The country spent the spring of 2010 waiting for a general election that was finally held in May. Unfortunately, voters failed to deliver a clear message about which party they would like in power.
The ended up with two: the Conservatives and the Liberal Democrats in coalition. Shadow health secretary Andrew Lansley got the top job at Richmond House, while Simon Burns became the latest minister to take charge of NHS IT.
Over the second half of the year, the sheer scale of Lansley’s plans to shake-up the NHS emerged, while patients were promised an “information revolution” to drive choice and accountability.
The end of the National Programme for IT in the NHS was effectively announced in the autumn; although its major contracts live on – and the National Audit Office is going to review the value for money of the latest versions, which will deliver far less functionality to fewer trusts than once envisaged.
When it came to NPfIT deployments, University Hospitals of Morecambe Bay NHS Foundation Trust finally went live with Lorenzo, but is struggling badly with it. And St George’s Healthcare NHS Trust was the only one to deploy Cerner Millennium. Although Imperial College Healthcare NHS Trust says it will go live in 2011…
January: The country had barely got back to work before the Conservatives started to issue their draft manifesto in chunks. The health service was told the Tories would set up an independent NHS board, let GPs commission care, unleash an “information revolution” and deliver electronic health records to all.
Meanwhile, shadow health secretary Andrew Lansley told E-Health Insider it might be possible to “abandon” the National Programme for IT in the NHS’ local service provider contracts, because the companies involved might not find it worthwhile to continue with them.
Mid-month, University Hospitals of Morecambe Bay NHS Trust reported it had not completed the go-live of Release 1 of iSoft’s Lorenzo electronic patient record system; a year after starting. Away from the national programme, NHS Connecting for Health advised the NHS to fix bugs in Internet Explorer 6 and to consider moving to IE7; while the French and German governments advised ditching IE altogether.
February: With four months to the election, the impact of Labour budget cuts on the national programme became clear when it emerged that Lorenzo would stop at Release 2. Effectively, this limited what was once billed as a whole health-economy system to hospitals. ISoft insisted it would win anyway, as the ‘descoping’ would help it to sell additional functionality to NHS trusts.
An independent report on the scandal at Mid Staffordshire NHS Foundation Trust called for an “impeccably independent and transparent source” to be set up to produce comparative statistics for the NHS. The government set up a working group to review the Hospital Standardised Mortality Ratio.
March: Shadow health minister Stephen O’Brien accused Labour of signing deals that would “lock in” the national programme. MP Richard Bacon urged the DH to explain how the ‘de-scoped’ deals could be value for money, while the Department of Health admitted it could only find three Southern trusts to take Cerner Millennium as part of a £540m deal signed with BT in 2009, rather than the four promised.
The national press gave rather more attention to the Summary Care Record, when NHS London started rolling it out. The British Medical Association called for the “break-neck” roll-out to be suspended, claiming patients were not sufficiently aware of it.
April: St George’s Healthcare NHS Trust delivered an Easter gift to the national programme by going live with Cerner Millennium. But a few days later, the debate about the value for money of the national programme’s deals intensified when it emerged that BT’s new LSP deal for the capital would deliver far less than once anticipated.
Back in the North, Midlands and East,Morecambe Bay missed the deadline set by DH director general of informatics Christine Connelly to fit to go-live with the latest version of Lorenzo, Release 1.9.
With the country preparing to vote, the Conservatives launched their manifesto at crumbling Battersea power station, with shadow health secretary Andrew Lansley talking about turning the DH into the Department of Public Health. And think-tank 2020Health issued a report by John Cruickshank on the action a new government should take to ‘fix’ NHS IT in its first 100 days in office.
May: The country finally went to the polls, but failed to award a general election victory to any one party. Eventually, a new Conservative-Liberal Democrat administration was formed. Andrew Lansley secured the top job at Richmond House, while Simon Burns became the latest health minister with responsibility for NHS IT.
The new administration immediately froze spending on big government projects, including IT projects. The Queen’s Speech put some flesh on the bones of the Conservative’s health plans, making it clear that strategic health authorities would be abolished.
June: The summer arrived and Morecambe Bay unexpectedly went live with Lorenzo Release 1.9. ISoft told the Australian stock-market that ‘political uncertainty’ in the UK had hit its revenues in fiscal 2010. A few days later, the company had to apologise to the NHS and CSC for any “unintended criticism” in its comments.
