Tag Archives: CSC

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

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”.

Are officials pressing GPs to switch IT supplier to SystmOne?

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.

 

CSC criticised again in The Times

By Tony Collins

The Times has followed up its three pages of coverage of the NPfIT yesterday with an article in which the chair of the Public Accounts Committee, Labour MP Margaret Hodge, criticises one of the programme’s main suppliers CSC.

Hodge tells The Times she was surprised to learn that CSC was hoping for a revised NHS deal – worth about £2bn – after it failed to deliver fully functional software to any of 166 NHS trusts in England.

CSC has said in a filing to the US Securities and Exchange Commission that, based on events to date, it does not does not anticipate that the NHS will terminate its contract.

CSC gave a series of reasons in its SEC filing why the UK Government may retain CSC and its NPfIT contracts, though it conceded that the outcome of its talks with the Department of Health, is uncertain.

CSC also said it has cured or is in the process of curing the alleged events of default. It asserted that failures and breaches of contract on the part of NHS have caused delays and issues; and it said that if the NHS wrongfully terminated the contract on the basis of alleged material breach, CSC could recover substantial damages.

Hodge told The Times:

“Any private sector company that cares so little about the public interest that they are prepared to extract this kind of money from the public purse should not be given the right to work for the Government again.

“If they are going to take such a private sector attitude to it that they don’t give a toss about the public interest they should be treated like a cowboy builder.”

CSC says it has made a significant investment in developing systems for the NHS and has demonstrated a strong and continuing commitment to improving the quality of healthcare in England. It says it has a demonstrable track record of successful and widescale delivery to NHS within the National Programme and beyond.

The Times also reported that Christine Connelly, the Department of Health’s former CIO,  was bought a £416 first-class train ticket for a visit to a hospital at Morecambe, and was flown to San Francisco and Seattle at a business-class rate costing £8,278.80.

American “cowboys” blamed for NHS fiasco – The Times

CSC confident on £2bn deal says The Times

CSC confident on £2bn NPfIT deal says The Times

The Times reports today that CSC is confident that the Department of Health will not terminate the supplier’s contracts despite the Government’s pledge to dismantle the national programme.

The paper says that “taxpayers will foot the bill for a further £2bn on a failed NHS IT project even though the Government has already pulled the plug on it”.

It adds that the “American technology company Computer Sciences Corporation (CSC) has boasted to Wall Street that it expects an extension of its contract to provide electronic patient records despite failing to deliver a fully functional version of its software”.

In a series of articles on the NPfIT, The Times suggests that the Government is locked into CSC, at least until 2017.

“The Government’s pledge to dismantle the failed NHS programme to computerise patient records is in tatters because it cannot afford to break its contractual commitments and start a search for alternative suppliers”.

The Times quotes a CSC filing to the US Securities and Exchange Commission in November which says: “Based upon events to date, the Company does not anticipate that the NHS will terminate the contract.”

CSC, the Department of Health and the Cabinet Office are still discussing a memorandum of understanding which may end with the supplier’s cutting £764m from its NPfIT contracts, leaving about £2.1bn in place.

CSC discloses in its SEC filing that the Memorandum of Understanding anticipates that the contract term will be extended one year to June 2017 and that CSC anticipates revenue of £1.5bn to £2bn over the remaining term.

With certain amendments “ the contract remains profitable and the Company would recover its investment,” says CSC in its filing.

But MP Richard Bacon, a member of the Public Accounts Committee, has received Parliamentary replies to his questions on the costs of NPfIT deployments at University Hospitals of Morecambe Bay NHS Foundation Trust and North Bristol NHS Trust which show that the costs of installing and maintaining a system under national programme contracts are more than twice that of systems bought by trusts outside of the NPfIT.

Health Minister Simon Burns said in a reply to Bacon that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust are £15.2m for deployment and an annual service charge of £2m. This brings the total cost of the Cerner system over seven years to about £29m, which is more than three times the £8.2m price of a similar deployment outside of the NPfIT at University Hospitals Bristol Foundation Trust.

