Department of Health

From Nhs It Info

Contents

Information for health: an information strategy for the modern NHS 1998-2005 (Sep 1998)

Department of Health

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4002944&chk=kwk%2BJz

"Executive Summary: The purpose of this information strategy is to ensure that information is used to help patients receive the best possible care. The strategy will enable NHS professionals to have the information they need both to provide that care and to play their part in improving the public's health. The strategy also aims to ensure that patients, carers and the public have the information necessary to make decisions about their own treatment and care, and to influence the shape of health services generally."

Shifting the Balance of Power within the NHS (Jul 2001)

Department of Health

http://www.dh.gov.uk/assetRoot/04/07/35/54/04073554.pdf

". . . The balance of power must be shifted towards frontline staff who understand patients' needs and concerns. A shift in the balance towards local communities so that they reconnect with their services and have real influence over their development. Frontline staff need to be in charge of frontline services and have the power to manage to meet the local communities needs' always within the context of clear national standards and a strong accountability framework. The NHS must support frontline staff and engage local communities to deliver the necessary reform to deliver faster more responsive high quality services. . ."

Service Management (18 Sep 2006)

Department of Health

http://www.connectingforhealth.nhs.uk/delivery/servicemanagement

"Statistics: The NHS is an enormous community requiring services and support which will be greatly enhanced with the introduction of new IT infrastructure, systems and services by the National Programme for IT. The technology will effectively link the many disparate NHS organisations to create a truly national health service. However, implementing the National Programme is a huge and complex operation. As such, there will be no 'big bang'; instead, systems will be gradually phased in according to priorities and when NHS organisations are ready to implement them. Our Availability Statistics and Deployment Statistics demonstrate the progress we have made to date."

DH carrying out 'confidential' review of CfH (15 Nov 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2266

"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. . ."

NHS chief executive to scrutinise Connecting for Health (28 Nov 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/11/28/220234/nhs-chief-executive-to-scrutinise-connecting-for-health.htm

"NHS chief executive David Nicholson has ordered a review of Connecting for Health, the organisation running the NHS's £12.4bn National Programme for IT. The Department of Health confirmed that Nicholson had commissioned the review, to be undertaken by CfH management 'to ensure that it is correctly structured and staffed to deliver the projected programme delivery schedule'. The review comes as CfH prepares for executive agency status. A DoH spokesperson added that a separate national programme was also under way, aimed at ensuring a shift towards 'local ownership' of NPfIT as 'an essential part of normal NHS business', in line with recommendations from the National Audit Office. Recent re-structuring of the NHS and the transfer of NPfIT contracts from Accenture to CSC created 'a good opportunity to undertake this work'. NPfIT is also set to come under scrutiny by the Commons Health Select Committee which has announced an inquiry into the programme."

Letter to Lord Warner

(Sent on 12 Nov 2006)

Letter to Mr David Nicholson

(Sent on 29 Nov 2006)

As of 12 December no reply to either of these letters had been received.

New scrutiny for IT programme as bigger role for SHAs mooted (7 Dec 2006)

Health Service Journal

http://www.hsj.co.uk/healthservicejournal/pages/n/06107/it

"Major changes to the national programme for IT in the NHS have been signalled as the NHS chief executive launched a review and MPs announced an inquiry. The Department of Health confirmed last week that David Nicholson had ordered a review to 'ensure that [IT] is a normal part of NHS business, supporting the delivery of better quality and safer care'. At the same time, NHS Connecting for Health, which runs the programme and is preparing for executive agency status, is 'looking to ensure [the programme] is correctly structured and staffed to deliver'. HSJ understands the two moves together indicate a much bigger role for strategic health authorities and a slimmed-down central team. . . Confirmation of the changes emerged as the Commons health select committee announced a new investigation into NHS IT. The move was welcomed by the British Computer Society and academics, who have been pressing for a further review since the National Audit Office issued a surprisingly positive report on the programme's early years this summer. . ."

NHS plan signals shift to local IT ownership (11 Dec 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2332

"A sharp shift of responsibility for NHS IM&T in England from the centre to local organisations is signalled in the service's new plan for 2007-8 published today. 'The NHS in England: the operating framework for 2007-8' was launched by NHS chief executive, David Nicholson, who says in his foreword: 'We are devolving power from the centre to the service in many ways, not least in how we allocate money, such as the unbundling of central budgets. 'Some of the key enablers of service transformation, such as the delivery of information technology, will also increasingly need to be driven and owned by the service rather than from the centre so that patients can get the full benefits as quickly as possible.' . . . Plans will be required from NHS organisations showing not only how local but national priorities will be achieved including: implementation of GP Systems of Choice; preparing for the National Summary Care Record; the completion of picture archiving and communications rollout; implementation and benefits realisation for the Electronic Prescriptions Service and further exploitation of e-booking. The framework also says plans should show how organisations will carry out the deployment and benefits realisation for patient administration systems and order communications and results functionality, in line with existing commitments and targets set by each SHA, in the context of existing commercial arrangements. . ."

GPSoC delivery goes local in IT devolution (11 Dec 2006)

e-Health insider Primary care

http://www.ehiprimarycare.com/news/item.cfm?ID=2333

Local NHS organisations will be required to draw up plans showing how they will deliver GP Systems of Choice implementation under new arrangements announced today. Primary care trusts, as commissioners, will be required to have their own comprehensive IM&T plan and work with all providers in their local health communities to align IM&T plans to enable patient-centred service transformation. The new requirements are part of a broad strategy of devolving responsibility for IM&T to local level announced in 'The NHS in England: the operating framework for 2007-8'. The framework was launched by NHS chief executive, David Nicholson, who says in his foreword: 'We are devolving power from the centre to the service in many ways, not least in how we allocate money, such as the unbundling of central budgets. 'Some of the key enablers of service transformation, such as the delivery of information technology, will also increasingly need to be driven and owned by the service rather than from the centre so that patients can get the full benefits as quickly as possible.' Nicholson is currently reviewing the National Programme for IT (NPfIT) and reports suggested he was keen to improve local ownership of the programme. . . Plans will be required from NHS organisations showing not only how local but national priorities will be achieved. These include: the completion of picture archiving and communications rollout; implementation and benefits realisation for the Electronic Prescriptions Service and further exploitation of e-booking. . . In addition to the responsibilities set out for PCTs, as commissioners, all NHS providers will have to have a forward looking IM&T plan which is 'core to their business, exploits fully the NPfIT opportunity and thereby demonstrates migration to the NHS Care Record Service.'

Health minister steps down (13 Dec 2006)

The Guardian

http://politics.guardian.co.uk/publicservices/story/0,,1971318,00.html

Lord Warner, the junior health minister, is to retire at the end of the year, Tony Blair's spokesman said today. The spokesman said that it was a "personal decision" by the 66-year-old peer to stand down. He strongly denied any suggestion that the minister's departure was connected to the troubled National Health Service IT project which he was overseeing. "His decision to retire has absolutely nothing to do with that at all," the spokesman said. "He genuinely wants to spend more time away from his red boxes." The Labour peer, who was once director of social services at Kent County council, and chairman of the Youth Justice Board for England and Wales, was considered a competent minister and a safe-pair of hands. The spokesman said that a successor will be appointed early in the New Year."

Lord Warner was spearhead of blairite NHS reforms (13 Dec 2006)

Liberal Democrats

http://www.libdems.org.uk/news/lord-warner-was-spearhead-of-blairite-nhs-reforms-pugh.11543.html

"Commenting on Health Minister Lord Warner's announcement that he is retiring, Liberal Democrat Health Spokesperson, John Pugh MP said: "Lord Warner has been the unelected spearhead in parliament of the Blairite NHS reforms and was consistently on message. "With the massive NHS IT project struggling and hospitals financially destabilised, he will be relieved to step down before the problems start to multiply. "The pilot may have been dropped but the ship is still heading for the rocks.""

Minister responsible for NPfIT to retire (14 Dec 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2347

Lord Warner the health minister responsible for the £12.4bn NHS IT project is to retire at the end of the year. No 10 has announced that the Labour peer will retire at the end of the year, in what was described as a "personal decision". The BBC reported that Downing Street had denied that his departure was linked to the growing difficulties over the NHS IT programme, and delays to the implementation of the national electronic record system. Since the 2005 election Lord Warner - a former special advisor to Jack Straw - has served as deputy to health secretary, Patricia Hewitt, with direct responsibility for some of the most contentious aspects of the government's health reforms, including the ministerial lead on competition and choice. Lord Warner, 66, has been closely linked to the CfH programme and repeatedly dismissed any criticism of the project. In October he rejected calls by leading computer science academics for a review of the technical architecture of the project to establish the scale of the risks facing the National Programme for IT (NPfIT). In June following the publication of the National Audit Office (NAO) report on NPfIT Warner was bullish about the progress of NPfIT, despite the NAO report stating that NHS Care Records Service was two years late and the total cost of the project had doubled to £12.4bn. At the Department of Health press conference on the NAO report Lord Warner told E-Health Insider that he was absolutely sure both the summary national part of CRS and the detailed local clinical record components of CRS would be fully delivered by 2010. 'I have no doubts in my mind whatsoever.' And in May Lord Warner appeared to muddy the waters over the cost of the programme when he said the price tag for NPfIT, by then officially stated as £12.4bn, would actually end up as £20 billion. A No10 spokesman told the Daily Mirror that Lord Warner's retirement was not linked to the NHS digitisation project: "His decision to retire has nothing to do with that at all. He wants to spend more time away from his red boxes." It is not clear which health minister will take over Lord Warner's responsibility for the NPfIT, which is currently being reviewed by the DH."

Text of letter sent from the Department of Health to patients expressing concern over electronic care records (Dec 2006)

Department of Heath

http://www.connectingforhealth.nhs.uk/newsroom/all_images_and_docs/guardian-letter.pdf

"I am replying to your letter addressed to the Secretary of State regarding your participation in the NHS Care Record Service (NHS CRS). Your letter raised some specific concerns about your personal health information being held electronically in a new NHS database as a summary care record, indicating that having your information held by the NHS in this way may cause you substantial unwarranted distress. You therefore asked the Secretary of State for Health to stop the process of adding your information to the new NHS database. I have responded to the reasons you have indicated for your distress in detail in an annex to this letter. However, much of what has been published on this matter is inaccurate and I am therefore providing the context for my response by setting out the reasons for the introduction of the NHS Care Records Service. . ."

Hunt returns to DoH (9 Jan 2007)

Kable's Government Computing

http://www.kablenet.com/kd.nsf/Frontpage/EE91BAFA0C04451D8025725E0041616B?OpenDocument

"After a four year gap Lord Hunt is back at the Department of Health, preparing to tackle the troubled NHS IT programme. Lord Hunt of Kings Heath returned to the Department of Health on 8 January 2007, and is expected to resume responsibility for the £12.4bn NHS National Programme for IT (NPfIT). Hunt resigned from his post as health minister nearly four years ago in protest against the Iraq War. He is replacing Lord Warner who retired at the end of 2006 in what was described as a "personal decision". A spokesperson for the Department of Health told GC News that final details of Hunt's portfolio are "still being ironed out", but he will take responsibility for quality and safety, research and development, relationships with the National Institute for Clinical Excellence and the Healthcare Commission. He is likely to lead on workforce issues and Connecting for Health, which were under Warner's brief. . . Hunt's appointment comes at a critical time for NPfIT and its governing agency, Connecting for Health: there have recently been reports of an internal DoH review of the programme's structure. At a hearing of Parliament's influential Public Accounts Committee last summer leaders of NPfIT were accused of failing to consult sufficiently with medical staff and buying the wrong technology."

NHS chief dismisses fresh call for review (6 Feb 2007)

Computer Weekly

http://www.computerweekly.com/Home/..%5CArticles/2007/02/06/221619/nhs-chief-dismisses-fresh-call-for-review.htm

"NHS chief executive David Nicholson has rejected a fresh challenge issued by 23 leading computer scientists to commit to an independent review of the £12.4bn National Programme for IT (NPfIT). Nicholson also dismissed a 212-page dossier of the NPfIT's problems, which details the concerns of some consultants and other clinicians over the programme. The dossier was compiled by the 23 academics, who include senior computer experts at leading universities. His rebuff will heighten concerns among some health experts about what they see as complacency among top-tier management at the Department of Health over the state of the NPfIT. Speaking at a one-day event dedicated to the National Programme, Martyn Thomas, visiting professor at Oxford University and a representative of the 23 academics, issued the challenge to Nicholson to commit within two weeks to launching an independent, published review of the programme. But Nicholson, who attended the whole event, repulsed the challenge only hours later. He expressed strong support for programme, while conceding that there were "issues", including a need for the NHS to "pull the programme in its direction". Nicholson said that the NHS did not respond well to being told what to do and there was a need for "more engagement and more ownership" by the NHS of the NPfIT. He added that the programme was "not wildly off course" and there was "no evidence which would lead me to believe there is a need for an independent review of the programme". Issuing his challenge, Thomas told the conference that a primary concern of the academics was whether the NHS's requirements had been correctly identified and agreed with clinicians and patient representatives, as well as being complete, consistent and feasible. "We also have technical concerns about the system architecture, the security policies, the system usability, the clinical coding standards, and other technical aspects," he said. "We believe that the professional way to address these risks is for there to be an independent, constructive review that publishes its findings and recommendations." Nicholson said he was impressed with the way the NPfIT was developing. He said he now wanted the NHS to own, love and understand the programme. . ."

NHS dismisses calls for IT review (6 Feb 2006)

ZDNet UK

http://news.zdnet.co.uk/itmanagement/0,1000000308,39285804,00.htm

"A group of IT academics has failed in its latest request to instigate an independent review into the NHS's National Programme for IT. Last October the group of 23 computer experts claimed urgent action was needed to put the £12bn National Programme for IT (NPfIT) back on track, with their spokesperson, Oxford University visiting professor Martyn Thomas, warning that the project was set to fail. Nothing came of their demands. Now, according to Computer Weekly, their latest attempt to instigate a review has failed. Speaking at an NPfIT event last week, Thomas said the academic group had "technical concerns about the system architecture, the security policies, the system usability, the clinical coding standards, and other technical aspects". The group wants an independent review to be conducted to ensure that the programme remains on track and meets the needs of medical professionals. But the NHS's chief executive David Nicholson turned down the academics' latest challenge, after Thomas called for an independent review within two weeks. Nicholson denied that NPfIT was "wildly off course" and said there was "no evidence which would lead me to believe there is a need for an independent review of the programme". The much-criticised NPfIT programme, which was been through a raft of supplier and budgetary issues, is the largest civilian IT project in the world."

The evidence base for the National Programme (15 Feb 2007)

Department of Health

http://www.connectingforhealth.nhs.uk/about/case/

"Since its inception, the National Programme for IT has evoked a huge amount of interest and debate. We present the evidence for the Programme and how it will support the NHS to provide better, safer care. We look at why it is needed and what people say about it, offering comments and opinions from patients and patient organisations, clinicans, MPs, the media and from the findings of independent reports looking at NHS Connecting for Health and the National Programme for IT."

Connecting for Health pulls speakers from Europe's largest healthcare IT conference at Harrogate (6 Mar 2007)

Computer Weekly - Tony Collins' Blog

http://www.computerweekly.com/blogs/tony_collins/2007/03/connecting-for-health-pulls-sp.html

NHS Connecting for Health, which runs the NHS's National Programme for IT NPfIT], has withdrawn its speakers from Europe's biggest annual IT health conference at Harrogate. The agency, which is part of the Department of Health, is under political pressure to improve its communications and engagement with the health service, which suggests its speakers would want to be at the HC2007 Healthcare computing conference in force. But two weeks before the conference and exhibition, the three speakers from Connecting for Health have been withdrawn. They are Richard Granger, Director General for NHS IT, Richard Jeavons, senior responsible owner for service implementation and Sir Muir Gray, director of clinical knowledge, process and safety for NHS Connecting for Health. . . It is not clear why Connecting for Health has withdrawn its top people at such short notice. There is speculation that some health officials are irritated by the strong links between the British Computer Society and 23 academics who have written an open letter calling for an independent review of the NPfIT. The academics have much information on the NPfiT on their wiki, comprising published and original material. There is also some speculation that health officials are concerned about a paper published by the British Computer Society's Health Informatics Forum Strategic Panel in December 2006. The paper "The Way Forward for NHS Health Informatics" contained much praise for the NPfIT and the work of Connecting for Health. It made it clear that the BCS wants the NPfIT to succeed. The paper also made some points that Connecting for Health may have found unendearing, an assertion for example that political pressure has caused health officials to "deny problems and to defend the indefensible".. . . But the authors ensured their report was balanced. Indeed they concluded that the NPfIT is changing for the better. . ."

