2011 with a Cerner patient administration system at Frenchay Hospital and Southmead Hospital that replaced two systems. But the Trust has had to revert to paper in some areas.

On its website the Trust says that its “65 wards and maternity department are all using the new system successfully”.

It accepts that it has “experienced significant problems” in outpatient clinics. It says “These problems have been caused by the incorrect set up of clinic lists, which meant staff could not access the system and errors in the data migration of existing appointments.

“As a result, some patients may have received the wrong appointment dates, no confirmation of appointment or letters being sent out in error.  Again, processes are in place to minimise further disruption to out-patient appointments and ensure patient safety.”

TheTrust says it has engineers and technicians re-building the clinics’ system or they are “in clinics correcting problems as they happen, providing solutions and resolving issues”.

The intention is that 90% of areas will be using Cerner by the end of today [31 January]. “Our aim is that by early February all outpatient clinics will be using Cerner. All other outpatient appointments are being managed via other systems and paper processes.”

The Trust says it is contacting patients by phone or letter to advise them of their current appointment slot. “We have ensured that any urgent referrals including cancer two week waits have been prioritised to ensure they are unaffected.”

It adds “During the process of correcting the issues with outpatient clinics and to support GPs and their patients we have written to them to advise them that all patients who have been referred to us either through Choose & Book, fax or Fast Track are within our appointments system.

“We have advised GPs of a dedicated telephone number, fax number and email address for GPs or their patients to contact for further advice. To provide further reassurance to patients and GPs we will keep the helpline service running until the end of February.”

Apology

The Trust says on its website:

“We apologise and would like to thank the public for their patience and our staff for their hard work and dedication in ensuring that patient safety is not compromised.

“These issues have caused disruption and frustration for our patients and our staff and we recognise that this has not delivered the level of service that we expect, and the public expect, from us.

“It has also placed extra workload on our staff, who nevertheless, remain dedicated to ensuring the best possible patient care during this period, and managing the issues that the Trust faces.

“Our Information Management & Technology Team, supported by our suppliers BT and Cerner, have been working very hard to sort out these initial issues and we are already seeing improvements.

“We remain confident that once the new system is fully implemented, it will significantly improve services for our patients and better equip us to meet future challenges.”

Meanwhile the Bristol Evening Post reports that the Chief Executive of the hospital trust, Ruth Brunt, has called for an independent inquiry into the issues surrounding the implementation of the Cerner system.

She said people who have turned up to appointments and operations that have been cancelled or were not on the system would be compensated.  A hotline has also been set up so that people can check whether their appointments are in the system.

The Bristol Evening Post also reported that reception staff had walked out due to the pressure of dealing with patients who were unhappy to find their appointments not on the new system.

“It is horrendous – what used to take us five or six clicks is currently taking 24 and we cannot access the details,” a staff member said. “The notes have not been available when people turn up.

“We have all worked hard and I am sure if it was anywhere else we would have gone on strike. The people on the ground are struggling. It is really demoralising because we are doing our best. Girls on reception are dealing with queues of people and there has been an occasion where a receptionist has walked out because they were so stressed.

“When patients call up we want to be able to help them, but at the moment we don’t know where to look.”

The employee did not believe the trust’s claims that everything would be sorted out by 13 February.

Halt Cerner implementations says MP

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Posted in Campaign4Change, capacity building, change management, Government IT, health, innovation, NHS, npfit, outsourcing, risk

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IT company’s “tea at the Ritz” offer to GP leaders

Posted on 30/01/2012 | 4 comments

By Tony Collins

An IT supplier to the Department of Health and the NHS has offered “tea at The Ritz” or two tickets to a West End show to GP leaders in return for helping to organise an event that would give the company a chance to demonstrate its systems.

TPP SystmOne, which says in its marketing literature that its systems hold a third of the country’s patient records and have more than 90,000 users, has ceased to offer the incentives, the Department of Health told Campaign4Change.

“We were made aware and asked the supplier about this activity,” said a Department of Health spokesperson. “The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

TPP also offered GP leaders a £25 Marks and Spencer voucher; and wished Merry Christmas and a Happy New Year to some potential customers with an offer of a box of Hotel Chocolat chocolates.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration …”

In its separate offer of tea at The Ritz, a TPP SystmOne manager told the senior partner of a London health centre last year that the company’s system was available free of charge through the government-funded GP Systems of Choice initiative.