At Morecambe Bay, the trust’s costs of being involved with the NPfIT (including the deployment of CSC’s Lorenzo 1.9 system) are £6.2m, according to Burns in his reply to Bacon, whereas the typical internal trust costs of deploying of a non-NPfIT system, excluding the cost of the system itself but including training, project management and additional corporate reporting tools, are about £1m-£2m.

Is the Department of Health locked into CSC?

CSC in its filing to the SEC says that the NHS, when considering its options of maintaining or terminating the contract, will “consider costs and risks that NHS may incur over and above those related to termination fees”.

These include:

– damages and costs that may be payable to CSC

– the cost of initiating and managing a public tender, procedure or procedures to obtain one or more suitable replacement suppliers

– the operational risk of switching suppliers at this stage in the contract with CSC

– the cost of alternative suppliers

– the cost of obtaining exit management services from CSC to ensure an orderly transition to one or more replacement suppliers.

In addition, said CSC in its filing, if the NHS terminated the contract for convenience, possible claims that the Company has against NHS include “claims for compensation due to delays and excess costs caused by NHS or for contractual deployment delay remedies or for costs associated with change.

If the NHS had terminated the entire contract for convenience with immediate effect at September 30, 2011, the termination fee would have been capped at approximately £430m.

CSC would also be entitled by way of termination fee to a sum to compensate for the profit that CSC would have earned over the following 12 months had the contract not been terminated.

CSC recognised in the filing, however, that the signing of a new NPfIT deal was uncertain.

Lorenzo “not right yet”

The Times quotes Dr Simon Eccles, the medical director of Connecting for Health, as saying “Lorenzo has had an extremely painful gestation. Lorenzo may yet be a great success because it is a brilliant bit of software but they haven’t got it right yet.”

In an editorial on its NPfIT investigations, The Times said that government IT failures have in common the fact that “we don’t really know who was to blame”. It says:

“Nobody took responsibility and nobody apologised. It is perhaps too much to hope that there will not be more disasters. But if there are, someone must carry the can.”

NPfIT to be dismantled – brick by brick

Summary Care Record – an NPfIT success?

By Tony Collins

Last month the Department of Health briefed the Daily Mail on plans to dismantle the National Programme for IT.  The result was a front page  lead article in the Mail, under the headline:

£12bn NHS computer system is scrapped… and it’s all YOUR money that Labour poured down the drain.

The article said:

The Coalition will today announce it is putting a halt to years of scandalous waste of taxpayers’ money on a system that never worked.  It will cut its losses and ‘urgently’ dismantle the National Programme for IT…”

Now the DH has briefed the Telegraph on the success of  Summary Care Records, the national database run by BT under its NPfIT Spine contract.

So the Telegraph has given good coverage to the summary care records scheme.

By its selective briefings the DH has achieved prominent coverage in the national press for dismantling a failing £12bn NHS IT programme, and for modernising the NHS by successfully creating summary care records (under an IT programme that is being dismantled).

The DH’s officials know that the national press will usually give priority to off-the-record briefings by representatives of departments, especially if the briefing is in advance of the issuing of a press release. The Telegraph’s article was in advance of the DH’s publication of this press release.

Prominent in the Telegraph’s coverage was Simon Burns, the NPfIT minister, who in May 2011 spoke on BBC R4’s Today programme of the “fantastic” NPfIT systems [which are based on Cerner Millennium] at the Royal Free Hampstead NHS Trust.

Last week in his praise of summary care records in the Telegraph Burns quoted various medical organisations as supporting the scheme. Taken together the Telegraph articles depict the Summary Care Records scheme as a success – an important part of patient care and treatment.  Said Burns :

“Patient charities have seized on the Summary Care Record; a new type of national, electronic record containing key medical information, as a way of making sure the NHS knows what it needs to about their condition.

“Some of these groups have told us how this can sometimes be a real struggle. Asthma patients being asked to repeat their medical history when they are struggling to breathe. The patient with lung disease carrying around a wash bag with ‘Please make sure I take this medication’ written on it when they are admitted to hospital. Or even the terminally ill patient who ends up dying in hospital because their wish to die at home wasn’t shared with an out–of–hours doctor.

