The NHS's service provider challengers

Britain's new government takes a mixed view of big IT and services suppliers. On the one hand, its constituent parties dislike big contracts, and have already decided to scrap a number of projects including the National Identity Scheme and ContactPoint – although England's National Programme for IT (NPfIT) has not yet been identified for cuts. On the other hand, the dominant Conservative Party has praised external providers of services as a way to save money, particularly the new Cabinet Office minister Francis Maude, who has done much of the party's thinking in this area. "Maude has spoken in the past about the potential for far more outsourcing by government, and there is scope for significant savings by pushing these functions towards private sector providers," says Kable's research director Stephen Roberts. "If the government is willing to face up to the implications of reducing the civil service headcount – and the Conservatives have conveyed that they are almost eager to do so – this will provide a clear path for the next year or two." The result may be that the NHS in England makes increasing use of business services firms. The health services of Scotland and Northern Ireland are also open for such business, although Wales' Informing Healthcare prefers to do much of this kind of work itself. Over the next two weeks, SmartHealthcare.com looks at some of the leading firms providing outsourcing, systems integration and business services to the NHS. Next week's article will examine BT and CSC , the remaining local service providers to NPfIT, but this week focuses on three other firms, Atos Origin, Steria and McKesson. All have substantial current contracts with the NHS – all three are on the Additional Supply Capability and Capacity (ASCC) list for the south of England, for example – although in each case the most significant deal is outside NPfIT. This list excludes several major suppliers – Fujitsu Services still deals with many trusts, despite its departure from NPfIT, while Dell Services, formerly known as Perot Systems, is keen to go beyond acting a subcontractor to BT in London, with contracts with Cambridge University Hospitals NHS Foundation Trust for strategy advice and The Rotherham NHS Foundation Trust installing software from Meditech. But the following three firms do share scale, extensive existing NHS business – and an ambition to win more health service work in future. Atos Origin Atos, which is headquartered in Paris but has more than 6,500 staff in Britain, has two substantial IT contracts with the NHS. It is the national IT services partner of the Scottish Government for health and social care, for which it provides services including a service desk that handles 200,000 calls a year and the delivery of more than 100 projects annually. In England, it holds the contract with NPfIT for the Choose and Book appointment booking system, and was the fifth biggest supplier to NHS Connecting for Health in 2009-10, which spent £36.5m with the firm in that financial year. While it has incorporated the controversial concept of patient choice, and its take-up has varied widely among primary care trusts, the system went live on time in 2004, and in March 2010 it passed the 20m mark on patient referrals, with 30,000 handled every day. But the firm goes beyond supplying IT – it also claims to be largest provider of medical services in the UK after the NHS, with 2,500 professionals. This includes direct provision of healthcare services, including two NHS walk-in centres in Manchester and Canary Wharf in east London, as well as GP and nursing services for NHS Tower Hamlets. It also assesses claimants for disability benefits including the employment support allowance for the Department for Work and Pensions. It does not, however, 'body shop' doctors. In addition, Atos works with individual trusts, including Mid Yorkshire Hospitals on a lean thinking pilot scheme which aims to increase productivity by streamlining processes. It is also acting as the main route to market for Neutrino Concepts, a new business intelligence firm running a pilot of its software with Shrewsbury and Telford Hospital which automates reports on waiting lists. Stephen Wells, the firm's UK vice president of health, says part of his job is to develop potential synergies in the firm's ability to provide IT and medical services, reckoning it is unique in offering both. He adds that the firm is well placed to work on areas including health and social care integration and welfare reform, both of which the Conservative Party has said it wants to push. Steria Like its rival Atos Origin, Steria is based in Paris and provides the NHS with major systems that go beyond IT. In Steria's case, its biggest deal is NHS Shared Business Services, a joint venture with the Department of Health, which it acquired along with its purchase of UK firm Xansa in 2007. SBS provides 130 trusts with back office processing services including finance, accounting and human resources. Initially intended to be compulsory – like the Electronic Staff Record system, which is used across the NHS (see McKesson) – SBS has to fight for business for its processing centres in Bristol and Leeds, although the numbers of trusts using it have steadily grown over the last year. In an interview with SmartHealthcare.com in April, Steria's UK chief executive John Torrie said that trusts using the service save around a fifth of the cost of carrying out such work themselves, and benefit from better data processing and business intelligence reporting. He added that it has "taken ages to get this to profit". Xansa specialised in outsourcing work to India, having bought a company there 25 years ago, and Steria has retained this: India is where much of the SBS work is carried out, and Torrie is chief executive of the company's operations in both countries. As well as the SBS work, Steria provides IT services to Northern Ireland's 400 health and social services organisations, including all GP surgeries. This work includes management of an iSoft patient record system, a central healthcare number and email and web access. The 10 year £26.7m contract runs until 2013. In January 2010 the firm also won a place on a framework contract to provide the NHS in England with a picture archiving and communications system (Pacs) for breast scans. McKesson The San Francisco based firm primarily provides software for healthcare. It is converting its Paragon software for use by the NHS, and in March NHS Connecting for Health signed a £36m deal to allow 26 trusts to continue to use its legacy patient administration systems. It also said in March that 21 NHS trusts will continue to use its CarePlus Child Health software for children. This includes NHS organisations in Gloucestershire, Wiltshire and the old county of Avon, including North Bristol NHS Trust, which chose the software in 2007. But McKesson also deals with every NHS organisation in England and Wales through providing the NHS Electronic Staff Record (ESR), which the firm says is the world's biggest single integrated human resources and payroll system. It pays 7% of the working population of the two countries, more than 1.3m people. It replaced 28 payroll, 67 human resources and 1,702 in-house systems in doing so, allowing staff records to be transferred between NHS organisations with ease. It went live in April 2008, following a phased introduction over several years. McKesson is using ESR as a way to expand its NHS work. In September 2009, it offered an electronic expenses system, DX Expenses, with Point Progress which will integrate with the staff record. It is part of a consortium led by Tribal which will provide nine primary care trusts in the South Central strategic health authority area with a commissioning enablement service, allowing the analysis of clinical services by PCTs. The firm was the third largest supplier to the central Department of Health in 2009-10, with spending of £49.8m ( news article ). BT and CSC: the National Programmers This article was last updated on 15 September 2010.