The £12.7 billion NHS IT Programme was thrown into further turmoil yesterday after news that local service provider Fujitsu was fired by NHS Connecting for Health.
The news looks certain to create increased delays to a programme already running five years late on delivery of electronic records systems. It also leaves it facing some extremely tough choices on what to do next – there are no easy options.
Fujitsu became the second LSP to exit the programme. In September 2006 Accenture decided to cut its losses and quit the programme.
Sources suggest that after ten months of tough negotiations a deal had all but been agreed between Fujitsu UK and NHS Connecting for Health by Tuesday. Although it was CfH that terminated Fujitsi’s contract the agency did so only after the LSP withdrew from contract re-set negotiations presumably in the full knowledge of what consequences would follow.
NHS and industry sources indicate that CfH had wanted to conclude a new deal with Fujitsu and is now having to urgently work out and evaluate alternatives. Sources indicate there is no immediate alternative plan worked out. CfH still has to conclude a contract reset with CSC in the North, Midlands and East of England.
With the Fujitsu contract terminated it means that its main software sub-contractor Cerner, providing the core electronic record software, now has no contract for the Southern NHS. Only this week Cerner told investors that the NHS remained its biggest client outside the US.
Eight smaller NHS trusts in the South have had an early NHS version of Cerner Millennium installed by Fujitsu, with Bath said to still be preparing to go live. Only two sites – Taunton and Worthing – have gone live in the past year.
Sources in the South say that due to reported problems at early sites and the uncertainty of the ten-month contract reset, development of the Millennium software for the south effectively ceased.
One senior NHS IT director in the region told EHI last night. “Why would you take what is now a legacy system, which is not being developed.” Development of later Southern versions of Millennium were also a casualty of contract reset negotiations.
Some of the sites to go live – including Nuffield Orthopaedic, Milton Keynes, Buckingham and Worthing – have reported severe problems with the software. In addition, over the last month there have been two instances of region-wide problems with the centrally-hosted system going down or being very slow to access over protracted periods.
The Southern trust IT director gave his view of the R0 Millennium software on offer so far. “The problem is that its part of a PAS, you may get theatres and you won’t get A&E.” For many trusts he said that the R0 software was a step backwards.
He added that part of the problem in the South was that until very late in the day Cerner was “never included in the relationship with the customer by Fujitsu”.
BT, the LSP for London, has indicated it would be interested in taking over from Fujitsu in the South. Like Fujitsu it is also offering Cerner Millennium – though a different London version of the software. But giving the South to BT would be a big gamble as it has only installed Millennium at three London trusts. Ominously there have been reports of significant problems at both Barnet and Chase Farm and Barts and the London.
The other immediate option would be to hand the South to CSC, the other remaining LSP, already responsible for the North, East and Midlands. But this may be an even bigger gamble. In late 2006 CSC picked up the two LSP contracts that Accenture had held. Awarding it the South would create a monopoly for all of England other than London.
CSC has also yet to complete its own contract reset with CfH or implement a single instance of its core electronic records software, the long delayed iSoft Lorenzo product. Three pilot sites are meant to begin using the new software this summer but these will be limited in size. Even if all goes well it will be some time before Lorenzo is a proven robust product.
In the meantime CSC has made clear it plans to continue offering existing older iSoft software. The LSP has also been forging links with other clinical software suppliers including Portugese firm Alert.
Sources from the North, Midlands and East region indicate that CfH is keeping its options open and recently negotiated contract changes that would allow it to direct the LSP to deliver systems to any part of the country.
Option three, post-Fujitsu, would be to contract directly with Cerner, either at a regional level or trust by trust. This has attractions for those trusts in the South that have already installed Cerner, but may not be commercially feasible.
The final option is to make use of the recently completed Additional Supply Capability and Capacity (ASCC) framework contracts. This could either be used to appoint a new LSP for the South or to offer trusts a choice of approved clinical systems meeting core national standards.
What appears certain though is that there is no quick fix option available and that any option will result in further delays. One NHS IT professional posted a comment on EHI calling for a period of reflection and stability before any decision is taken.
One trust IT director told EHI that based on the original project plans the region should be three years into implementation “with around forty trust systems deployed”. Instead over four years in the programme is at risk of starting over again in the South.
“What should happen next is that CfH should choose five PAS and clinical systems and let trusts choose which works best for them,” the IT director told EHI.
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Jon Hoeksma