“Patient groups are recognising that one of the easiest and most effective ways of giving these patients a stronger voice is to use the record to tell the NHS the most crucial information about their condition.

“The record contains information about medications, allergies and bad reactions to drugs and is mainly being used by outof–hours GPs to provide safer care where no other information is available…

“Patients can speak to their GP about adding extra information that they want the NHS to know about them in an emergency to their record. The Muscular Dystrophy Campaign has urged their patients to do just this as the first group to recognise the potential of the Summary Care Record. Mencap, AsthmaUK, DiabetesUKand the British Lung Foundation are also raising awareness among patients about how the Summary Care Record can be used to improve and personalise the care they receive.

“Some seriously ill patients have added information about their end of life wishes to their record, helping to ensure that their wishes, typically to die at home, are respected.

“This is because information about their wishes can be shared with everyone, including, most critically, outof–hours doctors and paramedics, involved in their care.

“Some patients have voluntarily added ‘do not resuscitate’ requests to their records, which would be cross–checked against other sources of information at the point of care. Families and carers report that this has saved them and their loved ones much needless distress…”

The Telegraph noted that about 8.8 million people – a fifth of the total number of patients in England – have summary care electronic records. All 33.5 million NHS patients in England are being offered the opportunity of having the service, said the newspaper which added that only a “few” people have opted out. [About 1.2% have opted out, which is about double the rate of opt-outs in the early stages of the SCR programme.]

Comment:

When he meets his Parliamentary colleagues Simon Burns does not like to hear criticism of the NPfIT. He is earning a reputation as the NPfIT’s most senior press officer, which may seem odd given that the programme is supposedly being dismantled.

But Burns’ enthusiasm for the NPfIT is not odd.  He is reflecting the views of his officials, as have all Labour NPfIT ministers:  Caroline Flint, Ben Bradshaw and Mike O’Brien were in the line of Labour NPfIT ministers who gave similar speeches in praise of the national programme.

That Burns is following suit raises the question of why he is drawing a minister’s salary when he is being simply the public face of officialdom, not an independent voice, not a sceptical challenge for the department.

Burns and his Labour predecessors make the mistake of praising an NPfIT project because it is a good idea in principle. Their statements ignore how the scheme is working in practice.

The NPfIT’s projects are based on good ideas: it is a good idea having an accurate, regularly-updated electronic health record that any clinician treating you can view. But the evidence so far is that the SCR has inaccuracies and important omissions. Researchers from UCL found that the SCR  could not be relied on by clinicians as a single source of truth; and it was unclear who was responsible or accountable for errors and omissions, or keeping the records up to date .

Should an impractical scheme be justified on the basis that it would be a good thing if it worked?

The organisations Burns cites as supporting the summary care record scheme are actually supporting the underlying reasons for the scheme. They are neutral or silent, and perhaps unaware, of how the scheme is working, and not working, in practice.

That has always been the way. The NPfIT has been repeatedly justified on the basis of what it could do. Since they launched it in 2002, ministers and officials at the DH and NHS Connecting for Health have spoken about the programme’s benefits in the future tense. The SCR “will” be able to …

Hence, six years into the SCR,  the headline of the DH’s latest press release on the scheme is still in the future tense:

Summary Care Record to benefit millions of patients with long term conditions, say patient groups

Burns says in the press release that the SCR has the “potential” to transform the experience of healthcare for millions of patients with long term conditions and for their families and carers.

Caroline Stevens, Interim Chief Operating Officer at the British Lung Foundation says in the same press release that the SCR “will” bring many benefits for patients.

And Nic Bungay, Director of Campaigns, Care and Support at the Muscular Dystrophy Campaign says in the press release that his organisation sees the great “potential” for Summary Care Records…”

Summary Care Records – the underlying problems 

Shouldn’t the SCR, hundreds of millions of pounds having been spent, be transforming healthcare now? The evidence so far is that the SCR scheme is of limited use and might have problems that run too deep to overcome.