On the Evolving NHS IT Strategy (15 Mar 2007)

Health Service Journal - HSJ Intelligence

http://www.shop.hsj.co.uk/pdf/hsj_intelligence150307.pdf

". . . in 2002, the national IT programme was set up to move things along with 'ruthless standardisation' and procurement from a few large firms. But there is now a sense that the programme is coming to an end, and that the agency that runs it, Connecting for Health, will evolve into a standards-setting and infrastructure body. The NHS's latest operating framework makes strategic health authorities, rather than the programme's local service providers, responsible for implementation and benefits realisation. Providers have been told to draw up IT plans that take account of business needs, while showing commitment to the NHS care records service. These changes will be welcomed as they are in line with those demanded by the NHS 23 group of academics (see news in brief), the public accounts committee and various trade bodies. They may also be inevitable, since trusts are increasingly reluctant to take programme systems. . . Few will weep if the arrogant, secretive 'NPfIT' fades. Its successes have been negotiating software deals, setting standards and creating infrastructure, so it seems to make sense for it to focus on them, Its failures lie in not managing to install the systems supposed to make up the 'functionally rich' local end of the NHS Care Records Service and to align IT and reform. The irony is that this is what it was set up to do. . . [Lynn Whitfield]"

On Developing Local Strategies (15 Mar 2007)

Health Service Journal - HSJ Intelligence

http://www.shop.hsj.co.uk/pdf/hsj_intelligence150307.pdf

". . . There are two possible versions of the Department of Health thinking behind recent guidance to the NHS on developing local information technology strategies to 'fully exploit' investments by the national IT programme. Either: 'There you are NHS, the national IT programme has delivered what it was set up to deliver and now it falls to you to put the sophisticated, value-for-money systems they have procured to good use for the benefits of patients.' Or: 'Well, we've made a right mess of that - nothing for it now but to pass the buck back to the NHS and hold local chief executives personally responsible if they don't retrieve the situation.' . . . Doubtless many primary care trust chiefs will feel, in being asked to co-ordinate local IT plans, they have been handed the mother of all poisoned chalices just at the time they have neither the financial or specialist intellectual capacity to cope with the scale of the task. However, those clinicians, managers and IT professionals across the NHS who, despite everything, hope for clinical systems that help to improve care (as distinct from booking appointments, etc.) may see a glimmer at the end of what many feel has been a dark tunnel. They will see that the DoH and the programme now accept that the national project will deliver much less, in terms of sophisticated local functionality to the NHS, than was originally hoped. While this is all disappointing, it does at least provide an opportunity at last for the more visionary local NHS health managers to sit down with clinical colleagues and decide how to build what is eventually provided by the programme into the sophisticated locally integrated health record. It may also offer a chance for the many small- and medium-sized IT suppliers to develop applications that can integrate with the infrastructure provided by the programme and turn it into the clinically rich, fully integrated local system that everyone had hoped for. . . This may well be a way out of the privacy quagmire that surrounds the creation of the national care record database. People worried that their records will be held on a national database may be much happier to see their local organisations commission secure, web-based personal electronic records - which can be made available, where they approve, to support their health wherever it is provided. . . [Frank Burns]"

NHS IT devolution plan goes into action (27 Mar 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/03/27/222674/nhs-it-devolution-plan-goes-into-action.htm

"Whitehall officials will start dismantling parts of Connecting for Health next month in a bid to "reinvigorate" the £12.4bn National Programme for IT (NPfIT). Under the plan, which forms part of an audit by NHS chief executive David Nicholson, some staff, job roles, budgets and responsibilities will be transferred from the agency to local and regional organisations. The rethink means that responsibility for meeting key local and national objectives of the NPfIT will be dispersed to more than 150 senior responsible owners at local and regional health service sites. Among these, the regional senior responsible owners - in practice, the chief executives of strategic health authorities - will be expected to commit to ensuring that deployments meet the NHS's contractual commitments to local service providers. Under the contract, the NHS has to place a minimum amount of business with these suppliers each year. The NPfIT Local Ownership Programme is Whitehall's response to a report by the National Audit Office last year that said that a critical factor in the success of the NPfIT would be the local support of doctors and other NHS staff. But so far it is unclear how much freedom local senior responsible owners will have to operate, and whether they would be held responsible for any failure of the NPfIT, which after four years continues to be beset by uncertainty - in particular over electronic health records. . ."

Passing the reins (30 Mar 2007)

The Guardian

http://society.guardian.co.uk/e-public/story/0,,2045822,00.html

"On April 1, much of the responsibility for the £6.2bn NHS National Programme for IT, parts of which are two years late, will pass from NHS Connecting for Health (CfH) to strategic health authorities (SHAs). The National Programme for IT local ownership programme will include the transfer of staff to SHAs from five super-regional "clusters" run by CfH as local delivery arms. According to a document released earlier this month by the North-East SHA, this might include redundancies. Dr Stephen Singleton, the authority's medical director, wrote: "The geographical spread of SHAs is far greater than current CfH clusters. Connecting for Health staff generally appear to be on higher grades than NHS counterparts. The two points above suggest there might be a reasonable risk that redundancies will be necessary (but there is no financial provision)." The SHAs have formed two new groups to deal with the dominant "local service provider" suppliers, according to documents placed online by SHAs, based on the areas covered by these companies. BT supplies London SHA only, but the southern CfH cluster supplied by Fujitsu - covering the South Central, South-East Coast and South-West SHAs - has established a south NHS management board, chaired by Mark Britnell, chief executive of South Central SHA, which first met on January 9. A similar structure has been created for a new "NME" (North, Midlands and East) group for the six SHAs covering the rest of England, which are all served by CSC following Accenture's withdrawal from the national programme in January. The NME NPfIT programme board met for the first time on February 21, according to the North-East SHA document. In what might be an indicator of future problems with these groups, Dr Singleton wrote that his SHA wanted a decentralised approach to CfH staff, whereas other authorities want to centralise. A spokesperson for North-East SHA said it prefers to place staff working across the region within individual trusts, to keep them in touch with frontline work. Richard Popplewell, chief executive of Stockport PCT and chair of the Greater Manchester IM&T programme board, welcomed the localisation, although he estimates it will take one to three months to become effective. . . Murray Bywater, managing director of health IT consultancy Silicon Bridge Research, said the localisation work could run into problems if SHAs and trusts disagree, or if they want to alter the terms of the local service providers' secret contracts. "There will need to be some readjustment of those contracts for [the suppliers] to operate effectively in the new environment," he said. The change comes as CfH launches a £100m tender to find additional software suppliers. Bywater said decisions including this and the localisation work show power shifting from CfH back to the Department of Health, following the national programme's numerous difficulties. "The Department of Health is beginning to reassert itself," he said. "Politically, you can interpret this as CfH having its wings clipped.""

Minister announces new directions, to overcome resistance to England's NPfIT (19 Apr 2007)

British Journal of Healthcare Computing & Information Management

http://www.bjhc.co.uk/news/1/2007/n704007.htm

"Health minister Lord Hunt announced a drastic switch in priorities for England's National Programme for IT at the HC2007 Conference in Harrogate last month. Delivery of the National Care Records Service is being put on the back burner - in favour of a concentration on projects that are most likely to deliver quick wins, and a transfer of ownership of the NPfIT - from the centre to organisations in the field - becomes a high priority. Both are part of a move by the Department of Health to win the hearts, minds and active support of frontline care providers in using the national IT infrastructure to enhance the quality of patient care. In his speech last month he also conceded that the Government had failed to convince the public that the goals of NPfIT - especially the shared care record - were worthwhile."

NHS computer records project chief quits (15 Jun 2007)

Financial Times

http://www.ft.com/cms/s/5a361d74-1b8a-11dc-bc55-000b5df10621.html

"Richard Granger, the UK's highest-paid civil servant, is to leave as head of the £12bn programme to develop an electronic patient record for the NHS. The 42-year-old head of the IT programme, who is on six months' notice, said on Friday he wanted to go because by October he would have fulfilled the five years he originally said he would devote to the project, and "most of the building blocks are now in place". His decision to go, he said, was also "a very personal one". He wants to spend more time with his three young children in Cumbria, with a break from a job that has been "quite simply relentless". He plans to "move to the next stage of my professional career" next year. He will be taking up "one of a number of approaches that are swirling around". He will go as the state of the programme remains a matter of controversy. Its key goal - a full, detailed, local, interchangeable electronic patient record - is running at least two years late. But Mr Granger can argue the programme is on budget, suppliers only get paid after they deliver, and large amounts of the infrastructure, and a host of other applications, including the wholesale replacement of X-ray film by digital images, are now in place, or being rolled out, and are working. The programme, however, also remains well behind on installing the new patient administration systems that are needed to work with the patient record software that is now due next year. There is, however, now "no doubt about the programme's achievability", Mr Granger said."

Granger to leave in transition by end of 2007 (16 Jun 2007)

e-Health insider

http://www.e-health-insider.com/news/item.cfm?ID=2784

"Connecting for Health chief executive, Richard Granger is to leave the agency responsible for delivering the National Programme for IT to the NHS in England 'during the latter part of this year.' In a personal statement issued today, he said he would "transition" from his full time post at the agency he was largely responsible for setting up. The controversial and outspoken IT boss who joined the NHS from Deloitte Consulting in September 2002 will return to work primarily in the private sector during 2008. The statement says he is currently considering several significant approaches. He said: "My decision should be seen in the context of the changing role of the centre of the NHS and the fact that when I took on this challenge I said I would give this job five years. I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years. There remain a number of challenges ahead, but I firmly believe that the leadership of the programme by Lord Hunt, David Nicholson and my colleagues within CfH will ensure these hurdles are overcome. I want to acknowledge the enduring professional support I have received from my team and colleagues throughout the NHS." The statement said that in due course an announcement regarding the identification of a successor and transitional arrangements will be made by the Department of Health. Health minister Lord Hunt said: "I would like to thank Richard Granger for his hard work and tremendous achievements in delivering the National Programme for IT for the NHS and wish him luck for the future. Richard will continue to lead Connecting for Health during the transition period, which we expect to be the late part of the year, and his decision will not affect the delivery of the NHS IT programme."

Boss of troubled £12bn NHS computer project quits (16 Jun 2007)

The Times

http://www.timesonline.co.uk/tol/news/uk/health/article1942900.ece

"Britain's highest paid civil servant has announced his resignation as head of the £12 billion computer project for the National Health Service. Richard Granger, 42, chief executive of NHS Connecting for Health, was responsible for upgrading information technology (IT) systems and introducing electronic patient records. Although computer systems have been improved in many trusts, the project has been criticised for delays and design flaws. The departure of Granger, who was paid £290,000 a year, will be seen as a further setback for the project. He has been credited with updating hospital IT systems from 'the stone age" and ensuring that private contractors involved in the project were not rewarded for failure. Granger will leave in the next few months and said he was considering offers to return to the private sector. "I passionately believe the programme will deliver ever greater levels of benefit to patients over the coming years," he said. The NHS project, the biggest civilian computer project, was backed by Tony Blair to deliver detailed electronic records for every NHS patient. The electronic record system is now more than two years late and Gordon Brown is expected to review its progress when he becomes prime minister. Tony Collins, executive editor of Computer Weekly, the industry magazine, which has called for an independent inquiry into the project, said: "Without Granger the risk is that this programme will now fall apart. The programme has highlighted the need for proper electronic records in the NHS, but you have to ask what it has achieved that trusts could not have done on their own. It has also not delivered on the main objective of a centralised patient record system." Granger was appointed head of the project in 2002 after successfully managing the introduction of the IT element of the congestion charge in London. Confronted with what he saw as the intransigence of the medical profession and the determination of IT suppliers to make high profits at the taxpayers' expense whatever their performance, Granger tried to introduce a tough competitive climate for the contractors. His metaphor for the project was a sledge being pulled by huskies. Those who fell by the wayside would be "chopped up and fed to the other dogs" to ensure that those who survived worked harder. The former management consultant was respected by many in the industry but others were taken aback by his abrasive and demanding approach. One contemporary once described working with him as a "deeply corrosive experience". Connecting for Health proved to be a huge challenge as NHS staff complained they had not been properly consulted and experts argued it was foolhardy to keep patient records in one central database, warning the system might be vulnerable to unauthorised users. . ."

Anger as best paid civil servant goes (17 Jun 2007)

Sunday Telegraph

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/17/ngranger117.xml

Britain's best-paid civil servant is to quit as the head of NHS information technology, claiming the new, accident-prone computer system is on track. Richard Granger, the chief executive of Connecting for Health, said he would leave the post, and its £290,000-a-year salary, in October. "There is no doubt about the programme's achievability," said Mr Granger, who took up the role in October 2002. "Most of the building blocks are now in place." Karen Jennings, the head of health at Unison, the NHS's biggest trade union, said Mr Granger's optimism was at odds with the views of the "majority of NHS staff". She said: "Technically... things are finally coming together. But lessons must be learned from the way these over-ambitious, big-bang IT projects have been brought in late and so over-budget." Parts of the project are two years behind schedule and it may now cost a total of £20 billion, which would put it £7 billion over budget. Mr Granger can point to some successes. An electronic patient-booking service now arranges 20,000 appointments a day and 250 million X-ray images are now stored electronically. But there have also been breaches of patients' confidential details and what has been called the "biggest computer crash in NHS history", when 80 NHS trusts had no access to patient records for four days. Richard Bacon, a Conservative MP on the Public Accounts Select Committee, said Connecting for Health had caused "anger and resentment among doctors, nurses and hospital managers".

Personal statement regarding Richard Granger (18 Jun 2007)

Connecting for Health

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/personal

"Richard Granger has announced that he will transition from his full-time post as the Chief Executive of NHS Connecting for Health. Granger will leave NHS Connecting for Health, the Department of Health Agency responsible for delivering the National Programme for IT to the NHS in England, later this year. He will return to work primarily in the private sector during 2008. He is currently considering several significant approaches. Granger said: "My decision should be seen in the context of the changing role of the centre of the NHS and the fact that when I took on this challenge I said I would give this job five years. "I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years. "There remains a number of challenges ahead, but I firmly believe that the leadership of the programme by Lord Hunt, David Nicholson and my colleagues within NHS CFH will ensure these hurdles are overcome. "I want to acknowledge the enduring professional support I have received from my team and colleagues throughout the NHS." An announcement regarding the identification of a successor and transitional arrangements will be made by the Department of Health in due course."

NHS director general of IT quits after repeated system delays (18 Jun 2007)

The Guardian

http://business.guardian.co.uk/story/0,,2105353,00.html

"Britain's highest paid civil servant, the man in charge of the NHS's delayed £12.4bn IT upgrade programme, has resigned amid calls from politicians and academics for a wholesale review of the project. Richard Granger, the NHS director general of IT, is to wind down his role and leave the health service by the end of the year. "I am proud of what has been achieved by the team I established in 2002," he said. But there is concern that the National Programme for IT (NPfIT) is in trouble. Designed to update the NHS's paper-based records in England over 10 years, it is the largest non-military IT project attempted in the world. Four years in, repeated delays, concern about the suitability of core software and the withdrawal of a number of suppliers have left many hospital trusts and clinicians disillusioned with the project. Last year Accenture, a lead contractor, walked away from two £1bn contracts, writing off hundreds of millions of pounds relating to work on the project. Mr Granger has argued that his insistence on not paying for work on the programme until it has been delivered has meant the taxpayer has not had to bear the extra cost as suppliers work round the clock to keep the project on track. He pointed out the NHS had spent £1.5bn on delayed contracts by April last year, instead of the £2.3bn it would have cost had the work been delivered as contracted. Mr Granger last week dismissed much of the debate around the IT programme as "complete tosh". Speaking at an IT conference, he said: "We would not have got to this point without our dedicated ring-fenced funding. I think that with a bit less whingeing and more support ... we might have even got the programme done quicker." But David Nicholson, who took over as chief executive of the NHS in England last September, has been under pressure from hospital trusts to decentralise the troubled IT programme and open out elements of the healthcare IT market to wider competition."

Richard Granger's NHS IT legacy (18 Jun 2007)

Silicon.com

http://www.silicon.com/publicsector/0,3800010403,39167548,00.htm

"Will the £12.4bn project be viewed as a success or a failure? After five years in charge of the biggest IT project in the world NHS IT director-general Richard Granger has announced he is to step down later this year. The former Andersen and Deloitte management consultant came to the NHS IT post on the back of his successful stint delivering the London Congestion Charge scheme, becoming the UK's highest-paid civil servant - a silicon.com Freedom of Information request last year revealed he earns around £280,000. It has undoubtedly been a turbulent five years and opinion is strongly divided on whether his time in charge of the £12.4bn NHS computerisation programme - also known as Connecting for Health - has been a success. While Granger's hard-headed and no-nonsense approach meant tough new contracts for suppliers, which would only get paid for systems they actually delivered, it also led to accusations of a project being imposed on the NHS with little input from the doctors, nurses and patients who would be using it. . ."

Fulsome praise for departing CfH boss (18 Jun 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2788

"The news that Richard Granger is to leave Connecting for Health and the helm of the NHS IT Programme later this year has elicited a clutch of glowing tributes from some of the most senior industry and NHS executives he has worked with over the past five years. Over the weekend Granger received effusive praise and statements of regret about his departure from NHS and industry leaders, forwarded to EHI by Connecting for Health's communications team. EHI readers commenting on site have also been sharing their thoughts, some pointing out that despite undoubted achievements on infrastructure, PACS and introduction of systems like Choose and Book the core NPfIT objective of delivering integrated shared electronic patient records remains unrealised. . ."

