The National Programme for IT in the NHS: an update on the delivery of detailed care records systems - Public Accounts Committee Contents

Written evidence from The Consultancy Partnership Ltd


All indicators suggest that CSC as owners of iSoft will not continue to develop Lorenzo. In which case, assuming a new MoU is signed with CSC as suggested, we believe the situation would be as follows:

—  All 130+ [CSC response to Q13] interim solutions delivered would de facto become permanent. Those mental health and acute trusts with the iSoft iPM system can, in time, be expected to enter a long term arrangement with CSC for an on-going service: similarly those community care organisations with the TPP system.

—  CSC would be well positioned to provide iSoft clinical application add-ons to any trust already with iPM. These add-ons sit naturally on an iPM foundation.

—  For those trusts which have not received interim solutions, the focus, apparently, will be to offer a choice of systems delivering "flexible (clinical) modules that would sit on a base care records platform". It is unclear what this choice will be or how, as owner of iSoft, CSC's conflict of interest in providing choice will be resolved.

In these circumstances, it seems clear that non-Lorenzo iSoft products, whether legacy systems or later developments, would proliferate, verging perhaps on a monopoly position for CSC as owner of iSoft. This surely cannot be in the best interest of the NHS. Had Lorenzo been successfully developed in line with CSC's original contract of 2003 it would be a different matter. But as it is there is no reason in terms of functionality to prefer iSoft systems to those of any other supplier. Furthermore, DoH would be at risk of being challenged in the courts by other suppliers complaining that EC procurement rules have been broken in de-scoping the original contract without re-tendering.


1.  It is not in the best interest of the NHS to retain CSC as LSP for the North, Midlands and East. The contract with CSC should be terminated. (This is based purely on the arguments developed above and takes no account of the Committee's concerns about value for money in the proposed amended contract with CSC.)

2.  With current cost cutting and performance improvement pressures on all the public sector, never have the benefits that NPfIT was supposed to bring been so desperately needed. Having terminated the contract with LSP, the Department should, by some mechanism to be determined, make over to hospital trusts the residue of the available national funding so that trusts can procure appropriate systems for themselves.


Long term role for Interim Systems/Implication that Lorenzo is to be dropped

Transcript of PAC Meeting of 23 May 2011

Q5: Mr Bacon: So, once you have iSoft—assuming all the regulatory hurdles are cleared and you get it, as it were, under your belt—you will have this large portfolio of old, profitable legacy systems where all the development work is already done. Why on earth would you continue pouring good money after bad, trying to make Lorenzo work?

Sheri Thureen: The acquisition of iSoft is a strategic decision of CSC to expand our global healthcare sector business.

Ms Thureen was given the opportunity to refute the suggestion that Lorenzo is to be dropped. She failed to take it. Taken with the reports immediately below, the inevitable conclusion is that CSC intends to focus on non-Lorenzo iSoft systems. This surely makes commercial sense. iSoft systems proliferate throughout the NHS (some supposed to be replaced by Lorenzo, others not). Then, additionally, there are the 80 or so iPM (patient administration) systems that NPfIT has allowed as interim solutions, with the strong suggestion that if trusts so wish these can be retained as permanent solutions. What responsible trust would want to replace the low risk, well proven iPM with the high risk Lorenzo? A rhetorical question, especially as Lorenzo development has stopped short of clinical applications and so offers no path to the future. So, why indeed would CSC as owner of iSoft want to pour good money after bad when it already has a solid, low risk income stream from legacy systems: a profit stream made even more profitable by the actions of NPfIT?

As reported in E-Health Insider of 24 May 2011 "Outline of new CSC deal takes shape"

Connelly gave a heavy hint that a new CSC deal is likely to recast the role of "interim" systems to give them a long-term role; a path that has already been followed with CSC's installations of SystmOne from TPP. Potentially this could see many of the 87 iSoft iPM systems for which CSC has already been paid being used as a basis for future development, possibly with future slices of Lorenzo. "We've certainly said that where we have a system that supports care, such as iPM, and the trust wants to keep it, we will not be forcing them to rip and replace. CSC has already been paid for implementing iPM. If they are willing to support it for longer then we would want to keep it."

