The 10 projects at the heart of NHS IT

It's the world's largest health IT project, its projected cost has doubled in its lifetime to £12.7bn, and parts of it are running four years late: welcome to the National Programme for IT (NPfIT).
While the NHS's NPfIT has already outlasted several heads of IT, its chequered track record is not surprising given the ambitious scale of the project: replacing an ageing patchwork of 5,000 different computer systems with a nationwide infrastructure connecting more than 100,000 doctors, 380,000 nurses and 50,000 other health professionals.

Find out more about the 10 key NHS IT projects

♦ NHS Care Records Service
♦ Choose and Book
♦ The Electronic Prescription Service
♦ N3 national broadband network
♦ Picture Archiving and Communications System (Pacs)
♦ The Spine
♦ The Quality Management and Analysis System
♦ GP2GP record transfer
♦ NHSmail- a central email and directory service for the NHS
♦ Secondary Uses Service

The NPfIT faced considerable scrutiny since its inception. A National Audit Office report in May this year highlighted serious delays in introducing the electronic care records system at the heart of the scheme due to technical challenges, while suppliers Accenture and Fujitsu pulled out of delivering the system and one trust halted implementation of the care records service.

Meanwhile, technical issues in implementing the Cerner and Lorenzo patient administration systems (PAS), which will be the basis of the future rollout of the care records service, have resulted in only 130 PAS being deployed in 380 health trusts.

Richard Bacon, a member of the parliamentary spending watchdog the Public Accounts Committee, said of the project's missed deadlines and immature systems: "The programme is a reflection of the poor project management as a whole when it comes to government IT. A lot of public money has been squandered on the National Programme for IT."

The NHS IT body Connecting for Health (CfH) counters that the programme is more focused on making sure systems work properly rather than rushing them in to meet deadlines.
CfH says the programme is already starting to pay for itself, citing the £1.1bn savings expected by 2014 highlighted in the NAO report.

A spokesman for CfH said: "Collectively, the early adopter trusts, strategic health authorities, NHS CfH and CSC recognise the need to achieve the necessary quality criteria for go-live and view this as more important than a particular date."

Paul Cundy, former chairman of the British Medical Association's IT Committee, believes the project has overall been a mixed blessing for UK healthcare.

"It is a real mixed bag - those projects that worked very well have been clearly defined as delivering the best benefits to users, where the users have had input and where there has been political support for them.

"The ones where there is bad political interference, where there is no user input into design or are doing things that users do not want, those are the ones that predictably fail," Cundy told silicon.com. "The key is to ask people what they want."

silicon.com first put the core NHS IT projects under the microscope in early 2006.
Much has changed since then, however, and silicon.com has decided the time is ripe to revisit each of the major projects in the programme to get the latest on their highs and lows, and find out just how far away the NHS is from its interconnected dream.

Clink on the links below for more details of each of the main NHS IT projects - and their progress so far.

The projects:

NHS Care Records Service

Choose and Book

The Electronic Prescription Service

N3 national broadband network

Picture Archiving and Communications System (Pacs)

The Spine

The Quality Management and Analysis System

GP2GP record transfer

NHSmail- a central email and directory service for the NHS

Secondary Uses Service

* - Article from Silicon.com

Barts underestimated impact of IT system

Barts and The London NHS Trust said today [1 September 2008] it had underestimated the impact of going live with a new system under the NHS's £12.7bn National Programme for IT [NPfIT].

Difficulties in scheduling patients for appointments have led to operating theatres and clinics being unused at times, despite high demand for them.

The trust is funding nearly £1m for extra temporary staff relating to the NPfIT go-live from its reserves. And it faces a further £1.5m shortfall in income because it may not be able to bill its local primary care trust for the patients it sees and treats.

A spokesman for Barts and The London NHS Trust told Computer Weekly an "intensive programme of measures is in place" which "will allow us to return to our previous performance levels as quickly as possible".

The trust has "apologised publicly to patients, GPs and staff for the difficulties they have experienced," he said.

