Simon Burns, minister of state for health
The National Programme for IT in the NHS is set to end in its current form, a ministerial statement will announce this morning.
A further £700m will also be cut from the cost of the programme, with £500m coming from ‘local savings’ and £200m from the local service provider contract with CSC.
E-Health Insider expects the ministerial statement to be made at around 10.30am.
Christine Connelly, the director general of NHS IT, will simultaneously brief staff at the Leeds offices of NHS Connecting for Health.
This suggests that a substantial number are likely to lose their jobs or see them change significantly.
However, the statement will say that the national infrastructure elements of the national programme will be retained, with oversight of programmes such as Choose and Book shifting to "new arrangements" by 2012.
An announcement on the future of the national programme has been expected since the launch of the government’s white paper, ‘Equity and excellence: Liberating the NHS’ in June.
At the launch, NHS chief executive David Nicholson told journalists that a statement would be made within four weeks.
The paper itself indicated that NHS organisations would be able to choose from “a more plural system of IT and other suppliers”, in line with Conservative policy before the general election.
EHI has been told that this morning’s statement will say that the programme’s national approach is “no longer appropriate” and that it will be “reconfigured” to “reflect the approach set out in the white paper.”
The national programme started in 2002. It had four main aims; to roll out a new national broadband infrastructure for the NHS and to create electronic booking, prescribing and records systems.
Multi-million pound contracts were awarded to national and local service providers in 2003 and 2004.
The programme has always been subject to intense criticism that has been
In the run up to the election, the Conservatives endorsed the findings of an independent review of NPfIT that called for the five-year old project to be radically rewritten and the LSP contracts to be “halted and re-negotiated.”
However, the white paper backed Choose and Book and the government has shown no sign of scrapping the Summary Care Record, although it is reviewing its content and consent model.
Following today’s announcement, the total value of the programme will be cut to £11.4 billion.
The last Budget by the Labour government cut £600m from the programme, with BT’s commitments to deliver Cerner Millennium to acute trusts in London severely curtailed. MP Richard Bacon is calling for a review of the deal.
CSC also agreed to limit the scope of the iSoft Lorenzo electronic patient record it is due to deliver to the North, Midlands and East of England.
It has been locked in talks with the government about the future of its contract since the belated go-live of Lorenzo at University Hospitals of Morecambe Bay NHS Trust in June.
Trusts in the South have been waiting to see whether they will receive funding to receive systems of choice through the Additional Supply Capability and Capacity framework.
Simon Burns will be speaking at EHI Live 2010, the essential two day conference and exhibition for anyone in the e-health community.
Online registration for the event, which will be held at the NEC in Birmingham from 8-9 November, is now open.
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A real choice for patients and tax-payerUnknown 209 weeks ago
We are not fighting the IT revolution, but fighting for a better IT revolution. The previous government snuffed out competition, choice and innovation in the healthcare IT market by imposing top-down reform, centralised purchasing and big contracts to companies that had limited track record in healthcare IT who then had to find sub-contractors to build the systems. The software developers could not engage directly with the clinicians but through layers of bureaucracy in the LSPs, DoH, SHAs, PCTs & hospitals. This three-legged race has been a painful and a decade-long financial disaster for all including the LSPs and their sub-contractors themselves. Fujitsu had to bow out. iSoft is losing its share value as we speak. Smaller companies already providing systems to hospitals and entrepreneurial clinicians were discouraged from developing applications utilizing the latest developments in consumer IT. We might as well have been in the USSR.
Now here are 2 challenges to the Health IT industry:
1. How about a choice of Choose & Book portals like expedia, lastminute, opodo? The individual hospitals can provide their own directory of clinics based on standard coding terms. Let patients and GPs decide which portal to use to book the hospital appointments. No public subsidies, no long-term contracts. You can earn by per-transaction commission.
