The NHS IT programme is not a “programme of paint by numbers” but more of an “expedition”, Gordon Hextall the acting boss of NHS Connecting for Health told MPs questioning why the £12.7 billion programme is now running at least four years late.
Answering questions at Monday’s Public Accounts Committee (PAC) hearing Hextall said he had a good map and compass, but due to its sheer scale the NHS IT programme continued to chart unknown territory, resulting in almost ineviatable delays.
PAC chairman, Edward Leigh, asked why even Connecting for Health’s new timetables should be believed. “Why should we be any more confident about these new timescales?”
NHS chief executive David Nicholson replied: “We’re now experienced and working much better with the LSPs [local service provdiers] that are left. We also have a product, or are close to having a product.”
Pressed by Leigh on whether there had yet been a single deployment of Care Records Service (CRS) software into an NHS hospital, the boss of the NHS said: “No, no.”
Ahead of the hearing CfH had provided the MPs with a demonstration of the delayed Lorenzo system at the Department of Health but Leigh said it was one thing to demonstrate a system and quite another to deliver it into a complex hospital.
Hextall said: “We’ve got real systems, it’s not a PowerPoint demo, but a live system. We are in pre-deployment tests in early adopter sites.” He added that “intensive collaboration with prime suppliers on Lorenzo” was underway, with later versions of the system soon to be released. Upgrades for Cerner systems in the south were also promised soon.
The CfH director said that Lorenzo had been “delivered” to Morecambe Bay Hospitals NHS Trust, but acknowledged it was not yet “live”, with the trust testing the software. He stressed that it was for the trust to decide when it was happy to go with the software.
During the hearing Hextall repeatedly returned to the theme that it was getting quality right, rather than hitting target dates that mattered. Asked when Morecambe Bay would switch on, he said: “They will go live when the quality is right.” He indicated this was now expected to be by July.
However, despite this clear statement that quality would trump all else the CfH director still offered an extremely aggressive timetable for Lorenzo implementations following Morecambe Bay, stating they would begin in earnest within three months – initially at two more pilot sites.
Was it enough time? “If everything goes according to plan then three-months will be fine.” He confirmed that the plan remained to deliver Lorenzo in four stages, with stage four occuring in 2010, at which point GPs are planned to get access to CRS.
Asked how things had changed since the PAC report on the NHS IT Programme two years ago, which had stated concerns about the then two years late delivery of the software, Hextall said CfH had become far more “intrusive” in the development of Lorenzo.
Richard Bacon, MP, quizzed Hextall about a confidential 2007 report by EDS and Mastek CfH commissioned into the development of Lorenzo. The CfH director said the report “Drew attention to the lack of sufficient programme management, that has since been strengthened.”
Asked whether there would ever come a point where delays were such that the department would look to ditch Lorenzo, Nicholson said: “I wouldn’t say everything has been delivered smoothly that is patently not the case, but we are now in a much better place than we were.”
Nicholson made clear that the aim remained to roll out the two strategic CRS systems across entire LSP areas. “We are trying to ensure all trusts take the same system in an area.”
Questioned by Leigh on Newcastle’s recent decision to go outside the NHS IT programme, and potential liabilities this created to the NHS, Nicholson said the department can insist non-Foundation Trusts (FTs) take CfH systems. “We can direct trusts to take the system”.
Hextall said Newcastle had committed to continue working with the programme, and the system they were looking at was Cerner.
Nicholson added that even for FTs it was extremely hard to go outside the programme, as they remain subject to Treasury rules, and have to show that whatever system they took was as cost effective as the CfH products.
“We think the product we are delivering they will want to take. They have to have a business case to show the benefits of taking another system and that’s very difficult to do.” He said that Bedford, which had looked to go outside the programme, had become convinced that iSoft was the best system to go for and were now great advocates.
“Will you force trusts to take the system?” Leigh asked. Hextall avoided a direct reply saying it would be very hard for them to make the business case necessary.
PAC member Richard Bacon, MP, asked why if Lorenzo was so good CSC were “touting an alternative Portugese product to trusts”, including to St Helliers NHS Trust. The CfH director said that CSC were offering the Alert product in question as an interim order communications system, until similar functionality became available in Lorenzo.
Hextall told PAC member Paul Burstow, MP, that there had been three major changes to the delivery dates, though he later added that delivery plans were changed on an almost weekly basis. He said the programme had always been ten years in duration.
Fellow PAC member Richard Bacon, MP, rebutted this assertion, saying that at its outest “Sir John Pattison said it would take two years and nine months and be completed by December 2005.” He asked the DH to provide a note explaining how the programme had changed into one that will take at least ten years.