Professor Trisha Greenhalgh and colleagues from University College London released a final evaluation of the NHS Summary Care Record, saying pilots had delivered few if any of its anticipated benefits. In response to press stories, rather than the evaluation, the government announced another review of the SCR’s content and consent model.
July: The scale of Lansley’s plans for the NHS became clear when the Department of Health issued a white paper – ‘Equity and excellence: Liberating the NHS’. In order to hand most commissioning to GPs, it not only abolished strategic health authorities but primary care trusts. Patients were again promised an ‘information revolution’ and "more control" over their health records.
As the Treasury continued to hunt for savings, Microsoft’s Enterprise-wide Agreement with the NHS was axed; the first of a number of EwAs to go. But the Information Centre emerged as one of the big winners of the DH’s arms length bodies review.
August: In the dog days of summer, rumours started to circulate that NPfIT would end in its current form, and that government chief information officer John Suffolk was none-too-keen on the NHS Connecting for Health brand, either. Hard news emerged that the Audit Commission was going to form the largest log on the government’s promised ‘bonfire of the quangos.’
Away from London and down in the South, Candy Morris, the manager leading the Additional Supply Capability and Capacity framework procurements for systems of various kinds in the South insisted that they remained on track and would be funded. Little had been heard of the procurements since the election.
September: ISoft’s troubles deepened when it announced major losses in its full year results. Gary Cohen, who had been both executive chairman and chief executive, stood down, having already been replaced as chairman by Robert Moran.
Meanwhile, one of ISoft’s big customers had its own end of era moment. Health minister Simon Burns effectively brought down the curtain on NPfIT, announcing that its central projects would become services, that there would be “more local procurement” and more modular deployment of systems. Confusingly, the DH insisted that despite this the LSP contracts would be “honoured.”
At the end of the month, more bad news emerged for ISoft and NPfIT, when E-Health Insider obtained weekly updates on the progress of Lorenzo at Morecambe Bay, detailing such major and persistent problems that the trust had been forced to launch a stabilisation plan to try and get them under control.
October: In the run-up to party conference season, an exclusive survey by EHI Primary Care revealed that staff in SHAs and PCTs were concerned that the latest round of NHS reforms would lead to a major loss of jobs and skills for little benefit. Unions also voiced concern about the direction and speed of change. Lansley vowed to push on regardless.
Chancellor George Osborne unveiled his spending review, saying NHS funding was “protected” although the service would need to find massive ‘efficiency savings’ (and £1 billion for social care).
The DH issued a consultation on a new information strategy for the NHS that focused instead on using information to improve quality and drive patient choice. ‘Liberating the NHS: an information revolution’ said patients would also get some “control” over their records, starting with those held by their GP and “over time” extending to others.
Separately, Simon Burns announced the SCR would go ahead. And the HSMR working group unveiled plans for a Summary Hospital-Level Mortality Indicator to act as a ‘smoke alarm’ for poor NHS care.
November: The often hilarious process of developing a government IT strategy was revealed by former health minister Tom Sackville on the eve of eHealth Insider Live 2010, when he recalled his time in charge of the 1992 IT strategy for the NHS. At the event, his successor Simon Burns urged EHI readers to get involved in the ‘information revolution’ consultation, while DH director general of informatics Christine Connelly said that NHS IT would “evolve” away from the NPfIT approach.
Connelly also admitted that Lorenzo Release 1.9 was still not stable at Morecambe Bay. A week later, EHI obtained figures suggesting that the DH could be on the brink of signing a new deal for the NME without firm support from NHS trusts. An editorial urged the DH to look at providing a choice of system instead.
December: As the nation started to open its advent calendars, Richard Bacon’s demands for a National Audit Office inquiry into the value for money of NPfIT’s new deals bore fruit. Amyas Morse, the head of the NAO, also revealed some fascinating figures in a letter to the MP, showing that BT will receive £36m for each of the ‘live seven’ Cerner sites, and £9m per RiO implementation.
Looking forward, the DH unveiled an NHS user forum for its interoperability toolkit programme. And the DH issued a public health white paper saying it was not – surprise – to be scrapped or renamed, although it would get a Public Health England service to add to its domains.