Trisha Greenhalgh and a team of researchers at UCL carried out an in-depth study of the SCR with funding from NHS Connecting for Health though CfH did not always  extend the hand of friendship to the team.

Greenhalgh showed a conference of Graphnet healthcare users at Bletchley Park code-breaking centre last year how the SCR scheme was entangled in a web of political, clinical, technical, commercial and personal considerations.

Quite how political the scheme had become and how defensive officials at the DH had been over Greenhalgh’s study can be seen in her presentation to Graphnet users which included her comment that:

“All stakeholders [in the UCL report] except Connecting for Health wrote and congratulated us on the final report.”

CfH had sent Greenhalgh 94 pages of queries on her team’s draft report, to which they replied with 100 pages of point-by-point answers. The final report, “The Devil’s in the Detail“, was accepted by peer review – though it later transpired, as a result of UCL investigations, that one of the anonymous peer reviewers was in fact working for Connecting for Health.

These were some of the Greenhalgh team’s findings:

– There was low take-up of the SCR by hospital clinicians for various reasons: the database was not always available for technical reasons, such as a loss of N3 broadband connection; and clinicians did not always have a smartcard, were worried about triggering an alert on the system, were not motivated to use it, or might have been unable to find a patient on the “spine”.  The  SCR was used more widely by out-of-hours doctors and walk-in centres.

– GP practices had systems that were never likely to be compliant with the Summary Care Record central system.

– The SCR helped when a record existed and the patient had trouble communicating.

– The SCR helped when a record existed and the patient was unable to say what multiple medications they were using.

–  There were tensions between setting a high standard for GPs to upload records or lowering standards of data quality to encourage more GP practices to join the scheme.

–  Front-line staff didn’t like asking patients for consent to view the SCR at the point of care. This consent model was unworkable, inappropriate or stressful.

–  There was no direct evidence of safer care but the SCR may reduce some rare medication errors.

– There was no clear evidence that consultations were quicker.

– Costly changes to supplier contracts were needed to take in requirements that were not fully appreciated at the outset of the programme.

– The scheme was far more complex than had been debated in public. Its success depended on radical changes to systems, protocols, budget allocations, organisational culture and ways of working. And these could not be simply standardised because nearly every health site was different.

So what’s the answer?

The SCR is an excellent idea in principle. Every out-of-hours doctor should know each patient’s most recent medical history, current medications and any adverse drug reactions.

But this could be provided locally – by local schemes that have local buy-in and for which there is accountability and responsibility locally. It can be argued that the Summary Care Record, as a national database, was never going to work. Who is responsible for the mistakes in records? Who cares if it is never widely used? Who cares if records are regularly updated or not? Why should GPs care about a national database? They care about their own systems.

It appears therefore that the SCR has benefited, in the main, the central bureaucracy and its largest IT supplier BT.  The SCR national database has kept power, influence and spending control at the centre, emasculating to some extent the control of GPs over their patient records.

The central bureaucracy continues to justify the scheme with statistics on how many records have been created without mentioning how little the records are looked at, how little the information is trusted, and how pervasive are the errors and omissions.

BT and DH officials will be delighted to read Simon Burns’ commentary in the Telegraph on the SCR. But isn’t it time IT-based schemes were unshackled from politics? DH press releases on the success of local IT schemes would be few and far between. But why should £235m – the last estimated cost of the SCR – be spent so that ministers can make speeches and be quoted in press releases?

.

Head of NPfIT remains in post says DH

Sir David Nicholson, the Chief Executive of the NHS and Senior Responsible Owner [SRO] of the NPfIT, will remain as the programme’s SRO until the scheme is dismantled, the Department of Health said this week.

The DH’s statement contradicts a suggestion in the media that, as the NPfIT programme board has been disbanded, Nicholson is no longer the scheme’s senior responsible owner.

Had Nicholson stood down as the NPfIT SRO there would have been no direct accountable owner for the £4bn worth of contracts with local service providers BT and CSC, or the scheme’s remaining systems such as Choose and Book, the Summary Care Record and the data “Spine”.