“Following recent success in the London area, TP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will receive afternoon tea at The Ritz or two tickets to a West End show of their choice! All we ask in return is a short slot at your meeting so we can demonstrate the benefits of SystmOne.”

Parts of the NHS have clearly-defined rules on the acceptance of gifts or hospitality. NHS Sheffield tells its staff:

“All offers of hospitality should be approached with caution. Modest hospitality, for example, a drink and sandwich during a visit or a working lunch is normal and reasonable and does not require approval of a manager. Offers of hospitality relating to theatre evenings, sporting fixtures, or holiday accommodation, or other hospitality must be declined…”

The guidance adds:

“Casual gifts by contractors or others, e.g. at Christmas time, must not be in any way connected with the performance of duties …”

TPP’s offer was not against the law. If all GP system suppliers offered the same or similar incentives, though, GP leaders could be inundated. Under the government’s health service reforms GPs who form part of Clinical Commissioning Groups will take on responsibility from primary care trusts for paying for GP systems.

We asked CSC, which supplies TPP SystmOne under the National Programme for IT, whether it was aware of the incentives and whether it, or TPP, wished to comment.

“Because we are in active negotiations with the government, we are not able to comment in depth on the programme until those negotiations have concluded,” said a CSC spokeswoman who said that the same applied to TPP as “they are a supplier to us working on the National Programme”.

4 Comments

Posted in Campaign4Change, Government IT, managing outsourced services, NHS, npfit, supplier relationships

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Halt NPfIT Cerner deployments after patient safety problems at 5 hospitals, says MP

Posted on 19/01/2012 | 2 comments

By Tony Collins

Conservative MP and member of the Public Accounts Committee Richard Bacon called today for a halt on deployments of the NPfIT Cerner Millennium system after patient safety problems at hospitals in Oxford and North Bristol.

Other hospital deployments underway include Royal Berkshire and Imperial College London.   The BBC has reported that patient-booking software at North Bristol was regarded by some consultants as ‘potentially dangerous’.

The software was installed at the Trust last month under the National Programme for IT [NPfIT].    According to a BBC Points West investigation, the implementation led to some patients missing their operations and, in other cases, the wrong patients being booked for operations.

One consultant told the BBC he had been put down to operate on patients from a completely different speciality.  Patients were also being booked for unlikely appointment times, such as five minutes past midnight, and patients were said to have turned up for phantom appointments on the New Year bank holiday.

Separately the Oxford Mail reported this week that Oxford University Hospitals NHS Trust, which includes Nuffield Orthopaedic, John Radcliffe, Churchill, and the Horton General hospitals, has difficulties booking in patients for treatment.  It deployed the Cerner Millennium software in December.

According to the Oxford Mail, some patients ringing in to book appointments waited up to an hour to have their calls answered and appointments were so delayed the Trust abandoned car parking charges for three days.

Patients reported problems that included ambulances queuing outside of A&E as staff struggled to book in patients.

Pensioner John Woodcock told the Oxford Mail that it took a week of calling the local contact centre to book an appointment for an important stomach examination.

The contact centre gives patients the option of leaving a message for staff to call back, or to join a phone queue. The 75-year-old said “I managed to get an appointment in the end by staying on the phone but it took half an hour almost.”

An Oxford University Hospitals spokesman was unable to say when the system would be able to function without delays but suggested it could be up to three months. Hospital officials blamed the disruption on deployment problems and training issues.

Bacon has long criticised the National Programme for locking the NHS into buying software that was unreliable, subject to serious delays and, even after contract renegotiations, unreasonably expensive.

He disclosed that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust are about £29m over seven years. This is more than three times the reported £8.2m price of a similar system, bought outside the National Programme, at University Hospitals Bristol Foundation Trust.

Bacon said the lessons from major patient safety problems at the Royal Free Hampstead, Barts and The London and Milton Keynes General Hospital had not been learnt.

“We now have two of our leading hospitals brought to their knees by this system.  These deployments need to be stopped until we are sure that they can be managed safely.”

He added “Effective, affordable and robust IT systems are vital to the future of the NHS, but it is clear that the fiasco that is the National Programme cannot deliver them.”

One patient emailed the Oxford Mail to say that the gain will be worth the pain.