Ailing project at heart of NHS (19 Jun 2007)

The Guardian

http://politics.guardian.co.uk/publicservices/story/0,,2106234,00.html

"The government's ambitious vision for a single, standardised IT programme that would drag NHS creaking paper records systems into the 21st century was always going to be a challenge. The largest non-military IT project ever attempted - forecast to cost £12.4bn, or enough to pay 650,000 nurses for a year - it has been under strain almost since its inception four years ago. Repeated delays and lingering concern about the suitability of core software, particularly that of iSoft and the US firm Cerner, has hampered progress, as has the withdrawal of a number of important suppliers. Worse still, the 10-year National Programme for IT (NPfIT) quickly fell out of favour with clinicians and hospital trust executives, many of whom felt such a centralised project was at odds with the federal structure of the NHS in England, where trusts were used to making decisions for themselves. To date, however, these festering problems have been kept at bay, largely thanks to the determination and drive of Richard Granger, the NHS's director general of IT and one of NPfIT's most zealous advocates, who quickly gained a reputation as a ruthless enforcer. "I cannot exaggerate the value of Richard to this programme and the likelihood of its success," the government's then medical adviser, Professor Sir John Pattison, told MPs five years ago. This week, though, Mr Granger, the UK's highest-paid civil servant, said he was quitting. The former Deloitte consultant, who introduced London's congestion charge IT system, is to wind down his NHS role and quit by the end of the year after a successor is found. There has been a mixed reaction to the shock move. A controversial figure from the start, Mr Granger was never afraid to upset those who challenged his vision of a ruthlessly standardised NHS care records system. . . Speaking at an IT conference in London last week, Mr Granger said: "I think with a bit less whingeing and more support we might have got the programme done quicker." In truth, however, Mr Granger's centralised NPfIT project has been unravelling for some months. Faced with widespread disaffection, David Nicholson, chief executive of the NHS, has taken steps to appease trusts, in part by offering them greater control of IT decision-making. He has also begun to open out parts of the IT healthcare market to increased competition. Low-profile and modest in scale, these measures have quickly won the enthusiastic support of many clinicians and hospital executives, as well as scores of smaller IT groups with a long record of working with the NHS. With Mr Granger's departure, they hope NPfIT will continue to evolve away from a monolithic, centrally co-ordinated solution into a network of "inter-operable" systems, all plugged into an electronic "spine" and accessible to trusts across the country. In public, the health minister Lord Hunt insists Mr Granger's departure "will not affect the delivery of the NHS IT programme" but behind the scenes even NHS officials are busy drawing up plans for further IT devolution. . . Five core multibillion-pound regional contracts, linked to iSoft and Cerner, could ultimately prove Mr Granger's most controversial legacy. The lead contractors CSC, Fujitsu and BT have refused to write down the value of their NHS work, signalling that they firmly believe the contracts will provide them with a commercial return. But with growing enthusiasm for devolution and choice within NHS IT, the future of the five regional deals looks uncertain. What is clear, however, is that at some point someone, somewhere, is going to have to pick up a colossal tab for an over-ambitious and unpopular IT project."

NHS and IT suppliers say Granger's departure 'won't change contracts' (20 Jun 2007)

ComputerworldUK

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=3612

"The NHS and trade body Intellect have both dismissed suggestions that key suppliers to the health service's £12.4bn National Programme for IT (NPfIT) might seek contract changes or compensation when NHS IT chief Richard Granger leaves. Granger is to quit his post as director general of NHS Connecting for Health, which runs NPfIT, by the end of the year. The combative NHS IT chief claimed in an interview with the Financial Times that there was a 'significant' risk of lead NPfIT suppliers CSC, Fujitsu and BT seeking contract changes or compensation because his departure would amount to a variation on their contracts. But a Connecting for Health spokesperson poured cold water on the idea. 'Contractors cannot make a claim on the basis that Richard Granger has resigned,' he said. He added: 'We are currently in a transitional period. An announcement about the identification of a successor to Richard Granger and also transitional arrangements will be made by the Department of Health Shortly.' Eddy Peers, vice-chair of the healthcare group at IT suppliers' body Intellect, said: 'I'm surprised at the interpretation that a contract of that magnitude would be tied to a person. I would be extremely surprised if it happened.' He added: 'For the vast majority of major contracts, key people will change.' Peers said there had been 'a lot of renegotiation' of the NPfIT contracts recently ' a move linked to the devolution of the programme's ownership to the NHS's strategic health authorities as some of the focus of NPfIT shifts towards implementing its systems in local hospitals. 'Contractual arrangements and the way implementation takes place, responsibility and so on have been reframed on the ground in the light of experience, as you would expect in a major project,' he said. Peers noted that there was 'a lot of excitement in the supplier marketplace' about Granger's departure and the possibility of change 'because a lot of suppliers have been put onto the margin' by the NPfIT contracts, which are structured around the three lead suppliers. . ."

NHS IT will never be the same again (21 Jun 2007)

Computing

http://www.vnunet.com/computing/news/2192474/nhs-never

"As Richard Granger prepares to step down, NHS IT programme focuses on implementation. No other public sector technology programme, however controversial, has generated quite the same furore as the £12bn National Programme for NHS IT (NPfIT). The project is held up as a paragon of tight contracting, technical vision and world-leading innovation. But it is also used as an exemplar of the worst excesses of disastrous government IT: autocratic, unworkable and a spectacular waste of money. Richard Granger's combative stewardship of the programme for the past five years has created almost as much controversy. And his departure in a few months, announced this week, will have a significant impact. Electronic X-ray systems and the high-speed N3 broadband networks are both widely acknowledged as successful. But there are still problems with the hospital software needed to make the most of the electronic bookings, prescriptions and patient records schemes. And although pilots of summary care records are about to begin, and corporate issues with key subcontractor iSoft may be nearing resolution, both remain significant challenges for the new director general. Reaction to the news of Granger's resignation veer from eulogy to condemnation. But, personalities aside, his resignation is part of wider changes for the programme. Critics of NPfIT have two major complaints. First, they say it was designed and run as a monolithic dictatorship that took no account of the diversity of the NHS. Second, they say it did not engage sufficiently with clinicians. . ."

'The NHS programme is like a Hummer, it will drive through anything' (21 Jun 2007)

Computing

http://www.vnunet.com/computing/news/2192472/nhs-programme-hummer-drive

"What the experts say about the departure of NHS IT chief Richard Granger.

  • Granger has not been ashamed to get on with things and at no point has he tried to cover his arse, which is refreshing in the public sector. But we have to step back and do things the NHS way rather than dictating from the centre. That was a mistake from the beginning - A senior supplier
  • The NHS IT community had never had any professional leadership before. Many commentators think Richard Granger is ruthless and uncompromising. And no doubt sometimes he is. But he is also a man of huge personal integrity and he has earned loyalty and respect - Andrew Haw, IT director, University Hospital Birmingham NHS Trust
  • The National Programme is like a Hummer: it is not subtle, it will drive through anything and will survive a few bomb blasts. But if you want to do anything with finesse, it is not the right vehicle. Now we need to change to something a bit more attractive, that people actually want to drive - A senior NHS source
  • Granger did what he needed to do to please his political masters. He decided that his reputation and his relationship with the industry could be sacrificed to deliver what the political climate demanded - A senior industry source
  • Richard Granger's focus and drive transformed the multitude of healthcare principalities, dukedoms and feudal states into a single NHS information state. 'Ruthless standardisation' has allowed freedom of communication for the benefit of patients, whose care was previously fragmented between these isolated entities - Professor Sir Muir Gray, Oxford University
  • Granger was always a dealmaker, not an implementer - A senior NHS source
  • When [his vision] is fulfilled, millions of patients should be reaping benefits for years to come - Barbara Greggains, formerly of the Council of the Royal College of Radiologists"

Richard Granger's departure may jeopardise NHS IT programme (26 Jun 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/06/26/224976/richard-grangers-departure-may-jeopardise-nhs-it-programme.htm

"It is a pity Richard Granger, director general of NHS IT, is to leave as head of Connecting for Health, the agency that is running the National Programme for IT (NPfIT). The decision was his - he was not asked to leave. Indeed, officials at the Department of Health may soon recognise that they are losing the NPfIT's most valuable asset. Without Granger the NPfIT is at risk of falling apart, for he has given the programme a credibility it would not otherwise have had. Long before he joined the Department of Health as director general of NHS IT, the future of the NPfIT was to a large extent sealed. By then a key lesson from the failures of three separate IT-related programmes - Wessex Regional Health Authority's Regional Information Systems Plan (1992), the Read Codes version three (1998), and the Hospital Information Support Systems initiative (1996) - should have been learned. And that was that large, centralised IT schemes imposed on semi-autonomous NHS sites rarely work. They engender a scepticism among doctors that becomes impossible to overcome. Instead of avoiding this mistake, officials at the Department of Health and Downing Street made it the central ingredient of a new scheme of unprecedented scale and boundless complexity. Ministers further deepened scepticism among clinicians by conceiving the national programme in secret and announcing it as a fait accompli. Later, when Granger joined the programme in autumn 2002, he gave it a credibility based on a conviction that it was needed. And he was right. Reliable electronic health records are needed urgently. Paper notes go missing, and are not generally available after hours. So there is no disagreement on the need for easily accessible electronic medical records. But local patient record systems were already being installed successfully before the NPfIT was born. It was just happening slowly. So it is understandable that ministers wanted progress to be accelerated. The answer was for national standards to be set, money put aside for modernisation, teams from successful sites deployed as troubleshooters within the NHS, and incentives paid to GPs, IT specialists and chief executives for successful implementations in which benefits for patients were measurable. Instead, the Department of Health wanted in early 2002 to put itself at the centre of everything that happened. Bureaucracies love complexity. And so an amorphous national programme without a simple, clear objective grew around the sound idea of electronic records for everyone in England. Later, Granger joined the programme. And he and his team have achieved much. IT is now a high priority for NHS trust boards and he has broken new ground in his firm dealings with suppliers. The NPfIT has also done much to force trusts into identifying duplicate and inaccurate patient records, and some trusts have had antiquated IT replaced with more modern systems. Connecting for Health has also delivered a number of useful systems that most people have never heard of, including the Secondary Uses Service (a healthcare planning, clinical audit and research tool), the Personal Demographics Service (a database of names, addresses, dates of birth and NHS numbers), and the Quality Management and Analysis System (a means of assessing the work of GPs). Though successful, these systems may, for the NPfIT as a programme, represent "scope creep" in that they were not among the original four main NPfIT systems. . . [Arguably] the biggest weakness in the NPfIT: ministers have politicised it. In the private sector the project would have been reviewed independently. If there were parts that did not work, and it was thought unlikely they would ever work, they would be scrapped. Money and people would instead have been directed into installing systems that yielded measurable patient benefits at an affordable price. But in politics, changing direction can be seen as a weakness, or even, dare we say it, a mistake. So changes must be made below the radar, without anyone really noticing, while transient ministers declare that all is well. Unannounced changes are indeed being made to the NPfIT. Local NHS trusts are installing standalone systems that are being adapted to national standards. These may be integrated in years to come when, for example, there is agreement among clinicians on how records can be shared. But with Granger's departure, the programme is losing a rock. About a dozen ministers with overall responsibility for the programme have come and gone, and the health minister Lord Hunt has gone and come back again. But Granger has for years remained as senior responsible owner for the IT parts of the scheme. So we are disappointed that he is leaving. And it is surprising the Department of Health is not doing more to keep him. A figure as charismatic and demanding will prove difficult to replace. We are by no means sure the programme can be held together without him."

Review of NHS could impact IT (4 Jul 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/07/04/225348/review-of-nhs-could-impact-it.htm

"The new health secretary has announced a review of the NHS that could affect the direction and funding of the £12.4bn National Programme for IT at a time of cost pressures. Alan Johnson today announced an independent review of the NHS, which will help inform the Treasury when it sets the funding for the health service as part of the 2007 Comprehensive Spending Review. The review will be led by practicing surgeon Sir Ara Darzi, and it will not be "controlled from above", said Johnson. He added that one aim of the review was to ensure the NHS is "clinically led, patient-centered and locally accountable". It will draw on the views of NHS staff, patients and the public. It will look among other things at ensuring that "clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery". Johnson also emphasised that money spent on the health service needed to be invested wisely. This review could be an opportunity for the government to revisit the £12.4bn National Programme for IT [NPfIT]. Many in the NHS want NHS trusts to have more discretion over what they buy, provided it meets national standards. If this happens as a result of the review, it is unclear how the programme's main suppliers, the so-called Local Service Providers, would make enough money from their NPfIT contracts to justify the investments they have made in national systems. . ."

Brown moves Lord Hunt, a ministerial head of the NHS IT plan (4 Jul 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/07/04/225342/gordon-brown-moves-lord-hunt-a-ministerial-head-of-the-nhs-it.htm

"Gordon Brown's ministerial shuffle has seen ardent supporters of the NHS IT programme moved on ' which could indicate a lower profile for the project in the lead up to a possible early general election. Lord Hunt, the health minister most closely associated with the launch of the NHS's National Programme for IT (NPfIT) in 2002, has left the Department of Health as part of Brown's shuffling of ministerial posts. Another vocal and passionate ministerial spokesperson on the NPfIT, Caroline Flint, has also been moved. . . In Gordon Brown's shuffling of ministers, Lord Hunt has joined the Ministry of Justice. Patricia Hewitt, who was Secretary of State for Health, and was another ardent supporter of the NPfIT, has been replaced by Alan Johnson."

DH denies report that NPfIT is to be shelved (9 Jul 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2851

"Suggestions in a weekend newspaper that the NHS is to shelve the National Programme for IT (NPfIT) have been strongly denied by the Department of Health (DH) today. According to the News of the World, NHS chiefs have agreed to shelve the programme after admitting it was an expensive failure. The report claims: 'Hospitals have been secretly told to buy in their own systems, with money that could have gone on looking after patients.' The article quotes an unnamed source as saying: 'It doesn't work and it's never going to.' However, the DH told E-Health Insider that it 'had no plans to shelve the national programme.' No official comment has been made regarding the authenticity of the claims that trusts are being told not to wait for an NPfIT system. The DH told EHI that they are awaiting information from Connecting for Health (CfH) to see if any guidance had been issue to trusts by the NHS body responsible for the NHS IT modernisation in England. CfH told EHI they were investigating the article and would issue a statement later in the day. The DH is working on a response to the newspaper and said that the article had come as a surprise as the newspaper had not asked about the IT programme in a previous briefing. The spokesperson acknowledged that aspects of the programme were open to scrutiny due to the ongoing delays, but said that systems such as the N3 network and PACS have demonstrated the programme's benefits in bringing the NHS into the 21st century. An official rebuttal from the DH is due later today, a press spokesperson told EHI."

Health department to put record straight on NPfIT (10 Jul 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/07/10/225455/health-department-to-put-record-straight-on-npfit.htm

"The Department of Health is seeking corrections to the official records of parliament after two ministers attributed to the National Audit Office positive statements on the NHS's £12.4bn IT plan (NPfIT) that auditors did not make. The corrections being sought by the department, which follow an investigation by Computer Weekly, are likely to add to scepticism within the IT industry about the extent to which ministerial statements on the progress of major technology projects can be relied upon. The Department of Health has conceded to Computer Weekly that it gave unclear briefing notes to ministers in advance of a Commons debate on the NPfIT. In the debate on 6 June 2007, two ministers, Caroline Flint and Ivan Lewis, attributed to public spending watchdog the National Audit Office positive statements on the NPfIT that auditors did not actually make. The separate ministerial statements gave the impression that the National Audit Office had, in its report on the NPfIT, given unequivocal backing to the programme: to the way it was being managed, the excellence of contracts with suppliers, adherence to budgets, and to major savings having been achieved. But the National Audit Office report in June 2006 contained none of the specific statements attributed to it by ministers, except one ' that substantial progress had been made. . . The Department of Health said it accepts that in its briefing notes to ministers about the National Audit Office report on the NPfIT there was 'lack of clarity on what was direct quote and what was reported speech'. The spokesman added, 'We will be contacting Hansard [which keeps the official record of parliamentary proceedings] to check their transcription and set this straight.'

End of the search for a cure (18 Jul 2007)

Information Age

http://www.information-age.com/article/2007/july_2007/last_word_july

"Richard Granger's decision to quit as the head of the UK government agency Connecting for Health was not the most high profile resignation in the month of June. Two of his political bosses, Tony Blair and Patricia Hewitt, both left office, leaving their own bitter-sweet legacy among the workers in the National Health Service. Among technology suppliers, and public sector IT and medical staff, however, Granger has been just as influential as his political masters, and the debates over his legacy, certainly among CIOs and IT suppliers, have been just as lively. It wasn't just that Granger presided over the roll out of the £12.4 billion National Programme for IT (NPfIT), the largest civil IT project in the world, that made his name so widely known, even outside the UK. His personal style, tough and uncompromising on certain issues, made him infamous. Within months of taking up his £280,000 a year appointment in 2002, he had become a highly controversial figure, inciting the worst kind of criticism and the best kind of praise. From the outset, Granger set out to change the way that public organisations buy and manage their IT. As a thousand headlines and half a dozen reports from the Public Accounts Committee (Parliament's spending watchdog) have shown over the years, public sector IT has been a disaster zone in the UK for two if not three decades. Granger recognised that in most cases, suppliers made large profits regardless of the catastrophic failure of the project. He decided to make them accountable every step of the way. That strategy created a huge amount of trouble in the supplier community. Some big suppliers, such as IBM and EDS, stayed out altogether. Others such as Accenture, pulled out half way through. One small but critical supplier, iSoft, begged for help when it ran into trouble, but while it got some help, it wasn't bailed out. As a result, Granger can say that while the project might have overrun, it is not over-budget. In this, Granger should have had the media and, indeed, the entire medical profession on his side. But his willingness to talk tough with suppliers also extended to those who criticised the programme or his decisions. One of the first skills of the modern leader is to listen ' to hold a genuine dialogue with all the stakeholders affected by the introduction of a new technology. But Granger seemed to epitomise the Labour government's belief that the big decisions were best taken at the start, by those with the power and the mandate. One of the key reasons why the fate of the National Programme for IT still hangs in the balance is that consultation has been treated as a means of securing acceptance, not as a co-operative process aimed at reaching the best solution. This is not a throw-away criticism, but a central one. Among the organisations that have articulated concerns about the lack of consultation or the imposition of inappropriate solutions are the British Medical Association; the Royal College of Surgeons; the Royal College of Physicians; the British Medical Journal; the Royal College of Nursing; London School of Hygiene and Tropical Medicine; and the Renal Association. In a survey by The Guardian, GPs also severely criticised aspects of the system and the lack of consultation, while many regional health trusts have also attacked several aspects of the system. . ."