2. You collectively pay for the CfH which will become the body to regulate competition and set standards for clinical + management data quality, safety of Health IT systems in the UK.
where we startedUnknown 209 weeks ago
I loved the comment that booking an appointment should be as easy as booking a flight. That is exactly what the proponents of C&B said at the start. Actually, of course, there are rather more complexities in booking an appointment and airlines don't play the same games that some trusts have. And while the actual on-line booking of a flight may be very quick, you can spend a very long time indeed finding the flight first (i.e. making the choice). Why should we think that a second go at C&B would be better than the first?
Just a point in passing about the cost of NPfIT. I think I'm right in saying that the cost of the contracts was about £6bn (still a huge amount of money for what has been delivered, I'll grant). The rest is the costs of implementation borne directly by the Trusts (I'm sure someone will correct me if I'm wrong on that). In other words pretty much what it would have cost if they'd acquired and implemented systems locally and what they will have to find if they want to do that now.
C&B and LudditesUnknown 209 weeks ago
Reply to 16;
You are living in a parallel Universe mate, saravana, a clinician user and fellow NHS IT suffferer has the correct diagnosis. The whole CfH/NPfIT exercise has not exploited the potential for improved healthcare and safety but done the exact opposite because the design of the systems is all about monitoring activity and doing time & motion while taking freedom and power from clinicians. Very little I have seen, apart from clinically centred add-on software bought outside the National initiatives, has done anything for clinical efficiency and safety. Systems don't talk to each other and hospital users sit with four or five different programs running each with different passwords that time out intermittently during a clinic or theatre session, sucking time and focus away from the people they are trying to care for.
Your wrist fracture experience made me laugh, but in fact it's not funny because your interpretation of the cause is incorrect and the overall impact of the policy behind it is so serious. Before the great NHS plan & C4H run out, GP's (and specialists) did have the freedom to refer where they wanted. However the way 'Choose & Book' (or Lose (the patient) & Cook (the books) as we called it) was implemented has destroyed that freedom. When I worked in Scotland 2000-4 I could, as a specialist, refer patients to another hospital in England if I saw fit, by the time I got to England 2004-9, I could not even refer to another specialty in my own hospital without sending the patient back to the GP. C&B supposedly offers 4-5 'choices' of referal to primary care, but in reality only one of these is ever practical for the patient. Many of my patients complained bitterly about the difficulty of getting through to C&B operatives on the phone and then they were not only offered only one choice of clinic to attend but usually a single date as well. If they asked to change the date they told me they were bullied into taking the first choice or threatened with a long wait. I frequently had patients arrive in my clinic, for me to tell them that I did not have the expertise to manage their problem and that they should have been directed to a departmental colleague. Consultants' sub-specialty interests and knowledge came way behind the directive to shove patients into the clinics with the current shortest waiting time. The point is C&B and referal management centres were a smoke screen for destroying clinical freedom as PCT & trust managers controlled the system to meet the Nu-Lab target focused culture. The interest of these systems has always been Governmental, Mangerial and Industrial first, patients and clnicians last.
As for the Luddites they rioted in response to machines that made them redundant, transformed industrial process and increased production 10-100 fold. Please show me where ANY C4H or NPfIT initiative has done the same! In Taunton after Cerner started 24 new WTE cleks had to be hired just to keep the scheduling of appointments up to speed. Doctors would kill for a system that enabled them to do their work more efficiently and with less paper. None of the current NHS Health IT initiatives achieve that - when I left Somerset a day case coming through main theatres had fifteen bits of paper on the front of the notes for a fifteen minute procedure. Kafka-esque does not even come close to the current work experience inflicted on hospital clinicians by the last Government and NHS Executive and C4H.
I don't see this view reflected in realityUnknown 209 weeks ago
I'm currently being bounced around the county to see a clinician for a wrist injury. I have no say in which place I'm going to, or when according to a certain receptionist. Your statement that patients have a choice without C&is not backed by my experiences, nor those of family and friends - what makes you think that patients are being offered different options if we do indeed have one?
Also, how long does it take to be offered an appointment without C&B? When I had to see a consultant last year, and could use C&B, I booked the appointment whilst still in the doctor's office.
