NHS IT debacle debated in parliament

MPs have waded into a debate about the state of the NHS computer systems.

And although there have been no changes suggested at the moment, MPs have brought up some interesting points surrounding failures and escalating costs.

The first speech came from Richard Bacon, a Conservative MP for South Norfolk who began the debate by talking about the national programme for IT in the health service. He said it was the “largest civilian computer project in the world” and was “spawned in late 2001 and early 2002.” by then Prime Minister, Tony Blair. He had a little tete a tete with Bill Gates and was “bowled over” by a vision of what IT could do to transform the economy and health service.

The idea was for information to be captured once and used many times, transforming working processes and speeding up communications.

Under the magic system hospital admissions and appointments would be booked online—the choose and book system; pharmacists would no longer struggle with the indecipherable handwriting of GPs; and drug prescriptions would be handled electronically. There was to be a new broadband network for the NHS, a new e-mail system, better IT support for GPs and digital X-rays.

However, Mr Bacon pointed out that most important of all, medical records would be computerised, thus transforming the speed and accuracy of patient treatment through what became known as the NHS care records service.

And the idea seemed so good to Mr Blair that he apparently rushed ahead in 2002 with promises that it would all be implemented by 2005. 

However it didn’t run smoothly. The project’s estimated whole-life costs were £5 billion and it provided a total risk score of 53 out of a maximum of 72. In other words, the project was very high risk. It was also estimated that the cost of the IT programme would be £2.3 billion.

However, to ensure it clawed back money Blair’s boys decided that contractors would not get paid until they delivered, and those not up to the mark would be replaced.

With this in mind you’d think no-one would want to play ball but in May 2003, potential
bidders were given a 500-page document called a draft output-based specification, and told to respond within five weeks. However there were again difficulties with what exactly the government wanted to achieve meaning that a set of contracts that were signed before the Government had understood what they wanted to buy and the suppliers had understood what they were expected to supply.

The lucky four bidders- and we say that loosely – were Accenture; Computer Sciences Corporation, or CSC; Fujitsu and BT. They were known as local service providers, or LSPs. BT and Fujitsu picked a US software firm, IDX, to work with, while Accenture and CSC both picked a British software company called iSoft. iSoft who offered a software system called Lorenzo, a program that had “achieved significant acclaim from healthcare providers”.

However, the program was not finished.

That caused a big headache for Accenture, the biggest LSP, with two contracts worth around £1 billion each. It was in partnership with iSoft and was trying to implement software that was basically not implementable. CSC faced a similar problem in the north-west and of course under the terms no one was supposed to get paid until something was delivered. As iSoft had not produced a working version of Lorenzo, the reality was that neither Accenture nor CSC had any software to deploy.

Accenture and CSC struggled on with the unusable Lorenzo but in 2006 they admitted the software had “no mapping of features to release, nor detailed plans.” In other words it had failed.

In March 2006, Accenture announced to its shareholders that it would use $450 million to cover expected losses on the programme. It made repeated offers to the programme that it would meet its contractual obligations by using other software. However, that might have bankrupted iSoft. The government wasn’t having any of it however, responding with a threat when Accenture talked about walking away.

And it was also bad news for CSC, with its own £1-billion contract for the north-west and west midlands regions, in no better a position than Accenture to implement the unfinished Lorenzo software. It was also struggling to mop up after having caused the largest computer crash in NHS history,

Finally, iSoft was forced to throw in the towel and declare a loss of £344 million, which wiped out all the company’s past profits.

CSC had to continue on its own, while the other two providers, BT and Fujitsu, were having their own problems. They were trying to implement American software, which is not such an easy thing to do in a British hospital, because American hospitals rely on billing for each and every activity and do not, conversely, expect to have to handle waiting lists.

The final report was delayed again and again, and it finally appeared in June 2006 leading critics to claim that the NHS would most likely have been better off without the National Programme in terms of what was likely to be delivered and when.

John Pugh a Liberal Democrat for Southport backed up these claims, telling MPs, “the project would not have done well in front of Alan Sugar on “The Apprentice”, let alone the Public Accounts Committee.”

He added that the government had to find £20 billion within the health service and that costs, particularly those of the patient administration systems, are still being picked up hospitals.

Jackie Doyle-Price Conservative for Thurrock however pointed out that the project had always been “over-ambitious”.

She added that “we would all agree that it has been poorly led and ineffectively delivered” and the cost had escalated considerably.