1 Progress in implementing the systems
1. The National Programme for IT is designed
to reform the way the NHS in England uses information, and hence
to improve services and the quality of patient care. The Programme's
aims are ambitious, and the scale and complexity make delivery
more challenging than similar projects elsewhere in the world.
The Programme requires substantial organisational and cultural
change to be successful and it is dependent on the deployment
of systems in an increasingly devolved NHS.[3]
2. At the outset of the Programme, the aim was
for implementation of the systems to be complete by 2010. While
some aspects, such as the N3 broadband network and the Spine,
are complete or well advanced, the original timescales for introducing
the Care Records Service have not been met. The Department's latest
forecasts are that it is likely to take some four years more than
planned—until 2014-15—before every Trust has fully
deployed the new care records systems which will support the creation
of Detailed Care Records. The introduction of the Summary Care
Record is also behind schedule, though deployment in five early
adopter areas began in March 2007.[4]
3. The Department pointed to three factors to
explain why the original timescales had proved unachievable. These
were the technically ambitious nature of the Programme; the need
to agree how consent would be handled in order to retain public
confidence; and customisation, where suppliers were having to
do more to meet the needs of individual NHS organisations than
was envisaged at the start of the Programme. Fujitsu agreed that
the need to tailor the systems to meet local requirements had
been a major cause of delay.[5]
4. The new care records systems are being deployed
in Trusts, but much more slowly than originally planned. At 31
August 2008, a total of 133 deployments had been made, including
37 in Acute Trusts (Figure 1). In the first five months
of 2008-09, just six deployments were made, two each in Acute
Trusts in London and in the North, Midlands and East, and two
in Mental Health Trusts in the North, Midlands and East. There
were no further deployments in Primary Care Trusts or in the South.[6]
5. Cerner's Millennium product has been deployed
in Acute Trusts in London and the South. Deployment of the first
release began in December 2005 in the South and in July 2007 in
London. Since April 2007, responsibility for developing plans
for implementing systems in all Trusts has rested with the local
NHS, working with the Local Service Providers. London has outline
plans, but deployment of the later releases of Millennium will
not be complete for several years.[7]
Figure 1:
Deployments of electronic care records systems under the Programme
at 31 August 2008
|
| Acute Trusts
| Mental Health Trusts
| Primary Care Trusts
|
| Area
| Local Service Provider
| Number of Trusts
| Number of deployments
| Number of Trusts
| Number of deployments
| Number of Trusts
| Number of deployments
|
| London | BT
| 31 | 6
| 10 | 6
| 31 | 20
|
| South | Fujitsu (to 28.05.08)
| 41 | 8
| 14 | 1
| 31 | 7
|
| North, Midlands and East
| CSC | 97
| 23 | 35
| 15 | 90
| 47 |
| Total | |
169 | 37
| 59 | 22
| 152 | 74
|
Notes
1. Two of the deployments in Acute Trusts in London
pre-date the Programme but have since been integrated into the
Programme, with services now provided by the Local Service Provider.
2. The deployments in the North, Midlands and East
are of iPM, the interim solution, which will be replaced later
by releases of Lorenzo.
3. This Figure does not include deployments of GP
systems.
Source: Department of Health
6. Trusts generally experience some technical
problems with the new care records systems, and the hospitals
in London and the South which have deployed Millennium have had
considerable problems. For example, in summer 2008 the Royal Free
Hampstead NHS Trust identified problems associated with data entry,
system processing, data management and reporting that were having
a significant impact in relation to waiting list management and
patient bookings, and on the finances of the Trust.[8]
7. Least progress has been made in the North,
Midlands and East because the Lorenzo care records software, the
strategic solution, has not been available. As a result, in the
meantime Trusts have been deploying iPM, an interim system. To
implement Lorenzo, these Trusts will have to go through a further
deployment in due course, with the attendant substantial additional
work. The Department acknowledges that the delivery of Lorenzo
has not gone smoothly and has taken much longer than planned.