A project’s SRO is held by Parliament to be the “business owner” of a central government project, the person responsible for the scheme’s results. Nicholson took on the job of NPfIT overall SRO when he accepted the appointment of NHS CE in 2006.  He has become the programme’s staunchest supporter.

A spokesperson for the Department of Health said: “We have already announced that we are dismantling the National Programme for IT and establishing new governance arrangements to support more local decision making.

“Sir David Nicholson will remain Senior Responsible Owner to ensure a clear line of accountability whilst this work is undertaken.”

It’s unclear when Nicholson will stand down as head of the NPfIT or whether he can be held accountable for the problems on the project under his leadership. In 2008 he declined to order an independent investigation into the NPfIT.

Nicholson tries to keep NPfIT alive.

NPfIT – criminal incompetence says The Times

By Tony Collins

In an editorial not everyone would have seen, The Times said the history of the NPfIT was “one of criminal incompetence and irresponsibility”.

The main leader in The Times on 23 September had the headline “Connecting to Nowhere”.

It said:

“The comically misnamed Connecting for Health will continue to honour its contracts with big companies and to swallow taxpayers’ money for some time to come: up to £11bn on current estimates. The figure demonstrates the truly egregious scale of the previous Government’s incompetence on this issue: this vast sum seems to have been committed irrevocably, even though the project has never achieved its objectives.

“The story is a dismal catalogue of naivity, ambition and spinelessness. NHS managers and officials …were [not] brave enough to question the direction of travel at crucial moments when IBM and Lockheed pulled out of the project early on. Whitehall was sold a grand vision by consultants, software and technology companies charging grandiose fees. It signed contracts that appear to have been impossible to break when the promised land did not appear. Yet no one seems responsible. No one has been sacked. Most of the officials involved have long moved on…

“There have been spectacular failures in the private sector too. But businesses, with tighter controls on spending, tend to halt things earlier if they are going wrong. Many prefer off-the-shelf systems such as SAP or Oracle, which are tried and tested. They know that it is cheaper to adapt their processes, not the software.

“This newspaper is in favour of serious investment in technology, which could play an important part in economic growth. The NHS debacle has done enormous damage to this country’s reputation for expertise in IT systems. The lessons for the future are clear. Governments must hire people who can make informed and responsible procurement decisions. Patients, in every way, are going to end up paying the price.”

A separate article in The Times 0f 23 September included comments by Campaign4Change whose spokesman said that if the Department of Health continues to spend money on NPfIT suppliers it will probably get poor value for money.

Comment:

Compare the remarks in The Times with those of David Nicholson, Chief Executive of the NHS and Senior Responsible Owner of the NPfIT who refused to agree to a request by 23 academics to have an independent review of the scheme. Nicholson could not contain his enthusiasm for the NPfIT when he told the Public Accounts Committee on 23 May 2011:

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

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

It’s difficult to accept Nicholson’s figures. But even if we do, we’d have to say that the 20% that hasn’t been delivered was the main reason for the NPfIT: a national electronic health record which hasn’t materialised and isn’t likely to in the near future.

The contrasting comments of The Times and Nicholson’s are a reminder that the civil service hierarchy at the Department of Health operates in a world of its own, unanswerable to anyone, not even the Cabinet Office or Downing Street.

Can the Department of Health be trusted to oversee health informatics when it has such close relationships with major IT companies and consultants? While Katie Davis is in charge of health informatics there is at least an independent voice at the DH. But as an interim head of IT how long will she last? The DH has a history of not being keen on independent voices.

Nicholson: still positive after all these years.

NPfIT goes PfffT.

Beyond NPfIT.

Surge in tenders for non-NPfIT systems.

Investors’ writ against CSC on NHS contracts – more detail

By Tony Collins

The Guardian has published the 123-page writ against CSC by lawyers acting behalf of some of the supplier’s investors. The writ contains many allegations against CSC and named directors. The company’s response is that it is corporate policy not to discuss litigation.