Confidential briefing to Tony Blair on the NHS's National Programme for IT (31 Jul 2007)

Computer Weekly - Tony Collins Blog

http://www.computerweekly.com/blogs/tony_collins/2007/07/confidential-briefing-to-tony.html#more

"NHS Connecting for Health has published on its website one slide from a 'confidential' briefing presentation to the former Prime Minister Tony Blair on the NHS's £12.4bn National Programme for IT [NPfIT], following inquiries by Computer Weekly. Other slides in the presentation to Blair, which Connecting for Health hasn't published, give an insight into how officials wish to counter criticism of the programme. The PowerPoint presentation to Blair was dated 19 February 2007. On NHS Connecting for Health's website is a slide from the presentation that depicts parts of the NPfIT as having been completed. Following our inquiries, NHS Connecting for Health has also published on its website the mathematical workings to explain the slide, though these calculations were not in the presentation to Blair. What struck me as particularly interesting were some of the slides that NHS Connecting for Health did not publish from the presentation. They sought to marginalise critics and criticism, although listening hard to constructive criticism may be of critical importance when managing a large and complex IT-based project. One of the slides marginalised the 23 leading academics, many of them professors in computer-related sciences, who have called for an independent review of the NPfIT. The slide said: 'The largely negative media has shaped public opinion by persistent criticism. An opposition campaign is being well orchestrated. The 'evidence' by the 23 academic critics is almost wholly based on media coverage, hostile submissions to the Public Accounts Committee and Select Committee and Parliamentary questions.' However some of the most pertinent criticism of aspects of the NPfIT has come from the apolitical British Computer Society and a variety of independent voices within the medical and IT communities. . . What none of the slides suggested was tacking criticism by improving, modifying or removing aspects of the programme that were being criticised, or providing good arguments on why things should carry on as they are."

Brown government rejects calls for independent review of NPfIT (9 Aug 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/08/09/226108/brown-government-rejects-calls-for-independent-review-of.htm

"The government under Gordon Brown has rejected a call by an all-party group of MPs for an independent review of the business case for the NHS's National Programme for IT [NPfIT], in the light of progress and experience to date. It has also rejected a call by the Public Accounts Committee for an urgent independent review of the performance of local service providers to the NPfIT, against the obligations of their contracts, which are worth £6.2bn. The rejections are part of a formal response by the government of a highly critical report on the NPfIT which was published by the committee in March 2007. Ministers have accepted some parts of the committee's report - but none of the recommendations that called for independent assessments of aspects of the NPfIT. The government had been due to publish its response to the committee's report by 26 May 2007. But it did not do so until 25 July, the day before Parliament broke up for the summer recess. . ."

Government says no to NHS IT review (9 Aug 2007)

ComputerWorldUK

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=4512&pn=1

The government has buried its response to a damning report by MPs on the NHS's £12.4bn National Programme for IT (NPfIT) in a set of Treasury minutes. The document, slipped out just before the parliamentary recess, includes a pledge to produce a first annual statement of the costs and benefits of the huge computer project later this year. In April, the powerful Commons Public Accounts Committee warned that NPfIT was unlikely to deliver significant benefits to the treatment of patients by the end of its 10-year contract without a fundamental change in the rate of progress on the project. Responses to Parliamentary Select Committee reports are usually published on the committee's web page. But at the time of writing the document was not available through this channel and spokespeople for the Department of Health and NHS Connecting for Health - the agency that runs NPfIT - could not confirm whether it had been published. The Public Accounts Committee warned that the Department of Health was 'unlikely to complete the programme anywhere near its original schedule', noting that, four years in, there was still uncertainty about the costs and benefits of the scheme. If the project fails, 'it could set back IT developments in the NHS for years, and divert money and staff time from front line patient services', the committee report said. But the government has rejected the MPs' call for an independent assessment of the business case for NPfIT in the light of progress and experience made so far. The response says: 'The intention is to include details of both the financial and non-financial benefits within the annual statement of benefits realised.' The government 'does not consider there are grounds for an independent review of the business case at this stage'. The response says the government 'accepts the general principle' of a recommendation to set out which elements of functionality originally contracted for under NPfIT would be available for implementation by the end of the 10-year period and to prioritise deployment of the systems that benefit the NHS most. 'Work is underway with the NHS to determine its priorities. The results will be provided to the Local Service Providers and plans will be adjusted as required,' it says. But ministers have rejected the MPs' calls - sparked by concerns that NPfIT suppliers such as the troubled iSoft were running late in delivering key components of the scheme - to modify the procurement process to let NHS trusts select from a wider range of patient administration and clinical systems. The response says: 'Centralised procurement, through a small number of suppliers, was a key feature of the procurement process so as to avoid the disadvantages, and the expense, of the haphazard approach of the past.' Although there are just two suppliers of the crucial acute patient administration systems, 'many more suppliers are contracted across the programme as a whole', it adds. A procurement exercise to increase the number of potential suppliers has brought expressions of interest from 221 suppliers, with 111 of these 'longlisted' so far. 'The intention is to award a series of framework contracts to selected suppliers who can then compete for subsequent business if the need arises,' the government response says. The framework contracts would be 'complementary to the existing suite of Programme contracts and provide contingency'. Ministers rejected the call for an independent review of the performance of NPfIT's lead contractors. 'It is better to target reviews at individual problems,' the response document says."

NHS National Programme for IT faces a hazy future (10 Aug 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/08/10/226119/nhs-national-programme-for-it-faces-a-hazy-future.htm

"The National Programme for IT in the NHS seems to be destined to be dissipated, in part, into general health IT in England. There are signs the programme is in flight from ruthless standardisation; Whitehall has dropped plans to give NHS Connecting for Health, the agency set up to run the programme, the status and independence of an executive agency; officials are struggling to find money for plans to localise the scheme; and a more diffuse leadership may be poised to subsume the departing Richard Granger's role as director general of NHS IT. At a government IT summit in May in London, a senior health official gave an assurance - of sorts - about the future of the NHS's £12.4bn National Programme for IT (NPfIT). "It has three wheels still on, and it is still moving. But things are in hand to a certain degree. They are not in other respects but we are going to get there," said Andy Burn, head of IM&T planning at NHS Connecting for Health, which runs much of the NPfIT. Not all trust IT directors share Burn's confidence about the future of the programme. A comprehensive assessment of the programme by Birmingham and Solihull NHS Trust raised a question about whether the NPfIT would achieve its objectives. It said, "The NPfIT is an ambitious programme that has experienced delays, with current system migrations running two years late, and there are concerns over its achievability." The paper was referring in part to a plan to give 50 million people in England a reliable and useful medical record - called the NHS Care Records Service - which is running at least two years late. Some trusts are now buying essential systems outside of the NPfIT. The paper said, "In priority situations, full EU procurements are being undertaken for systems outside the local or national product portfolio. "The financial impact on national contracts has yet to be resolved, but some trusts may need to pay financial penalties for operating systems outside of the national contracts." Birmingham and Solihull NHS Trust is not the only trust to make such an assessment of the NPfIT. Given the problems with the programme, including concerns in the NHS over the quality and reliability of some NPfIT products installed so far, what is the government of Gordon Brown to do about its future? Several developments indicate that the government, advised by Whitehall officials, has decided to blend the NPfIT more into NHS IT in general. Thus the scheme may not have such a distinctive - and controversial - character. This would make it more difficult for observers of the programme in the NHS, parliament and the media to delineate what is and what is not a success. In the run-up to a possible early general election, ministers would welcome a reduction in the number of articles that cast the NPfIT in a grim light. . . NHS Connecting for Health is expected to continue refusing calls by Computer Weekly, academics and other independent voices for a new high-level, published, independent review of the programme. So there will continue to be no independent verification of the government's claims for the success of the scheme. . . All of which may help to explain why the NPfIT - after a series of ministerial announcements about the programme during its early years of the programme - is hardly mentioned in the latest annual report of David Nicholson, the chief executive of the NHS. But if, as seems the case, some politicians and officials want the programme to head slowly towards obscurity - at least until the next general election - they may be disappointed, especially if suppliers start levying fines on NHS trusts over a lack of NPfIT orders."

Granger's successor remains a mystery (5 Sep 2007)

e-Health Insider

http://www.e-health-insider.com/news/3002/granger's_successor_remains_a_mystery

"Richard Granger's successor as chief executive of Connecting for Health and director general of IT at the Department of Health is still unknown, twelve weeks after he announced his resignation in transition from the post. Enquiries from E-Health Insider this week have been unable to clarify when Granger will officially leave CfH, and more intriguingly when, and if, a successor will be appointed. With power and responsibility for delivering CfH now to be handed over to strategic health authorities under the NPfIT Local Ownership Programme (NLOP) the role of CfH is likely to become constrained. Some industry sources have lamented his departure saying that without a similarly strong figure to drive the NHS IT programme it risks stalling. Others argue that the last thing that NHS and health IT industry need is another leader of conviction, calling for quiet pragmatism. . . Sources within and close to CfH suggest that the director general has in recent weeks become an infrequent visitor to the organisation's Leeds HQ. Others however say he is still actively involved but on strict instructions to maintain a low profile. Granger announced his decision to leave his job in June saying he had fulfilled the job for five years as he said he would in 2002. A variety of industry sources have told EHI that in their view Granger's sudden announcement of his intention to leave "was not a planned succession". Speculation has focused on the mixed record of CfH, as set out in this year's damning public accounts committee report; and Granger's propensity to attract and generate controversy; together with the reduced role of the organisation as the programme is recast and the National Programme for IT Local Ownership Programme (NLOP) begins to gather momentum. . . The Health Select Committee will release its report into the electronic patient record next week and it will be interesting to see who the inevitable response from Connecting for Health will be attributed to. On possible pointer to the future is the fact that recent official responses from CfH have been coming from NHS veteran Richard Jeavons, the current director of service implementation."

Wanless warns NPfIT risking NHS modernisation (11 Sep 2007)

e-Health Insider

http://www.e-health-insider.com/news/3019/wanless_warns_npfit_risking_nhs_modernisation

"In a review of NHS modernisation efforts Sir Derek Wanless has criticised the slow progress of the National Programme for IT (NPfIT) and called for an audit of the programme to ensure it supports wider health service modernisation. The report warns that considerable challenges lie ahead in modernising NHS IT systems and says there is "continuing debate over the feasibility of some current NPfIT plans". With limited progress on its core objectives, and the lack of a clear measurable business case against which savings can be measured it says that Connecting for Health, the agency responsible for NPfIT, appears to be being allowed to follow "a high-cost, high-risk strategy that cannot be supported by a business case". Concerns are also expressed about the future impact of the monopolistic contracts awarded by the agency. The report analyses the progress of NPfIT within the wider context of NHS modernisation and investments made and finds the programme wanting in key areas, particularly enabling productivity gains within the service. It observes that NPfIT has largely occurred in the absence of any published or measurable business case. . ."

Wanless report 2007 - what it says in full on the NHS's National Programme for IT (12 Sep 2007)

Computer Weekly - Tony Collins' IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2007/09/wanless-report-2007-what-it-sa-1.html#more

"For those who'd rather not read the 250 pages of the latest Wanless report the following paragraphs are excerpts that relate directly or indirectly to the NHS's National Programme for IT [NPfIT] They are in the order they appear in the report. There is some repetition in the paragraphs. . . "
[From Chapter 4: Recommendations:
"There is a need for an audit of the technical aspects of the Connecting for Health programme and the financial costs and benefits before deciding whether or not to continue with the implementation of current plans. Unless there is greater clarity about the costs and benefits of the programme, it will be difficult to make assessments of the longterm costs and investment needs of the NHS. It is recommended that Connecting for Health is subject to detailed external scrutiny and reporting so that forecasting of long-term costs and benefits can be made with more confidence."]

Tories promise own review of £12.4bn NHS computer programme (12 Sep 2007)

ComputerWorldUK

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=5115

The Conservative Party has promised to organise its own review of the NHS's £12.4bn National Programme for IT (NPfIT) after the government refused calls for greater scrutiny of the scheme. In a follow-up to his landmark 2002 report on healthcare funding, former Nat West bank chief Derek Wanless warned that NPfIT lacked a business case setting out how benefits would outweigh costs. He called for the scheme to be "comprehensively audited" and for "detailed external scrutiny" of NHS Connecting for Health, which runs NPfIT. Wanless's criticism is significant because his original report - produced for the Treasury under then-chancellor Gordon Brown - championed investment in IT and urged that the proportion of NHS spending devoted to IT be doubled. But the government has rejected the call for greater scrutiny of the huge computer programme. "We do not consider there are grounds for another independent review of the national programme at this time," a Department of Health spokesperson said. Last month, the government turned down calls for a review of the programme from the Commons public accounts committee in a response that was buried in Treasury minutes published during the parliamentary recess. Shadow health minister Stephen O'Brien slammed the government's refusal, saying: "Having called endlessly on the government to come up with a review, we have now decided to call our own. I will be leading work on this in the next parliamentary session." He added: "The government's IT programme has been woeful. What Wanless has shown is that despite the huge sums of money being poured into IT schemes, the results have yet to be shown. All we have witnessed in the past few years is problem after problem." Liberal Democrat health spokesperson John Pugh MP also criticised the government's response. "Derek Wanless has drawn attention to the fact that we are saddled with a centrally imposed and very expensive IT programme that doesn't evolve from the needs and requirements of hospitals and health professionals," he said. . ."

Lord Darzi pledges IT review (5 Oct 2007)

e-Health Insider

http://www.e-health-insider.com/news/3093/lord_darzi_pledges_it_review

A review of England's NHS IT modernisation programme to ensure it 'delivers real clinical benefits' is promised in health minister Lord Darzi's interim report on the health service published yesterday. Lord Darzi, a practising surgeon who joined the Department of Health's(DH) ministerial team in Prime Minister Gordon Brown's new government, says he will be considering the best way forward in the second stage of his review. He says the National Programme for IT has created an opportunity to make a step-change. "The national infrastructure established by the National Programme for IT has connected every hospital and GP surgery to a common secure network. Clinicians should benefit from access to digital x-rays and scans ' Picture Archiving and Communications Systems (PACS)," Lord Darzi says. "But I believe more work is now needed to ensure that the Connecting for Health programme delivers real clinical benefits, and I will be considering in the second stage of my review how best to achieve this." The DH has stoutly resisted external calls for a review of its IT agency, Connecting for Health (CfH) and Lord Darzi's report will be seen as a U-turn by the CfH's critics. However it falls short of pledging a root-and-branch review and appears instead to signal an adjustment of the £12billion IT programme and a re-focusing of its work. . ."

NHS shakes up £12bn IT programme (6 Oct 2007)

Financial Times

http://www.ft.com/cms/s/0/89fba648-7399-11dc-abf0-0000779fd2ac.html

"A big revamp of the National Health Service's 12bn IT programme is under way that will see NHS trusts given more choice of how systems are installed and which software they get. At the same time the Department of Health is launching a review of the information it collects from the service, aiming to gather less but use what it gets far better. The department persistently refuses to say that the £12bn programme is formally under review. But senior figures in Connecting for Health were expecting the announcement of a review to go alongside Lord Darzi's interim report on Thursday on the "next stage" of the NHS. That appears to have been pulled amid the general election fever for fear it would generate headlines about the government admitting mistakes over the multi-billion-pound 10-year programme. However, one senior health department official said a study was under way to establish "will this actually work?" The big local service provider contracts held by CSC, BT and Fujitsu are being moved out of Connecting for Health, an arm of the health department, to local level in the NHS, he said. He added that "a big step change is that we will give people more choice" about what systems are installed in hospitals, to go alongside the wider choice of systems being offered to GPs. One of the main problems, he said, had been that "we have forced people to take systems that were either worse than those they had already got, or were ones that they didn't want". As a result, installation of new patient administration systems that are needed to underpin the long delayed electronic patient record are themselves also running way behind schedule. Instead contractors are expected to let hospitals locally choose from "best of breed" applications that suit their local circumstances, while remaining compliant with the communication standards that the national programme has set. The big contractors are also accepting that they will have to give individual NHS trusts more support to get the systems in. One effect of the change, according to programme insiders, is likely to be more concentration on getting local systems up and running, and less on the national summary record, which many clinicians see as having little relevance. The move follows a call from the Commons health select committee last! month for hospitals to be offered a wider choice of systems."

Reviews of the NHS IT scheme appear to be underway - comment (11 Oct 2007)

Computer Weekly - Tony Collins' Blog

http://www.computerweekly.com/blogs/tony_collins/2007/10/reviews-of-the-nhs-it-scheme-a.html

"Health Minister Professor the Lord Darzi opens the introduction to his interim review of the NHS by saying he is a doctor not a politician. But in his comments about the National Programme for IT [NPfIT] Lord Darzi knows he needs to be the quintessential politician. He is a consultant in the field of robot-assisted, minimally-invasive surgery; and when he mentions the NPfIT in his interim report he manoeuvres delicately over the thin skins of ministers and officials at Whitehall who do not want to read any criticism of the scheme, particularly by public figures. Lord Darzi's report mentioned the success of PACS - Picture Archiving and Communication Systems. So his praise was in line with the marketing strategy of NHS Connecting for Health, which runs part of the NPfIT. A confidential briefing paper by Connecting for Health to the Prime Minister on the progress of the NPfIT said in February 2007 that there was a plan to launch a "proactive campaign, based upon the success of the Picture Archiving and Communications System." . . . To the tactful Lord Darzi, in his interim report, the success of PACS and the national programme were analogous. He also praised the linking of hospitals and GPs to a common secure network - the N3 broadband infrastructure supplied by BT. Local upgrades of the N3 broadband capacity can be expensive and on its own the network brings few clinical benefits but the bandwidth is an important advance on what the NHS had before so it is a success of the NPfIT. Lord Darzi said in his interim report . . . But IT directors in the NHS are entitled to ask why it is only after five years - the NPfIT was launched in 2002 - and after more than £2bn has been spent centrally on the scheme, that a professor is undertaking a review to ensure that the national programme delivers clinical benefits. Separately, the Financial Times says a review of the National Programme for IT [NPfIT] may be underway to establish "will this work?" There is no indication that this internal review will be published. It's difficult to avoid the conclusion that these are political compromises, half-done replacements for a high-level published review of the NPfIT. . . One reason for the absence of an unrestricted, independent published review is that the NPfIT has become politicized. It has become a test of the ability of govermment to manage mega-projects. This could explain why ministers and some Whitehall officials want NPfIT's realities locked in a dark bedroom. They fear the full facts emerging into the sunlight and being judged harshly by a cruel world. So the NHS and those funding it are denied the truth, the programme limps along without clearly understood and realistic objectives and the government pretends all is well."

