A board paper written for the largest NHS trust in England says that its region of the National Programme for IT does not have a roadmap for delivering an electronic care record.

The report, submitted to Leeds Teaching Hospitals NHS Trust, by director of informatics, Brian Derry and his deputy, Alastair Cartwright, in October says: “Other than PACS (digital radiology), there are no strategic clinical systems on offer in Yorkshire and the Humber.

“CFH is increasingly announcing ad hoc developments, for example blood tracking and oncology e-prescribing systems, not least as a means of increasing clinician engagement in the national programme. However, such initiatives are invariably under-funded and over-ambitious.”

The paper makes plain that the LTHT technology team is aiming to stay self-sufficient in IT while working in a ‘new landscape’ of slow progress nationally in acute trusts.

Derry and Cartwright say: “…for the North-East of England, CfH [Connecting for Health] does not have a roadmap for delivering an electronic care record; nonetheless the trust continues to make progress.

“We have very positive and constructive relationships with the SHA IT team, who share our perspective.”

Summarising the CfH position at the beginning of the paper – which was obtained under the Freedom of Information Act by Computer Weekly – Derry and Cartwright say the implementation of GP systems has generally been a success and good progress has been made with community and child health systems.

They add however that little has been achieved in providing strategic systems for secondary care (acute and mental health) – especially in the North East and East of England. In particular, they say patient administration system replacements for several West Yorkshire trusts are running at least two years late.

Derry and Cartwright outline good progress with LTHT’s own information strategy. “Numerous departmental systems have been rationalised and integrated; and true clinical systems are being implemented, notably the new Clinical Information System and PACS.”

They also point out a number of improvements and new-builds they have put into their infrastructure including the electronic archiving of 150,000 health records and full connection to the N3 network. Work has also been completed on patient pathway management, staff libraries and e-learning modules.

Despite this positive picture of progress, at several points the IT director and his deputy refer to difficulties that the National Programme for IT is creating locally.

In another damning paragraph, they say: “LSPs and their sub-contractors are not keeping up with the scale and complexity of the national programme. Existing supplier offerings are obsolescent, as major policy initiatives – notably the 18 weeks waiting times target and Choose and Book – arrive with inadequate DH allowance for the significant informatics and associated change management consequences.”

There is also concern about the future of iSoft, the clinical systems sub-contractor to the North East and a supplier used independently by LTHT.

“The company has gone from being a market-leader with a large user base, to a company with open financial problems due to its inability to meet CfH demands and whose accounting practices are under investigation by the Financial Services Authority,” write Derry and Cartwright.

They speculate that the company is likely to be taken over before a complete collapse but warn that there could be future problems with support and development for iSoft systems and possibly extra costs.

The paper refers to Accenture as the local service provider – a factor which has changed since CSC stepped in to take over Accenture’s contracts. A handover is due to be completed by early January.

CFH responded with a lengthy statement which did not refer directly to the LTHT paper but said that early adopters of the NHS Summary Care Record would be introduced in a small number of locations from early 2007.

It added: "A wider roll out strategy is in development – after evaluation of the early adopter activity, 2007/08 will see the gradual delivery of the NHS Summary Care Record system to GP practices across England.

"Many new systems have gone live and represent a huge effort on the part of the NHS, the suppliers and NHS Connecting for Health staff in deploying much needed new systems. As is inevitable in any large IT enabled change programme that is deploying into operational NHS sites there will be changes to deployment dates for a range of reasons that can either be supplier or NHS driven or a combination of both. Where deployments have not taken place, these have been re-scheduled by agreement between the NHS trust and the supplier.