Into the end-game

In 2002, NHS trusts were promised state of the art electronic patient record systems via the National Programme for IT in the NHS.

Centrally-contracted local service providers were expected to deploy such systems to trusts and create an integrated care records system in the process.

Progress has, of course, been slow – not least in the North, Midlands and East of England, where CSC has been the sole LSP since Accenture quit the programme in 2006, and where attempts to deploy the Lorenzo system have been beset by delays.

But it may be about to end completely. Last week, CSC told investors that it may fail to get a new memorandum of understanding that is advantageous to the company – or any deal at all. As a result, it warned investors that it might suffer an ‘impairment’ of £1 billion.

MoU or not to MoU

The news comes almost a year after the Department of Health first announced that it might terminate CSC’s contract, when Pennine Care NHS Foundation Trust pulled out of becoming an early adopter for Lorenzo.

Former DH director general of IT, Christine Connelly, had told the company it must get Lorenzo deployed and working at four early adopters to trigger contract payments and show it was making “significant progress” with the system.

Pennine Care was the fourth early adopter – and the first mental health adopter – so its go-live was key. Since then, Humber NHS Foundation Trust has stepped into the early adopter gap. But a number of critical reports have also made it harder to get a new deal done.

Last May, the National Audit Office argued that the whole integrated care record services project had failed to deliver value for money, and that the £4.3 billion still to be spent might not do so, either. It was particularly critical of CSC’s performance on Lorenzo.

However, during a Commons’ Public Accounts Committee hearing into the report, Connelly, told MPs that pulling out of the contract could be more expensive than sticking with it.

In September, the government announced that it was ‘accelerating’ the end of the national programme, but it failed to say what would happen to the CSC contract.

The company itself continued to tell investors that it expected to win a new deal. Indeed, in December it said it expected to make £2 billion from it.

But over the Christmas and New Year break, it apparently changed its tune; although it is still possible that it will win a deal – albeit a smaller and less lucrative deal than was on the table last May and even into the autumn.

Trusts think beyond NPfIT

The tumultuous run of events over 2011 has left many of those working in NHS IT unsurprised by CSC’s recent announcement.

Paul Walsh, an independent consultant who has been responsible for running the Mid Staffordshire NHS Foundation Trust’s procurement for a new electronic patient record, says: “The news last year was a bit of a watershed moment and allowed trusts to go out and procure locally – it gave a strong indication of how it was likely to end.

“With the fact that there are very few trusts that have selected a CSC solution, and then the big questions around the value for money that the DH was getting from the contract, I think that’s a bit of a watershed and many more trusts are now going out to procurement.”

He said trusts have not exactly been “sitting on their hands” waiting for news of what is going to happen, but have instead begun looking at how they can manage the situation independently.

“I can’t guesstimate how many [EPR] procurements are currently running, but I would say it would be upwards of ten or 15 within the NHS. I think that’s likely to continue. Trusts that have been delaying EPR procurements, or were awaiting delivery, will re-approach their IM&T strategy.”

Daniel Ray, director of informatics at University Hospitals Birmingham NHS Foundation Trust, also feels that many trusts have been proactive about considering their IT needs and, where necessary, procuring systems.

“Trusts had already started to consider what their other options may be. I don’t think any organisation would have waited until last week to consider what their options were around implementing an EPR solution,” he says.

However, he also feels that the long-drawn out nature of the CSC and DH negotiations has been unfortunate.

“Yes, it was unfair on the trusts that it took that long. However, it was important that the negotiations – in terms of wrapping up the contracts – was done in the right and the best way.

“It may well be that it was appropriate for them to take that amount of time to ensure that what we were left with was… seen to be the best for the NHS.”

Finding other paths

University Hospitals Birmingham long-since stopped expecting the national programme to provide it with new IT systems, as did The Rotherham NHS Foundation Trust.

It pulled out of the programme in 2008, opting instead to be the first trust in the UK to attempt an implementation of Meditech’s system. While it is still in the final stages of finalising its go-live, chief executive Brian James says it made the right decision to go it alone.

“Clearly with hindsight – and some foresight – we made the right decision. We can now look forward to introducing a new, state of the art EPR system at a time when many other trusts will be having to make very difficult decisions about what to do with their existing, and by now archaic, IT systems,” he tells EHI by email.

However, Christine Walters from Pennine Acute Hospitals NHS Trust says CSC’s announcement took her by surprise.

“I was surprised, I did think that they would have come to some sort of compromise… because if you think of all the money and all the resources that have been invested in it, I did think they would have come to some sort of compromise over it.”

Her trust’s long-term strategy has been to wait for Lorenzo to become viable and to then implement it under the national programme. In the meantime, it has been implementing other iSoft systems to upgrade its IT. Walters says the trust will now wait and see what happens in the marketplace before it decides which path to take.

“I am [disappointed] for a number of reasons. One as a taxpayer – because a huge amount of money and resources that have been invested in this. And also because trusts were held back for quite a number of years with the promise that the national programme would deliver.”

Standards, standards, standards

If CSC doesn’t get the deal it wants, and it then pulls out of the national programme, the consensus is that this will allow more room for smaller players and create a more open market.

Chief executive of Channel 3 Consulting, Rhys Hefford, says it is an exciting time for NHS trusts. “The national programme issues, aligned with the NHS financial challenges, provide a strategic opportunity for re-thinking how services can be better delivered through innovative re-thinking.

“My advice to any trust right now is to clearly establish a strategic direction, ensure this supports change in the organisation and move forward to make the most of this opportunity.”

Daniel Ray says one of the key imperatives in moving forward to a more open market is ensuring standardisation. “What we need to do is make sure that standards and definitions are really important and they are kept and adhered to.

“When you’ve got CSC you’ve got one contract… the standardisation wasn’t a problem because it was only one supplier. [Now] if they all offer different systems and different solutions it could signal danger in the long run because those systems may not be compatible with one another.”

When the DH announced it was axing the national programme for the second time in September, it also announced a partnership with Intellect to foster “a vibrant and healthy” market and facilitate standardisation.

The partnership’s first joint plan for working together, published last week said it was developing plans to achieve this. Ray says they need to happen. “It needs to come to fruition, we must not lose sight of how important that standardisation is.”