A Few Good Men

Debbie Williams

Blog, Monday 9th November 2009

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It’s been reported in Computing magazine that there are only 174 clinicians using Lorenzo patient software to set up centralised electronic health records across the five early adopter trusts.

Five Boroughs Partnership, Bradford Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay, Hereford Hospitals and South Birmingham have only ever had 19 clinicians using the systems at the same time.

The low uptake is of course skewing the costs for deployment, and providing ammunition for NPfIT sceptics…with so few clinicians on board, the cost per user is currently many hundreds of thousands — possibly even more than a million — pounds per user per year.

Critics claim the low uptake is hardly surprising, given the teething problems witnessed amongst early adopters, and the fact that this part of the programme is already running four years late.  What’s more, it’s the taxpayer we are told, who will also have to pick up some of the bill if sceptical trusts refuse to deploy Lorenzo or Cerner software.

However, financials aside, the more worrying issue seems to be the lack of buy-in from clinical staff.  A truly national programme necessarily requires buy-in from every trust and from every clinician – without this universal support, the idea simply does not and cannot stand up.

The £12.7bn National Programme for IT – the world’s largest civilian IT project – is a hugely ambitious one, and obstacles are to be expected.  To make it a success will require a lot more blood sweat and tears from all involved.  The question is, is there enough support from the trusts themselves and from the clinicians who will depend on the system for the work they do every day?

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Paying Fujitsu its Dues

Debbie Williams

Blog, Tuesday 1st September 2009

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Computer Weekly’s report on the ongoing disputes between Fujitsu and the Department of Health raises interesting questions about the National Programme for IT, and the government’s relationships with key suppliers.

Having received a termination notice from the DoH last May, Fujitsu is said to be seeking £700m in lieu of work already done, and litigation seems to next likely step.  Given DoH defensiveness over NPfIT, however, the case is unlikely to ever be heard in court, with a secretive settlement the likely outcome.

It’s difficult to know where to stand on this.  On the one hand, Fujitsu clearly invested the time, effort and resource into helping to develop its part of the world’s largest civilian IT project, the full complexity of which has only become apparent as the project progressed.  So you might say a fair day’s pay is due for a fair day’s work.

However, the government’s motto has always been payment by results, and that by failing to deliver on its commitments, Fujitsu should not be paid.  This is a fundamental element of the government’s attempts to control costs for the project.  It ensures best value for the taxpayer and yet rewards companies for genuine progress made.

To pay or not to pay, that is the question.

16 months on, and luckily Fujitsu’s departure from its role as local service provider on NPfIT for the south of England has not hindered progress made in the region.  We’re continuing to work closely with many of the trusts in the region including Southampton University Hospitals Trust, Hampshire Partnership and Royal Devon & Exeter, who are all making real strides towards improving key areas of trust management from finance and referral to treatment time reporting, through to managing the complexities of mental health reporting.

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Sweden Follows the UK Example With its Own National Programme for IT

Debbie Williams

Blog, Tuesday 18th August 2009

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It was encouraging to read news in Public Service magazine about Sweden’s progress in delivering its own version of the UK’s National Programme for IT – the National Patient Summary (NPÖ) – which will help Sweden’s health service improve healthcare whilst maintaining patient privacy and data security.

I say encouraging, because Sweden – like its Scandinavian neighbours – has an enviable record for its public services and state welfare, from health and social care through to education.  So for them to be looking to the UK for inspiration on how to better manage healthcare delivery, the NHS must be getting things right.

The goal to digitalise healthcare in Sweden will involve linking up 21 county councils, 290 municipalities and 6,000 private care providers to the NPÖ, a system that will improve diagnosis, treatment and follow-up, and ensure patients have greater access and control over their medical records, and security controls that will ensure peace of mind.

The healthcare challenges faced in Sweden are the same that we face here in the UK, amongst them that of an ageing population.  With an increasingly mobile population, an interoperable records system is vital to ensuring vital information flow between different care providers.

The effective flow of patient and clinical data is crucial in ensuring timely and joined-up care provision. Care providers at every stage, from the primary care setting through to acute, A&E and mental healthcare provision need accessible patient data, in order to delivery the high quality care we expect.

As other countries begin to follow the UK’s lead in developing national healthcare IT infrastructures, we should take the opportunity to look and learn from the progress and success they are witnessing, in order to continue to improve upon our own national system.  Closer collaboration and sharing of ideas can only lead to improved systems and improved outcomes, which has to be a good thing.

