NHS Connecting for Health
Encyclopedia
NHS Connecting for Health is part of the UK Department of Health
and was formed on 1 April 2005, replacing the former NHS Information Authority. It has the responsibility of delivering the NHS National Programme for IT (NPfIT), an initiative by the Department of Health in England to move the National Health Service
(NHS) in England towards a single, centrally-mandated electronic care record for patients and to connect 30,000 General practitioner
s to 300 hospitals, providing secure and audited access to these records by authorised health professionals.
In due course it is planned that patients will also have access to their records online through a service called HealthSpace. NPfIT is said by NHS CFH to be "the world's biggest civil information technology programme".
The cost of the programme, together with its ongoing problems of management and the withdrawal or sacking of two of the four IT providers, have placed it at the centre of ongoing controversy, and the Commons Public Accounts Committee has repeatedly expressed serious concerns over its scope, planning, budgeting, and practical value to patients. As of January 2009, while some systems were being deployed across the NHS, other key components of the system were estimated to be four years behind schedule, and others had yet to be deployed outside individual trusts at all.
While the Daily Mail
announced on 22nd September 2011 that "£12bn NHS computer system is scrapped...", The Guardian
noted that the announcement from the Department of Health on 9th September, had been "part of a process towards localising NHS IT that has been under way for several years". Whilst remaining aspects of the National Programme for IT were cancelled, most of the spending would proceed with the Department of Health seeking for local software solutions rather than a single nationally imposed system.
, the organisation it replaced. CfH is based in Leeds
, West Yorkshire.
As of 2009, it is still managed nationally by CfH, with responsibility for delivery shared with the chief executives of the ten NHS strategic health authorities.
, has attracted significant criticism, and was one of the issues which in April 2006 prompted 23 academics in computer-related fields to raise concerns about the programme in an open letter to the Health Select Committee
. 2006-10-06 the same signatories wrote a second open letter
A report by the King's Fund
in 2007 also criticised the government's "apparent reluctance to audit and evaluate the programme", questioning their failure to develop an ICT strategy whose benefits are likely to outweigh costs and the poor evidence base for key technologies.
A report by the Public Accounts Committee in 2009 called the risks to the successful deployment of the system "as serious as ever", adding that key deliverables at the heart of the project were "way off the pace", noting that "even the revised completion date of 2014-2015 for these systems now looks doubtful in the light of the termination last year of Fujitsu's contract covering the South", and concluding "essential systems are late, or, when deployed, do not meet expectations of clinical staff".
The initial reports into the feasibility of the scheme, known to have been conducted by McKinsey, and subsequent reports by IT industry analyst Ovum among others have never been published nor made available to MPs.
2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the National Audit Office
to be £12.4bn over 10 years, and the NAO also noted that "...it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme". Similarly, the British Computer Society (2006) concluded that "...the central costs incurred by NHS are such that, so far, the value for money from services deployed is poor". Officials involved in the programme have been quoted in the media estimating the final cost to be as high as £20bn, indicating a cost overrun
of 440% to 770%.
In April 2007, the Public Accounts Committee of the House of Commons
issued a damning 175-page report on the programme. The Committee chairman, Edward Leigh
, claimed "This is the biggest IT project in the world and it is turning into the biggest disaster." The report concluded that, despite a probable expenditure of 20 billion pounds "at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period."
The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger
charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.
* NHSmail was renamed to Contact in late 2004, before being reverted to NHSmail in April 2006.
The Spine also provides a set of security services, to ensure access to information stored on the Spine is appropriately controlled. There are, however, already suggestions these security measures are inadequate, with leaked internal memos seen by the Sunday Times mentioning "fundamental" design flaws. In addition, government spokeswoman Caroline Flint failed to dispel concerns regarding access to patients' data by persons not involved in their care when she commented in March 2007 that "in general only those staff who are working as part of a team that is providing a patient with care, that is, those having a legitimate relationship with the patient, will be able to see a patient's health record."
is also running a national programme for service improvement and development via the use of Information Technology - this project is called Informing Healthcare
. A challenge facing both NHS CFH and Informing Healthcare is that the use of national systems previously developed by the NHS Information Authority are shared by the both these organisations and the Isle of Man. Separate provision needs to be made for devolution, while maintaining links for patients travelling across national borders.
NPfIT is currently focussed on delivering the NHS Care Record Service to GPs, Acute and Primary Hospitals, medical clinics and local hospitals and surgeries. Whilst there are no immediate plans to include opticians or dentists in the electronic care record, services are delivered to these areas of the NHS.
into five areas known as "clusters": Southern, London, East & East Midlands, North West & West Midlands, and North East. For each cluster, a different Local Service Provider (LSP) was contracted to be responsible for delivering services at a local level. This structure was intended to avoid the risk of committing to one supplier which might not then deliver; by having a number of different suppliers implementing similar systems in parallel, a degree of competition would be present which would not be if a single national contract had been tendered. However, in July 2007 Accenture
withdrew from the project, and in May 2008 Fujitsu
had their contract terminated, meaning that half the original contractors had dropped out of the project.
