The New Year opened with CSC in somewhat hung-over mood. Whether or not it would secure a new local service provider contract for the North, Midlands and East of England was one of the big, unanswered questions left over from the National Programme for IT in the NHS. Throughout 2012, the company was optimistic that it would, despite its persistent failure to deliver the Lorenzo electronic patient record. Over the holidays, however, it warned that it might not get a good deal – or any deal - and that it might have to write-off £1 billion as a result.
Meanwhile, the NHS Future Forum that was set up to review the government’s ‘Liberating the NHS’ plans published a piece of work on IT that urged trusts to invest in information and clinical leaders. In response, the DH said the much-delayed NHS information strategy would be out in April. News emerged that two big implementations of Cerner Millennium, in Oxford and North Bristol, had not gone as well as billed; as Royal Berkshire NHS Foundation Trust prepared to implement the same system outside the programme. And the Commons’ health select committee warned that the NHS was resorting to “salami-slicing” cuts to try and meet the ‘Nicholson challenge’ to save £20 billion over four years.
As the health committee fretted about NHS finances, the government fretted about getting its Health and Social Care Bill through Parliament. By the start of February, two medical journals and almost all of the royal medical colleges had joined unions in opposing the reforms. After which a full-scale row broke out in the Lords. As the row continued, the NHS Commissioning Board got on with setting itself up in Leeds, and announced that it would be setting up commissioning support organisations to help clinical commissioning groups with IT and information.
CSC duly wrote off $1.49 billion against its investment in NPfIT, in what was thought to be the biggest ever write-off against a single IT project in the UK. An investigation by EHI newseditor Rebecca Todd revealed that Southern trusts that had received NPfIT systems had seen precious few benefits as a result. As the end of the national programme’s contracts came into view, nine London trusts using or likely to use Millennium issued a massive PAS and EPR tender worth up to £400m, saying they hoped to have a new contract in place by spring 2013.
Telehealth has been billed as “the next big thing” and “the only thing standing between an ageing population and public sector Armageddon” for a decade now; yet it still refuses to take off. Labour set up the Whole System Demonstrator trials to deliver some “definitive” evidence in its favour. Yet 18 months after the WSD ended experts were still waiting for full results. The coalition had launched a 3millionlives campaign with industry on the back of a press release of ‘headline’ results, but indications were emerging that the full results were “complex” rather than “compelling.”
Meanwhile, CSC announced that it had secured a revised deal with the DH after all. In briefings, the government indicated this would secure £1 billion “savings” on the £3.1 billion contract. Health secretary Andrew Lansley launched a CCIO Leaders Network to follow up on the EHI CCIO Campaign for the NHS to appoint clinical leaders to support IT and information projects. After an anti-climactic debate in the Commons, the government saw its reform legislation passed; just in time for the NHS CB to issue a job ad for a national director of patient insight willing to scrape by on £165,000 a year. Royal Berkshire failed to go live with Millennium.
The end of the NHS financial year coincided with some big changes for some big healthcare IT suppliers. CSC officially retired the iSoft brand – although the logo outside its Banbury headquarters took some shifting – and McKesson confirmed that Markus Bolton and Dr Ian Denley would be leaving, as it consolidated its acquisition of System C. A week later, CSC said its talks with the DH over the NME had not concluded after all; and would drag on until June. Meanwhile, the tenth anniversary of the Wanless report – which forecast future NHS spending requirements and unleashed major investment in NHS IT - rolled around.
As the unfinished business of NPfIT remained unfinished, more and more NHS trusts started to plot their own IT futures. Liverpool Heart and Chest Hospital NHS Foundation Trust became the first in England to pick Allscripts to install a new electronic patient record; while University Hospitals Bristol NHS Foundation Trust went live with its Medway EPR. Then, in the middle of the month, two trusts in Cambridge announced that Epic had won the contract to provide the IT for their marquee eHospital project; one of the biggest and most closely watched tenders for some years.
In a rather different sign of things to come, the Information Commissioner’s Office fined its first NHS organisation. Aneurin Bevan Health Board was hit with a £70,000 penalty after a secretary picked the wrong patient details out of its EPR and sent a “confidential and highly sensitive” letter to the wrong person. The DH finally published the long-awaited NHS information strategy. ‘The Power of Information: putting us all in control of the health and care information we need’ painted a broad-brush vision of a world in which everyone would have access to data; and patients would have online access to their records – at least their GP records – by 2015.
The queen’s Diamond Jubilee weekend dawned soggy wet. But it was a bright spot for what remained of the national programme. Humber NHS Foundation Trust, which had taken over as the fourth ‘early adopter of Lorenzo’, confirmed that it had gone live with the system. Less happy was Brighton and Sussex University Hospitals NHS Trust, which was fined a record £325,000 by the ICO after a contractor employed to destroy old computers sold them on eBay instead. The trust went on to say it would appeal; on the grounds that it was the victim of a crime and couldn’t afford to pay anyway.
The NHS Commissioning Board appointed its first national director of patients and information. To nobody’s great surprise, Tim Kelsey, the former journalist who helped to found Dr Foster and who served as the government’s ‘transparency tsar’, got the job. Kelsey arrived just as the tenth anniversary of ‘Delivering 21st Century IT’ – the strategy that launched the national programme – rolled around; prompting EHI managing editor Lyn Whitfield to compare and contrast it with ‘The Power of Information’ . But just to prove that going outside the programme did not, of itself, make all things smooth and easy, The Rotherham NHS Foundation Trust went live with Meditech – two years later than planned.