MPs can't read Gateway reviews into NHS national programme (23 Oct 2007)

ComputerworldUK

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=5803

"Ministers have refused to make "Gateway" reviews of the £12.4bn NHS National Programme for IT (NPfIT) available to MPs, extending the clampdown on publication of the project assessments. Gateway reviews of major public sector projects are carried out at key points in their lifecycle by the Office of Government Commerce to assess whether they are sure of progressing to the next stage of development. But the government has been adamant that it will not publish the reviews and has filed a high court appeal against a ruling by the Information Commissioner's Office - upheld by the information tribunal - that it must publish reviews of the £5.4bn ID card scheme in the public interest. Ministers have also repeatedly refused calls for a feasibility review of the huge NHS computer project, despite support from the influential Commons Public Accounts Committee among others. Surgeon-turned-minister Lord Darzi is set to investigate how the IT project will produce clinical benefits - but he failed to reply to an offer by a Oxford University professor Martyn Thomas to supply details of the feasibility study proposed by 23 computing academics. Health minister Ben Bradshaw has now refused a request by his Conservative shadow Stephen O'Brien to place the NPfIT gateway reviews in the House of Commons library, where they would be accessible to MPs. "We have no current plans to do so," Bradshaw said in his reply. "The gateway review reports are intended to help and inform the management of the programme and the Department [of Health]'s own decisions. They are not intended for publication." Reinforcing the government's key argument against publishing the OGC documents, he added: "More generally, the government believe that the prospect of disclosure of any gateway review would restrain the frankness and candour with which participants engage in the gateway process, and that this in turn would undermine its effectiveness and the quality of recommendations arising." O'Brien told ComputerworldUK: "It is disgraceful that this government continues to hide the NHS IT programme away from public and parliamentary scrutiny. What have they got to hide? More then £12bn of public money is being spent, but the figures, and what progress, if any, are being kept secret from MPs." Despite the change of prime minister and ministerial team, the government remained "focused on spin and secrecy", O'Brien said."

Unclear whether Granger will be replaced (29 Oct 2007)

e-Health Insider

http://www.e-health-insider.com/news/3161/unclear_whether_granger_will_be_replaced

"The Department of Health has rejected strong rumours that one of its senior policy advisers, Matthew Swindells, has been appointed interim chief executive of NHS Connecting for Health, replacing Richard Granger. In a statement to E-Health Insider the department that suggests Granger may not be replaced and that following review of NHS IT now underway, the current Connecting for Health agency may potentially be recast or even replaced. . . In a statement to EHI the DH said: "Richard Granger remains the director general [of NHS IT] until he leaves the department, which is expected to be the end of the year." Swindells is known to have led the review of the NHS IT Programme on behalf of NHS chief executive David Nicholson and be heavily involved in the wider review signaled by health minister Lord Darzi earlier this month, designed to ensure NPfIT delivers greater clinical benefits than it has achieved to date. The DH told EHI: "Matthew Swindells is working for David Nicholson on the review of informatics that was announced in Lord Darzi's interim Next Stage report." . . . The apparent lack of a replacement leaves succession plans for leadership of the UK's largest civil IT project, the £12.4bn NHS National Programme for IT, shrouded in mystery. Even after the introduction of the NPfIT Local Ownership Programme, CfH is still responsible for the national contracts for England. Clear leadership and succession planning is generally regarded as an essential attribute for the success of complex IT projects. . ."

Main NPfIT contractors paid £1.2bn last year (27 Nov 2007)

e-Health Insider

http://www.e-health-insider.com/news/3254/main_npfit_contractors_paid_%C2%A31.2bn_last_year

"Despite continued delays in many areas of the National Programme for IT (NPfIT), Connecting for Health (CfH) paid its main contractors over £1.5bn in the past financial year, with the lion's share going to its prime contractors, professional services firms and software vendor, iSoft. Figures obtained by E-Health Insider under the Freedom of Information Act, show that in 2006/2007 the five lead contractors - Computer Sciences Corporation, Fujitsu, BT Global Services, together with BT Syntegra and Accenture - received a total of £1.17bn between them. The £42m paid to ATOS Origin for the national Choose and Book service takes the total payments to principal contractors to more than £1.2bn last year. This despite very slow progress on the main NHS Care Records Service component of the programme. . . The LSP payments appeared to have little direct correlation with clinical systems delivered by the LSPs, with the possible exception of picture archiving and communications systems (PACS). BT in London, for instance, had delivered only one acute hospital core patient administration system (PAS) by April 2007 - since replaced - while Fujitsu had only completed five installations of its Cerner PAS. Accenture, which negotiated its exit from the programme as LSP for the North East and Eastern regions for all but PACS in January 2007, still received a £130m payment. Accenture virtually ceased work on hospital systems from early summer 2006, handing over to CSC. . . Perhaps the most surprising name on the list of firms to receive more than £100k in professional services fees from CfH was the US consultants Kellogg Root and Brown (KBR), part of the US Haliburton Group. Four years ago KBR was awarded an initial three-year contract for £37m to establish the NPfIT programme management office. But after reported differences sightings of KBR have become rare. Even so they were still paid £7.2m for their troubles last year."

Government spin - Whitehall tries to disparage our NHS article (28 Nov 2007)

Computer Weekly - Tony Collins' IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2007/11/government-spin-whitehall-trie.html

"On 22 November I asked a straightforward question of NHS Connecting for Health which runs part of the NHS's £12.4bn National Programme for IT [NPfIT].The question: Could you let me know, by end of today please, if the possibility is being considered of having patient data processed abroad? If so could I have a statement please? NHS CfH's answer was straightforward: "No," said its spokesman. He passed my question to the Department of Health because it involved policy. The Department's spokeswoman was unable to reply promptly because she said the answer to my question needed to be cleared by the minister. Eventually, after phone calls and emails, I received the Department's "cleared" reply. It said: "NHS organisations are legally responsible for complying with data protection laws". That was it: 11 words signed off by a health minister that didn't answer my question. . . When my article was followed up by national newspapers and other media including, BBC Radio 4's Today programme [broadcast at approx. 6.55am on 27 November 2007], the Department of Health issued a slightly longer statement - one it hadn't given to me. Its statement to the national news media suggested my article had been fabricated. This is the department's statement: "Patient data is not currently sent abroad. There is no review, and there are no considerations relating to the National Programme for IT for patient data to be processed abroad in future. NHS organisations are legally responsible for complying with data protection laws and patient records can never be put at risk in compliance with these laws." . . . But the department's statement appeared to contradict a document issued by NHS Connecting for Health which said a review was underway into the possibility of patient data being processed overseas. . ."

Granger to depart NHS IT at end of year: But will he be replaced? (5 Dec 2007)

silicon.com

http://www.silicon.com/publicsector/0,3800010403,39169375,00.htm

"The head of the £12.4bn NHS IT programme will step down from his role in charge of the project at the end of this year. NHS IT director-general Richard Granger announced his plan to leave his role in charge of the National Programme for IT in the NHS (NPfIT) and Connecting for Health (CfH) in June and the timetable for his departure has now been confirmed. No replacement for Granger has been appointed yet and an NHS CfH spokeswoman said there will be a review of the "management arrangements" for taking the NHS IT programme forward. This will form part of NHS CEO David Nicholson's wider review of how the health service uses informatics and technology to improve patient care. The CfH spokeswoman told silicon.com: "We expect to be able to outline this before the end of the year. In the meantime, Richard Granger and his team continue to do an excellent job in leading the programme." Former Andersen and Deloitte management consultant Granger took on the NHS IT role in 2002 after delivering the London Congestion Charge scheme."

Department of Health found in breach of data protection (19 Dec 2007)

Information Commissioner's Office

http://www.ico.gov.uk/upload/documents/pressreleases/2007/doh_undertaking_pr.pdf

The Information Commissioner's Office has found the Department of Health in breach of the Data Protection Act following an investigation into a security breach on the Medical Training Application Service (MTAS) website. The ICO was alerted in May 2007 to the security breach which allowed for the sensitive personal details relating to junior doctors, including religious beliefs and sexual orientation, being accessible to anyone accessing the site. In order to protect against unauthorised access the Department of Health has been required to encrypt any personal data on their website which could cause distress to individuals if disclosed. Regular penetration and vulnerability testing must also be carried out on developing applications and systems to minimise unauthorised access. The Information Commissioner has also ruled that staff are trained on compliance with the Data Protection Act. The ICO has required the Department of Health to sign a formal undertaking to comply with the principles of the Data Protection Act. Failure to meet the terms of the undertaking is likely to lead to further enforcement action by the ICO and could result in prosecution by the Office. Mick Gorrill, Assistant Commissioner at the ICO, said: "This is an unacceptable breach of security. Organisations must ensure that the personal information they hold on us is secure - this is an important principle of the Data Protection Act. Individuals must feel confident that their personal details cannot be accessed by another party. Research by the ICO shows that nine out of ten individuals are concerned that organisations are failing to keep their information secure so it is essential that the Department of Health takes the appropriate measures that we have outlined in order to protect individuals' personal information."

2007 in review (20 Dec 2007)

e-Health Insider

http://www.e-health-insider.com/comment_and_analysis/280/2007_in_review

"The biggest health story involving IT had nothing to do with the NHS IT programme, but was the debacle of Medical Training Application Service which resulted in personal details - including religious beliefs and sexual orientation - of junior doctors being openly viewable. The theme of breaches in data security, and the perception that government is far too often cavalier with citizen's personal data, came back with a vengeance by year end with the HM Revenue Customs' loss of 25 million personal records, and now risks undermining public confidence in electronic patient records. . . It was the year in which politicians and the Department of Health (DH) lost patience with the heavily centralised Connecting for Health (CfH) approach to delivering the NHS IT modernisation, and belatedly decided that local ownership was the way ahead. The NHS Local Ownership Programme was born, quickly labelled by beleagured NPfIT veterans as 'No Longer Our Problem'. Following NLOP there are big questions about what, if any, the future role of CfH is. Is it now about providing core infrastructure and services - similar to the NHS Information Authority it replaced? There also remain huge questions about how the local service provider (LSP) contracts can be squared with local ownership. Contract 're-negotiations' with LSP continued at the end of the year. That these are happening in secrecy does not bode well, suggesting local ownership still has some way to go. . . Its also been a year of reviews. First in April the Commons Public Accounts Committee published its report, saying the aims of NPfIT were commendable but delivery of central clinical aims badly awry: it pointed out that the project was two years late and had doubled in cost. It also questioned the ability of suppliers to deliver. The PAC called for an independent review, a call subsequently rejected by the government. In September it was the Commons Health Select Committee's turn. It concluded electronic patient record systems are vital to the future of healthcare in England, but said there remain big questions and concerns over how and when they will be delivered by the NHS National Programme for IT. Quietly the DH launched the Gibbs review of informatics, and spent much of the year trying to cut through the Gordian knot of CfH's byzantine contracts with LSPs. The change of Prime Minister in July accelerated the review process with Patricia Hewitt replaced by Alan Johnson as health secretary. An interim report from Lord Darzi called for NPfIT to focus on delivering clinical benefits and NHS chief executive commissioned DH insider Matthew Swindells to carry out a root and branch review of information in the health services. The year ends with Swindells now titled DH director-general for information and policy, and the indications are that big announcements are due on the future structure of CfH."

Connecting for Health will be leaderless for months (21 Dec 2007)

Health Service Journal

http://www.hsj.co.uk/news/2007/12/no_replacement_for_granger.html

"The Department of Health will not appoint a new chief for NHS Connecting for Health until spring 2008 at the earliest.,With current chief executive Richard Granger due to leave at the end of the year, there will be a gap at the top of the £12.4bn IT programme for at least three months. The hiatus comes at a crucial time with contractual talks under way with all the big IT companies leading the local implementation. "CfH said that no appointment would be made until a review of NHS informatics is complete" In a statement, NHS CfH said that no appointment would be made until a review of NHS informatics ordered by NHS chief executive David Nicholson is complete. Matthew Swindell, the interim director general for information and programme integration, is leading this. But the review will not be complete until March or April next year and will only produce an interim report this month. NHS CfH said: 'Since Richard announced his resignation, David Nicholson has set up a review of how the NHS uses informatics to improve patient care. This is not a review of Connecting for Health, nor of the national programme for IT, but it was recommended by [junior health minister] Ara Darzi in his next stage report. 'In the light of these developments, David now thinks the time is right to look closely at what skills and management arrangements we need to take Connecting for Health forward. We expect to be able to outline this before the end of the year. In the meantime, Richard Granger and his team continue to do an excellent job in leading the programme.' The Department of Health has failed to respond to a separate Freedom of Information request made by HSJ about Mr Granger within the time limit set in legislation. The DoH has not given a guaranteed date by which it will reply. HSJ has been told by the Information Commissioner's Office it has grounds for a formal complaint."

Announcement on CfH future due in 'weeks' (24 Dec 2007)

e-Health Insider

http://www.e-health-insider.com/news/3342/announcement_on_cfh_future_due_in_%E2%80%98weeks%E2%80%99

The future of NHS IT agency, Connecting for Health, remains unclear as 2007 ends, with the Department of Health saying that arrangements have yet to be finalised. The DH says "Interim management arrangements are being finalised and an announcement will be made in the next few weeks." The uncertanty extends to the exact status of Richard Granger, the head of the agency who had been due to depart by year end. It now looks as though he may continue at the helm into the beginning of 2008. Accounts differ as to how hands-on Richard Granger has been in recent months, though EHI did have a confirmed sighting in Leeds last week. New IM&T planning guidance issued by the DH this week, meanwhile, makes clear the future of health service IM&T is now expected to be based on local planning, ownership and delivery, with PCTs, trusts and Strategic Health Authorities now expected to take the lead. An indication of the direction of travel comes in the language and acronyms now being used. The new guidance, issued as part of the NHS Operating Framework 2008-09, no longer talks about the NHS National Programme for IT (NPfIT) in the once familiar singular, but instead refers to the Programme for IT (PfIT), comprised of the NPfIT and Local Programmes for IT (LPfIT). The contract reset negotiations underway with each of the three CfH-appointed local service providers (LSPs) are understood to have not yet concluded. Asked by E-Health Insider whether Granger would still be departing by year end, a DH spokesperson said: "Richard Granger has done a great job in leading the National Programme for IT, which has delivered new and innovative systems that have helped NHS staff to transform the services they provide for patients. Interim management arrangements are being finalised and an announcement will be made in the next few weeks. The DH spokesperson went on to add that the review, set up by NHS CEO David Nicholson, on how the NHS uses information to improve patient care was underway: "This is not a review of Connecting for Health or the National Programme for IT, but the contribution of both will be included within this wider work, as recommended by [health minister] Ara Darzi in his NHS Next Stage Review. "In the light of these developments, David now thinks the time is right to look closely at what skills and management arrangements we need to take Connecting for Health forward. We expect to be able to outline this shortly. In the meantime, Connecting for Health continue to do an excellent job in leading the Programme."

Confusion over Granger's NHS departure - No one seems to know when he is leaving... (15 Jan 2008)

Silicon.com

http://www.silicon.com/publicsector/0,3800010403,39169687,00.htm

"Confusion surrounds the future of the job running the NHS' £12.4bn flagship IT programme and the timetable for the departure of director-general Richard Granger. On announcing his decision to step down from his position running the National Programme for IT in the NHS and as CEO of Connecting for Health (CfH) in June last year, Granger initially indicated he would leave in October last year. Granger was still there in December, however, and the NHS said the former Andersen and Deloitte management consultant would leave his £280,000-a-year post at the end of 2007, after five years in the job. But an NHS spokesman admitted this week that Granger is currently still in the role and said they did not now know what the timetable was for his departure. The spokesman confirmed Granger is still employed by the department and not working on any sort of consultancy basis. . . The prospects for the IT director-general's role will not become clear until a review of the "management arrangements" for taking the NHS IT programme forward has been completed. A spokesman for the Department of Health said at Christmas a decision about the interim management arrangements would be finalised within a "few weeks" - but no decision had been made as of this week. The review is part of NHS CEO David Nicholson's wider examination of how the health service uses informatics and technology to improve patient care. . ."

