Insider View: Jon Hoeksma

Has the bar been dropped so low that the NHS IT programme is now guaranteed to succeed?EHI editor Jon Hoeksma ponders some recent announcements.

Over the past few weeks, the E-Health Insider team have reported a flurry of announcements on the future of the NHS IT programme. But with spectacularly bad timing, I was off on paternity leave. So since returning to the office, I’ve been trying to work out: what do they all mean?

Some thing’s don’t change

First off are the dogs that didn’t bark. There are still two local service providers, something that looked less than certain even a few months ago. BT has taken an enormous write-off on its Global Services Division, but it hasn’t walked away from its NHS deals, as some analysts suggested it might.

The eight Cerner trusts in the South now have BT to support them, and a path to future upgrades to the same version of the Cerner Millennium software that is to be used in London.

More Cerner implementations have also been promised; something else that didn’t look certain not so very long ago. One more has been promised in London this year and four more to Southern trusts over an unspecified period.

At the same time, there will be some choice, at least in the South. Admittedly this is where things start to get a bit more vague. But people have been saying they want choice, and now they’ve been told they can have some.

Quite how the choice between Cerner, iSoft or something else from the ASCC catalogue will work is unclear, but its still a change on what’s come before.

Choice will not be offered elsewhere in England. In the North, hope continues to spring eternal for Lorenzo, which now has to be deployed in a trust by November and running smoothly across an acute trust by next March.

Although Lorenzo is now working in a small number of pilot sites, including a new one in Bradford, making the leap to a full scale acute implementation is going to be extremely demanding.

Meanwhile, Computer Sciences Corporation, the local service provider for the North, Midlands and East, has confirmed that TPP is no longer a stop-gap, interim system but a strategic solution.

Give it another six months

Despite all this, it does appear that after years of waiting for the key Care Records Systems patience has finally run out at the Department of Health.

In January, the Public Accounts Committee called for a review if delivery had not been achieved in six months,  and in March NHS chief executive David Nicholson said that unless the core NPfIT systems were successfully delivered within months the DH would look, and possibly tender, for alternatives.

Christine Connelly, who is now titled director general of health informatics, gave a similar, though not identical, message last month when she told the FT: "If we don’t see significant progress by the end of November 2009, then we will move to a new plan for delivering informatics in healthcare."

Interestingly, Connelly said she did not “want to talk very much” about what a new approach might involve but “at this point we are not ruling anything out.”

Hopefully, everything will run according to the latest plan, but the experience of the NPfIT to date would suggest that it would make sense to work on the assumption that just maybe it won’t. Yet there is little sign that those at the top of the DH are urgently, looking for alternatives.

Despite the tougher talk on suppliers and more conciliatory tone on choice, fundamentally Connelly has decided to stick with the existing supplier line-up and hope they can deliver. Realistically, she may have no other choice; time is against her.

It is all too easy to imagine how November becomes December, becomes January and then we’re within touching distance of a General Election.

An election is likely to be won by the Conservatives, whose leader, David Cameron, recently moved beyond promising to “abolish the NHS supercomputer” to promising to scrap some bits of NHS Connecting for Health, including its electronic records programme.

Running out of time

Current efforts to restart CRS implementations are going to prove difficult and take time. Many experts believe it takes two years, minimum, to successfully prepare for and install a big hospital information system.

Chief executives of trusts being asked to sign on the dotted line are also certain to want a lot more assurance that the problems seen at sites like Royal Free will not be visited upon them, whatever CfH head Martin Bellamy has to say about a “new delivery model.”

Adding up four more trusts in the South, one in London and one in the north accounts for six more NHS hospital trusts in line to take ‘strategic’ CRS systems. It would be a great start, but what about the rest – there are around 200 NHS hospital trusts; the NHS IT programme has barely covered 10% of them?

The question is not when will the next six NHS hospital sites go live, but when will the last six get new IT systems? As things stand, it looks as though the programme will only ever meet the needs of a fraction of NHS trusts (and that’s without getting into the question of how many trusts are now prepared to buy or do their own thing).

Ultimately, the significance of the next implementations will not be how they shape the current NHS IT programme, but what comes after it.