DH carrying out ‘confidential’ review of CfH

E-Health Insider has learned that an urgent ‘confidential’ review of the NHS IT programme and structure of Connecting for Health, the agency responsible for its delivery, has been launched by the new chief executive of the NHS David Nicholson.

The new boss of the health service has commissioned a review of the £6.2bn NHS digitisation project as one of his first actions since taking up post in September.

The CfH review, which has already begun taking evidence, is understood to be focusing on reviewing how to re-structure CfH to make it and the programme it is charged with delivering more locally responsive.

Described to E-Health Insider as a ‘confidential rapid review’, suppliers have already been called in by a CfH study group to answer questions on the state of the programme with sessions being held this week.

But some industry figures contacted questioned how thorough it would be and suggested the terms of reference were too limited. "It’s a rush job," said one senior industry figure. "It appears to be very short and a not very thorough job."

Those involved indicate that this is a review that dare not speak its name. "CfH are insisting this is not a ‘review’, and is nothing to do with the past but all about the future," explained one senior industry source.

One CfH source stressed that the review was not being undertaken by CfH but by DH: "It’s a review that’s being done to us". However, several of the key figures conducting the review are understood to be senior executives from CfH.

Despite the well-documented delays and significant difficulties in delivering the core clinical and care records systems at the centre of the project the Nicholson review is believed to exclude technical questions and performance to date. Instead the review is being cast as strictly forward looking, focusing on how to improve future prospects for success through re-configuration.

The DH confirmed to EHI that the review has been ‘commissioned’ by Nicholson. A spokesperson said a review was timely given "the re-structuring of the NHS and the recent transfer of responsibilities from Accenture to CSC".

The DH spokesperson added that the review was linked to CfH "preparing for Executive Agency status". Health Minister Caroline Flint recently confirmed that CfH would be a time-limited agency with a lifespan of no more than a further five years.

The spokesperson said the review also took in a new programme of work – "the NPfIT Local Ownership Programme" – which in line with the summer NAO report on the IT programme aims to achieve "a shift in ownership to the local NHS to ensure it is an essential part of normal NHS business in supporting the delivery of better quality and safer care".

NHS Connecting for Health declined to offer any comment on the review.

One of the most likely outcomes of the ‘NPfIT Local Ownership Programme’ is that much of CfH’s work and responsibilities will be devolved to the nine new strategic health authorities, rather than be concentrated centrally in Leeds.

An indication of the likely direction of travel is provided in the person of Kevin Jarrold, who as well as being the CfH regional implementation director for the London cluster is also the chief information officer for London Strategic Health Authority. Nicholson was chief executive for London SHA immediately before taking up his new post.

Two weeks ago CfH staff were notified in a letter from chief operating officer Gordon Hextall that re-structuring plans were being drawn up, and sources within the agency indicate these will be based on moving a significant number of staff out to structures aligned to SHAs.

Calls for a review of the project, including calls from both the British Computer Society and from a group of 23 eminent computer academics, have all previously been rejected.

Just three weeks ago health minister Lord Warner rejected the academics call for a review stating: "I want the programme’s management and suppliers to concentrate on implementation, and not be diverted by attending to another review." DH thinking appears to have since moved on.

Dr Glyn Hayes, vice-president of the BCS and chair of its health informatics forum said: "If this review is designed to refocus CfH towards a more local implementation approach we are all in favour as we want those successes that have been achieved to be built on."

Dr Hayes added that a local implementation approach potentially provided the way to address a lot of the very real anxieties around confidentiality.

The BCS is itself due to publish a full review of the technical architecture of the NHS IT programme within the next two weeks.