DH vows to right chaos in IT strategy management (6 Feb 2008)

Health Service Journal

http://www.hsj.co.uk/news/2008/02/shakeup_promised_at_the_top_of_dhs_information_strategy.html

"No one is taking responsibility for the NHS's information strategy, the Department of Health's informatics review has been told. Review manager Tom Denwood has promised that the chaos over the management of the strategy will be put right within weeks. He told a conference of NHS information professionals that his team had found that there "doesn't appear to be one person or one bit of the organisation who owns the big picture around information". "There is no one taking a strategic view over healthcare, social care and mental health," he said. The review is being overseen by Matthew Swindells, interim director general for information and programme integration. It was commissioned by NHS chief executive David Nicholson. Mr Denwood said NHS IT leads had said "there is a complete absence of a function that translates policy into business requirements", and there was no overarching responsibility for IT within the DH. This was illustrated in continual shifting of responsibility for the NHS IT strategy around the department. Although his team's report is not due until the end of March, Mr Denwood suggested that a shake-up at the DH to achieve a "unified governance [structure] which is the decision making body" would happen "over the next couple of weeks". Mr Denwood presented some of the review team's interim findings at a conference held by NHS information contractor CHKS. And he revealed another concern which had emerged from the review: the mismatch between NHS activities and the amount of data available. "Potentially there is a lot of information where there might be little expenditure, but very little information where there is a lot of expenditure," he said. Mr Denwood said social care was his main concern - as it is a huge area of spending, yet there is relatively little information available about it. The new DH governance structure aims to bring the strategic management of health and social care information together."

DH vows to right chaos in IT strategy management (7 Feb 2008)

Health Service Journal

http://www.hsj.co.uk/opinion/2008/02/informatics_policy_finally_gets_direction_after_the_years_of_drift.html

"The Department of Health review of its NHS informatics strategy is finally revealing the secrets of the service's IT debacle. The biggest civilian IT procurement programme in the world, led by Richard Granger, the country's highest-paid civil servant, was undermined by failures right at the top. Last week the review's manager, Tom Denwood, exposed the fundamental flaws that doomed the Connecting for Health strategy from the start: no one owning the big picture on information, an absence of a system to translate policy into business requirements, and continual shifting of responsibility for IT strategy round the department. Mr Denwood is to be congratulated for his openness; without coming clean with the health service about the problems, the DH would be unable to win support for a more coherent strategy. "There is a mismatch between the volume of data generated by different bits of healthcare and the volume of activity and cost." Sadly not all of the DH is as open. Mr Granger was at the epicentre of this debacle, but HSJ Freedom of Information Act requests about his work are still being blocked, in breach of the act's rules. But looking to the future, the review team is beginning to plot a way forward. It has been listening carefully to what NHS managers and clinicians have been telling them about the problems to date and how they should be overcome. Internally, the DH is about to shake up its governance structure to deliver a single decision-making body for IT, giving the next phase of development much-needed direction. A director general-level chief information officer is being recruited to develop and deliver the information strategy for health and social care, backed up by a director of programme and systems delivery. The team has also grasped that there is a widespread mismatch between the volume of data generated by different bits of healthcare and the volume of activity and cost related to it. While relatively obscure parts of the service are awash with data, social care is a glutton for cash but a miser when it comes to churning out information. The DH is determined to address this. The informatics review matters not just because of the central importance of IT to the NHS and the amount of public money it consumes, it is also the biggest test to date of whether the department can address the shortcomings identified last year by the Cabinet Office's so-called capability review of its performance. There is a long way to go, but the early signs are encouraging."

Secret Downing Street papers reveal Tony Blair rushed NHS IT (18 Feb 2008)

Computer Weekly

http://www.computerweekly.com/Articles/2008/02/18/229447/secret-downing-street-papers-reveal-tony-blair-rushed-nhs.htm

"Tony Blair repeatedly sought to shorten the timetable for the NHS IT programme in a move that would have brought results for patients in time for a general election in 2005, Computer Weekly has learned. Papers obtained under the Freedom of Information Act show that the Department of Health drastically underestimated the time it would take to make electronic patient records available online. In papers presented to an NHS IT meeting at Downing Street, the Department of Health promised systems would provide "seamless" care across the NHS by 2004/05 - less than half of the time now allotted to the scheme. The meeting, on 18 February 2002, was attended by IT suppliers, policy advisers and health experts. But Tony Blair made it clear that he regarded even the 2004/05 timescale as too long. He asked repeatedly for it to be shortened, which would have brought visible benefits in time for a general election in May 2005. Blair told the meeting that implementing the programme faster than planned would underpin the government's reform agenda and provide evidence of NHS modernisation to the public. But the timetable in the Department of Health papers has proved hopelessly optimistic. Access by patients and doctors to national summary care records are only at a trial stage. And contracts for the delivery and implementation of new national systems run until 2013 - eight years later than the timetable presented to Downing Street. The Department of Health awarded a series of contracts in record time under the NHS's National Programme for IT (NPfIT) in 2003, but some suppliers complained they were being given too little time to consider their proposals. The main part of the programme - a national electronic health record - is running three years behind the original timetable, in part because the idea is more difficult than first thought to put into practice. The papers raise questions about whether the timetable for the NPfIT was geared towards a general election, rather than the practicalities and complexities of the scheme - and whether the Department of Health put politics before realities in promising the programme in less than three years. Paul Cundy, GP IT spokesman for the British Medical Association, said it appeared that the Department of Health had been "wildly, even delusionally, optimistic about the timetable for the NPfIT in order to secure funding". Vince Cable, deputy leader of the Liberal Democrats, said the Downing Street papers showed that the NPfIT was launched after a discussion that stood out for its "amateurism, naivety and a lack of consideration of the practicalities"."

Secret papers reveal Blair's rushed NPfIT plans (18 Feb 2008)

Computer Weekly - Tony Collins IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/02/secret-papers-reveal-blairs-ru.html

". . . Papers obtained by Computer Weekly under the Freedom of Information Act show that the Department of Health drastically underestimated the time it would take to make electronic records available to doctors and patients. In a paper presented to an NHS meeting at Downing Street, which was chaired by Tony Blair, the Department of Health gave undertakings of what the NHS would be like in 2002/3, 2003/4 and finally 2004/5, if the right investments were made. The paper promised that an IT-based modernisation would provide "seamless" care across organisational boundaries wherever patients are by 2004/5 - less than half the time now allotted to the scheme. It said that by 2004/5, as a patient:

  • I can receive telecare at home, so I can leave hospital sooner
  • I can access my own electronic records
  • I know that if I have an emergency away from home that a summary of my health record will be available
  • I can book appointments where and when it is convenient for me (and get reminders)

And as a doctor, by 2004/5, the paper said:

  • EPRs [electronic patient records] will enable me to have clinical data online as well as reporting of results
  • I can prescribe drugs more safely at less cost by using computer support
  • As a junior doctor I save 30 minutes a day in chasing results and getting ready for ward rounds.
  • I will be able to use patient summaries from their electronic health record eg for emergency care
  • I will know that clinical terms in use are clearly defined and support analyses in practice

As a health professional, by 2004/5, the paper promised:

  • I can really work as part of a multiprofessional team, and across organisational boundaries, providing seamless care to a patient wherever I see them
  • I can begin to use some video-based materials from the NHS U [university].

The Downing Street meeting on 18 February 2002 was attended by several Cabinet ministers, the Cabinet Secretary, representatives of IT suppliers including Microsoft UK, No. 10 policy advisers and health experts. Blair made it clear at the meeting that he regarded even the 2004/5 timetable as extending over too long a period. He asked repeatedly for it to be brought forward. It was likely at that time that there would be a general election in 2005. Blair told the meeting at Downing Street that taking the programme faster than currently planned would help underpin the reform agenda and provide visible evidence of NHS modernisation to patients and the public. Those at the meeting argued for the NHS IT scheme, as did Blair, but he alone wanted an acceleration of the programme. But the timetable in the Department of Health paper has proved hopelessly optimistic. Today, access by patients and doctors to national summary care records are only at a trial stage. And contracts for the delivery and implementation of new national systems run until 2013 - eight years beyond the 2004/5 period mentioned in the Department of Health's paper to Blair. . ."

Was NHS IT plan agreed before Downing St meeting? (19 Feb 2008)

Computer Weekly - Tony Collins IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/02/was-nhs-it-plan-agreed-before-downing-st-meeting-.html#more

"Among the Downing Street papers released to Computer Weekly by the Cabinet Office under the Freedom of Information Act is a letter which indicates that the NHS IT programme was agreed largely before a meeting of Tony Blair on 18 February 2002. It seems that Blair's main influence on the programme was, initially at any rate, to compress the projected timescales. The letter is from Simon Stevens, then No 10 health adviser. He writes to Tony Blair to brief him before a meeting on NHS IT at Downing Street. The meeting is to be chaired by Blair and attended by representatives of two IT suppliers, Cabinet Ministers, policy advisers, and health experts. The letter leaves the casual reader in little doubt that a plan for a "step change" in NHS IT has been all but decided and that one of the biggest remaining challenges is speeding up progress. . ." [Followed by transcript of the letter]

Secrets Behind the UK Electronic Health Record System Decision (20 Feb 2008)

IEEE Spectrum - The Risk Factor

http://blogs.spectrum.ieee.org/riskfactor/2008/02/secret_rush_to_uk_electronic_h.html

"Tony Collins, over at ComputerWeekly, has written a fascinating story about the secret (until now) political decisions to create the UK National Program for IT (NPfIT), the UK's attempt at creating a national electronic health record (EHR) system, similar to what Hillary is currently advocating, and what President Bush wants in place by 2014. In papers obtained by the UK Freedom of Information Act, it appears that former Prime Minister Tony Blair in 2002 wanted a full fledged EHR system by early in the year 2005, before the next general election he would have to call. Even an EHR system operational by the 2005 date was seen by Blair as taking too long! It is apparent that the potential for improved patient health care that EHRs promise was cavalierly traded off for immediate political gain - not a big surprise, of course. The haste and lack of concern for the technological implications in which the NPfIT decision was made is still breath-taking, nevertheless. Best guess is that it will be 2013 before NPfIT is fully up and running; however, doctors aren't particularly supportive of it; nine out of ten doctors don't believe that the UK government can protect patient data; many doctors and privacy advocates are suggesting patients opt of of it; and support contractors are thinking of pulling out. As I have mentioned, politicians seem to believe that they are the most brilliant and clever IT system architects that exist."

What officials promised Blair on NHS IT reform - release of secret papers (20 Feb 2008)

Computer Weekly

http://www.computerweekly.com/blogs/tony_collins/2008/02/what-officials-promised-blair-1.html

"Among the Downing Street papers released by the Cabinet Office under the Freedom of Information Act was the Department of Health's briefing to Tony Blair. The briefing was given to Blair four days before an NHS IT seminar at Downing Street on 18 February 2002 which spawned the National Programme for IT - NPfIT. The Department of Health's paper made it clear that the new programme to modernise the NHS using IT would be led by technology; it was not a project to change working practices with IT as a support tool. Indeed the paper to Blair was headed: "Strategy for modernising NHS Information Systems". The Department of Health's briefing to Blair mentioned three private sector companies that officials had been "active in learning from" including Microsoft, BT and Cisco. Bill Gates had met Tony Blair in 2001 and had discussed an IT-based modernisation of the NHS. BT much later won more than £1.5bn worth of contracts under the NPfIT. Microsoft has been briefing in secret the chief executives of NHS trusts on the benefits of the NPfIT. The Department's paper did not denigrate the state of NHS IT in 2002 to sell to Blair the need for a new national programme. Indeed the paper quoted statistics - much as NHS Connecting for Health does now to promote the NPfIT - to show that there had been a "step change following publication of Information for Health in 1998". The paper's main objectives appeared to be to put the case for much more investment in NHS IT - with the promise of achieving a national summary care record by 2004/5 . . . When this paper was discussed at the NHS IT seminar at Downing Street on 18 February 2002, Tony Blair asked repeatedly about speeding up the timescales - 2004/5 being too long a wait. There wasn't a dissenting voice at the meeting, not to the plan or the compressed timescale. Has there ever been a society which has died of dissent? Several have died of conformity in our lifetime, said the scientist Jacob Bronowski. Less than four months after the Department of Health paper was written the NPfIT was announced."

NHS boss says NPfIT 'was not in right place' (12 Mar 2008)

e-Health Europe

http://ehealtheurope.net/news/3551/nhs_boss_says_npfit_'was_not_in_right_place'

NHS chief executive David Nicholson says the NHS IT programme had become too centralised to support the move to a health service based on plurality and far more locally-based decision making by clinicians and patients. Speaking at the World Healthcare Congress in Berlin on Monday Nicholson explained why the introuduction of the NHS National Programme for IT (NPfIT) Local Ownership Programme had become necessary to support the future structure and achieve a far more integrated and devolved health service, in which services are "wrapped around patients". Nicholson said: "It felt we'd reached a position where the balance was not in the right place". The challenge he said was extremely difficult, "How does a very central system adapt to becoming a very local one." The NHS chief executive said that as a result of listening to the views of clinicians and patients the NHS IT programme was being reviewed and reshaped. "We are working through that now." . . . Despite difficulties and changes to the programme now underway, Nicholson said the health service's IT programme had achieved significant benefit, already saved 400 lives. It also highlighted efficiency savings saying a quarter of a million paper prescriptions had so far been eliminated. "We are already seeing real benefits and real problems as well."

Senior executive Richard Jeavons quits NHS IT programme (1 Apr 2008)

Computer Weekly

http://www.computerweekly.com/Articles/2008/04/01/230068/senior-executive-richard-jeavons-quits-nhs-it-programme.htm

"Richard Jeavons, senior responsible owner for service implementation in the NHS's £12.4bn National Programme for IT (NPfIT) is leaving for a different health service job. He is one of a succession of senior responsible owners to leave the NPfIT. Others who have left include Richard Granger, formerly director general of NHS IT and senior responsible owner, John Bacon, the Department of Health's director of delivery and overall senior responsible owner for the NPfIT, Aidan Halligan and John Pattison. Only last month Jeavons was one of the key figures at a press conference in Whitehall to announce details of an annual statement on the costs of the NPfIT. Jeavons was seated next to the minister in charge of the NPfIT, Ben Bradshaw. . . He has been appointed chief executive at the Independent Reconfiguration Panel, which provides expertise on NHS service change. The panel was established in 2003 to provide advice to the secretary of state for health on contested proposals for health service change in England. It also offers support and advice to the NHS and elsewhere on making changes. The panel has announced the appointment of Jeavons on its website where it said it was "finalising commencement dates and a formal announcement will be made in due course". No announcement has yet been made on the website of NHS Connecting for Health. Its spokeswoman made no comment."

Swindells quits DH ahead of review publication (10 Apr 2008)

e-Health Insider

http://www.e-health-insider.com/news/3640/swindells_quits_dh_ahead_of_review_publication

"The Department of Health's interim chief information officer Matthew Swindells is to leave the department to take up a position with consultancy firm Tribal. The news comes ahead of publication of the Swindells review of NHS Informatics, which was expected to contain criticism of the overall strategic management of information in the NHS. A former director of clinical services at Heatherwood and Wexham Park Hospital and head of IT for Guy's and St Thomas' Swindells has been leading the DH's Informatics Review, which a DH spokesperson said will be published "later this spring". The spokesperson declined to comment on whether or not the review had been completed. Swindells had been expected to present key findings as keynote speaker at the Healthcare Computing 2008 show at the end of April. However, a report in the current issue of the Health Service Journal, suggest that Swindells report has been completed and "is expected to contain strong criticisms of the general informatics programme to date". EHI contacts indicate publication of the review may be put back until the summer. . . One industry source said that Swindells had been "very sensible" and "would be missed". They speculated that reasons for his departure might include failing to win support from the DH for his review's more critical conclusions, or being passed over by the DH for the CIO position. . ."

Another leading figure in NHS IT and the NPfIT quits (10 Apr 2008)

Computer Weekly - Tony Collins' IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/04/another-leading-figure-in-nhs-1.html

Matthew Swindells, who has been leading a review of NHS informatics including the £12.4bn National Programme for IT[NPfIT], has resigned and is to leave the Department of Health "shortly". He has played a key role in leading NHS IT since the departure of Richard Granger in January 2008. News of his departure comes only weeks after Computer Weekly revealed that Richard Jeavons is leaving the NPfIT as its much-respected senior responsible owner for service implementation. Their resignations are a blow to the credibility of the NPfIT which is now left without strong independent voices. Some will see the departures as indicating that the programme is now in trouble. Swindells is moving to the private sector, to a consultancy Tribal. His review of NHS IT, which has yet to be published, is likely to include some criticisms of the NPfIT as it stands. . . Swindells and Jeavons are seen as independently-minded executives who are not noted among colleagues for using statistics to promote past achievements of the NPfIT, though both support the scheme. In January, at an NHS CIO Summit at the UK headquarters of Microsoft in Reading, Swindells spoke of the need to move from "monolithic providers of services to many providers that are more patient centric". However the NPfIT was founded on the principle of NHS trusts in England being supplied by a small number of large IT service providers. With some NHS trusts buying hospital systems outside of the NPfIT because of delays in the supply national systems there is pressure on the Department of Health to allow hospital executives to buy what they want provided it meets national standards. Swindells has argued for plurality and against what he called 19th-century capitalism or 20th-century nationalisation. . .