As of May 2008, two IT providers were LSPs for the main body of the programme:
announced the "National Programme, Local Ownership programme" (known as "NLOP") which dissolved the 5 clusters and devolved responsibility for the delivery of the programme to the ten English NHS strategic health authorities (SHAs). Connecting for Health retains responsibility for the contracts with the LSPs.
Under NLOP, staff employed by CfH in the Clusters had their employment transferred to the SHAs, with some being recruited to revised national CfH posts.
and the national elements of the NHS Care Records Service that support the summary patient record and ensure patient confidentiality and information security. As of October 2005, the NASPs are:
had their 10-year contract to supply the NHSMail service terminated. On 1 July 2004, Cable and Wireless were contracted to provide this service, which was initially renamed Contact.
IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005 following repeated failure to meet deadlines. They were replaced in September 2005 by Cerner Corporation
.
In early 2006, ComMedica's contract for supply of PACS
to the North-West/West-Midlands cluster was terminated, and they were replaced by GE Healthcare.
In July 2006, the London region started the contractual replacement of IDX (which had been bought out by GE Healthcare in January 2006) as its supplier. Systems for secondary care, primary care and community and mental health services are proposed by BT to be provided by Cerner
, INPS (formerly In Practice Systems) and CSE Healthcare Systems, part of the CSE-Global group of companies, respectively.. This is subject to contractual negotiation known as 'CCN2'.
In September 2006, the CSC Alliance, Accenture and Connecting for Health signed a tripartite agreement that as of January 2007, the CSC Alliance would take over the responsibility for the majority of care systems the North East and Eastern clusters from Accenture, with the exception of PACS
. As part of the handover process, around 300 Accenture personnel transferred under a TUPE process to CSC, and CSC took over the leases for some of Accenture's premises in Leeds
. Accenture now retains only a small presence in the city for the delivery of its PACS responsibilities.
In May 2008 it was announced that following the failure to conclude renegotiation of the contract for the Southern Cluster, CfH terminated the contract with Fujitsu.
for its plans to implement what would become the NPfIT. In 2004 the NPfIT won the "Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards.
The balance between the right to privacy and the right to the best quality care is a sensitive one. Also there are sanctions against those who access data inappropriately, specifically instant dismissal and loss of professional registration.
More worryingly, a January 2005 survey among doctors indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year. There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project.
Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition from civil liberties campaigners such as NO2ID
the anti-database state pressure group and The Big Opt Out who provide patients with a letter to send to their doctor so that their records are withheld from the database.
. The Public Accounts Committee observed in 2009 that "the current levels of support reflect the fact that for many staff the benefits of the Programme are still theoretical".
Surveys in 2008 suggested that two-thirds of doctors will refuse to have their own medical records on the system.
The programme's largest software provider iSOFT
has been seriously affected by this process and is under investigation by the UK Financial Services Authority
for irregular accounting. On 28 September 2006, the consultancy Accenture
announced its intention to withdraw from £2bn of 10 year contracts with NPfIT, which were taken over in January 2007 by the CSC Alliance - both Accenture and CSC laid blame with iSOFT, although CSC has said it will be retaining iSOFT as its software provider for all its clusters. Earlier in the year Accenture had written off $450m from its accounts because of 'significant delays' in the programme. iSOFT announced in March 2011 that trading in its shares would be suspended pending a corporate announcement. Subsequently in April 2011, the company announced that it was recommending a cash offer from CSC. CSC acquired iSOFT in August, 2011
system found it problematic, with NHS hospital trust
board minutes revealing a catalogue of errors. Difficulties with the system meant that:
As of 2009, overall leadership of CfH was described by the Public Accounts Committee as having been "uncertain" since the announcement that Richard Granger would be leaving the project.
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
and was formed on 1 April 2005, replacing the former NHS Information Authority. It has the responsibility of delivering the NHS National Programme for IT (NPfIT), an initiative by the Department of Health in England to move the National Health Service
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
(NHS) in England towards a single, centrally-mandated electronic care record for patients and to connect 30,000 General practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
s to 300 hospitals, providing secure and audited access to these records by authorised health professionals.
In due course it is planned that patients will also have access to their records online through a service called HealthSpace. NPfIT is said by NHS CFH to be "the world's biggest civil information technology programme".
The cost of the programme, together with its ongoing problems of management and the withdrawal or sacking of two of the four IT providers, have placed it at the centre of ongoing controversy, and the Commons Public Accounts Committee has repeatedly expressed serious concerns over its scope, planning, budgeting, and practical value to patients. As of January 2009, while some systems were being deployed across the NHS, other key components of the system were estimated to be four years behind schedule, and others had yet to be deployed outside individual trusts at all.
