The agenda was set at the highest level with the UK government’s proposal that the National Health Service in England and Wales would be made fit for the 21st century, with IT systems to link every hospital and GP’s surgery. However, two years into the National Programme for IT scheme, things are not looking too promising
The vision of UK prime minister Tony Blair was that an ambulance paramedic should have real-time access to the medical notes of a casualty, irrespective of where they lived, and family doctors (GPs) could book convenient hospital appointments for patients before they left the surgery.
Richard Granger was appointed as the highest paid civil servant, on GBP250,000 per annum (more than the prime minister!), to head the National Programme for IT (NPfIT) and facilitate the delivery of the core infrastructure that would support the vision, at both a national and regional level.
Mr Granger brought in some of the most capable people in the IT business, and they very quickly (in public sector experience) established contracts for a number of national application providers (NAPs) for projects, such as a data spine and centralized hospital bookings, and for five local service providers (LSPs) to deliver new patient administration systems (PAS) and GP systems on a regional basis. These contracts ‘transferred’ risks to the suppliers, with payments to the providers being based on results, and incorporating fines for non-delivery. So far, so good – or so we thought.
Now, two years after contracts were signed, the performance of the suppliers for the LSPs and ASPs is available on the NPfIT web site and it doesn’t make good reading. Mr Granger has rightly criticized the suppliers for having ‘variable ability’. With regard to the ASPs, BT is reportedly 12 months behind on one of its contracts, as is Atos Origin, with only 20,000 appointments having been made through the ‘Choose and Book’ appointments system, instead of the 250,000 target. Defending the latter delay, Mr Granger is reported, in a leaked email recently seen by the UK Sunday Times, to have told a senior civil servant in the Department of Health (DoH) that the delays in the development of the system stemmed from changing specifications from the department.
However, it could be with the LSPs that we are starting to see even bigger challenges to the program.
The negotiations with the selected companies for the LSPs were obviously ‘commercial in confidence’, and the potential liability for those LSPs for non-delivery were so onerous that one company, Lockheed, voluntarily withdrew from the process. An appointed LSP, Accenture, has already warned its shareholders that short-term profits will be cut because of its involvement with the program. However, the confidentiality was so great that local health trusts were not told that those contracts also included the secondment of 200 NHS employees a year to the LSPs to act as domain experts to facilitate implementation.
The fact is that not every trust has ‘spare’ experienced IT personnel to second. Quite the reverse, the NPfIT itself placed requirements on trusts to implement technologies to enable the national applications and new PAS systems to be accessed within hospitals, health centers and GP surgeries. Consequently only about one fifth of the expected secondees have been found, and obviously the LSPs have taken longer to ‘get up to speed’.
Deploying a large number of systems rapidly requires standardization, and the LSPs entered into contracts with software providers that they believed gave the greatest standardization, and also chose providers that were prepared to take on some of the risk. However, this has also meant that in some cases ‘lowest common denominator’ solutions were selected, without the involvement of the healthcare staff that were to be using them.
Many GPs rightly ‘kicked off’ about the fact that the relatively advanced, and widely-used, EMIS system was not included in the initial choice of products to be deployed in their surgeries, because the supplying company was not large enough to take on the potential liabilities in the contract.
One group of mental health hospitals is now starting to pressurize its LSP to drop the PAS provider, because they do not believe that the system will ever be up to the job. One IT director is noted as stating that the PIMS system from iSoft was only now (in 2005) providing the bug-free functionality that was expected in 2000.
In the leaked email, Mr Granger reportedly went on to say that the whole program was at risk because of the DoH changes, but the risks appear much greater from the local level.
This is not the right place to dissect the emerging problems. What is needed now to keep the program going is clear and strong leadership. The potential rewards are too great for the program to be abandoned at this point, but if it is not brought under control soon, we have the potential for the world’s biggest public sector IT debacle.
Source: OpinionWire by Butler Group (www.butlergroup.com)