The spokesman was responding to Computer Weekly's questions after the trust published board papers on its website describing "significant" ongoing problems after the implementation of the Care Records Service,

The trust has had difficulty maintaining an overview of which patients have been treated for what following roll-out of the system. It is paid according to the information it provides to the local primary care trust on the patients it sees and treats. But the trust warns in its latest board papers that income may be much less due to difficulties gathering accurate information on who has been seen for what and when.

A financial paper to the board on the first quarter of the trust's 2008/9 year says:
"There remain significant data quality issues with the Trust's activity and patient activity and income information due to the implementation of the Care Records Service.
"To reflect the high risk around income the trust has provided £1.5m against the first quarter's income."
The paper adds: "There are also known system errors where data which has been entered into CRS [the Cerner Care Records Service system] has not been reflected in the data warehouse and therefore is missing from SLAM [Service Level Agreement and Monitoring system]. These issues have caused [a] significant understatement of both inpatient and outpatient activity and income".

The trust says that BT and Cerner are "working on solutions to stop further errors". With fewer than expected patients being booked clinics and operating theatres have been under-used.
"There is some evidence that April activity was reduced due to the implementation issues of CRS. Clinics were reduced in some areas and issues with bookings meant that in some areas the clinics and operating theatres were not operating their usual capacity".

The trust has directed nearly £1m from central reserves nearly £1m to ICT to "fund additional temporary staff costs relating to the implementation and subsequent validation of CRS".
Bart's and the London Care Records System is based on a patient administration system from US supplier Cerner and BT, London's NPfIT local service provider.

Two other London trusts, Barnet and Chase Farm and the Royal Free Hampstead have also had significant and protracted problems after going live with the Cerner system. There have difficulties at go-lives of trusts outside London too. But the government and the Department of Health want trusts to accelerate plans for trusts to deploy NPfIT systems.

A spokesman for Barts and The London said: "The Trust anticipated that there would be a greater degree of fluctuation in activity levels in the period before and after the CRS [Care Records Service] go-live in April, but we underestimated the level of impact that CRS would have on our operations."

* - Article from Computer Weekly.

As a point of interest, i was at the Royal Free Hampstead only a few weeks ago as my Girlfriend unfortunately had to go into A & E and stay in Hospital for a few days. There was no obvious sign of the significant and protracted problems with the speed of the service or the treatment she received. However, there were signs everywhere explaining that the new system had been installed and that there may be some teething issues.

Good luck to them, sometimes change isn't easy but has to happen!!! If they need a hand with their recruitment of temporary ICT staff they could always contact us.

Patients left untreated at Barnet and Chase Farm Hospitals NHS Trust

Dozens of patients at a north London hospital went untreated for at least six months after the hospital introduced IT systems under the NHS's £12.7 billion National Programme for IT, Computer Weekly has learned.

Barnet and Chase Farm Hospitals NHS Trust did not see or treat patients within government-imposed 26 week limits following difficulties with its roll-out of the Cerner Millennium Care Records Service.

The trust was the first in the capital to go live with the system under the National Programme for IT [NPFiT].

Staff at Barnet and Chase Farm Hospitals NHS Trust were unaware of the problem for up to five months. This was because the trust could not produce monthly information on patients who had been waiting too long for treatment following the roll-out.

A trust board paper said: "The introduction of a new Patient Administration System meant the [Barnet and Chase Farm Hospitals NHS] Trust was unable to produce monthly waiting time data between July 2007 and January 2008."

"The production of the waiting time data in February revealed a significant number of waiting time breaches which had occurred there were 63 inpatient breaches."

Barnet and Chase Farm hospitals had 8,500 extra complaints from patients, largely because of delays in making follow-on appoinments after introducing the Cerner Millenium Care Records Service.

The hospital did not re-admit patients whose operations were cancelled at the last minute, within 28 days, as required by government guidelines.

Computer Weekly has learned that a surveillance system - for tracking patients whose operations were cancelled at the last minute by the hospital for non-clinical reasons - was not working in the Cerner Care Records Service.