Swindells leaves NHS CIO role for consulting (11 Apr 2008)

CIO

http://www.cio.co.uk/concern/managers/news/index.cfm?articleid=2732&pagtype=allchandate

"Richard Granger success leaves within months. The NHS National Programme for IT has lost its second CIO this year. Matthew Swindells, who replaced Richard Granger earlier this year, is leaving to join Tribal Group, which provides consulting to the public sector. Swindells took up the role after Richard Granger left the Connecting for Health programme in January following a highly publicised resignation last year. In a statement the Department of Health said: "Matthew Swindells will shortly leave the department at the end of his secondment from the NHS to take up an external appointment. This has been approved under the rules that govern the acceptance of outside appointments by civil servants, subject to certain conditions. In the meantime, the department is recruiting a Chief Information Officer (CIO), at Director General level, who will lead the development and delivery of the overall information strategy for the health and social care system." Swindells and Gordon Hextall took over the Connecting fro Health programme on January 31, 2008. Earlier this month Richard Jeavons also stood down as the Connecting for Health director of IT service implementation. At Tribal Swindells will be the MD of its health division, which provides a range of services to healthcare providers, including consulting on technology; use of building space; human resources and public relations. A spokesperson for Tribal said it is a new role for the company and that he will be responsible for increasing its presence in the healthcare sector. 'Matthew has had a successful career, he took the Royal Surrey County Hospital from a zero star rating to two star,' she said. Tribal hope Swindells will be in place by the summer and push the company into new directions and introduce them to new clients. In his career Swindells has been head of IT for Guy's and St Thomas foundation trusts, as well as chief executive of the Royal Surrey before he switched to the Connecting for Health programme."

Health IT is too big for one boss: NHS needs two at £200,000 each (24 Apr 2004)

The Times

http://www.timesonline.co.uk/tol/life_and_style/health/article3803652.ece

". . . Mr Granger, a former management consultant, resigned as Director-General, NHS IT, last year after five years. But the Government is splitting his job into two, costing the taxpayer potentially 40 per cent more in managerial wage bills for the project. The Department is creating the posts of chief information officer (CIO) for health as well as a director of IT programme and system delivery, each advertised with salaries of about £200,000. Combined, the two jobs are equivalent to Mr Granger's former position, on increased wages, which critics labelled an "abuse of taxpayers' money". Some IT experts question whether it is even possible to manage effectively an unwieldy project such as the National Programme for IT (NPfIT). . ."

A big week ahead for NHS IT watchers (15 Apr 2008)

Pulse

http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4118472&c=2

"It may play host to more technological whizzkids and software megacorporations than rank and file GPs, but Pulse will be keeping a weather eye on next week's Healthcare Computing Conference & Exhibition in Harrogate. . . These are troubled times for Connecting for Health, the body charged with overseeing the National Programme for IT. On the one hand, real progress is being made in some areas. Choose and Book looks finally to be getting off the ground, thanks in part to PCTs deciding to fund local incentive schemes, whilst the GP2GP rollout is continuing well. But progess on the flagship project, the Summary Care Record, has slowed to a crawl. And whilst the series of data security breaches this winter were nothing to do with Connecting for Health or shared electronic records, mud sticks, and to many patients the idea of a centralised Government records database seems less appealing than it once did. The £12.6 billion question though, for the hugely ambitious/expensive national programme, is how long the political will to support it will last. Things have been very rocky for the upper echelons of the Connecting for Heatlh hierarchy lately. Richard Granger, who led the organisation for the past five years, left in January, while Richard Jeavons, head of service implementation, and the Department of Health's interim chief information officer Matthew Swindells have this month both announced they are to follow suit. Even more worryingly, the Department of Health's Informatics Review is still pending - and according to the Health Service Journal 'is expected to contain strong criticisms of the general informatics programme to date.' And with Pulse's revelation this week that the Summary Care Records evaluation will not be completed until 2010, and a general election to come, the long-delayed Tory review of NHS IT suddenly becomes that much more signification. . ."

Summary Care Record Early Adopter Programme (30 Apr 2008)

Trisha Greenhalgh et al, University College London

http://www.ucl.ac.uk/openlearning/documents/scrie2008.pdf

"An independent evaluation by University College London. . . This evaluation used mainly but not exclusively qualitative methods, comprising around 1500 hours of ethnographic observation within CFH and the Early Adopter sites; 250 interviews with NHS staff; some 2500 pages of correspondence and documentary evidence; interviews and focus groups with 170 NHS patients and carers; and incorporation of relevant surveys and statistics produced by others. . . . The hoped-for benefits of the SCR (notably improvements in the quality and safety of care and the opportunity for patients to be more actively involved in their care) remain unproven, but this is not surprising since there has not yet been sufficient opportunity to demonstrate them. . . The SCR raises important ethical and practical questions. It has potential benefits and potential disbenefits. Public debate up to now has tended to be conducted by the minority of individuals with extreme views (positive or negative) and been somewhat simplistic, polarised and tied to hypothetical situations. It is time to focus the debate on how the balance between benefits and disbenefits might play out for different individuals in different circumstances, and how these may change over time. . . we suggest that the NPfIT National Programme Board consider carefully the finding of this evaluation (which confirms previous observations by academics and policy analysts) that 'technology push' is being prioritised at the expense of attention to wider socio-technical change and that this is, in the opinion of the evaluation team, a major risk to the success of the NPfIT. Should the Board seek to address this, it follows that fundamental changes are needed to the structure, culture and preferred change model of the NPfIT. . ."

NHS head is content about rejecting NPfIT review (17 Jun 2008)

Computer Weekly, Tony Collins' IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/06/nhs-head-is-content-about-reje.html

"The head of the NHS told MPs yesterday [16 June 2008] that he has no regrets about rejecting calls by 23 leading academics for an independent review of the NHS's £12.7bn National IT scheme - even though the main software programme is four years behind schedule. David Nicholson, Chief Executive of the NHS, said the priority had been to ensure the delivery of software as part of the National Programme for IT [NPfIT]. He made his comments to the Public Accounts Committee at a hearing on the NPfIT on 16 June 2008. Nicholson's arguments against a review of the programme were similar to those put by National Air Traffic Services when its board fought a call for an independent assessment of delayed software to support a new air traffic control centre at Swanwick in Hampshire. Directors of NATS lost their battle after a campaign by Computer Weekly. The government ordered a review - even though directors of NATS had argued that this could distract managers from the more important task of delivering the software. The air traffic control system eventually went live in 2002 - after NATS implemented the recommendations of an independent review by consultancy Arthur D Little. At the hearing yesterday of the Public Accounts Committee over the NPfIT, Conservative MP Richard Bacon asked Nicholson whether it would have been wise for there to have been a genuinely independent review of the NHS IT programme - by those unconnected with the programme. "Do you wish you'd done that now?" asked Bacon. Nicholson replied "no" and added that officials at the Department of Health had met the "all the people who have had criticisms of the programme". Twenty-three academics had written an open letter to the Health Committee in 2006 calling an independent review of the NPfIT - and they wrote another open letter to the committee in 2006. Nicholson said: "There was no coherent argument for us to have it [an independent review] . The most important thing people said is: you should get on and get something done and delivered. That's exactly what we have been focusing our attention on." Arthur D Little's report in 1999 on the NATS software project listed serious weaknesses in the way the scheme was being run. Computer Weekly has campaigned for a similar review of the NPfIT. Nicholson told Bacon that he had read the Arthur D Little report. He said that there have already been reviews of various parts of the NPfIT- but Bacon said the programme needed to be reviewed as a whole. "No," said Nicholson. " I don't believe that's sensible at all." Nicholson said: "The most important thing now is to deliver. The service [the NHS] is crying out for this product." He was referring to the Cerner "Millennium" software and the "Lorenzo" system which are due to be delivered to hospitals across England to provide a Care Records Service - a pivotal part of the NPfIT. The National Audit Office last month found that the Care Records Service - which would give every patient in England an electronic health record - will take at least four years longer than originally planned."

CfH boss says NHS IT programme an 'expedition' (18 Jun 2008)

e-Health Insider

http://www.e-health-insider.com/news/3864/cfh_boss_says_nhs_it_programme_an_'expedition'

"The NHS IT programme is not a "programme of paint by numbers" but more of an "expedition", Gordon Hextall the acting boss of NHS Connecting for Health told MPs questioning why the £12.7 billion programme is now running at least four years late. Answering questions at Monday's Public Accounts Committee (PAC) hearing Hextall said he had a good map and compass, but due to its sheer scale the NHS IT programme continued to chart unknown territory, resulting in almost ineviatable delays. PAC chairman, Edward Leigh, asked why even Connecting for Health's new timetables should be believed. "Why should we be any more confident about these new timescales?" NHS chief executive David Nicholson replied: "We're now experienced and working much better with the LSPs [local service provdiers] that are left. We also have a product, or are close to having a product." Pressed by Leigh on whether there had yet been a single deployment of Care Records Service (CRS) software into an NHS hospital, the boss of the NHS said: "No, no." . . . The CfH director said that Lorenzo had been "delivered" to Morecambe Bay Hospitals NHS Trust, but acknowledged it was not yet "live", with the trust testing the software. He stressed that it was for the trust to decide when it was happy to go with the software. During the hearing Hextall repeatedly returned to the theme that it was getting quality right, rather than hitting target dates that mattered. Asked when Morecambe Bay would switch on, he said: "They will go live when the quality is right." He indicated this was now expected to be by July. However, despite this clear statement that quality would trump all else the CfH director still offered an extremely aggressive timetable for Lorenzo implementations following Morecambe Bay, stating they would begin in earnest within three months - initially at two more pilot sites. . . Nicholson made clear that the aim remained to roll out the two strategic CRS systems across entire LSP areas. "We are trying to ensure all trusts take the same system in an area." Questioned by Leigh on Newcastle's recent decision to go outside the NHS IT programme, and potential liabilities this created to the NHS, Nicholson said the department can insist non-Foundation Trusts (FTs) take CfH systems. "We can direct trusts to take the system". Hextall said Newcastle had committed to continue working with the programme, and the system they were looking at was Cerner. Nicholson added that even for FTs it was extremely hard to go outside the programme, as they remain subject to Treasury rules, and have to show that whatever system they took was as cost effective as the CfH products. "We think the product we are delivering they will want to take. They have to have a business case to show the benefits of taking another system and that's very difficult to do." He said that Bedford, which had looked to go outside the programme, had become convinced that iSoft was the best system to go for and were now great advocates. "Will you force trusts to take the system?" Leigh asked. Hextall avoided a direct reply saying it would be very hard for them to make the business case necessary. . . Hextall told PAC member Paul Burstow, MP, that there had been three major changes to the delivery dates, though he later added that delivery plans were changed on an almost weekly basis. He said the programme had always been ten years in duration. Fellow PAC member Richard Bacon, MP, rebutted this assertion, saying that at its outest "Sir John Pattison said it would take two years and nine months and be completed by December 2005." He asked the DH to provide a note explaining how the programme had changed into one that will take at least ten years."

Health chiefs tell NHS trusts not to wait for NPfIT (10 Jul 2008)

Computer Weekly

http://www.computerweekly.com/Articles/2008/07/10/231439/health-chiefs-tell-nhs-trusts-not-to-wait-for-npfit.htm

"NHS trusts should implement interim IT systems instead of waiting for the National Programme for IT (NPfIT) to deliver in 2012, a government review of health IT has concluded. The Department of Health's Health Informatics Review, said that trusts needed access to interim solutions before the conclusion of the £12.4bn NPFIT. . . Under the plan, trusts will be able implement interim solutions for patient administration systems, order communications and diagnostics reporting, discharge and accident and emergency letters, scheduling for beds and tests, and e-prescribing. Local Strategic Health Authorities (SHAs) and Connecting for Health, the body that is delivering the NPfIT, will develop "roadmaps", to roll out the interim systems. Trusts will be able to buy the systems from suppliers who are already developing the strategic systems for the NPfIT. The systems will be delivered on a case-by-case basis, and each trust will have to provide a business case for each system, the Department of Health said. . . Trusts will not be encouraged to find their own suppliers, said Bruce Keogh, NHS medical director and interim director general for informatics. "If people start going it alone we'll have a free for all. That would be a great opportunity cost." . . . The Informatics Review looked at how information can be better used across the NHS. It will be followed by an Implementation Report this autumn."

Doctors repeat call for inquiry into CFH (14 Jul 2008)

e-Health Insider

http://www.e-health-insider.com/news/3943/doctors_repeat_call_for_inquiry_into_cfh

"Doctors' representatives have called for an independent inquiry into Connecting for Health and demanded that trusts be allowed to seek solutions directly from IT providers. Dr David Wrede, consultant obstetrician and gynaecologist at Taunton and Somerset NHS Trust, told the BMA's annual meeting that it was "Groundhog Day" for the representatives. He said the meeting passed a motion last year calling for an inquiry because of problems with the National Programme for IT (NPfIT) and a year later problems were still continuing and there had been no inquiry. He cited problems including the Worthing trust chief executive's claim that Cerner's functionality was inferior, delays in start dates for the system at Barts and the London NHS Trust, and cancer care delays at Barts blamed on the Cerner system. He added: "What we have experienced as clinicians is a system that's very slow and difficult to get things done." Dr Wrede claimed the specification had not been properly considered and that a one size fit all approach was not right when trying to implement systems in hospitals as diverse as Weston General, St Barts and the Royal London. He said the NHS needed to understand what had gone wrong with NPfIT. . . Dr Alan Russell, BMA council member, said he was concerned that too many local trusts were not good enough to be given responsibility for local implementation and that problems with Choose and Book were often caused by trusts. He added: "There are too many trusts that take what's put out nationally and change it and make it worse than it ever was." However Dr Wrede's call for trusts to be given local autonomy on IT systems was backed by representatives. . ."

Informatics Review and NPfIT: an opportunity (15 Jul 2008)

Computer Weekly - Tony Collins' IT Projects blog'

http://www.computerweekly.com/blogs/tony_collins/2008/07/informatics-review-and-npfit-a.html

". . . Some in the NHS are saying that the Informatics Review is the eulogy being read at the funeral of the NPfIT. That's a bit unfair. The Informatics Review says what NHS IT should be. But almost the same visionary words could have been written 10 or 20 years ago - and many were, in the NHS IT strategies of 1992 and 1998. Talking about a Utopian future for NHS IT will not disinter the NPfIT. It will, however, help to justify the edifice of a central bureaucracy to oversee NHS IT of the future. That's politics; and executives working for the NHS say it's time to put politics to one side and do what's best for patients, which is, within the ASCC, to give a subsidised choice of IT suppliers to the boards of NHS trusts. They can then buy products they know work, not vapourware. It's one thing for the NHS to have invested, in decades past, in a multitude of systems that weren't joined up, cost a small fortune and worked. It's another thing to put faith in a visionary IT programme in which the investment is in a minimal number of systems that aren't joined up, cost a bigger fortune and don't work. . ."

Milton Keynes' CRS caused 'near melt down' (29 Jul 2008)

e-Health Insider

<http://www.e-health-insider.com/news/4003/milton_keynes'_crs_caused_'near_melt_down>http://www.e-health-insider.com/news/4003/milton_keynes'_crs_caused_'near_melt_down'

"The deployment of a national programme care records system at Milton Keynes Hospital NHS Foundation Trust "developed into an untenable situation which resulted in near melt down of the organisation." According to papers from the CRS project board, obtained by E-Health Insider under the Freedom of Information Act, the trust experienced a far from smooth go-live of the Cerner Millennium system. The CRS project team described it as "eight weeks of extreme pressure and operational issues to the acute trust." Board papers from the CRS project board, dating from July 2005 to June 2007, show a turbulent journey before the system finally went live on 24 February 2007. Milton Keynes was an early implementer site for the local service provider, Fujitsu, and the acute trust urgently required a new patient administration system to replace its existing legacy system, which was considered obsolete. An initial go-live was scheduled for 16 June 2006. The system was meant to include basic PAS, clinical noting and order communications, maternity, A&E, theatres and information for analysis functionality. . . When EHI reported on Milton Keynes's implementation, which also covered the community hospitals run by Milton Keynes Primary Care Trust, Fujitsu said it had benefited from the experience gained from earlier implementations. However, the minutes from the CRS project board show problems being continuously identified and go-live dates continuing to slip. In two years of planning, the go-live date changed seven times. The cost of the slippages was almost £800,000. . . The green-light to go ahead with the deployment was only given three weeks ahead of the actual go-live. However, post-go-live, doctors began to identify a series of problems, resulting in the "near melt down" described by the project board. The board papers suggest that problems at this stage included bed availability not displaying correctly, notes for clinics going missing, patient appointments not displaying on lists, reports not printing correctly, GP labels being unavailable, clinic rebuilds being necessary, back office help being unavailable, printers not working and passwords being forgotten. . ."


Foundation trusts tender outside NPfIT (21 Aug 2008)

e-Health Insider

http://www.e-health-insider.com/news/4077/foundation_trusts_tender_outside_npfit

E-Health Insider has learned that just a month after the publication of the Health Informatics Review, a number of NHS foundation trusts have begun to move to non-National Programme for IT in the NHS solutions. Royal Berkshire NHS Foundation Trust and The Rotherham NHS Foundation Trust have seperately placed advertisements for electronic patient record systems in the the Official Journal of the European Union, rather than go through NHS Connecting for Health's Additional Supply Capability and Capacity (ASCC) framework contracts. Rotherham's OJEU tender is a ten year contract for a locally configurable, fully fledged electronic patient record. The tender sets the requirement for a high degree of local control. . . Meanwhile, two further foundation trusts, Harrogate and District and South Tyneside, have put in place new, long-term contracts to support their existing patient administration systems. Harrogate and District NHS Foundation Trust has signed a new five-year support deal for ICS, an existing iSoft patient administration system already in use at the trust that pre-dates NPfIT. The same PAS is thought to be in use at South Tyneside NHS Foundation Trust. Both trusts have Computer Sciences Corporation as their LSP, and are meant to recieve the Lorenzo Care Records Service product when it becomes available. By awarding five-year support deals to iSoft they appear to have pushed back the date at which they might eventually take an NPfIT CRS solution back to 2013. . .


