Hextall says details on PACS and legacy imminent

In an exclusive interview with E-Health Insider Gordon Hextall, chief operating officer for the NPfIT and Ian Cowles, LSP programme director, hinted that additional funding to ‘pump-prime’ PACS procurements was currently being sought from Treasury and that a policy paper clarifying the position on legacy systems was imminent.

Before joining the national programme Hextall was chief operating officer for the modernisation programme at the Department of Work and Pensions, a programme he describes as very similar to the NPfIT "there is only £100,000 difference between the two programmes," said Hextall.  He also has past experience of working with Richard Granger, NHS IT director general, dating back to the early 1990’s.

Cowles meanwhile brings with him 12-years’ experience as an NHS director and chief information officer working in several acute and community trusts, "My experience includes not just working with technology," he told EHI. 

Explaining the NPfIT’s latest position on PACS, Hextall said that as part of the initial procurement each LSP was to provide more than one PACS supplier.  "Having gone through that process we had seen fairly significant price reductions in virtually every other element of IT components, we didn’t see the same reductions as far as PACS systems were concerned. 

"Therefore we went back to the LSPs to say ‘you’ve done exactly what we’ve asked you to do, but can we try and look at this in a slightly different way because we are looking at the choice of PACS systems for potentially the country."

LSPs are now due to come back to the national programme with more ‘imaginative’ solutions on PACS. "We’ve encouraged them to look imaginatively at how they can provide the PACS solution without necessarily providing every trust with its own end-to-end solution.  So they’ve got opportunities to be imaginative on technical architecture and providing an enterprise-wide solution if people wanted to buy it."

Mr Hextall said that if the national programme didn’t get the solution it was looking for it did retain the option of going out for a PACS OJEC procurement.

Asked whether there would be new money from the centre, in the form of pump priming, to support PACS procurements or implementations, Hextall said: “It’s too early to say, but that would certainly be our strategy if money became available.”  Clarification of the situation on PACS is promised "in the next couple of weeks".

“We’ve had very useful meetings with LSPs and PACS suppliers over the past two to three weeks,” added Cowles, who stressed that negotiations were occurring not just around prices but on "the totality of solutions, its about interoperability and connectivity to the health community and about working across the clinical networks we are developing".

Questioned about continuing negotiations with legacy system suppliers, not included as LSP sub-contractors Hextall made clear that suppliers will be expected to bear the cost of making systems compliant.  "Our expectation is that we expect suppliers to make their systems compliant at their cost." 

The NPfIT COO said that a policy document would be published within the next couple of weeks setting out the position on legacy systems "and the steps we expect people to take".  

Asked about the latest position on negotiations with EMIS Hextall said: "I thought EMIS was not an ongoing problem as far as we were concerned," adding that constructive negotiations were continuing – the standard line that both EMIS and the national programme have been providing for the past two months.

On the issue of whether LSPs have all signed back-to-back contracts with their main clinical application providers, Cowles said: "I think that is a question better directed to LSPs." Of the five LSPs only IDX has so far publicly announced that it has signed a full subcontractor agreement with BT for London.

Hextall commented: "In the same way that you’ve made quite a bit about suppliers having to clear things through us, we have to clear some things through suppliers [due to the potential impact on their share prices]."

Moving on to the state of implementation plans within each of the NPfIT’s five implementation clusters, Cowles was upbeat: "The picture is very similar in terms of implementation plans currently being signed off with the LSPs and the NHS.  So the early adopters have been identified and we are now going through the process of going through board [trust and LSP] approvals."

Questioned whether the national programme will announce who the early adopters in each cluster will be, Cowles said it was not the intention to have early adopters. "This is more about when they are going to take a range of technologies or the bundles we have procured."

He added: "Will we be announcing early adopters? Probably not.  The NHS will know because it will start its own internal planning process that meets those timescales, but there will not be formal early adopters."

Hextall made clear that he personally believed the national programme had already attracted an unprecedented and perhaps unwarranted degree of media attention. "My experience of large IT change programmes is that I fail to see what the point would be of making an announcement, because we’ve got a fairly intense testing programme with the LSPs; we’ve got legacy systems to integrate; we’ve got compliance between the legacy; and interoperability with the new systems which are coming out."

He argued moving from the current testing phase to live implementation could potentially be threatened by undue external scrutiny.  "I would have no intention of jeopardising anyone’s go-live by having it done under a blaze of publicity, and then the first time someone presses a button it doesn’t actually work.

“So I fail to see what the point of that would be.  I’d far rather let the thing get implemented gradually, because that’s the best practice, big bang and all that kind of thing doesn’t work.  So we’ve very keen to ease these systems in each of the locations.” He added that if individual locations and NHS organisations wanted to publicise their work and progress "it would be their decision… That’s fine, but I wouldn’t make a big splash about it."

Hextall confirmed that there will be changes to the national programme following Aidan Halligan’s appointment last week.  "In line management terms I still report to Richard, but because this is a programme in matrix terms I will report to Aidan for whatever he wants doing." He added it was a structure and environment he was familiar with working with.