Delivery delays mount across the national programme

NHS Connecting for Health (CfH) has confirmed that there are delays in implementing the National Programme for IT (NPfIT) in four of the five regions in England, with the biggest slippages occurring in delivering new integrated clinical systems to acute hospitals.

As previously reported the delivery of new hospital systems in London and the South is running at least nine months late. The national programme, however, has now confirmed that delays are also occurring in the North East and East of England.

E-Health Insider understands that the problems have occurred despite a great deal of hard work and commitment from the NHS and suppliers to push the work through.

The first hard evidence of delays in the North East and Eastern regions was reported ten days ago by local service provider (LSP) Accenture in filings to the US Securities and Exchange Commission, which showed a $24m (£12.5m) loss on the NHS contracts in the second quarter of the firm’s current financial year. The accounts also predicted losses of up to $150m (£78.5m) in the full financial year due to delivery delays.

In response to questions on the nature of these delays an NHS CfH spokesperson told EHI: "Accenture is less well advanced with some secondary care deployments than its original plans intended."

The spokesperson downplayed the significance of the delays adding: “In the context of a ten year programme these are not significant delays – a few months.”

Accenture’s financial report was sufficient, however, to set the alarm bells ringing among investors and to prompt a renegotiation of deployment plans and payment schedules between Accenture and the NHS.

Sources within the NHS indicate that behind the scenes delivery schedules are being revised and pushed back, creating a log-jam of sites that had been due to receive new systems now having to make stop-gap plans.

Despite repeated requests from EHI over the past month NHS CfH has refused to provide details of deployment schedules for any of the five clusters. The programme has confirmed that progress has been made on Choose and Book, where around 500 patients are now said to have "benefited from the service" – still short of the 205,000 electronic bookings that were due to have been completed by December 2004.

Providing an overview of what had been implemented by LSPs so far across the English NHS, the NHS C4H spokesperson made no mention of any sites in either London or the South. EHI understands though that 17 new practice systems have been implemented in London, and that the South is expected to be where the first Picture Archiving and Communications sites go live.

In London the pace of delivery is unlikely to have been helped by the suspension of David Kwo last week as regional implementation director, especially when combined with a recent shake-up of the BT-led Capital Care Alliance LSP senior management team. The South meanwhile remains in the midst of a root and branch ‘120 day’ review, which is intended to produce a detailed implementation plan.

Also conspicuously absent across all of the regions is any mention of a successful implementation at a large acute trust of the first phase of either of the reference solutions being developed by IDX and iSOFT. Community patient administration system (PAS) implementations have begun to be implemented along with a small number of stand alone off-the-shelf departmental systems in the acute sector.

Deployments in the two Accenture regions include a single assessment process (SAP) system and three initial implementations of the iSOFT GP system connected to the NHS Spine. The contracts for 165 Phoenix Partnership practices and a small number of child and mental health sites have been novated to Accenture, with management and support remainign with The Phoenix Partnership.   No implementations of the core clinical solution or a PAS system without clinical applications have occurred yet.

But despite this slow progress NHS CfH remains upbeat that delivery is about to begin en masse, stating that "over the next few months" Accenture will deliver a new PAS system to 45 hospitals. This would be a remarkable achievement, based on the difficulty of delivering a single PAS so far, partly due to reported problems with the NHS data spine.

From the limited information officially available, CSC in the North West and West Midlands (NWWM) cluster appears to have made the greatest progress, and has recently been singled out for praise by NHS IT Director General Richard Granger. The NWWM cluster has begun deployment of nine new systems. These early implementations have been of a stand-alone theatre system, provided as an "emergency bundle" by the LSP, and an interim community PAS system.

Stockport NHS Foundation Trust and NHS trusts at Morecambe Bay and Tameside have each received a new theatre system, while deployment of a community PAS has begun in four health communities: Greater Manchester, South Birmingham, North Cheshire and Lancashire Care Mental Health. The numbers of users remains low, though: only one of the new implementations serves more than 100 users.

According to NHS CfH "over the next few months" systems will be deployed to about 20 trusts "across acute, mental health and community care settings" in the cluster. Sources at a local level within the region strongly indicate that this prediction looks optimistic and the timings far less certain.

Asked about local implementations West Midlands South Strategic Health Authority, which began testing shared electronic record systems for the national programme two years ago, told EHI that it had three sites – Coventry PCT, Worcestershire Community and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust – due to go live by the end of June with the LSP reference solution "based on current plans – though those plans are currently under review".

At UHCW, which is due to go live with an acute PAS, together with maternity and A&E systems by 28 May, both the implementation date and the elements of the LSP reference solution to be implemented are under review. Asked whether 28 May remained the go live date, a spokesperson for the trust said the current published plan was "currently under review".

"We expect a revised set of plans by the end of April," said a spokesperson for the SHA, who confirmed that a wider discussion on implementation timetables was underway across NWWM.

An NHS source within NWWM region told EHI that delays are stretching the finite implementation capacity in the region. He said that ten sites had been due to implement the reference solution by March but been unable to do so, and now the next wave of scheduled implementations is due. As a result timetables are again being redrawn. Another stoical NHS IT director elsewhere in the region told EHI that their delivery slot has now gone back on four separate occasions.