The legal action appears to have been based, in part, on CSC’s poor share price, which is today near a five-year low, and the supplier’s repeated positive statements and assurances on the performance of its NHS IT contracts and its iSoft Lorenzo software

These are some of the claims made in the document:

– Lorenzo was originally designed by iSoft as a one-size-fits-all software for use in local medical practices. “However, the UK healthcare system is highly diverse, ranging from large university hospitals to small private medical practices to prison medical facilities. Thus, according to the Deputy Head of Testing for Lorenzo, Lorenzo was never the correct software for the job. Lorenzo therefore required significant development before it could be deployed throughout the UK’s healthcare system.”

– In September 2008, after years of delays in Lorenzo’s development [CSC] sent a Delivery Assurance Review Team to England to assess the development and testing of Lorenzo. In mid-September, the Testing Review Team met with the Deputy Head of Testing for Lorenzo, a CSC employee from December 2007 until April 2011. The Deputy Head of Testing told the Testing Review Team that the level of testing and test results for Lorenzo was “abysmal,” and that the various releases on which the project was based could not be delivered on time. Subsequently [a CSC employee] told the Deputy Head of Testing to “shut up,” which he took to mean that he should not further criticise the quality of the testing nor the testing results.

– The Deputy Head of Testing claimed that the Lorenzo software was rife with severe defects that were unacceptable under the NHS Contract. The Deputy Head of Testing said that the software defects were subject to the following ratings: Severity Level I: the defect cause important part of the Lorenzo system to fail. Severity Level II: similar to Severity I, but the defect has a workaround. Severity Level III: the defect is an important defect, but one that would not stop the system from functioning. Severity Level IV: defect is a minor defect and would not impact the Lorenzo system’s function, but would be a nuisance to a software user.

– According to the Deputy Head of Testing, throughout 2008 and 2009, the level of Severity I and II defects in every release of Lorenzo was “high and grossly beyond” what the NHS would accept. According to the Deputy Head of Testing, while CSC publicly reported that it had met certain delivery milestones and therefore could recognize revenue, CSC’s statements in this respect were misleading in view of the software defects detailed above.

– CSC said in November 12, 2008, when analysts asked about missed deadlines, that “Our confidence continues to build on the program. We are pleased with our progress.”

–  In financial statements CSC continued to assert that the NHS contract was profitable and the Company expected to recover its investment.

– Shortly before the Deputy Head of Testing retired from CSC in early April 2011, he sent an email directly to a CSC director, copying several other CSC executives, in which he said ‘You hope that you will succeed by August 2011. I do too but you won’t. The project is on a death-march where almost as many defects are being introduced as are being fixed.”

–  by 2006 CSC had determined that it had no believable plan for delivering on the NHS Contract and should not have booked revenue under the contract from that point forward.

– The significance of the NHS Contract to CSC “placed the project squarely in the spotlight of Wall Street analysts”.

–  CSC “continuously denied media reports critical of CSC’s performance of the contract”

CSC is expected to file its response to the allegations in due course.

CSC sued on losses over disastrous NHS contracts – Observer

CSC class action – document in full on Guardian’s website

CSC repays £170m to DH after non-signing of MoU

By Tony Collins

CSC reports today that it has repaid to the Department of Health £170m of a £200m advance it received earlier this year for NHS IT work that was due to be carried out under a memorandum of understanding.

The MoU was not signed as had been expected by 30 September 2011, so CSC has repaid the money.

But the Department of Health has entered into an “extended advance payment agreement” with CSC for £24m.

In a statement dated 3 October 2011 CSC has also disclosed that uncertainty continues over the future of its NPfIT contracts that are worth about £3bn.

It says that it is having a series of meetings with the NHS and Cabinet Office officials over the “next several weeks” and adds that: “there can be no assurance that the MOU [memorandum of understanding] will be approved nor, if it is approved, what final terms will be negotiated and included in the MOU”.

The statement relates to CSC’s negotiations with the Department of Health and the Cabinet Office’s Major Projects Authority over a draft memorandum of understanding that proposes cutting the cost to taxpayers of CSC’s contracts by about £800m but would cut back planned deployments of Lorenzo by nearly two thirds and could nearly double the cost of each remaining deployment. One Cabinet Office official has described the terms of the memorandum of understanding as unacceptable.