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Dispelling NPfIT Blues

Debbie Williams

Blog, Friday 7th August 2009

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It’s all too easy, at times, to join in with the many and vocal critics of the National Programme for IT, to complain of the delays, the overspend, the perceived lack of progress.  In our enthusiasm, it’s all too easy to overlook the scale of the project, and the significant progress made to date.

The Guardian published a timely reminder of what has actually been achieved, stripping away the much reported delays, contractor disputes and spending rows.

In what is the largest civilian IT project in the world, across 330 NHS trusts and hundreds of geographically diverse hospitals and clinics, four of the five key systems are already in place, progressing well, and completed ahead of time.  Choose and Book, the electronic transfer of prescriptions, broadband networking and x-ray archiving are already delivering benefits to patients and staff.

The electronic patient record (EPR) system is admittedly behind schedule, but similar projects have caused headaches the world over.  President Obama has recently committed $19.2bn for EPR systems in the US – proof if needed that the aims of NPfIT are worth striving for.

No other country has managed to connect up its healthcare systems.  Perhaps England, as she has done so many times in her history, can be a world leader in this field.

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St Helens and Knowsley Splits from the National Programme

Debbie Williams

Blog, Friday 29th May 2009

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St Helens and Knowsley Teaching Hospitals NHS has split from the National Programme for IT, deploying its own patient records system. The Trust also expects to save £3.2million as a result.

The main driver behind the Trust’s decision was simple – getting the right patient notes to the right clinical staff at the right time – and who can argue with this line of thinking?

The aim of NPfIT is a noble one, but the fact remains that trusts have a duty of care towards those that they care for. So while Waiting for Godot may be towing the party line, it also means that many trusts are still using paper-based systems, meaning processes are not as efficient as they can be.

St Helens and Knowsley has taken a sensible and proactive decision, working with a smaller provider to develop a bespoke solution capable of meeting its immediate operational needs, improving operational efficiency, getting the right information to the right people, and improving outcomes.

Win-win for clinicians and patients.

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NPfIT An Inspiration To Governments Around The Globe

Debbie Williams

Blog, Tuesday 19th May 2009

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In a shock turn of events within the world of politics, the government has heaped praise upon its flagship National Programme for IT. According to health minister Ben Bradshaw, NPfIT has inspired other nations to consider similar programmes.

Bradshaw said: “Countries all over the world are considering this, including Barack Obama’s America, where people are looking to introduce a similar sort of national computer system into the American health care system as the one we have here.”

Equally surprising was the opposition promptly taking aim to shoot down such claims of success, accusing the government of failing to deliver, low take-up rates on Choose and Book, and moving the goalposts on national targets.

NPfIT has the potential to transform healthcare management, improving access to data and the sharing and exchanging of data, to help streamline healthcare delivery, and deliver cost and efficiency savings.

However, the self congratulatory tone of the government is somewhat premature. Progress is being made, but the one-size-fits-all approach does seem to be causing issues, with some Trusts opting to leave the national programme and adopt more flexible solutions from smaller, often more innovative suppliers.

NPfIT is undoubtedly bringing improvements to clinicians and to patients, through continued evolution and development – it will be interesting to see how and where it’s adopted overseas, as the government predicts.

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Back to Square One, as Government Retenders for core NHS IT systems?

Debbie Williams

Blog, Tuesday 17th March 2009

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The Department of Health has announced it will tender for alternatives to the iSoft Lorenzo and Cerner Millennium care record systems, in what many must surely view as a step backwards in the national programme.

NHS chief executive David Nicholson has admitted that the tender was being carried out as a back-up plan because the National Programme for IT (NPfIT) in the NHS is now at a “critical phase”. The iSoft and Cerner products need to come good in the next few months and deliver what they promised, and if not, then the Government will look to alternative options.

Back to square one, anyone?

Whilst the Government continues to defend the progress made and cost involved in its flagship NHS IT project, an increasing number of questionsare being raised, both from outside observers and those within NHS Trusts, as to the viability of the project.

Success will mean truly world-class commissioning and world-leading care. Failure would be a colossally expensive IT project gone horribly wrong.

Let’s hope this latest hitch does not serve to derail progress made to date.

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