In addition, the software developer, iSOFT, has experienced a
series of financial, accounting and governance difficulties. In
the light of concerns about progress, in summer 2007 the Department
and CSC (the Local Service Provider) jointly commissioned two
reviews of the delivery arrangements for Lorenzo. Among other
things, the reviews drew attention to deficiencies in programme
management, which has since been strengthened. The Committee requested
copies of the reviews, but the Department responded that it could
not release them because CSC had agreed to the reviews only on
the basis of strict confidentiality agreements, advising that
the information supplied was commercially sensitive to third parties.[9]
8. Despite the delays, the Department is optimistic
about the prospects for Lorenzo, which is now being demonstrated
to the clinical community. At the time of our hearing in June
2008, the first release of Lorenzo was in pre-deployment testing
in three early adopter sites. (The first release is solely clinical
and functionality for the patient administration system will follow
in the second release.) Trusts will not go ahead with a deployment
until they are satisfied that the system will not put patient
safety or the running of the hospital at risk. It can be very
disruptive if a system is deployed too early and a Trust has to
revert to clerical records. Decisions about 'go live' dates are
therefore a matter for individual Trusts, rather than being determined
centrally.[10]
9. The Department had expected that Lorenzo would
be deployed first at University Hospitals of Morecambe Bay NHS
Trust at around the end of September 2008. In the event, the planned
'go live' date at Morecambe Bay was not met, and the first Trust
to deploy Lorenzo was South Birmingham Primary Care Trust, on
3 September 2008, where the system is supporting the podiatry
service. Roll-out of the first release of Lorenzo across the North,
Midlands and East, to follow implementation in the early adopters,
was expected to begin later in 2008 but was not achieved. As for
Millennium, further releases are planned to be implemented over
several years.[11]
10. Progress on two other key components of the
Programme—Choose and Book and the Electronic Prescription
Service—is mixed. Choose and Book incorporates an electronic
booking service, although not all Trusts can take direct bookings
and utilisation has been lower than expected. Although on average
around 98% of GPs use the Choose and Book system at some stage
in a week, in total only around half of new outpatient appointments
were being made in this way. Choose and Book involves significant
change in the way people work and it is taking time to train,
educate and support GPs to use the system. The Department is also
planning to publicise patients' rights in order to increase awareness
of Choose and Book.[12]
11. In relation to the Electronic Prescription
Service, over 70% of GPs and pharmacies have the first release
of the software, which enables them to handle electronic prescriptions.
But as the GPs and pharmacies are not necessarily in the same
areas, only around 40% of prescriptions are issued with readable
barcodes. Paper prescriptions will continue to be required until
the second release of the software is deployed, which cannot begin
until GP and pharmacy systems have been accredited. The Department
expects that most suppliers of GP systems will be accredited by
the middle of 2009. After the introduction of the second release
of the software, paper prescriptions will continue only in certain
limited circumstances, for example, when a patient requests a
paper prescription or when the prescription is a private prescription.[13]
3 Q 72; C&AG's Report, para 1 Back
4
C&AG's Report, paras 5-6, 2.16 Back
5
Qq 11-12, 150 Back
6
C&AG's Report, para 2.14, Figure 1; Ev 29 Back
7
C&AG's Report, paras 2.8, 2.15-2.16 Back
8
C&AG's Report, para 3.85; Royal Free Hampstead NHS Trust,
Chief Executive's Report to the Board on 6 November 2008, http://www.royalfree.nhs.uk/doc/061108/Appendix%20C.pdf Back
9
Q 44; C&AG's Report, paras 2.10-2.12, 2.14; Ev 24 Back
10
C&AG's Report, para 2.13; Qq 16-17, 46-48, 58 Back
11
Ev 29 Back
12
Q 31; C&AG's Report, paras 3.92-3.93, Figure 5 Back
13
Qq 24-26; Ev 22-23 Back
|