While the Daily Mail
Daily Mail
The Daily Mail is a British daily middle-market tabloid newspaper owned by the Daily Mail and General Trust. First published in 1896 by Lord Northcliffe, it is the United Kingdom's second biggest-selling daily newspaper after The Sun. Its sister paper The Mail on Sunday was launched in 1982...
announced on 22nd September 2011 that "£12bn NHS computer system is scrapped...", The Guardian
The Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...
noted that the announcement from the Department of Health on 9th September, had been "part of a process towards localising NHS IT that has been under way for several years". Whilst remaining aspects of the National Programme for IT were cancelled, most of the spending would proceed with the Department of Health seeking for local software solutions rather than a single nationally imposed system.
Structure and scope of the programme
The programme was established in October 2002 following several Department of Health reports on IT Strategies for the NHS., and on April 1, 2005 a new agency called NHS Connecting for Health (CfH) was formed to deliver the programme. CfH absorbed both staff and workstreams from the abolished NHS Information AuthorityNHS Information Authority
The NHS Information Authority was part of the UK National Health Service . It was established by an Act of Parliament in 1999. With headquarters in Birmingham, UK, its aim was to bring together four NHS IT and Information bodies to work together to deliver IT infrastructure and information...
, the organisation it replaced. CfH is based in Leeds
Leeds
Leeds is a city and metropolitan borough in West Yorkshire, England. In 2001 Leeds' main urban subdivision had a population of 443,247, while the entire city has a population of 798,800 , making it the 30th-most populous city in the European Union.Leeds is the cultural, financial and commercial...
, West Yorkshire.
As of 2009, it is still managed nationally by CfH, with responsibility for delivery shared with the chief executives of the ten NHS strategic health authorities.
Reviews
The refusal of the DoH to make "concrete, objective information about NPfIT's progress [...]available to external observers", nor even to MPsMPS
MPS may refer to:* Robinson List, aka Mail Preference Service, direct mail opt-out system* Malmin Palloseura, association football club from Helsinki, Finland.* Marginal propensity to save* Master Production Schedule...
, has attracted significant criticism, and was one of the issues which in April 2006 prompted 23 academics in computer-related fields to raise concerns about the programme in an open letter to the Health Select Committee
Health Select Committee
The Health Select Committee is one of the Select Committees of the British House of Commons. It oversees the operations of the Department of Health and its associated bodies.-Membership:...
. 2006-10-06 the same signatories wrote a second open letter
A report by the King's Fund
King's Fund
The King's Fund is a charitable foundation in England. Founded as the Prince of Wales Hospital Fund for London in 1897, the fund changed its name in 1902 to King Edward's Hospital Fund after the accession to the throne of King Edward VII...
in 2007 also criticised the government's "apparent reluctance to audit and evaluate the programme", questioning their failure to develop an ICT strategy whose benefits are likely to outweigh costs and the poor evidence base for key technologies.
A report by the Public Accounts Committee in 2009 called the risks to the successful deployment of the system "as serious as ever", adding that key deliverables at the heart of the project were "way off the pace", noting that "even the revised completion date of 2014-2015 for these systems now looks doubtful in the light of the termination last year of Fujitsu's contract covering the South", and concluding "essential systems are late, or, when deployed, do not meet expectations of clinical staff".
The initial reports into the feasibility of the scheme, known to have been conducted by McKinsey, and subsequent reports by IT industry analyst Ovum among others have never been published nor made available to MPs.
Costs
Originally expected to cost £Pound sterling
The pound sterling , commonly called the pound, is the official currency of the United Kingdom, its Crown Dependencies and the British Overseas Territories of South Georgia and the South Sandwich Islands, British Antarctic Territory and Tristan da Cunha. It is subdivided into 100 pence...
2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the National Audit Office
National Audit Office (United Kingdom)
The National Audit Office is an independent Parliamentary body in the United Kingdom which is responsible for auditing central government departments, government agencies and non-departmental public bodies...
to be £12.4bn over 10 years, and the NAO also noted that "...it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme". Similarly, the British Computer Society (2006) concluded that "...the central costs incurred by NHS are such that, so far, the value for money from services deployed is poor". Officials involved in the programme have been quoted in the media estimating the final cost to be as high as £20bn, indicating a cost overrun
Cost overrun
A cost overrun, also known as a cost increase or budget overrun, is an unexpected cost incurred in excess of a budgeted amount due to an under-estimation of the actual cost during budgeting...
of 440% to 770%.
