The Department of Health may be renegotiating a £3 billion deal with CSC using inaccurate figures on how many NHS hospital trusts plan to take Lorenzo.

Officially reported figures, seen by EHI, strongly indicate that the vast majority of trusts in the North Midlands and East of England plan to take either Lorenzo or SystmOne electronic patient record software from local service provider CSC under the National Programme for IT in the NHS.

This apparently resolute commitment to Lorenzo stands despite of lengthy delays, significant reductions in functionality, and being offered the chance to take alternative electronic record systems outside NPfIT.

However, EHI’s analysis of its recent reporting of IT investments at local trusts throw significant doubt on the reliability of the figures, and suggest there may be a much lower take-up of Lorenzo in particular.

The news comes with the Department of Health thought to be on the brink of signing a new Memorandum of Understanding with CSC, covering future installations of the iSoft system. 

A new deal hinges on the numbers of NHS sites the DH can commit to taking the software.

Negotiations with CSC for a new deal delivering £500m in savings, reductions in product scope and numbers of sites have run for 18-months.

In March, trusts across the NME were sent correspondence telling them that the functionality of Lorenzo would be scaled back and asking them whether they would like to opt out of taking the system – or ‘get off the Lorenzo bus.’

EHI sent Freedom of Information requests to all six strategic health authorities across the NME requesting information on how many trusts in each region had confirmed their intent to deploy Lorenzo and also TPP’s SystmOne.

In response, NHS North West said that out of 60 responses, 56 trusts confirmed intent and only four had withdrawn. It declined to to name these trusts.

Yet EHI’s own recent coverage suggests that more than four trusts in the North West are actively pursuing EPR strategies that mean they will never take Lorenzo.

EHI estimates that at least seven but more likely 11 trusts in the North West are now actively pursuing alternative IT strategies.

Blackpool, Flyde and Wyre Hospitals NHS Foundation has just gone live with an Alert EPR. Wirral University Teaching Hospital NHS Foundation Trust is in the midst of a huge Cerner implementation.

And Wrightington, Wigan and Leigh NHS Foundation Trust recently committed to a new EPR from Cambio.

Together with the three above, EHI has reported that four more trusts in the North West no longer plan to take Lorenzo, taking the total to seven.

In September, EHI reported that Trafford Healthcare NHS Trust has opted out of Lorenzo.

In October EHI reported that NHS Wirral has dropped its implementation  and would go out to tender.

At the beginning of November, the IT lead for South Cumbria told an audience at eHealth Insider Live 2010 that NHS Cumbria was no longer committed.

Just a week ago, St Helen’s and Knowsley Hospital NHS Trust told EHI that having introduced electronic document management they are no longer committed to Lorenzo.

But the true figure of hospital trust opt outs is likely to be even higher. Four further acute trusts in the area – Alder Hey Children’s NHS Foundation Trust, Liverpool Women’s NHS Foundation Trust, Countess of Chester NHS Foundation Trust and Warrington and Halton Hospitals NHS Foundation Trust – all run Meditech.

They are not expected to switch to systems that offer reduced functionality. One source explained the big discrepancy with the SHA’s figure of four.

“It costs the trust nothing, and it’s politic to tell NHS Connecting for Health and the SHA that you may one day take Lorenzo; while quietly getting on with planning to do something else”.

The discrepancy suggests that many trusts may have told their SHA they intend to deploy Lorenzo to simply keep their options open, not fully appreciating they would be counted as a 100% committed as part of a binding new deal.

The remaining five SHAs refused to provide responses to the FOIs, citing commercial confidence on the grounds that negotiations between the DH and CSC are still ongoing.

The responses added that there was “potential to prejudice the commercial interest of one or other party to the negotiations by providing the requested information at this stage.”

If similar numbers to those offered by NHS North West were applied across the 230 trusts across the whole of the NME, only 16 trusts would withdraw from the programme.

But if the true figures are in line with EHI’s calculations for the North West, almost 70 trusts out of a total of 230 have already effectively opted out.

When asked whether this figure was accurate, a Department of Health spokesperson told EHI: "Current feedback from the NHS indicates that the majority of trusts across the North, Midlands and East of England remain committed to deploying Lorenzo once it has passed the verification testing underway at the early adopter sites."

EHI understands though that only a handful of absolutely firm commitments to take Lorenzo yet exist after the four early adopters.

A source close to one SHA said that there had been extensive discussions as to whether the information under the FOI should be disclosed.

The discussions had concluded that EHI would try to aggregate the data to find out how many trusts would opt out, and that this had the potential to affect company share prices.

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