CfH jigsaw still ‘missing pieces’

The NHS IT programme is a jigsaw “still missing pieces”

The NHS IT programme is a jigsaw “still missing pieces” that need “to be found and put in place”.

Martin Bellamy, the boss of NHS Connecting for Health, the agency responsible for delivering the NHS IT programme, said that eight of the 11 components required were now in place. The challenge is now to deliver the “missing” jigsaw pieces in the acute hospital sector: Cerner Millennium, iSoft Lorenzo and the Summary Care Record.

Speaking at Smart Healthcare yesterday, the CfH boss said he wasn’t proud of the delays of “four years” on the missing parts of the programme. "I don’t attempt to say that is acceptable performance.”

Bellamy said the aim is to deliver the “missing” pieces of the NHS IT Programme by early 2010. Assuming this can be achieved, the intention is then to “scale up” to large numbers of large scale implementations by the end of 2010.

Bellamy told E-Health Insider that if the missing pieces can be successfully delivered by early 2010, followed by a six month bedding down period, the NHS major “complex implementations” of new IT systems in NHS trusts will occur at the rate of “10s every six months” between 2011 and 2013.

He said that 2009 is about “proving components”, with 2011 to 2013 being the years in which delivery will have to occur, with the pace building in 2011 and 2012.

Completing the roll out by the end of 2013 will be a huge challenge, he told EHI. “It will require a couple of hundred complex implementations across the three years, as well as over 9,000 GP practices.”

With the NHS facing real-term budget cuts from 2011, the very year from which acute hospital delivery is now projected to ramp up, Bellamy stressed that CfH only accounted for a portion of NHS IT expenditure. Trusts, he said, needed to commit significant resources to ensure the success of complex IT projects critical to their operation.

But before this can happen CfH must first show it can deliver hospital systems, which are stable and deliver clinical benefits. The key deadlines fall first this November for the next Cerner Millennium implementation at Kingston; and then March 2010 for the first iSoft Lorenzo installation in an acute trust.

He said three key lessons had been learned from the severe problems at the Royal Free and Barts and the London, which would be applied to all future hospital implementations. Royal Free, he said, was only now getting to back to a level of functionality it had before switching to Cerner, which he described as unacceptable.

The number one lesson was the need for very clear executive leadership and commitment; second, was the necessity of in-depth preparation and clinical engagement; and finally, the need to provide detailed in-depth support, including modifying systems, following go-live.

Bellamy stressed that it was more important to have a successful go-live than hit an “artificial deadline”. “You need a stable system at least a month before go-live. You must have a no-go decision before you go live, and there is no shame if you have to take more time to get right.”

He said it was essential to recognise that support and change was an ongoing requirement: “You need in-depth support for four months post go-live and there needs to be a resource around the level of change that will be required locally.”

Bellamy said latest plans were to have Lorenzo version 1.9, including patient administration system functionality, live and operational in at least one NHS trust, and “getting Lorenzo live at a significant acute hospital by March 2010”.

The CfH boss said that he was monitoring the development and testing work on Lorenzo very closely, with a team in Chennai, India, “I’m getting very regular updates, and was on the phone talking to them today.”

Asked whether he was confident the delivery deadlines set by Christine Connelly, the Department of Health’s chief information officer, and his boss, Bellamy chose his words carefully: “We’ve got a better than fighting chance.” But he added: “I’d never say it’s easy or guaranteed.”

Asked whether England’s NHS National Programme for IT was still national in scope, given how far it still has to go, the difficulties encountered and developments such as such Foundation Trusts buying systems outside the programme, the CfH boss said: “There is still scope for national delivery of some elements of the National Programme for IT. The approach to have a series of systems that enable a joined-up patient record is still valid.”