In April 2007, the Public Accounts Committee of the House of Commons
British House of Commons
The House of Commons is the lower house of the Parliament of the United Kingdom, which also comprises the Sovereign and the House of Lords . Both Commons and Lords meet in the Palace of Westminster. The Commons is a democratically elected body, consisting of 650 members , who are known as Members...
issued a damning 175-page report on the programme. The Committee chairman, Edward Leigh
Edward Leigh
Edward Julian Egerton Leigh is a British Conservative politician. He has sat in the House of Commons as the Member of Parliament for Gainsborough in Lincolnshire since 1997, and for its predecessor constituency of Gainsborough and Horncastle between 1983 and 1997...
, claimed "This is the biggest IT project in the world and it is turning into the biggest disaster." The report concluded that, despite a probable expenditure of 20 billion pounds "at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period."
The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger
Richard Granger
Richard Granger is a British management consultant and former UK civil servant responsible for the NHS's information technology project.- Early career :...
charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.
Deliverables
The programme is divided into a number of key deliverables.| Deliverable | Since | Name of software | Original delivery date | Progress 2007 | Progress 2009 |
| Integrated care records service | 2002 | NHS Care Records Service NHS Care Records Service The NHS Care Records Service is a service provided by NHS Connecting for Health for the National Health Service in England.The project describes its objectives as follows:... (NCRS) / Lorenzo |
2004 | "Real progress only just beginning", no go-live date specified | "Recent progress...very disappointing", completion date of 2014-2015 now looks unlikely following withdrawal of Fujitsu, arrangements for South region not resolved, Lorenzo still not live in a single acute Trust |
| Electronic prescribing | 2002 | NHS Electronic Prescription Service | 2007 | Implementation began in early 2005, used for 8% of daily prescriptions | 70% of GPs and pharmacies had 1st release of software, but only 40% of prescriptions issued with readable barcodes |
| Electronic appointments booking | 2002 | Choose and Book Choose and Book Choose and Book , is an E-Booking software application which has been introduced to the National Health Service in England... |
2005 | Take-up slow, system reliant on outdated technology, GPs dissatisfied, target of 90% of referrals on system by March 2007 missed | Mixed, around half of new appointments made using system, additional training and time required |
| Underpinning IT infrastructure | 2002 | New National Network N3 (NHS) N3 is the national broadband network for the English National Health Service , connecting all NHS locations and 1.3 million employees across England. In 2004, BT was awarded the contract to deliver and manage N3 on behalf of the NHS.... (N3) |
March 2002 | On schedule, with 98% of GP practices connected | |
| Medical imaging software | Picture Archiving and Communication System Picture archiving and communication system A picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities . Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or... (PACS) |
||||
| Performance management of primary care | Quality Management and Analysis System (QMAS) | ||||
| Central e-mail and directory service | NHSmail NHSmail NHSmail is a secure, web-based email service developed for the National Health Services of England and Scotland as part of the NHS National Programme for IT by NHS Connecting for Health.... * |
The Spine (including PDS & PSIS)
The Spine is a set of national services used by the NHS Care Record Service. These include:- The Personal Demographics Service (PDS), which stores demographic information about each patient and their NHS Number. Patients cannot opt-out from this component of the spine, although the can mark their record as 'sensitive' to prevent their contact details being viewed by 831,000 staff.
- The Summary Care Record (SCR). The Summary Care RecordSummary Care RecordA Summary Care Record is an electronic patient record, a summary of National Health Service patient data held on a central database covering England, part of the NHS National Programme for IT. The purpose of the database is to make patient data readily available anywhere that the patient seeks...
is a summary of patient's clinical information, such as allergies and adverse reactions to medicine. - The Secondary Uses Service (SUS), which uses data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery.
The Spine also provides a set of security services, to ensure access to information stored on the Spine is appropriately controlled. There are, however, already suggestions these security measures are inadequate, with leaked internal memos seen by the Sunday Times mentioning "fundamental" design flaws. In addition, government spokeswoman Caroline Flint failed to dispel concerns regarding access to patients' data by persons not involved in their care when she commented in March 2007 that "in general only those staff who are working as part of a team that is providing a patient with care, that is, those having a legitimate relationship with the patient, will be able to see a patient's health record."
Exceptions
The NHS in WalesWales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...
is also running a national programme for service improvement and development via the use of Information Technology - this project is called Informing Healthcare
Informing Healthcare
Informing Healthcare was set up by the Welsh Assembly Government in December 2003 to improve healthcare services for people in Wales by introducing modern ways of sharing and using information....
. A challenge facing both NHS CFH and Informing Healthcare is that the use of national systems previously developed by the NHS Information Authority are shared by the both these organisations and the Isle of Man. Separate provision needs to be made for devolution, while maintaining links for patients travelling across national borders.
