Insider view: Jon Hoeksma

The news that Pennine Care NHS Foundation Trust has decided not to implement Lorenzo after two years of trying represents a watershed moment for the Department of Health.

It has repeatedly told CSC, the local service provider for the North, Midlands and East of England, that it must get the iSoft electronic patient record live and bedded down at four ‘early adopter’ trusts to retain its National Programme for IT in the NHS contract.

Pennine was the last of these early adopters, although it was the first mental health trust to take the system that is already live – if not exactly bedded down – at one primary care trust (Bury) and two acute trusts (University Hospitals of Morecambe Bay and Birmingham Women’s).

A letter from NHS chief information officer Christine Connelly to MP Richard Bacon indicates that the DH is now looking for another mental health trust willing to step into Pennine’s shoes. Yet rather than simply seeking to press on regardless, the Department should be asking some more fundamental questions.

Such as: does its £3 billion contract with CSC still provide a realistic prospect of delivering new, clinically rich systems to most NHS professionals? Or even to those working in the acute sector?

Or: is the relationship with CSC primarily driven by fear? Fear of the penalties the NHS might face if it sought to end the deal. Or fear of what would happen if iSoft – which CSC is looking to buy, and which is responsible for a large base of installed systems in the NHS - were to collapse.

Time to be open

As fearsomely difficult as the contract position may be, the DH should now grasp the opportunity to be open and candid with the health service about what the problems with the Lorenzo installations are, how far the product is from being ready to be widely used, and which organisations can feasibly expect to use it.

If there is a case to be made for retaining Lorenzo, it needs to be based on where we are now, rather than on where it might wish we were instead.

So: what has been the experience at each of the four test sites? And why, in particular, has the most high profile of them, Morecambe Bay, still not signed off on its Lorenzo deployment?

When it comes to the product itself, what, if any, are the problems with the software? What is built and works? What isn’t there? What is easy to adapt to current ways of working? And what causes difficulties?

When it comes to NHS trusts, why have some apparently failed to put their houses in order on data, training and legacy systems and made commensurate investment?

And based on time taken to date, how long will it take to implement at a fourth site, assuming that one can be found? How long to do the four after that?

Asking such searching questions will be uncomfortable. But it is precisely because they are difficult that they need to be asked. They have been fudged for far too long.

Time for a review

Candour is also an essential first step to turning around the part of the national programme that has always had the highest profile, and is failing. After after so much time, money and effort, it has to be hoped that Lorenzo can still deliver, and deliver on a wide scale. But hope alone is not enough.

Candour could also be the essential first step to conceding that this part of the programme has failed, and to build trust in another way forward.

What we don’t need are more heroic exhortations for one more push over the top. They’re clearly failing to inspire the troops; and this is a government that is supposed to be committed to transparency.

It’s also a government committed to axing big, failed projects; and to trimming back the public sector wherever it can. The government may have decided it was unable to cancel two white elephant aircraft carriers, but the CSC deal could yet go the same way as Nimrod.

Once again, if Lorenzo is worth saving, we need to know so a case can be made for saving it. So what we need now is a genuinely dispassionate review of the Lorenzo experience.

Time for an outsider

Ideally, a rapid review should be commissioned by a highly credible person who has not been at the heart of the programme, has real expertise and could offer practical recommendations. Frank Burns, the highly respected former chief executive of Wirral Hospitals, might be one ideal candidate.

Alternatively the NHS could once again call on the services of Sir Derek Wanless, whose seminal 2002 strategic review of the health service for the Treasury, first set out the case the heavy investment in NHS IT to deliver modernisation. He previously reviewed progress on NPfIT in 2007.

Or the NHS could look for a figure who has led another big technology project in a different sector. One way or another, such a review should be based on talking directly to trusts in the NME, and it should be wholly independent of the DH.

A similar review should also apply to BT, the LSP for London and parts of the South, which is now locked into change control negotiations round five (CC5). Searching questions still remain to be asked of BT’s £546m deal for the South which sees it paid £9m a go to install the RiO system community and mental health system.

Time to escape the past

The DH should see a review as an opportunity to escape the shackles of the past. Connelly has repeatedly spoken of the need to not be trapped by contracts signed seven years ago. Yet there seems no ‘escape’ lever.

Ultimately, the most important consideration should be the calculation: can CSC demonstrably help the NHS deliver the improvements in patient care and productivity it needs to achieve over the next three years? If the answer is no, it has to go.