Carrots, sticks and the NPfIT

E-Health Insider talks to the National Programme for IT’s chief operations officer, Gordon Hextall about progress on Choose and Book and what the programme really wants from its suppliers.

A point not always fully appreciated about National Programme for IT is that it wants to incentivise its suppliers to deliver services, not penalise them. So says the programme’s chief operations officer, Gordon Hextall, who clearly prefers carrots to sticks.

In the high profile case of BT, which missed summer delivery targets on the spine, the company can still earn back the money attached to those targets, Hextall explains.

"BT was not fined as such, but the contract provides for suppliers to pay penalty payments to be paid into a key escrow account. But suppliers can win that money back.

"The whole focus of our contracts is not to penalise suppliers but to incentivise them for delivery. Them making payments into an escrow account isn’t much use to us. We want working systems."

With the roll-out of ‘Choose and Book’ now underway, Hextall was talking to E-Health Insider about the state of progress of the programme and challenges still ahead.

Rounding up progress he said that NPfIT had awarded contracts on schedule, been through the IT development work and was now implementing Choose and Book: "I think we are broadly where I would expect us to be with any IT programme of this complexity and scale.

He singled out Choose and Book as the first application to go live. "We always said that the national programme would start to implement Choose and Book in the summer, so that was obviously a key milestone for us."

The NPfIT COO said lack of fanfare over Choose and Book going live is deliberate. "Since the end of July we’ve had the electronic booking application being able to book appointments from primary to secondary care, in a very low-key way, at a small number of locations and that will gradually prove itself during the summer."

Hextall declined to say how many sites were so far using e-booking, saying "that could cause problems". The NPfIT number two says that it is unfair to expose these early adopter sites to media scrutiny until they have bedded down new systems.

As all Choose and Book messages pass through the spine, getting electronic booking underway first required early components of the spine to be in place and working, and for key suppliers to pass through the NPfIT sandpits to be accredited as spine compliant.

Hextall said the components of the spine required for e-booking included the messaging and personal demographics services, together with the registration authority, which issues the smart card to control access.

"So what we’ve actually got is elements of the NHS CRS spine, developed by BT, working with electronic booking application, which ATOS have developed and we are now working with primary and secondary care providers to get their systems compliant."

Asked whether the national programme will be able to accelerate the roll out of the electronic booking to hit the target of having Choose and Book nationally available by the end of 2005, Hextall says: "There is a very specific target. The Government are expecting a fully booked NHS, for day care, by the end of 2005."

Turning to the work programme with legacy suppliers, Hextall says that the August guidance issued to existing suppliers on becoming compliant is based on listening to their "hopes, fears and concerns" and the experience of working with a number of existing system suppliers through the integration testing in the sandpit in the run-up to e-booking applications going live and beyond.

He points out that the national programme has "established an existing systems programme, with a programme director to work specifically with the existing systems suppliers".

The COO also explains that there are now three sandpits for testing applications, each of which can be accessed remotely from Leeds or the supplier’s own premises. He confirms that both EMIS and McKesson have both passed the compliance tests for electronic booking and that work is now focusing on those suppliers who will support the early adopters. The NPfIT COO added: "Yes there is a core of key suppliers that NP expects to go through process. We’ve looked ahead through to the end of 2004 and we are reasonably confident we are able to accommodate and have a good relationship with the suppliers who [we need] need to support those applications.”

Another vital milestone reached by NPfIT, says Hextall, is that LSPs and trusts have now completed their implementation plans for 2004-2005. Asked whether these had been signed off in every cluster Hextall says, "I think so. But they are dynamic you know… They are only as good as they are on that date. So they can, and in fact need to, change constantly as part of the ongoing planning process."

He identifies improved communications and engagement with clinicians as further important achievements: "Our other main effort has gone in to improving communications and clinical engagement, the piece that Aidan Halligan [joint NPfIT director-general] has been leading."

The centrepiece of the work on clinical engagement will be "setting up the frontline service academy, and preparing the simulation environments that are all part of that leadership training."

Hextall says that the aim of the leadership academy will be to help frontline clinicians to have the leadership skills that will enable them to take on change management roles in implementing the national systems and achieving the benefits from that.

Hextall stresses, however, that the national programme remains in the foothills on delivery and still has heights ahead to scale. "We’re still at the start of this process. Until we have implementations in primary and secondary care that the public will see, that’s when the real achievements will start to be delivered."