NHS Connecting for Health, the DH agency responsible for delivery of the NHS National Programme for IT, has issued a briefing note stating that service levels have been restored to normal following service reliability and availability problems with the NHS spine over recent weeks.

According to CfH briefing note a normal service has been operating since 12 January 2006. Its latest briefing apologises for inconvenience the disruption the recent spine problems has caused to NHS staff.

As previously reported by E-Health Insider the NHS Care Record Spine and connected national systems, including Choose and Book and the Electronic Prescription Service, have been suffered from reliability issues following a troubled upgrade to the spine beginning 17 December.

A 2 January internal briefing note from CfH’s Choose and Book team identified problems experienced by end users including "intermittent failure updating patient demographic information", "failure to automatically generate a patient password" and "occasional slower searches for patients".

The new briefing paper stresses the scale and complexity of the NHS National Programme for IT, being delivered by "an incremental series of software releases over time to build increasingly richer "functionality" to support patient care and clinical safety."

It goes on to state: "The upgrade release to the NHS Care Record Service over the weekend of 17 and 18 December 2005 was the largest and most complex to date. It is estimated that it involved around 3 million hours of IT development over the previous year by various suppliers. The upgrade involved major changes to the Personal Demographic Service (PDS)."

At the centre of the December update was the introduction of software to limit access to a patient’s clinical record "to ensure that only those clinicians with a legitimate relationship with the patient could access the record".

The CfH statement says: "It is regrettable that our suppliers were unable to maintain full availability without interruption during the integration of the multiple systems that took place following the upgrade. It is also regrettable that the solutions do not yet appear to meet the exacting standards we require to support continuous working 24 hours a day seven days a week."

Identifying the specific issues that caused "intermittent interruptions" to the live service the briefing paper says these include:

• One of the existing suppliers of GP IT systems [understood to be InPractice Systems] had a defect in the way its system linked with the upgraded Spine. It meant that the system persistently and automatically sent high levels of erroneous traffic into the Spine. This caused “congestion” as data flowed round the system without making a connection and made problem detection difficult.

• The congestion described above together with intermittent slow response times and changes in the Spine upgrade made it difficult to use Choose and Book and the Electronic Prescription Service.

• In particular, the Choose and Book application, when generating a password for the patient to access their booking, did not link correctly with the PDS. An immediate improvement has been applied to the Choose and Book application and the permanent solution is due in February.

• Following diagnosis of the reported problems with the updated PDS service, a number of improvements have been made, including how information is written to the database.

CfH says that throughout the recent problems it has held "twice daily escalation and resolution dialogues with the suppliers involved" including during the Christmas and New Year holiday. In addition it says the issues were escalated within each of the supplier organisations "to ensure that the seriousness of the situation was understood and that priority was given to providing resources and expertise".

The NHS IT agency says that following recent problems it will be seeking additional assurances from its suppliers over how they will make their systems more robust and how in future we all ensure their systems interface with each other seamlessly. It also states that under the contracts signed the December spine upgrade work will not be paid for until there has been "a run of 120 hours normal continuous service".


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