Patients get veto on access as NHS database expands across England (18 Sep 2008)

The Guardian

http://www.guardian.co.uk/society/2008/sep/18/health.nhs

"NHS staff are to be required to seek patients' specific consent before reading their electronic medical records under tougher rules to protect confidentiality due to be unveiled today. The government is pressing ahead with plans to upload the records of 50 million patients in England on to a national database known as the Spine. They will contain a summary of key personal data including allergies and current medications. But, in a further move to protect confidentiality, the Department of Health has decided to give patients a veto on when the information can be accessed. The electronic record was designed to give paramedics and staff in casualty units and walk-in centres immediate access to patients' records. The system - part of the NHS's £12.4bn IT upgrade - was hailed by ministers as a potential lifesaver for anyone in an accident or taken ill far from home. But ministers have accepted patients may object to personal information being disclosed to NHS staff who do not need to know it. For example, someone treated for depression may not want to advertise the fact to anyone other than their GP. After a Guardian campaign in 2006 the government conceded that patients should have the right to stop medical information being passed from the GP to the NHS Spine, if they were concerned about leaks of information or attacks by computer hackers. During subsequent trials of the scheme in Bolton, Bury, Bradford, south Birmingham, and Dorset, Connecting for Health, the NHS's IT procurement agency, ran information campaigns telling patients they were entitled to protect their data. . . But a review of the scheme by University College London found most patients in the trial areas did not know their records had left their GP's surgery. Doctors and nurses in hospitals also did not know they had to ask permission from a minority of patients before calling up the files. New rules agreed yesterday by the NHS care records board will require staff to seek prior approval of all patients fit to give it, on every occasion that files are accessed. . ."

NHS Informatics Planning 2009/10 (8 Dec 2008)

Department of Health

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091437

". . . The NHS Operating Framework for 2009/10 outlines the need for informatics planning with board level ownership and support to deliver information enabled service transformation. This document, which includes a link to supporting tools for Chief Executives and other key stakeholders, provides further guidance. The national expectations contained in this document should be used by all NHS organisations to refresh and re-focus their informatics plans. . . Individual NHS organisations working collaboratively within local health communities should plan for the roll-out of the Summary Care Record (SCR) across LHCs with a focus on urgent care settings. Learning lessons from the Early Adopter Programme, national roll-out will have commenced during 2008/09, once compliant software is available. SHAs will agree the timeline for implementing the SCR with PCTs as commissioners, and full roll-out of the SCR will be demonstrated in LHC plans. Roll-out will be based on a two year window for the full deployment of SCR from the date on which all GP systems in the PCT are compliant. PCTs will manage compliancy of GP systems in accordance with their primary care informatics strategy and to bring forward the benefits offered by SCR. . . It is NHS policy that patient level data should not contain identifiers, including NHS Number, when it is used for purposes other than the direct care of patients. It is important that organisations commissioning and providing NHS care develop and implement plans for the use of data, which has either been anonymised or in which identifiers have been replaced with pseudonyms. This should cover all patient level data which is not used for direct care purposes and in particular NHS wide data which is extracted or received from the Secondary Uses Service. . ."

Health records scheme at 'pivotal' point (12 Dec 2008)

Financial Times

http://www.ft.com/cms/s/0/c8cff74c-c7db-11dd-b611-000077b07658.html

"The NHS's multi-billion programme to create an electronic health record has reached a "pivotal position" where it will require a big rethink if more progress is not made soon, David Nicholson, the NHS chief executive, said on Thursday. The programme is running at least four years late. New installations in London are on hold, no roll-out of the programme has yet been agreed for the north of England and the Department of Health is still deciding how to replace Fujitsu, the contractor for the south whom the NHS fired in May. Mr Nicholson told the Commons health committee he remained "confident" that the NHS would have a workable system by 2015. But in a first public admission that a rethink might be required, he told MPs: "We do have to think about how we take it forward. We can't go on and on for this." While parts of the programme had gone well, he said, there were "some really difficult issues to tackle" around installation of the clinical record. The software that was to be used for the whole of the north, Midlands and east of England was finally being tested on a small scale, he said. "Good results are coming out of that", but "we need to be careful" before rolling it out, he said. In London, the latest installation at the Royal Free hospital has hit big problems which BT, the installer, and Cerner, the software provider, are working to resolve. "We have said to Cerner and BT that they have to solve that problem at the Royal Free before we will think about rolling it out across the rest of the NHS," he said. And he hoped that around February there would be a decision about who would take over in the south. The options included BT, which is responsible for the London systems, and CSC, which runs the north; a combination of the two; or bringing in another contractor. But as MPs queried the scale of the delays, he conceded "we really are at quite a pivotal position. If we don't make progress relatively soon, we are really going to have to think it through again." With the BT and CSC contracts running until 2015 and 2016, the department refused to comment on what "thinking it through again" might imply. It said: "We remain confident that the situation at the Royal Free will be resolved and so are not prepared to speculate about possible scenarios if it is not". BT said it was "making good progress" at the Royal Free."

CfH stripped of key roles and reorganised (5 Mar 2009)

e-Health Insider

http://www.e-health-insider.com/news/4629/cfh_stripped_of_key_roles_and_reorganised

"In a major shake-up of health service IT, key leadership roles are to be moved directly to the Department of Health, with NHS Connecting for Health playing a strictly supporting role. Documents seen by E-Health Insider indicate that the moves will make CfH a "delivery organisation", with technology policy, technology and strategy questions decided by a team reporting directly to chief information officer for health Christine Connelly. A new DH Informatics Directorate will be established, consisting of six directors reporting directly to Connelly plus Tim Straughan, chief information officer of the NHS Information Centre. The six directors will include Martin Bellamy, director of programme and systems delivery, whose key objective will be "to deliver elements of the NHS systems portfolio." Intriguingly, the National Programme for IT in the NHS is only described as a short-term objective for the current head of CfH: "In the short term, the main area of focus is the National Programme for IT." Also eye-catching is the transfer of the role of technology officer from CfH to the DH, which will now set a common technical architecture for the NHS and ensure that systems conform to it. Paul Jones will transfer directly from CfH to the DH as chief technology officer. The documents seen by EHI say: "The CTO will own the overall technical architecture to be used by the NHS and Department for Health and will ensure that systems developed conform to that architecture." The other director positions, yet to be filled are: a director of policy and planning; a chief business architect; a commercial director, informatics; and a clinical director, informatics. All sit outside CfH. One senior NHS IT professional told EHI that the restruture indicated a major shift in power and resources: "The implication of this to me is that both the informatics architecture and the financing for that is moving back into the control of the NHS." EHI understands that CfH has also announced a restructure designed to enable it to refocus efforts and "build on the culture of delivery throughout the NHS." In a letter to the agency's staff, Bellamy said the restructure will "fully align NHS CfH's systems of internal control with those used in the Department of Health." . . . The two shake-ups are the first obvious outcome of the appointments of Christine Connelly and Martin Bellamy last September, and come against a background of rumoured lively conversations behind the scenes. The changes will come into effect on 6 April."

McBride scandal exposes smear culture (16 Apr 2009)

Computer Weekly Tony Collins IT Projects Blog

http://www.computerweekly.com/Articles/2009/04/16/235662/mcbride-scandal-exposes-smear-culture.htm

One of Gordon Brown's ministers, Ed Miliband, said this week that the departure of Damian McBride should put an end to the e-mail smear scandal. But smearing is a cultural problem, as Computer Weekly discovered during Parliamentary debates in 2007 on the NHS's £12.7bn National Programme for IT [NPfIT]. During the debates the then health minister, Caroline Flint, - and a former health minister, Lord Warner, - made allegations against individuals and organisations, based on incorrect briefings they had received. The false claims have never been corrected. The allegations named individuals and various organisations in the IT industry, implying that they had become allies of the Tories in making politically motivated criticisms of the NPfIT. A few months before the debates, in February 2007, a small delegation representing the Department of Health had briefed the then Prime Minister Tony Blair that criticisms of the NPfIT were politically motivated. Computer Weekly obtained a copy of the confidential briefing paper which was given to Blair. At a debate on the NPfIT in the House of Commons in June 2007 Caroline Flint ascribed to a report of the National Audit Office positive comments on the national programme that the NAO had not made. She then claimed that a Computer Weekly reporter, Tony Collins, had briefed only the Conservative Party on the NPfIT. She told the Commons, "I am sure that members of the Conservative opposition are familiar with the content of the [NAO] report because it was laid before Parliament on 16 June 2006. I am sure that they do not rely only on the opinions of such people as Tony Collins of Computer Weekly, who has, I understand, provided briefings solely to members of the Conservative party and produced material for publication by Conservative party think-tanks." Computer Weekly has not given briefings solely to the Conservative Party, nor produced material for its think tanks. Separately, Lord Warner, the former Health minister who had been the government's spokesman on the NPfIT, obtained a series of e-mails which had been written by Ross Anderson, Professor of Security Engineering at the Cambridge University Computer Laboratory. Anderson was at the time an adviser to the Health Committee during its investigation into aspects of the NPfIT. Lord Warner cited the e-mails during a debate on the NPfIT in the House of Lords on 21 June 2007 when he questioned the political neutrality of Anderson. Lord Warner said, "Some of my puzzlement over hostility to the programme has been removed, since leaving office, by discovering people working together to campaign against this programme. "The campaign seems to be made up of the Foundation for Information Policy Research, the Big Opt Out organisation, the Conservative Technology Forum, Computer Weekly, Medix surveys and the Worshipful Company of Information Technologists, which I only recently discovered. "An energetic presence in this network is a Cambridge professor called Ross Anderson. Some interesting e-mails of his have found their way to me." After quoting from several e-mails, Lord Warner said, "I have insufficient time to entertain the House with more extracts. I am willing to let them be seen on a private basis by my honourable friend in the other place who chairs the Health Select Committee. In a spirit of bipartisanship, I would encourage Conservative parliamentarians to look closely and sceptically at some of the sources of advice they appear to be using." Even today, and despite a request under the Freedom of Information Act, Anderson has been unable - yet - to discover how Lord Warner obtained his personal e-mails. Miliband, some ministers and the Cabinet Secretary Gus O'Donnell, see the Damian McBride affair as the beginning and end of smear. But the desire to try and debase the reputations of individuals and organisations to further political aims runs much deeper in the government system. In the case of the NPfIT, the smears served only to divert attention temporarily from the most potent criticisms of the national programme. It is worth nothing that a year after Caroline Flint's speech the National Audit Office published its second report on the NPfIT - which was strongly critical of aspects of the programme.

NHS IT programme given seven months to improve (29 Apr 2009)

Health Service Journal

http://www.hsj.co.uk/5000918.article

"The Department of Health has given the NHS IT programme seven months to make "significant progress" in installing working IT systems in hospitals. The deadline was set yesterday by DH director general for informatics Christine Connelly. She said "a new plan" for delivering informatics in the NHS would be adopted if the deadline was missed. Ms Connelly also announced plans to invite suppliers on Connecting for Health's supply framework to provide IT systems for hospital trusts in the South of England. Fujitsu was previously the service provider for the region but pulled out of the programme last May. The programme will continue to allow more flexibility in the choice of IT systems. Ms Connelly announced a DH "tool kit" that will allow software developers to design new IT products that can be plugged into the central system. Ms Connelly said: "We now want to open up the healthcare IT market to new suppliers and new technological developments, to inject more pace into this programme. Working together, we can help trusts configure systems to best meet their local needs as well as take advantage of market developments to make more use of the information held in the core systems." Ms Connelly has been reviewing NPfIT since she took over the role in August. It was widely understood that she would be publishing a report outlining her findings, but a spokesman for NHS Connecting for Health this week said there would be no report and that expectations to the contrary were incorrect."

NHS CfH boss Bellamy to depart (23 Jun 2009)

e-Health Insider

http://www.e-health-insider.com/news/4958/nhs_cfh_boss_bellamy_to_depart

Martin Bellamy, the head of NHS Connecting for Health, is to leave his position as director of programme and systems delivery for a new position at the Cabinet Office. His departure comes as part of a wider shake-up of NHS Connecting for Health that will see the IT agency become directly managed by the Department of Health Informatics Directorate. Director general of informatics Christine Connelly presented the new plans to CfH staff in Leeds yesterday. In an exclusive interview with E-Health Insider, she explained that the move was primarily intended to create a new integrated Informatics Directorate, and was not about cost savings. "I talked about embedding the Informatics Directorate within the DH and all aspects of the delivery of healthcare," said Connelly. She stressed that the challenge was to ensure informatics permeated and underpinned all of healthcare. The very name of the agency, synomymous with the £12.7 billion National Programme for IT in the NHS, is uncertain. Connelly said consultation is now underway on how the CfH "brand" might best be used in the future. Bellamy will depart at the beginning of July to take up a new Cabinet Office position. He will be responsible for developing the government's strategy for cloud computing, GCloud, which was given prominence in the recent Digital Britain report. He will leave just nine months after taking up the post in September 2008. His appointment was announced in August 2008, alongside that of Connelly, the DH's first chief information officer. The two jointly replaced Richard Granger, the former NHS director general of IT and head of CfH, who had left in January 2008. Gordon Hextall, who left the agency this April, acted as its head in the interim. Although no direct replacement will be appointed, EHI has learned that Tim Donohoe will take responsibility for CfH, in his role as the Informatics Directorate's head of programme and operations. In March, it became clear that the DH Informatics Directorate was aiming to recast CfH as a "delivery organisation", with technology policy, technology and strategy questions decided by a team, including Bellamy, that reported directly to Connelly. Some 1,155 staff work for CfH. In her interview, Connelly said that the challenge on the National Programme and CfH was to "move from beyond programmes to operations and delivering services that will run for a very long time." To do this requires the programme "to get to stability and not large scale development." Connelly added: "I spoke today about the need to look for the time when programmes finish." She said this included planning for the world of very different needs that would exist at the end of NPfIT. "At the moment, the informatics programme is dominated by NPfIT, but when that is done there will be a whole lot of other things we need to do." Sources suggest that the relationship between Bellamy and Connelly has at times been strained, but they had worked jointly on the informatics strategy. Referring to Bellamy's Cabinet Office position, a DH spokesperson said: "They came to a mutual agreement it was a good opportunity for him to follow." Prior to joining CfH, Bellamy worked for the Department for Work and Pensions since 2003, where his main role was chief information officer for the Pension Service.

Department of Health publishes criteria for successful introduction of Electronic Patient Records (29 Oct 2009)

Department of Health

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eprcriteria

The Department of Health has published criteria for suppliers to successfully introduce information systems into hospitals which will enable electronic patient records. An end of November deadline was set for suppliers to deliver significant progress in the acute sector. This was in the context of good progress having been made in delivering the infrastructure which can support electronic records, but greater pace needing to be injected into the programme for hospitals' electronic information systems. Successful implementation has been achieved in many areas, including digitised imaging replacing x-rays, online patient referrals, electronic transfers of records when patients change GPs and a broadband network linking acute hospitals, GP surgeries and community services. Through the implementation of Picture Archiving and Communication Systems across all NHS hospital trusts in England, patients are experiencing faster and safer diagnoses and treatment while freeing up vital resources to invest in even better patient care. The new systems and services introduced as part of the National Programme for IT also support choice and convenience for patients in booking outpatient appointments and obtaining repeat prescriptions. Some 54% of all new outpatient appointments are being now booked through Choose and Book and recent evidence suggests that using Choose and Book is reducing referral response times from 25 to 5 days, making a key contribution to achieving 18 weeks targets for treatment. In April 2009, the Director General for Informatics, Christine Connelly, made clear that if significant progress was not achieved in the acute sector by the end of November, a new plan for delivering informatics to healthcare will be considered.

The criteria for success are:

  • Do all the elements of the product exist?
  • Is the product robust and reliable?
  • Has the product been successfully deployed?
  • Can the product be deployed at scale?

The NHS at trust and strategic health authority level has agreed the detail of how these criteria will be assessed.

Government to review Summary Care Record rollout (11 Jun 2010)

Pulse

http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4126279&c=2

The Government is to launch a sweeping review of the Summary Care Record rollout it emerged today, in a shock announcement at the LMCs conference. GPC chair Dr Laurence Buckman told delegates that health minister Simon Burns has sent a letter revealing he is to intervene following huge GP concern over the rollout. It comes amid mounting confusion over the future of the Summary Care Record. The Government announced last week that it planned to keep the Summary Care Record, despite the Conservatives and Liberal Democrats both previously pledging to scrap the national system. The Government's review will cover the possibility of a change to an opt-in model of consent and also the entire content of the record, amid concern over security. It comes with a report due out next week from the University of London expected to reveal that major inaccuracies in Summary Care Records uploaded so far have put patients at risk. The intervention came as LMC representatives supported a motion calling for the BMA to 'formally and publicly abandon its acceptance of an 'opt out' system'. Pulse revealed earlier this week that the BMA was confident it could persuade the new Government to intervene and change the consent model, despite ministerial announcements in the commons having appeared to suggest that it was pressing ahead with the rollout under the same terms as the previous Government. In his letter Mr Burns said the Government accepted the need for electronic records but not in their current form. He said: 'We believe that the current processes that are in place need reviewing to ensure that both the information that patients receive and the process by which they opt out are as clear as possible.' Dr Ian Rummens, of Shropshire LMC, told the conference: 'The concept of complied consent is fundamentally flawed and unsound.' Dr Gill Francis, of Wirral LMC, said: 'It's a huge gamble with public money at a time when the purse is empty. Do we need it? No. Can we afford it? No.' Dr Andrew Richardson, of Devon LMC, said: 'Scrap it! It's been a huge waste of money. We've managed without it in the past.' But GPs stopped short of calling for the Summary Care Record to be abandoned altogether, with 50% voting against in favour of 43% who backed the abandonment of the SCR.

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