As always, the future of the National Programme for IT in the NHS was the key topic of debate at Healthcare Computing conference in Harrogate. Christine Connelly and Martin Bellamy both gave clues about the way ahead. Sarah Bruce reports.
This year’s Healthcare Computing conference in Harrogate was the first chance for Christine Connelly to end speculation about the future of the National Programme for IT in the NHS.
The newly-styled ‘director general of informatics’ was appointed alongside a new head for NHS Connecting for Health, Martin Bellamy, last summer. Almost immediately, she launched a review of NPfIT and, in particular, its troubled attempts to deliver ‘strategic’ electronic patient records to acute trusts and healthcare communities.
In Harrogate, it soon became clear that the conclusions of the review are not to be published. Instead, the Department of Health issued a statement saying that: “Having reviewed the progress and strategy for the NPfIT, the CIO is clear that all the core aims of the NPfIT around providing accessible and timely information to support patient care should be retained.”
The statement said this included the existing procurement model, since it meant the NHS was not paying for systems that had not been delivered. However, in her keynote speech, Connelly had two key announcements to make.
The one that caught her audience’s attention was a new delivery model and an Apple App Store-style toolkit that should be available next March. The one that caught attention outside the conference was the November deadline for the national programme’s key suppliers to make “significant progress” with their strategic EPRs.
At a press conference after her speech, Connelly indicated that this meant the deployment of Cerner Millennium in one acute trust in the south by November and the deployment of iSoft Lorenzo in “any care setting” to the same timescale.
Connelly said little about what would happen if the deadlines were not met other than: “We’ve set a series of milestones and measures that are made to be looked at the end of November.”
Connelly’s speech went down well, with delegates saying they found her refreshing and even “inspirational.” However, there was little confidence that NPfIT implementations would be delivered in the latest timescale.
At the end of a debate titled “this house believes that it is likely that the NPfIT will provide an effective solution for acute trusts within six months”, more than 80% of the audience voted that it would not.
One of the key speakers also reflected ongoing concern that the systems to be delivered are not good ones. “Cerner is a very poor system, which has never been updated in terms of reliability,” they said.
However, other conference speakers argued that much has been learned from last year’s deployments of Cerner Millennium in London. These caused huge problems at Royal Free Hampstead NHS Trust and Barts and the London NHS Trust in particular.
Heather O’Brien, director of ICT at the Royal Free, gave a detailed presentation on what went wrong, what had been learned, and what was now achievable for others. She said: “You have to be ready on day one; using a real-time system is a complete cultural change.
“Staff need to be shown the corrective processes before go-live and all the departments need to be included in the run-through. We forgot to include departments such as intensive care in our dress rehearsal.”
Bellamy built on this by announcing a new model of delivery, with more flexibility and support for trusts. In his keynote speech, he admitted the national programme had delivered relatively little to acute care to date.
“Our position today is that we have deployed three Lorenzo systems, 12 Cerner systems and a sizeable number of interim systems into acutes. But that’s not very much, when there are a couple of hundred acute trusts out there.”
But he added: “We are making changes to our delivery that gives me the confidence that we will meet the given objectives by November.”
Bellamy also said he wanted to focus on the deployment of the Summary Care Record, with further roll-outs in local health economies in 2009.
He said that one of the early adopter sites, Bury, had received positive feedback. “The trust said that it generally found it useful, particularly in the A&E department. Now they want to know why can’t it go faster?” He added: “We have some way to go to get full support for the record but it is definitely becoming more accepted.”
By November, a general election will be not more than six months away, and this may put a further pressure on the national programme to deliver. Just before Healthcare Computing opened, Conservative Party leader David Cameron told his party’s spring conference that he did not believe in big, government IT projects.
He said that he would scrap CfH’s “electronic patient record system”, the children’s database ContactPoint and ID cards as part of his party’s plans for “a new age of austerity.” He also radiated enthusiasm for commercial personal health records, such as Microsoft’s HealthVault and Google Health.
Those attending Healthcare Computing had been hoping to hear more about the Tories’ plans; or at least what they may be advised to do in relation to healthcare IT.
Dr Glyn Hayes, former head of the BCS, was due to provide a public preview of the results of an independent review of NHS IT that he was commissioned to lead by health minister Stephen O’Brien last August. However, the report – which was originally anticipated in March – has been further delayed and no announcement was made.
Even so, many of those attending the conference were mindful of the short time left before the general election, which gives the national programme little time to prove itself to politicians. Of the future, Bellamy said: “We’re on the way, we just need to work together and we need to work faster.”
Podcast – Healthcare Computing 2009: voxpops (right click and ‘save target as’ to download)