As a result, at least 18 patients were not re-admitted within a month of the hospital cancelling their operations. The government has set a target that patients should be re-admitted within 28 days of their operations being cancelled.

The trust has sent an explanation of the problems with the patient administration system, and its effect on targets, to the Healthcare Commission, the NHS's regulator.

The trust has also contacted the patients who had been waiting more than 26 weeks. The trust has reported that many of the affected patients have now been treated. And it has given its local primary care trust, at Enfield, an assurance that it now has a system for tracking patients to ensure they are seen within the target waiting times.

Despite the delays in treating patients, Barnet and Chase Farm hospitals had under-used capacity - which is likely to mean under-used operating theatres and wards - in April and May this year, according to a paper to the trust's board last month.
It said: "The ongoing technical patient administration issues have caused problems with scheduling and admission of patients. In April and May the Trust had unutilised capacity arising from this issue."

Implementations in London and the south of England of the US Cerner system - which is only partially modified for use in the UK - has caused disruption at several trusts including the Royal Free at Hampstead, Barts, where some cancer appointments were delayed.
Geoff Martin of London Health Emergency, a group which campaigns on NHS matters, said: "You cannot have operations cancelled at the last minute in these kinds of numbers."

Richard Harrison, Consultant Gastro-intestinal Surgeon and Medical Director at Barnet and Chase Farm Hopsitals NHS Trust said: "You can test the system but you will only find out some of the complexities of operating it when you put it into real life."

Barnet and Chase Farm executives say the Cerner system requires staff to change the way they work. They said they have found it can take much longer to do things that were straightforward before.

There have also been problems with the system. They said many of the problems have been solved and extra staff have been brought in which has helped to ensure that processes run quicker.

NHS Connecting for Health which runs part of the NPfIT said: "Teething problems are to be expected. However, it is clear that the patients and clinicians are beginning to see the potential benefits of the system."

Some officials will regard the patients affected at Barnet and Chase Farm Hospitals NHS Trust as the unfortunate few victims of an IT-based strategy which will eventually help to improve safety, care and health. But others will say that the Department of Health should not embark on go-lives when they know there is a likelihood the health of some patients could suffer as a result.

* - Article from Computer Weekly

NPFiT - Making Progress?

Delivering the NHS Connecting For Health National Programme for IT is proving to be an enormous challenge, says the National Audit Office.

All elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk. Today’s progress report on the Programme by the National Audit Office concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS Trust in England has fully deployed the care records systems, four years later than planned. In the North, Midlands and East area, the software has taken much longer to develop than planned, so some Trusts have had to take an interim system. Completing the development of the system and introducing it in this area are significant challenges still to be addressed.The estimated cost of the Programme is £12.7 billion. The costs of the main contracts have remained broadly unchanged, aside from the purchase of increased functionality. Because of the delay in deployments, actual expenditure to date (£3.6 billion by 31 March 2008) has been much lower than expected. Planned ‘go live’ dates were missed for many of the first Trusts to take the new care records systems and the NHS and suppliers are now increasing their emphasis on establishing realistic timelines for deployments, reflecting the circumstances of each individual Trust.According to today’s report, the success of the Programme will depend on the commitment of NHS staff. The Department’s latest survey, conducted in spring 2007, showed that 67 per cent of nurses and 62 per cent of doctors expected the new systems to improve patient care. Identifying and realising the benefits of the systems are essential to raising confidence further and convincing all staff of the value of the Programme. The Department reported on the benefits of the Programme for the first time in March 2008.Tim Burr, head of the National Audit Office, said today:"The scale of the challenge involved in delivering the National Programme for IT has proved to be far greater than envisaged at the start, with serious delays in delivering the new care records systems. Progress is being made, however, and financial savings and other benefits are beginning to emerge. The priority now is to finish developing and deploying care records systems that will help NHS Trusts to achieve the Programme’s intended benefits of improved services and better patient care."

* Article from http://www.publictechnology.net/