“… A word of congratulations to staff. I too had problems with booking an appointment a few days after launch, but sent an email to which I first received an answer in the form of a call-back to fix an appointment and then a personalised apology and explanation…

“Think about the time, effort and accuracy gains of an electronic records system, and not having all those sometimes thick files being ferried round the different departments; think too of the gains in patient confidentiality – now every time someone accceses your records, that will be logged.

“When things have bedded in properly, and I believe this will be sooner rather than later, if the committed and dedicated staff have anything to do with it …  we’ll soon come to be grateful, both for the increase in efficiency and the financial savings – which can then be used on frontline services…”

NPfIT Cerner go-live has “more problems than anticipated”

System still causing chaos – Oxford Mail

London trusts in chaos

 

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Posted in Campaign4Change, change management, Government IT, managing change, managing outsourced services, NHS, npfit, openness and transparency, project management, risk

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Are officials pressing GPs to switch IT supplier to SystmOne?

Posted on 12/01/2012 | 5 comments

By Tony Collins

There’s concern in the NHS that Primary Care Trusts, which are due to be abolished next year, are putting GP practices under pressure to switch their IT systems to TPP SystmOne, a patient record system that is supplied by CSC under the National Programme for IT.

The conversions are being subsidised by taxpayers under unpublished NPfIT local service provider contracts. The concern of at least one aspiring Clinical Commissioning Group – which is one of the CCGs being formed under Andrew Lansley’s health reforms –  is that GP system conversions to TPP SystemOne under local service provider NPfIT contracts could leave CCGs a legacy of financial commitments that are as yet unknown.

One CCG contacted Campaign4Change to express concern that it may have uncertain financial commitments when it begins to take on SystmOne commitments next year. On 1 April 2013 PCTs and strategic health authorities are due to be abolished and their responsibilities passed to authorised CCGs.

Aspiring CCGs are now taking a close interest in PCT financial commitments because the Groups are due to inherit any of their local PCT deficits incurred from 1 April 2011 to 31 March 2013.

At present, GP practices receive PCT funding whether they take replacement SystmOne patient record technology from CSC  under the NPfIT or acquire new IT under a scheme known as GP Systems of Choice.

But the Group’s spokeswoman said that PCTs are putting pressure on GP practices to replace their systems with SystmOne. She said it’s because it can cost PCTs less – or nothing – for a GP switch to SystmOne under NPfIT-funded local service provider contracts. In comparison PCTs may have to pay costs such as hardware maintenance when GPs acquire systems under GPSoC.

Incentives for GPs to switch IT supplier

Our inquiries show that at least one PCT has received what it called “incentives” from its strategic health authority for GP practices to change computer systems, according to the PCT’s response to an FOI inquiry. The FOI response said: “The PCT can confirm that the incentives passed to [GP] practices to change computer systems as follows”.

It went on to say that its strategic health authority gave the PCT a £10,000 implementation fee [for each GP practice that changed its systems]. The PCT passed £3,000 of the £10,000 to the GP practice to part fund its implementation costs.

The PCT’s preferred GP system supplier was SystmOne, as supplied by CSC.

What happens when CSC’s NPfIT contract expires in 2015?

At that time Clinical Commissioning Groups may have to pay whatever costs are levied because GP practices with SystmOne could be reluctant to switch systems again, said the CCG spokesperson.

The Department of Health’s Informatics Directorate, which has subsumed NHS Connecting for Health, has confirmed that the prices it pays CSC for TPP installations are confidential.

Said a DH spokesperson “While prices within the LSP [Local Service Provider] contracts are commercially confidential we are in partnership with Intellect, the Technology Trade Association, to develop an open and transparent approach to costs and quality, as part of working to create a vibrant marketplace.”

A spokesperson for CSC said  “Because we are in active negotiations with the government, we are not able to comment in depth on the programme until those negotiations have concluded.”

The spokesperson said the comments applied to TPP as it is “a supplier to us working on the National Programme”.

Department of Health response

When asked if GP practices are taking on non-transparent NPfIT commitments for TPP systems, the DH spokesperson said “If a GP practice chooses to take a system under an LSP contract they are made fully aware of the product they are taking and the length of the contract.

“We are committed to ensuring transparent and trusting working relationships between suppliers and their NHS customers.”