NPfIT is currently focussed on delivering the NHS Care Record Service to GPs, Acute and Primary Hospitals, medical clinics and local hospitals and surgeries. Whilst there are no immediate plans to include opticians or dentists in the electronic care record, services are delivered to these areas of the NHS.
Clusters and Local Service Providers
The programme originally divided EnglandEngland
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
into five areas known as "clusters": Southern, London, East & East Midlands, North West & West Midlands, and North East. For each cluster, a different Local Service Provider (LSP) was contracted to be responsible for delivering services at a local level. This structure was intended to avoid the risk of committing to one supplier which might not then deliver; by having a number of different suppliers implementing similar systems in parallel, a degree of competition would be present which would not be if a single national contract had been tendered. However, in July 2007 Accenture
Accenture
Accenture plc is a global management consulting, technology services and outsourcing company headquartered in Dublin, Republic of Ireland. It is the largest consulting firm in the world and is a Fortune Global 500 company. As of September 2011, the company had more than 236,000 employees across...
withdrew from the project, and in May 2008 Fujitsu
Fujitsu
is a Japanese multinational information technology equipment and services company headquartered in Tokyo, Japan. It is the world's third-largest IT services provider measured by revenues....
had their contract terminated, meaning that half the original contractors had dropped out of the project.
As of May 2008, two IT providers were LSPs for the main body of the programme:
- CSC Alliance - North, Midlands & Eastern (NME) cluster
- BT Health London (formerly BT Capital Care Alliance) - London cluster
- Accenture had full responsibility for the North East and East/East Midlands clusters until January 2007, when it handed over the bulk of its responsibilities to the CSC Alliance, retaining responsibility for Picture archiving and communication systemPicture archiving and communication systemA picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities . Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or...
(PACS) rollout only. - The Fujitsu Alliance - had responsibility for the Southern cluster until May 2008, when their contract was terminated. Ownership of this cluster from that date remains uncertain.
Local ownership
In the first half of 2007, David NicholsonDavid Nicholson (civil servant)
Sir David Nicholson KCB CBE is Chief Executive of the English National Health Service, appointed in September 2006.-Education:Nicholson was educated at Forest Fields Grammar School in Nottingham, and graduated from Bristol University with a 2:1 in History and Politics.-Career:Nicholson joined the...
announced the "National Programme, Local Ownership programme" (known as "NLOP") which dissolved the 5 clusters and devolved responsibility for the delivery of the programme to the ten English NHS strategic health authorities (SHAs). Connecting for Health retains responsibility for the contracts with the LSPs.
Under NLOP, staff employed by CfH in the Clusters had their employment transferred to the SHAs, with some being recruited to revised national CfH posts.
National Application Service Providers
In addition to these LSPs the programme has appointed National Application Service Providers (NASPs) who are responsible for services that are common to all users e.g. Choose and BookChoose and Book
Choose and Book , is an E-Booking software application which has been introduced to the National Health Service in England...
and the national elements of the NHS Care Records Service that support the summary patient record and ensure patient confidentiality and information security. As of October 2005, the NASPs are:
- BT - NHS Care Records ServiceNHS Care Records ServiceThe NHS Care Records Service is a service provided by NHS Connecting for Health for the National Health Service in England.The project describes its objectives as follows:...
and N3N3 (NHS)N3 is the national broadband network for the English National Health Service , connecting all NHS locations and 1.3 million employees across England. In 2004, BT was awarded the contract to deliver and manage N3 on behalf of the NHS.... - Atos OriginAtos OriginAtos S.A. is an international information technology corporation which operates in 42 countries worldwide, with over 78,500 employees...
and CernerCernerCerner Corporation is an international health care information technology corporation that specializes in providing complete systems for hospitals and other medical organizations to manage and integrate all electronic medical records, computerized physician order entry , and financial...
- Choose & Book - Cable and Wireless - NHSmail
Changes to service providers
In March 2004, EDSElectronic Data Systems
HP Enterprise Services is the global business and technology services division of Hewlett Packard's HP Enterprise Business strategic business unit. It was formed by the combination of HP's legacy services consulting and outsourcing business and the integration of acquired Electronic Data Systems,...
had their 10-year contract to supply the NHSMail service terminated. On 1 July 2004, Cable and Wireless were contracted to provide this service, which was initially renamed Contact.
IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005 following repeated failure to meet deadlines. They were replaced in September 2005 by Cerner Corporation
Cerner
Cerner Corporation is an international health care information technology corporation that specializes in providing complete systems for hospitals and other medical organizations to manage and integrate all electronic medical records, computerized physician order entry , and financial...
.
In early 2006, ComMedica's contract for supply of PACS
Picture archiving and communication system
A picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities . Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or...
to the North-West/West-Midlands cluster was terminated, and they were replaced by GE Healthcare.
