Granger says ‘consultation’ led to records delays

Richard Granger, the director general of IT for the NHS today (26 April) told the House of Commons Health Select Committee that he blames the two year delay in delivery the electronic patient record system at the heart of the NHS IT programme on ‘consultations’ taking longer than anticipated

He said: “Some aspects have been delayed by 24 months because the consultation schedule on these aspects has gone on far longer than was originally scheduled. Significant further work was necessary in the task of creating an environment where the necessary specification was stable. It would be inappropriate to roll it out as it was because it would later need serious re-working at a cost to the taxpayer.”

Granger was giving oral evidence as part of the committee’s investigation into the electronic patient record, just a week after the Commons Public Accounts Committee issued a damning reports on the delayed programme.   The NHS IT boss began by making a statement of benefits delivered, reeling off statistics on systems delivered.

Granger told the committee that things had changed since the NCRS [NHs Care Records Service] strategy was first published in 2002 and Connecting for Health had spent time working on adapting the strategy to meet the modern needs.

“For the past three years, my colleagues have undertaken very expensive exercises with clinicians and patients to ensure that we strike the right balance between what all parties involved want. The delays have been due to a mixture of software complexity and consultation time.”

However, he also told the Health Select Committee that the majority of the programme would still be delivered by 2010, with the spine central infrastructure release programme due to be released by this time next year and stating that the majority of the NPfIT strategy for up until 2010 will be done on time.

“It will be gradual but most of it will be complete by 2010, bearing in mind that more things have been added since 2002.”

However he warned a paper-free NHS may prove a pipe dream: “We may never have a paperless NHS.”

Also called to today’s session were Harry Cayton, Department of Health (DH) national director for the patients and the public and Dr Gillian Braunold, national GP clinical lead for DH IT agency Connecting for Health.

Detailing the number of patient administration systems now in place outside of the acute sector, Granger listed 13 community hospital PAS’s, 171 community care PAS’s and 30 mental health PAS’s. He added 200m patient records were now in place across the spine [more than three times the population of the UK].

“The main problem we are facing are two extremities – waiting patients and privacy fascists and we are trying to find a pathway for the middle of the two.”

Explaining the reasons behind difficulties in implementing systems in the acute sector, he said: “It is very difficult to implement in brownfield sites but we are making progress. Last week we did three simultaneous deployments in Surrey and Sussex, Ipswich and Northampton.”

He labelled medical consensus on the national programme as oxymoronic and said that the challenges were because of the ‘tribal nature of medical practice meaning different stances and postures.’

Asked about the systems behind the delays, he said the two main software products – Millennium from Cerner and Lorenzo by iSoft – were very different.

“Millennium is a very rich system, used widely in the US, but there are issues with it, particularly with anglicisation – can we change it as much as we need to – and also with sorting out the US components that we do and don’t want.”

On the second system being developed by iSoft he said: “Lorenzo however is a new build system, which has cost an estimated £250m. The development of which has taken longer than the providers Accenture and CSC had estimated which has caused iSoft considerable difficulty.”

He said that iSoft’s interim solutions – iPM and iCM – were not of the same rich functionality as Lorenzo would eventually be, but were suited to the needs of an NPfIT acute trust, mentioning Ipswich, the first trust to receive both under NPfIT this weekend, as an example of how the two systems will work together.

Summarising the programme he said: “It will continue to be difficult, if it was easy it would have already been done. Health is the last industry to go into an IT programme because it is the most difficult.”

In a later session, Dr Paul Cundy, chair of the General Practitioner’s Joint IT Committee, Dr Martyn Thomas representing the UK Computing Research Committee and Andrew Hawker, a former system developer and an NHS patient dismissed Granger’s comments and called for an independent hearing into NPfIT.

Dr Thomas said: “As the specification is still evolving, the plan for delivery is built on sand. This project has all the hallmarks of a massive failure, when it is meant to transform the way of working.”

Dr Cundy added: “The failure to consult with us has led to the amount of consultations that have been mentioned. We would have had a much more incremental process if we had our views dealt with from the start.”

When asked if he felt an independent review was necessary, Granger said: “Are the people calling for it themselves independent? We have a programme under immense scrutiny, and the minister took a decision last year that such a review was not necessary.”

The hearing follows the submission of 68 pieces of written evidence compiled in a 192 page document submitted to the committee.

Links

House of Commons Health Committee, The Electronic Patient Record, written evidence