As for "When clinicians raise concerns about 'patient safety, privacy, slow speed, poor function, excessive cost, unfriendly display & input interface, ergonomics etc"...
Patient Safety: let's have a minimum data standard, and avoid the situation where Dr A just records a broken arm, and Dr B specifies the location and type of break. Accurate demographic data would be nice too.
Security: Receptions discussing patient details loudly in waiting rooms, terminals left unlocked, pre-signed blank prescriptions left out, unencrypted laptops/flash drives containing patient data lost...
Slow speed: yes, this was a problem, and is still a work in progress. However, it is gratifying to see the strides in communications technology and practices which have been made during the project have been totally ignored in the press and medical; it started off with what was seen as a nigh on impossible spec, to something which was actually usable and helpful in real life (I spent a lovely weekend at a seaside A&E during the middle of summer measuring system responses)
Function, display and input: Comments on user interfaces were asked for and welcomed, but when the majority of responses were contradictory and based on personal working practices rather than clinical function, developers can only provide a best fit.
It's ironic that you're complaining about being called a Luddite, and mentioning the industrial revolution, when you've been fighting the IT revolution.
To poster 11 - 'Lack of understanding'Unknown 210 weeks ago
"NPFIT might not have been perfect, but real benefits have been realised by many, including patients (sic)."
Please can you give examples, and give your view of cost appropriateness for each (including opportunity cost)?
Whose savings ?Unknown 210 weeks ago
Smoke, mirrors and devolve the problem. £700M, only £200M saving from the central contracts, £500M local savings, so that's alright then.
Not only did we not get local funds to deploy this rubbish, (nor anything worthwhile for the South), and will have to resurrect local plans, we're taking the brunt of the savings.
Oh Joy !
A collective failure...The Luddite Insider 210 weeks ago
Defence, Child Support Agency, HMRC and now the NHS.
Yet another shoddy job...
A public enquiry is need to know why the Whitehall mandarins allowed these monopoly contracts to be written like a blank cheque. Did the ministers and civil servants not know that the best technologies emerge through open and fair competition rather than from big companies with monopoly contracts sub-contracting the job to another developer in a far-away land? At the CfH Conference at Birmingham last year there was no sign of the dozens of successful healthcare IT systems; only the stalls of struggling LSPs and the 'Yes' men from CfH. What a stitch-up!
Why keep C&B and SCR? Choose and Book is a failure both as an IT and a clinical tool. We didn't need a multi-million pound system to tell patients that they have a choice which they always had to see any consultant in the country ever since the NHS was founded! How many doctors in the NHS use C&B to view the referrals themselves? Let us go back to the drawing board and re-design a slick electronic booking system. I want to be able to view a referral letter in the same time it takes me to print my flight ticket.
We should all share the blame for this collective failure resulting from an endemic culture of poor communication, ignorance, indifference and arrogance. When clinicians raise concerns about 'patient safety, privacy, slow speed, poor function, excessive cost, unfriendly display & input interface, ergonomics etc.' we are accused of being ignorant luddites by those who speak a different language of 'PID, OBS, KPI, LSP, SUS, HRG, CDS and a thousand other combinations of alphabets'. Majority of the clinicians let this saga carry on by their indifference to finance, management & informatics.
Shame on a country that started the industrial revolution and failed the IT revolution badly.
Politics Driving ITUnknown 210 weeks ago
".....another Large Government IT Project fails....."
Where have we heard this before and it had all the hallmarks of failure from the off. I wonder what the OGC make of this?
...and alarm bells have been ringing loud and clear for years - and with one LSP in particular in mind.
The only good news is that time has been called - at last.
I going to enjoy watching what the Public Accounts Committee makes of this one.
I only hope that those surviving healthcare IT suppliers who have a track record of sucessfully delivering what the customer wants will now stand a better chance of getting a bite of the apple.
Welcome back McKesson.
Lack of understandingUnknown 210 weeks ago
9) because people don't understand the benefits and seem to have completely forgotten what the world was like 8 years ago.
NPFIT might not have been perfect, but real benefits have been realised by many, including patients.