In July 2006, the London region started the contractual replacement of IDX (which had been bought out by GE Healthcare in January 2006) as its supplier. Systems for secondary care, primary care and community and mental health services are proposed by BT to be provided by Cerner
Cerner
Cerner Corporation is an international health care information technology corporation that specializes in providing complete systems for hospitals and other medical organizations to manage and integrate all electronic medical records, computerized physician order entry , and financial...
, INPS (formerly In Practice Systems) and CSE Healthcare Systems, part of the CSE-Global group of companies, respectively.. This is subject to contractual negotiation known as 'CCN2'.
In September 2006, the CSC Alliance, Accenture and Connecting for Health signed a tripartite agreement that as of January 2007, the CSC Alliance would take over the responsibility for the majority of care systems the North East and Eastern clusters from Accenture, with the exception of PACS
Picture archiving and communication system
A picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities . Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or...
. As part of the handover process, around 300 Accenture personnel transferred under a TUPE process to CSC, and CSC took over the leases for some of Accenture's premises in Leeds
Leeds
Leeds is a city and metropolitan borough in West Yorkshire, England. In 2001 Leeds' main urban subdivision had a population of 443,247, while the entire city has a population of 798,800 , making it the 30th-most populous city in the European Union.Leeds is the cultural, financial and commercial...
. Accenture now retains only a small presence in the city for the delivery of its PACS responsibilities.
In May 2008 it was announced that following the failure to conclude renegotiation of the contract for the Southern Cluster, CfH terminated the contract with Fujitsu.
Failure to deliver clinical benefits
The 2009 Public Accounts Committee report noted that the NPfIT had provided "little clinical functionality...to-date"Data security risks
NPfIT has been criticised for inadequate attention to security and patient privacy, with the Public Accounts Committee noting "patients and doctors have understandable concerns about data security", and that the Department of Health did not have a full picture of data security across the NHS. In 2000, the NHS Executive won the "Most Heinous Government Organisation" Big Brother Award from Privacy InternationalPrivacy International
Privacy International is a UK-based non-profit organisation formed in 1990, "as a watchdog on surveillance and privacy invasions by governments and corporations." PI has organised campaigns and initiatives in more than fifty countries and is based in London, UK.-Formation, background and...
for its plans to implement what would become the NPfIT. In 2004 the NPfIT won the "Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards.
The balance between the right to privacy and the right to the best quality care is a sensitive one. Also there are sanctions against those who access data inappropriately, specifically instant dismissal and loss of professional registration.
More worryingly, a January 2005 survey among doctors indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year. There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project.
Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition from civil liberties campaigners such as NO2ID
NO2ID
NO2ID, the public campaign, was formed in 2004 to campaign against the United Kingdom government's plans to introduce UK ID Cards and the associated National Identity Register, which it believes has negative implications for privacy, civil liberties and personal safety.NO2ID is entirely independent...
the anti-database state pressure group and The Big Opt Out who provide patients with a letter to send to their doctor so that their records are withheld from the database.
Reservations of medical staff
As of August 5, 2005, research carried out across the NHS in England suggested that clinical staff felt that the programme was failing to engage the clinicians fully, and was at risk of becoming a white elephantWhite elephant
A white elephant is an idiom for a valuable but burdensome possession of which its owner cannot dispose and whose cost is out of proportion to its usefulness or worth...
. The Public Accounts Committee observed in 2009 that "the current levels of support reflect the fact that for many staff the benefits of the Programme are still theoretical".
Surveys in 2008 suggested that two-thirds of doctors will refuse to have their own medical records on the system.
Impact on IT providers
According to the Daily Telegraph, the head of NPfIT, Richard Granger, 'shifted a vast amount of the risk associated with the project to service providers, which have to demonstrate that their systems work before being paid.' The contracts meant that withdrawing from the project would leave the providers liable for 50% of the value of the contract; however, as previously mentioned, when Accenture withdrew in September 2006, Granger chose not to use these clauses, saving Accenture more than £930m.The programme's largest software provider iSOFT
ISOFT
iSOFT is an international supplier of software applications for the healthcare sector. Its products are used by an estimated 13,000 organisations in 40 countries for managing patient information and healthcare services. Its headquarters are in Sydney, Australia.iSOFT was founded in 1996 as a...
has been seriously affected by this process and is under investigation by the UK Financial Services Authority
Financial Services Authority
The Financial Services Authority is a quasi-judicial body responsible for the regulation of the financial services industry in the United Kingdom. Its board is appointed by the Treasury and the organisation is structured as a company limited by guarantee and owned by the UK government. Its main...
for irregular accounting. On 28 September 2006, the consultancy Accenture
Accenture
Accenture plc is a global management consulting, technology services and outsourcing company headquartered in Dublin, Republic of Ireland. It is the largest consulting firm in the world and is a Fortune Global 500 company. As of September 2011, the company had more than 236,000 employees across...
