NPfIT goes to the country

There were a few advance hints that CSC was going to miss its end-March deadline for implementing iSoft's Lorenzo software suite at University Hospitals of Morecambe Bay NHS trust. Among others, in an interview with SmartHealthcare.com in mid-March, the supplier's UK managing director Adrian Stevens said: "I think Morecambe Bay is important, but not the date." It is certainly important for England's NHS National Programme for IT, as well as for iSoft. The Morecambe Bay implementation, if or when it happens, will be the first of Lorenzo Regional Care 1.9, the version of the suite designed specifically to work across an NHS trust. Existing implementations manage departments or sections of trusts. It is meant to be NPfIT's core software for the Care Record Service (CRS) in the North, Midlands and East cluster, covering 60% of England. If it fails, the programme's future – which is already being challenged by opposition politicians about to fight a general election – would be in serious doubt. Some reports have suggested that failure is inevitable, and that CSC will follow Accenture and Fujitsu in leaving the programme. However, some of the organisations concerned are signalling a short delay rather than abandonment. In a statement from chief executive Tony Halsall, Morecambe Bay echoed Stevens' 'when rather than if' line, saying it was committed to going live with the software – "but we will make sure it works for us and our patients before we roll it out across our hospitals". An indication of when that might happen came from iSoft's chief executive Gary Cohen. On 1 April, he told FT.com that "we are very confident that we have a 'go live' in early May". Abandoning the uniform Although Morecambe Bay's missed deadline gathered most of the attention, BT's new agreement with the Department of Health may provide a better indication of the programme's future. The company, which met the deadline it was set to implement Cerner Millennium at Kingston Hospital last year, agreed to cut £112m (11%) from its £996m local service provider contract to the NHS in London. It will do so by abandoning the idea of uniform software: if London hospital trusts already have fit for purpose IT, BT will connect those systems rather than replace them. This means NPfIT currently has three models for its three regions (with exceptions for foundation trusts, several of which have chosen alternative systems). Trusts in the southern cluster, which does not have a local service provider, are meant to have just completed choosing software suppliers from the Department of Health's Additional Supply Capability and Capacity (ASCC) list. Acute trusts in London will get Cerner Millennium from BT – unless they already have a working system in place. Those in the North, Midlands and East cluster run by CSC are, at least for the time being, committed to iSoft Lorenzo. "CSC is expected to deploy CRS to the largest chunk of health trusts in England – more than 200 organisations," says Kable's senior health analyst Victor Almeida. "This is an enormous challenge. Yet it is offering these organisations very limited systems in terms of choice and flexibility. "It should take an approach similar to BT, allowing trusts to reconcile Lorenzo with their existing systems. One size fits all is not the key to success." It certainly seems possible that, if the government agrees a new deal with CSC, that this will involve loosening along the lines of BT's revised contract for London. BT has had some success in the capital: in November, NHS London said four hospitals were using Cerner Millennium and all but one primary care trust was using CSE's RiO software for community based services. With this in mind it would not be surprising if CSC was given a further push towards a similar model – but it could come with a cost. In December, health secretary Andy Burnham said the costs of NPfIT would be cut by £600m. If the £112m lopped off BT's charges was scaled to CSC's much larger region, the government would be asking the company for savings in the region of £330m. Together, these would provide most of the projected savings. If Cohen's prediction is right, such negotiations could take place as the political future of the National Programme hangs in the balance. The election will take place on 6 May and the Conservatives and Liberal Democrats want to give trusts the power to choose their IT systems, with the latter wanting to scrap NPfIT. For the Tories, shadow health minister Stephen O'Brien wrote for SmartHealthcare.com in January that he wants his party to "negotiate more choice for local NHS trusts over their IT systems," while LibDem health shadow Norman Lamb wrote recently that "the time has come to pull the plug on centralised systems". If Morecambe Bay is able to go live with Lorenzo in early May, it is possible that it will be the last achievement of Labour's National Programme for IT – at least in its current form.