More evidence from the Whole System Demonstrator programme was finally published, which also suggested that the results were more nuanced than the government’s ‘headline’ findings suggested. The BMJ concluded that they did not support the roll-out of 3millionlives. The NHS Confederation’s annual bunfight in Manchester heard unprecedented tales of financial doom and gloom. Katie Davis announced that would step down from her job as managing director for NHS Informatics by 1 September. Royal Berkshire NHS Foundation Trust signed two contracts with Cerner for remote hosting of Millennium, a helpdesk and support, ahead of finally getting the EPR live.
Britain geared up for the Olympics, with trusts warned to take account of the potential impact of trusts live-streaming events on the N3 national network. With the departure of Katie Davis, it was announced that NHS IT at a national level would be split into three; with the DH leading on policy, the NHS CB on commissioning, and the ‘new’ Health and Social Care Information Centre on delivery. There was much speculation on how this might work; or not work. More pieces of the new NHS fell into place when the NHS CB announced the ‘at scale’ commissioning support units that would do data warehousing and analysis for CSUs and CCGs.
As the new NHS started to take shape, some of the unfinished business of NPfIT came closer to being finished. The Southern Programme for IT in the NHS issued a tender for community and child health systems and acute trusts started to form into groups ready for a similar procurement for their sector. By the end of the month, it was starting to look as if CSC really would sign a new LSP deal for the NME; and that more trusts would be prepared to sign up for Lorenzo if it did.
Party conference season started with a Cabinet reshuffle. Health secretary Andrew Lansley was somewhat surprisingly shuffled out of Richmond House, along with most of his ministerial team, and culture secretary Jeremy Hunt was shuffled in. One of Lansley’s last acts must have been to sign off on the new deal with CSC. This put an end to any threat of legal action, and apparently opened up the way for trusts that wanted Lorenzo to get it with some central support and funding; although CSC secured no volume commitments.
A week later, Tameside Hospital NHS Foundation Trust became the first to take Lorenzo under the new arrangements. Moving in the opposite direction, the Royal Hampshire County Hospital in Winchester confirmed that it was shifting away from its programme-installed Cerner Millennium system, following a merger with Basingstoke and North Hampshire NHS Foundation Trust, which had decided on a portal policy. A week after its big announcement, EHI established that CSC was going to withdraw from primary care and that it would only support its Synergy, Premiere and Ganymede products for another year; to the great disappointment of users of what had once been leading-edge systems.
Tim Kelsey caused a stir in one of his first interviews in his new role by suggesting that doctors, nurses and other front-line staff should learn to program; to the amusement of some EHI commenters who suggested that, in that case, .they’d quite like a go at a bit of surgery. Kelsey followed his remarks up by saying that the NHS should be paperless by the end of 2015; to the bemusement of many EHI commentators, who argued there was no chance of achieving such an ambitious goal in such a short timeframe – if, indeed, it was the right goal.
EHI’s annual survey of acute sector IT discovered that the ‘Liberating the NHS’ reforms have yet to win over NHS staff, with only 5% of 120 respondents saying they would have a positive effect. However, the survey also found that despite the huge financial strain on the NHS, some trusts are starting to invest in IT, and a quarter are planning PAS and EPR projects. EHI editor Jon Hoeksma visited University Hospitals of Morecambe Bay NHS Foundation Trust, and found that it had a positive tale to tell of its experience of Lorenzo while it emerged that Royal Berkshire had spent £30m on its Cerner implementation, and Brighton had paid its fine after all.
EHI Live 2012 took place in Birmingham. Dr Dan Poulter, the minister in charge of NHS IT, said the new regime at Richmond House is not only committed to technology but to Andrew Lansley’s mantra of ‘no decision about me without me’, while his shadow, Andrew Gwynne, admitted that Labour may not have taken the right approach with the national programme, and various speakers stressed that they really, really love SMEs. EHI launched a new channel, EHI Imaging Informatics, and hosted a lively first CCIO Leaders Network Annual Conference, with ten CCIOs in post.
The NHS Commissioning Board received its “historic” mandate from the government, with instructions to make lots of use of IT, and to create an integrated care record for everyone in the country by 2015; an idea that gave EHI commenters déjà vu all over again. The NHS Commissioning Board also announced that it would be looking to build a new customer service platform to replace NHS Choices, NHS Direct and other services, and that it would be replacing NHSmail with the imaginatively named NHSmail2. Monitor declared that it wanted to shift the basis of the NHS tariff to patient level information and costing.
The year ended with a CSC announcement that its top health executive, and the man who headed up its involvement in the national programme, would be leaving. Guy Hains, who had been responsible for securing the company’s original NPfIT contracts, said that with a “way forward” in place for Lorenzo it was time to “move on.” Meanwhile, EHI learned that the next ten trusts to take Lorenzo will get significant incentives to do so. Also moving on into retirement was Brian James, the outspoken chief executive of The Rotherham NHS Foundation Trust; convinced that its Meditech deployment would pay off, even though it had been “very, very hard.”