announced its intention to withdraw from £2bn of 10 year contracts with NPfIT, which were taken over in January 2007 by the CSC Alliance - both Accenture and CSC laid blame with iSOFT, although CSC has said it will be retaining iSOFT as its software provider for all its clusters. Earlier in the year Accenture had written off $450m from its accounts because of 'significant delays' in the programme. iSOFT announced in March 2011 that trading in its shares would be suspended pending a corporate announcement. Subsequently in April 2011, the company announced that it was recommending a cash offer from CSC. CSC acquired iSOFT in August, 2011
Implementation
The first trusts in the London & Southern Clusters to implement the new CernerCerner
Cerner Corporation is an international health care information technology corporation that specializes in providing complete systems for hospitals and other medical organizations to manage and integrate all electronic medical records, computerized physician order entry , and financial...
system found it problematic, with NHS hospital trust
NHS Hospital Trust
An NHS hospital trust, also known as an acute trust is an NHS trust that provides secondary health services within the English National Health Service and in NHS Wales. Hospital trusts are commissioned to provide these services by NHS primary care trusts....
board minutes revealing a catalogue of errors. Difficulties with the system meant that:
- 2007: EnfieldLondon Borough of EnfieldThe London Borough of Enfield is the most northerly London borough and forms part of Outer London. It borders the London Boroughs of Barnet, Haringey and Waltham Forest...
PCT were unable to obtain vital data on patients awaiting operations and were obliged to delay 63 patients of the BarnetBarnet General HospitalBarnet Hospital, formerly called Barnet General Hospital, is a hospital in Barnet, north London, run by Barnet and Chase Farm NHS Hospitals Trust as part of the National Health Service.-Overview:...
and Chase Farm HospitalChase Farm HospitalChase Farm Hospital is a hospital in Enfield, north London, run by Barnet and Chase Farm NHS Hospitals Trust as part of the British National Health Service.The oldest part of the hospital was formerly part of a children's home...
s. Further, 20 patients were not readmitted for treatment within 28 days towards the end of the year because the surveillance system for tracking them "was not operational in the new ... system". Buckinghamshire Hospitals NHS Trust found that problems with the system had meant potentially infectious patients with MRSA were not isolated for up to 17 days, requiring six weeks work by staff to update them manually. - April 2008: Enfield PCT found that the system had failed to flag up possible child-abuse victims entering hospital to key staff, "leaving the responsibility to the receptionist"
- May 2008: Enfield PCT found that 272 elective operations were cancelled at the last minute for "non-clinical reasons"
- May 2008: Barts and The London NHS TrustBarts and The London NHS TrustBarts and The London NHS Trust is an NHS Trust operating in the City of London and east London.It runs three hospitals:* The Royal London Hospital in Whitechapel* St Bartholomew's Hospital in Smithfield in the City...
blamed their failure over the preceding six months to meet targets for treating emergency patients within four hours on staff not being familiar with the new computer system. The same report cited "breaches of the two-week urgent cancer access guarantee" and delays in assessing 11 patients with possible cancerCancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
as being due to the computer system. - July 2008: the Royal Free Hampstead NHS TrustRoyal Free Hampstead NHS TrustThe Royal Free Hampstead NHS Trust is an NHS trust based in London, United Kingdom. It comprises The Royal Free Hospital, The Royal National Throat, Nose and Ear Hospital and clinics run by the Trust at Edgware Community Hospital, Barnet and Chase Farm Hospital, Finchley Memorial Hospital and North...
said 12,000 patient records had to be manually amended over a three-week period due to the system, and noted that "The outpatient appointment centre has experienced a significant increase in the time taken to process individual patient appointment bookings. This has had a consequent and negative effect on call-answer performance."
Management team
The NHS appointed a management team, responsible for the delivery of the system:- Richard GrangerRichard GrangerRichard Granger is a British management consultant and former UK civil servant responsible for the NHS's information technology project.- Early career :...
- is the former Director General of IT for the NHS. He took up his post in October 2002, before which he was a partner at Deloitte Consulting, responsible for procurement and delivery of a number of large scale IT programmes, including the Congestion Charging Scheme for LondonLondon congestion chargeThe London congestion charge is a fee charged for some categories of motor vehicle to travel at certain times within the Congestion Charge Zone , a traffic area in London. The charge aims to reduce congestion, and raise investment funds for London's transport system...
. In October 2006, he was suggested by The Sunday TimesThe Sunday Times (UK)The Sunday Times is a Sunday broadsheet newspaper, distributed in the United Kingdom. The Sunday Times is published by Times Newspapers Ltd, a subsidiary of News International, which is in turn owned by News Corporation. Times Newspapers also owns The Times, but the two papers were founded...
to be the highest paid Civil Servant, on a basic of £280,000 per year, £100,000 per year more than former Prime MinisterPrime ministerA prime minister is the most senior minister of cabinet in the executive branch of government in a parliamentary system. In many systems, the prime minister selects and may dismiss other members of the cabinet, and allocates posts to members within the government. In most systems, the prime...
