Alas, poor NPfIT, we knew it well

1998: The government publishes ‘Information for Health’ strategy. This sets up an NHS Information Authority to deliver national infrastructure and electronic health records, and to set targets and standards for electronic patient record systems in trusts. Trusts are left to pick and implement systems.

February 2002: It is clear IfH’s targets are being missed. The blame is put on technical issues, a lack of money and the difficulty of procuring IT in a fragmented market. Microsoft chief executive Bill Gates comes to London and takes part in a Number 10 Downing Street seminar on NHS IT. A new approach, focused on “ruthless standardisation” emerges.

June 2002: The Department of Health releases another IT strategy, ‘Delivering 21st century IT support for the NHS: national strategic programme.’ This lays the foundations for what will become the National Programme for IT in the NHS.

September 2002: Richard Granger, who has led the introduction of the congestion charge in London, is appointed director general of NHS IT. He says £2.3 billion will be spent modernising NHS IT over three years; and that key targets will be achieved by 2005.

2004: England is split into five regions; London, South, East, North West/West Midlands, and the North East. Massive local provider contracts worth £6.2 billion are given to BT, Fujitsu, Accenture and CSC to get electronic patient records into health communities. In addition, BT secures contracts worth £1.1billion to implement a broadband network (N3) and National NHS Care Records Service.

2005: NHS Connecting for Health is created to take over the work of the NHSIA and to deliver the National Programme for IT in the NHS. In June, US software company IDX, which was tasked with supplying systems in the South and London, is fired by Fujitsu and BT. Negotiations begin with Cerner as a replacement.

December 2005: Nuffield Orthopaedic Hospital NHS Trust becomes the first in the South to go live with an electronic patient record system from Cerner, implemented by Fujitsu. Weston Area Health NHS Trust follows 2006.

June 2006: A National Audit Office puts a figure on the total cost of NPfIT. It says trust costs will be around £6 billion and that it will cost £12.4 billion over 10 years. Although it notes that all the LSPs are behind schedule, the “remarkably upbeat” report says NHS Connecting for Health is making “substantial progress” and it could “revolutionise” the way the NHS delivers care.

A leaked review of iSoft’s Lorenzo, the system due to be deployed in the three regions outside London and the South, shows hospitals won’t get it until at least 2008; even though it was supposed to be ready for deployment in 2004. Accenture is set to make big losses on its LSP contracts and in September pulls out of the programme.

CSC makes a bid to take over Accenture’s contracts, and eventually signs a nine year deal worth £1.3 billion to become LSP for the North, Midlands and East. In the South, a third trust goes live with Cerner Millennium. However, four more trusts delay their go-lives, citing the need for more time to fix software glitches.

November 2006: NHS chief executive Sir David Nicholson launches the NPfIT Local Ownership Programme, to transfer ownership to the NHS and “reinvigorate” the project. Strategic health authorities are given much more responsibility for choosing NPfIT products and planning deployments with their trusts and other organisations, and for matching the programme to changing NHS requirements.

2007: CSC deploys IT systems into GP practices and Cambridgeshire Primary Care Trust receives an iSoft Community iPM system. However, Lorenzo remains elusive.

In May, Nuffield Orthopaedic Centre NHS Trust reveals that its Cerner Millennium system is still presenting problems a year and a half after its initial go live date. More bad news follows. Milton Keynes says its deployment has led to problems with missing records, while Taunton and Somerset NHS Trust delays its deployment of the software because of “severe security problems”.

Despite this, Barnet and Chase Farm Hospitals NHS Trust becomes the first London trust to go live with Millennium and Queen Mary’s Sidcup follows in November. Taunton and Somerset finally goes live six months late at the start of 2008; completing the ‘Live 8’ set of trusts using the system in the South.

January 2008: Richard Granger leaves his post as director general of NHS IT, stating most of the ‘building blocks’ for the national programme are in place. CSC is fined £5m for the late delivery of patient administration systems in the North Midlands and East. But in London, Barts and the London NHS Trust goes live with Cerner Millennium, and is followed by the Royal Free Hampstead NHS Trust.

May 2008: The National Audit Office issues another report on the national programme. It says it looks as if the programme will now cost £12.7 billion and is running four years late. However, it’s still “feasible”.