CSC says today that “progress is continuing in development and deployment projects under the contract in cooperation with the NHS, although progress has been constrained due to the uncertainty created by the government approval process”.

It adds:

“Humber NHS Foundation Trust has been confirmed as the early adopter for mental health functionality to replace Pennine Care Mental Health Trust, which withdrew as an early adopter in April 2011, and CSC and the NHS are preparing to formally document this replacement under the contract.

“On April 1, 2011, pursuant to the company’s Local Service Provider contract, the NHS made an advance payment to the company of £200m related to the forecasted charges expected by the company during fiscal year 2012.

“The amount of this advance payment contemplated the scope and deployment schedule expected under the MOU and the parties had anticipated that the MOU would be completed and contract amendment negotiations would be underway by September 30, 2011.

“… the advance payment agreement provided the NHS the option to require repayment of the advance payment if the parties were not progressing satisfactorily toward completion of the expected contract amendment by September 30, 2011.

“Because completion of the MOU has been subject to delays in government approvals and, as a result, contract amendment negotiations have not progressed, the NHS required the company to repay approximately £170m of the April 1, 2011 advance payment on September 30, 2011, and the company agreed and made the repayment as requested.

“Also on September 30, 2011, the NHS and the company entered into an extended advance payment agreement providing for an advance payment of approximately £24m to the company in respect of certain forecasted charges for the company’s fiscal year 2012.

“The extended advance payment agreement acknowledges that the company’s Local Service Provider contract, as varied by the parties in 2010, is subject to ongoing discussions between the parties with the intention of entering into a memorandum of understanding setting out the commercial principles for a further set of updated agreements.

“The company intends to discuss the extended advance payment structure and certain fiscal year 2012 deployment charges with the NHS in connection with the MOU negotiations.

“However, there can be no assurance that the parties will enter into the MOU or that the company’s forecasted charges under the contract for the remainder of fiscal year 2012 will not be materially adversely affected as a result of the delay in completing the MOU and the related contract amendment.”

Meanwhile some investors of CSC have taken legal action against the company.

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Investors sue CSC

By Tony Collins

The Observer reported yesterday that some CSC investors are suing the company, saying it was giving assurances about the “Lorenzo” software when it had been warned that the software project was on a “death march”.

According to the class action complaint, which was brought on behalf of a number of investors led by a major Canadian fund, the Ontario Teachers’ Pension Plan, CSC knew in May 2008, through reports and testing, that Lorenzo was “dysfunctional and undeliverable”.

The complaint cites one member of an internal CSC “delivery assurance review team” which visited the UK and India, where Lorenzo was developed, in early 2008.

He said the team were consistent in the message that CSC could not meet its deadline. “We could not deliver the solution set that we had contracted with the NHS.”

The review team member added that, at the time, “costs were building up on the balance sheet and the project was behind schedule”. The review team knew that the contract was a loser and CSC should have recognised a loss in 2008, according to The Observer, quoting the team member.

Lorenzo’s deputy head of testing told a second delivery review team that test results were “abysmal”. According to court filings, the test official was later told by his boss to “shut up”, which he took to mean he should no longer criticise testing.

Shortly before retiring in April this year, the deputy head of testing emailed CSC chief executive Michael Laphen saying: “The project is on a death march where almost as many defects are being introduced as are being fixed. Look at the defects reports.” Despite these internal concerns, CSC told investors that Lorenzo and CSC’s work for the NHS was on track.

Investors said they dismissed negative media reports on the basis of reassurances from CSC that the NHS work was on track, making significant progres in testing, and receiving positive feedback from the NHS. In response to press coverage, CSC is said to have told investors: “The press speculated wildly and inaccurately on the status of the NHS programme.”

CSC has made no statement.

Lorenzo is the main NPfIT product to be delivered and deployed to NHS trusts by CSC under contracts worth about £3bn. The Cabinet Office and the Department of Health are negotiating with CSC to continue or drop Whitehall’s commitments to CSC Lorenzo deployments.

CSC’s share price today stood at $26.85,  close to a five-year low.

Class action document – Guardian website

Simon Bowers’ article in The Observer