Tony Blair. Granger announced on 16 June 2007 that he would leave the agency "during the latter part" of 2007. Granger finally left the programme in February 2008. Granger's credentials were questioned by his own mother, a campaigner for the preservation of local health services in her area, who expressed her amazement at his appointment, criticising the whole scheme as "a gross waste of money". - Gordon Hextall - Chief operating officer for NHS Connecting for Health. A career civil servant. On Richard Granger's departure, Hextall assumed overall responsibility for the programme.
- Richard Jeavons - Senior responsible owner for service implementation. Previous posts include being CEO of the West YorkshireWest YorkshireWest Yorkshire is a metropolitan county within the Yorkshire and the Humber region of England with a population of 2.2 million. West Yorkshire came into existence as a metropolitan county in 1974 after the passage of the Local Government Act 1972....
NHS strategic health authorityNHS Strategic Health AuthorityNHS strategic health authorities are part of the structure of the National Health Service in England. Each SHA is responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn each SHA area contains various NHS trusts...
. - Harry Cayton - Chair of the Care Record Development Board.
As of 2009, overall leadership of CfH was described by the Public Accounts Committee as having been "uncertain" since the announcement that Richard Granger would be leaving the project.
See also
- MegaprojectMegaprojectA megaproject is an extremely large-scale investment project. Megaprojects are typically defined as costing more than US$1 billion and attracting a lot of public attention because of substantial impacts on communities, environment, and budgets. Megaprojects can also be defined as "initiatives that...
- National Identity Register
- Citizen Information ProjectCitizen Information ProjectIn the United Kingdom, the Citizen Information Project was a plan by the Office for National Statistics to build a national population register....
- Cost overrunCost overrunA cost overrun, also known as a cost increase or budget overrun, is an unexpected cost incurred in excess of a budgeted amount due to an under-estimation of the actual cost during budgeting...
- Universal Child DatabaseUniversal Child DatabaseContactPoint was a government database that held information on all children under 18 in England. It was created in response to the abuse and death of eight-year-old Victoria Climbié in 2000 in England; in which it was found that various agencies involved in her care had failed to prevent her death...
- Medical privacyMedical privacyThe main subject of medical privacy or health privacy is the 'medical record' which historically has been a paper file of the entire medical history of the patient. Various electronic forms of medical records have existed in western countries, but mostly in an unintegrated fashion. This lack of...
- Health InformaticsHealth informatics.Health informatics is a discipline at the intersection of information science, computer science, and health care...
- N3 (NHS)N3 (NHS)N3 is the national broadband network for the English National Health Service , connecting all NHS locations and 1.3 million employees across England. In 2004, BT was awarded the contract to deliver and manage N3 on behalf of the NHS....
- NHS Care Records ServiceNHS Care Records ServiceThe NHS Care Records Service is a service provided by NHS Connecting for Health for the National Health Service in England.The project describes its objectives as follows:...
- Choose and BookChoose and BookChoose and Book , is an E-Booking software application which has been introduced to the National Health Service in England...
- OPCS-4OPCS-4Currently on version 4.6, OPCS Classification of Interventions and Procedures is a procedural classification list for the coding of operations, procedures and interventions performed on NHS patients during an episode of health care in the UK...
- Picture archiving and communication system (PACS)
- NHS Electronic Prescription Service
- Quality Management and Analysis System
- NHSmailNHSmailNHSmail is a secure, web-based email service developed for the National Health Services of England and Scotland as part of the NHS National Programme for IT by NHS Connecting for Health....
External links
- NHS Connecting for Health website
- NHS number
- Personal Demographics Service (PDS)
- "A guide to the National Programme for Information Technology" (PDF), NHS Connecting for Health, April 2005
- PC Coaching appointed to provide Trainers & MTUs for NPfIT, NHS Connecting for Health award contract for NPfIT Trainers and Mobile Training Units
- Programmes and Systems Delivery, NHS Connecting for Health, retrieved October 30, 2005
- NHS Connecting for Health NPfIT site
- NHS Connecting for Health History Page
- BT Health, Delivering three major contracts to the NHS as part of the NPfIT
- June 2006: NHS risks £20bn white elephant, say auditors
- Times Online: Patient records go on database
- Computer loophole hits hi-tech NHS trial
- NHS IT upgrade success 'at risk'
- The Big Opt Out, Advice to patients - How to opt out
- Opting out of the NHS Database Detailed information from Dr Neil Bhatia, a GP in Hampshire
- NHS Information Standards Board for Health and Social Care