As reported in E-Health Insider of 26 May 2011 "Memo reveals latest CSC offer"

A leaked memo from a Cabinet Office …… confirms that the DH is looking to sign a new memorandum of understanding with CSC, and that this would result in fewer trusts being contracted to use the system, in return for a further reduction in contract price. ….. The memo says that in February, CSC offered a deal in which the number of trusts offered a CSC system would be cut from 220 to 80, and that they would be offered a choice of system, not just the iSoft Lorenzo software that CSC was contracted to deliver by the National Programme for IT in the NHS. …… Interviewed by EHI, NHS chief information officer Christine Connelly said that the new focus would be on delivering flexible [clinical] modules ….. that would sit on a base care records platform


Having no knowledge of the contract we can offer no opinion on this matter. We do, however, suggest that potential value of "interim" iPM contracts made permanent is considerable and that any such income would offset any claim for damages.

NHS trusts which have been provided with iPM through NPfIT are unlikely to prefer the upheaval of moving to new systems if presented with the opportunity to retain iPM as a permanent solution. This will generate considerable income for CSC. Based on a recent business case for PAS replacement undertaken by The Consultancy Partnership the typical annual charge from the supplier is circa £400,000. Assuming 80 interim iPM systems made permanent and typically 10 year contracts, this would generate some £300 million for CSC. Conservatively, this could double to £600 million allowing for clinical applications to be subsequently added. And this just covers the acute sector. TPP interim arrangements made permanent will generate further revenue for CSC. It may not be fanciful to suggest total income over 10 years at £1,000 million. Clearly, further consideration is required.


Whilst this is a matter for lawyers, it has been suggested that other suppliers might already have grounds for complaint that EC procurement rules have been broken given that CSC has been allowed within NPfIT to implement as interim solutions systems that were rejected in the original procurement as being unfit for NPfIT. [NAO Report Executive Summary para 18 "CSC has also delivered 81 interim systems to trusts whose systems needed to be replaced urgently. These systems were not previously considered by the Department to meet the aims of the Programme and under the terms of the current contract will need to be replaced.] How much greater might that complaint be if these interim systems are established as permanent and CSC is allowed to build them into long term income streams?


Alan Shackman has over 20 years experience as an independent consultant to the public sector, principally to the NHS, specialising in the business/user focused elements of preparing for and implementing IT systems. He is an expert in the usage of IT at grass roots level in the NHS, having undertaken assignments across all sectors - acute, mental health, community and primary. Over the past 15 years his work has focused on electronic patient record systems. In that time he has prepared business cases and detailed definition of requirements, led procurements at major acute trusts and across local health communities, and facilitated the management of change.

Alan is familiar with the products being offered by the two suppliers of core CRS software to NPfIT having worked on PAS replacement projects in both the South and North West & West Midland clusters. During 2004 and 2005 he acted as NPfIT programme facilitator for the north east sector of Greater Manchester.

At national level, Alan led the development of a national output based specification for electronic patient record for acute trusts as part of the NHS IM&T Procurement Review of 1999. Earlier in the 1990s he was a member of the NHS Information Management Group's panel of consultants advising trust boards on electronic patient records. He was also a member of the team that reviewed the national resource management programme

Most recently during 2010-11 he has been assisting two acute trusts in the East of England prepare for the open procurement of a replacement patient administration system and integration engine/clinical portal.

Alan is a Chartered Engineer and Member of the Institution of Engineering & Technology. In an earlier phase of his career he was a member of the UK Industrial Space Committee and represented the UK on international telecommunications standards and regulatory forums.

2 June 2011

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Prepared 3 August 2011