Asked whether GP practices that choose GPSoC systems cost the PCT more than TPP acquired through the LSP contracts, the DH spokesperson said “ It is up to the GP practice as to whether they choose a system through GPSoC or through the LSP contracts.

“The GPSoC PCT/ Practice agreement provides a mechanism for GPs to raise and resolve any concerns they may have.”

Comment

Centrally-funded incentives to PCTs to encourage GPs to switch to SystmOne as supplied by CSC under the NPfIT keep alive one of the original objectives of the national programme, which was to have health IT dominated by a few suppliers that would be under firm central control.

But that strategy creates an imbalance in the health IT market, inhibits open competition and leaves the NHS with unquantifiable future costs given that SystmOne is being supplied under NPfIT contracts that are secret.

Favouring central control, Labour created the NPfIT. In contrast the coalition favours decentralisation so it makes sense for GPs to have a genuine choice of suppliers, with the funding PCTs remaining neutral on the decision.

TPP SystmOne is good enough to compete freely in the open market. It does not need a leg up from the PCT or the Department of Health – just for the sake of keeping a part of the original NPfIT alive.

 

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Posted in Campaign4Change, IT projects, NHS, npfit, openness and transparency, outsourcing, procurement, public sector, public services, reforms, supplier relationships

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NPfIT Cerner go-live at Bristol has “more problems than anticipated”

Posted on 11/01/2012 | 7 comments

By Tony Collins

The BBC reports that there are “more problems than anticipated” with a patient-booking system at two Bristol hospitals run by North Bristol NHS Trust.

The trust describes the problems as “teething”.  Consultants say the problems are “potentially dangerous”.

Last month North Bristol went live with the Cerner Millennium system under an NPfIT contract with BT. The Trust says problems are due to software being used incorrectly. They have led to some patients missing their operations and the wrong patients being booked for operations, says the BBC.

Emails from executives at Frenchay and Southmead hospitals, seen by the BBC, said staff should be “vigilant” to check lists were “completely accurate”.

BBC Points West’s health correspondent Matthew Hill said emails sent by consultants to hospital bosses claimed operation lists printed by the system were “complete fiction” and “potentially dangerous”.

One consultant told the BBC he had been put down to operate on patients from a completely different speciality.

The trust said there had been “teething problems” and that there had been “more problems than anticipated”.

In an email to staff the trust said the change of system had been “a very big change” so there was “no surprise” there had been difficulties.

A trust spokesman said there were a series of problems around outpatients and the associated clinics and some of the data moved from old systems had not migrated as planned.

“We need to ensure that we rebuild and recreate the clinics to match what people expect them to be on the ground,” he said.

“In theatres we have had some issues but have absolutely ensured from the outset that clinical safety has been at the top and have ensured any risks and issues have been mitigated.”

Conservative MP Richard Bacon, a member of the Public Accounts Committee, has established through a Parliamentary question that the cost of the North Bristol Cerner implementation is much higher than for a non-NPfIT installation in the same city.

Health Minister Simon Burns told Bacon that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust were £15.2m for deployment and an annual service charge of £2m.

This brought the total cost of the Cerner system over seven years to about £29m, which was more than three times the £8.2m price of a similar deployment outside of the NPfIT at University Hospitals Bristol Foundation Trust.

Comment

Several Cerner implementations under the NPfIT have gone awry but the problems have eventually been resolved. The question is whether patient care and treatment is affected in the meantime. The lack of openness over problems with patient care in the NHS mean that the answer will probably never be known, which underlines the need for better regulation of hospital IT implementations.

Does hospital IT need airline-style safety certification?

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Posted in Campaign4Change, change management, Government IT, health, improving communications, IT projects, managing change, managing outsourced services, NHS, npfit, openness and transparency, operational issues, outsourcing, private sector lessons for the public sector, project management, public sector, public services, risk

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CSC to change hands in 2012?

Posted on 03/01/2012 | 1 comment

By Tony Collins

Techmarketview analyst Tola Sargeant who has followed the NPfIT closely, and particularly the ups and downs of CSC, says the implications for CSC of the government’s tough stance against the company are “dire”. She adds:

“Indeed, we wouldn’t be at all surprised to see CSC change hands in 2012 as a result”.

Maude gets tough 

Within the Department of Health and CSC in May last year executives were confident a new memorandum of understanding under the NPfIT would be signed.