August 2008: After a long hunt for people to fill the £200,000 a year jobs, Christine Connelly, a former Cadbury Schweppes executive, is appointed as the first chief information officer for health and Martin Bellamy is appointed as director of programme and systems delivery, leading NHS Connecting for Health.

Shortly afterwards, Fujitsu’s £896m contract for the South of England is terminated. Royal United Hospital Bath NHS Trust, which was due to take Cerner Millennium, has to shelve its plans. BT is eventually appointed to take over the ‘Live 8’ sites and to extend the use of Cerner Millennium to four ‘greenfield’ sites.

In London, Barts says it has suffered a £3m shortfall in income due to serious data, reporting and technical problems with Cerner Millenium and the Royal Free says it is facing a £7.2m deficit caused, in part, by similar issues. St Mary’s Hospital, part of Imperial College Healthcare NHS Trust, delays its go-live plans.

November 2008: The first version of Lorenzo – Lorenzo Regional Care Release 0 - is finally deployed into the first trust when University Hospitals of Morecambe Bay NHS Trust gives it a ‘soft landing’; on one ward at Barrow in Furness.

January 2009: The Commons’ public accounts committee delivers its opinion of the second NAO report, and says the national programme’s remaining local service providers should be given six months to make significant progress in the acute sector – or trusts should be able to make the case for getting the money to do their own thing.

East Cheshire NHS Trust turns its back on NPfIT by opting to shift its existing patient administration system onto a new hardware platform; despite being offered incentives of around £1m to move to Lorenzo. Meanwhile, Epsom and St Helier University Hospitals NHS Trust decides to remain with iSoft; despite rejecting an offer to switch to Cerner Millennium.

April 2009: Christine Connelly sets new deadlines for BT and CSC to make “significant progress” with Cerner Millennium and Lorenzo. She says she wants to see BT get Millennium into a London acute trust by November, and CSC to get the latest version of Lorenzo into “a care setting” by March and “working smoothly across an acute trust” by November.

June 2009: Martin Bellamy leaves for a new job at the Cabinet Office. NHS Connecting for Health becomes directly managed by the Department of Health Informatics Directorate. Discussions start on how best to use the CfH “brand” in the future.

November 2009: CSC meets the first of Connelly’s new milestones, when NHS Bury goes live with Lorenzo Regional Care Release 1.9, which includes a native Lorenzo PAS. BT meets its deadline when Kingston Hospital NHS Trust goes live with Cerner Millennium; and then sees St George’s Hospital NHS Trust follow in March 2010.

April 2010: BT secures a new deal for London. This cuts 10% off the original £1.1 billion contract, but leaves the LSP delivering much less: no GP systems and far fewer Millennium deployments. MP Richard Bacon questions the value for money of this deal and the one for the South. Eventually, he writes to the head of the National Audit Office, Amyas Morse, asking the watchdog to investigate.

Up in the North, Midlands and East, Morecambe Bay has missed the second of Christine Connelly’s deadlines for CSC by failing to go live with Lorenzo R1.9 by the end of March. However, it does go live with the system at the end of May. Unfortunately, the deployment runs into problems. By September, it has been forced to launch a ‘stabilisation programme’ to address problems with clerking, appointments and orders.

September 2010: Health minister Simon Burns issues a ministerial statement on the future of NHS IT. This says the national programme will end in its current form. New structures will be put in place, the programme’s national projects will become NHS services, and trusts will be given far more freedom to choose their own IT. However, the crucial LSP contracts will be “honoured.”

November 2010: Birmingham Women’s Hospital NHS Foundation Trust goes live with Lorenzo R1.9.

However, Christine Connelly reveals in an exclusive interview with eHealth Insider Lorenzo is “not yet stable” at Morecambe Bay and is not ready for wider deployment by CSC.

2011: Conservative MP Richard Bacon sends a letter to the National Audit Office and Christine Connelly raising serious concerns about the value of a new CSC contract; and follows it up with a letter to Prime Minister David Cameron asking him to get the Cabinet Office involved in the negotiations.

Pennine Care NHS Foundation Trust withdraws from taking Lorenzo. CSC tells investors that despite this, it is expecting a new memorandum of understanding with the NHS in a matter of weeks. Prime Minister David Cameron tells Bacon that nothing will be signed until the NAO reports and the Commons public accounts committee has examined its report. All options are on the table, he adds.