NHS chief executive David Nicholson has said the National Programme for IT in the NHS is at a “pivot position” and that the DH would not tolerate continued delays, “we can’t go on and on like this.”
Answering questions from the House of Commons Health Select Committee yesterday Nicholson said: “If we don’t make progress relatively soon, we are really going to have to think it through again.”
He stressed that the programme could count many successes on areas such as PACS, QMAS and electronic transfer of prescriptions but said it continued to struggle on the core integrated shared electronic record systems – the Care Records Systems – meant to be provided by local service providers BT and Computer Sciences Corporation (CSC).
“The thing about the National programme for IT is that it has had some difficulties delivering part of it, but there have been significant improvements as well.”
In May, the National Audit Office said delivery of CRS systems was running at least four years late. Since then delays on CRS have further mounted across England, and Fujitsu fired as the LSP in the South. In London, there have been major problems at the first sites to receive the Cerner CRS system from BT.
Nicholson said part of the problem on CRS was that “there are not the products available to do the things we want them to do.” He added: “Nowhere else in the world do they provide services in quite the way we do.”
He said that the Cerner CRS system planned for London and the South offered “fantastic functionality clinically, but its also based on billing, its been developed in America, and does not take into account a whole series of issues around 18-weeks and patient tracking that we need, as a result we’re having to change all of those.”
He said that consequently, the Cerner CRS product “was not absolutely there”. Asked whether these problems should have been foreseen, Nicholson said of the four-plus year delay to CRS: “It’s not a good result.”
Nicholson made clear the DH’s patience was wearing thin. “We’ve got to think about how we take it forward. We can’t go on and on like this.”
He said there were encouraging early reports of the Lorenzo system, “very tentatively being tested” in early sites in the North and East of England, but said it remained at an early stage “we’ve got to be very careful about that.”
On Cerner he said: “We’ve got some serious issues around the Cerner system, particularly in London at the Royal Free, and what we’ve said to Cerner and BT is that they’ve got to solve that problem at the Royal Free before we think about rolling it out across the rest of the NHS.
“So we’re really at quite a pivotal position in terms of the national programme for IT. If we don’t make progress on this relatively soon I think we’re going to have to think it through again.”
He concluded: “We’ve got some very difficult issues to tackle in the National Programme right at this moment”.
He denied, however, that there have been cost over-runs, saying where extra costs had been incurred, more functionality had been asked for. “The basic contracts with the local service providers are fixed for the whole period.”
Despite continued delays, Nicholson also stressed that the way the DH had contracted “did save several billion in procurement costs” and meant that it only paid by results. “We’ve only spent something like 28% of the money available to us for the National Programme for IT. I wish we’d paid more but I do think it has proved a very effective way of taking things forwards.”
Asked whether there were plans to replace Fujitsu as LSP in the south, Nicholson said he’d been involved in the termination of the contract “because we didn’t believe they could deliver.”
He said options in the south included “one of the existing LSPs take them over, so BT or CSC, or a combination of both, and we’re working through that with them.” Nicholson said there was also the option of “going for another local service provider outside of those two and we’re currently working through that. We’ll be making a decision around February on what to do with that”.
Referring to the Wanless review on NHS, Nicholson said Wanless had said the service needed to spend 4% of budget on IT “and we’ve not got there yet”.
Asked whether he remained confident the care Records System would be delivered by 2015 [five years later than NPfIT’s original 2010 timetable], Nicholson remained optimistic: “Yes I’m confident we’ll have a workable system by 2015.”
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