Now the Government, in the form of the Cabinet Office minister Francis Maude, has declined so far to sign any new deal with CSC. This is the way CSC put it in a filing to the SEC, the US regulators, on 27 December 2011:

“… Since mid-November 2011, the parties [Department of Health, Cabinet Office and CSC) have been engaged in further discussions relating to the MOU [Memorandum of Understanding], which have included discussions regarding a proposed contract amendment with different scope modifications and contract value reductions than those contemplated by the MOU.

“However, CSC recently was informed that neither the MOU nor the contract amendment then under discussion would be approved by the government.

“Notwithstanding the failure to reach agreement, CSC anticipates that the parties will continue discussions in January 2012 regarding proposals advanced by both parties reflecting scope modifications and contract value reductions that differ materially from those contemplated by the MOU.

“As a result of the circumstances described above, CSC has concluded, as of the date of this filing, that it will be required to recognize a material impairment of its net investment in the contract in the third quarter of fiscal year 2012.

“Until CSC and NHS conclude their on-going discussions concerning a possible contract amendment, including any scope modifications and contract value reductions that might be part of any such amendment, the Company is unable to estimate the amount of such impairment.

“However, depending on the terms of such an amendment or if no amendment is concluded, such impairment could be equal to the Company’s net investment in the contract, which, as of November 30, 2011, was approximately £943m ($1.5bn).

“Additional costs could be incurred by CSC depending on the nature of such an amendment, or if no amendment is concluded. The Company is unable to estimate the amount of such additional costs; however, such costs could be material.”

Why the Cabinet Office has left draft MoU unsigned?

The non-signing of a new deal with CSC is the firmest indication so far that the Cabinet Office is prepared to bring a rigorous, independent scrutiny to big IT projects and contracts.

Though the DH had wanted to sign a new deal with CSC, at least to assure continued support and upgrades to the few NHS trusts that have installed CSC and iSoft’s “Lorenzo” patient records system,  Maude is said to have seen a new deal with CSC as rewarding the company for failings in the past.

Also Cabinet Office officials regarded the terms of a new deal with CSC as unattractive. One Cabinet Office official wrote in a memo dated March 2011 that CSC’s proposals would mean a reduction in Trusts using CSC IT from the original number of 220 Trusts to 80.

 “My view is that, on the face of it, while the additional savings are appealing, the offer is unattractive. This is because the unit price of deployment (per Trust) under offer roughly doubles the cost of each deployment from the original contract.

“Ultimately, we [Cabinet Office] are not convinced the [Department of] Health commercial team are approaching this in the best way.”

It is possible that a new deal for signing was put before Maude – and went unsigned. Had any appeal gone to the Prime Minister David Cameron it is highly likely he would have given his full backing to Maude.

David Cameron’s view?

Cameron may be delighted that at least £2bn remains uncommitted to the NPfIT and could be saved by not signing a new deal with CSC.

Conservative MP Richard Bacon, a member of the Public Accounts Committee who has become an authority on the NPfIT, said of CSC’s warning of write-offs on the Programme:

“It was always a worry that the Department of Health was initially keen to sign a new deal with CSC that would have been poor value. Now it seems the Cabinet Office has done its job as an independent scrutineer and has made sure the interests of taxpayers are protected.

“This shows how important it is for the Cabinet Office to have the final say on big Government IT-based projects.”

What does CSC’s plight mean for the NHS?

NHS trusts have long wanted open competitive tendering and now, to a large extent, they have it. More than a dozen acute trusts are likely to tender for major systems replacements this year which is a big increase on the annual rate for past years.

Some iSoft and Cerner sites may also seek to renew contracts or find replacement systems. CSC, which may be lifted of the burden of meeting high-priced NPfIT commitments, may be a strong competitor in the UK health market.

One problem for NHS trusts will be finding enough strong candidates for their shortlists. They may look to the US market – but end up with products that need anglicising, which will be risky process.

Techmarketview says that what is doom and gloom for CSC is an opportunity for others. Rival suppliers “will be cheered by the prospect of more NHS Trusts procuring systems that CSC should have delivered by now”.

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Posted in Campaign4Change, change, change management, Government IT, health, IT projects, managing change, managing outsourced services, NHS, npfit, outsourcing, procurement, project management, public sector, public services, reducing cost strategically, supplier relationships

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