Contract ‘reset’ underway in the South

The new NHS programme director for the NHS IT programme in the South of England says she is not happy with the core patient administration system delivered so far, and confirmed that a far-reaching ‘reset’ of contracts has been launched. 

Sarah Elmendorf took up the new post of programme director at the Southern Programme for IT earlier this summer. Already she has acquired a reputation for straight talking and demanding results in a hurry. 

In an exclusive interview with EHI she spoke candidly of the problems with Cerner’s Millennium patient administration system, as provided by local service provider Fujitsu: “I am not happy with what has been delivered thus far, but with the focus of Cerner, Fujitsu, the NHS and ourselves, we can get an acceptable baseline PAS.”

She added: “The NHS needs a good PAS and an excellent clinical system quickly. For this to happen the interests of the NHS Fujitsu and Cerner need to be fully in alignment.”

Her appointment, the three southern SHA’s creation of a Southern NHS IT programme and decision to hit the ‘reset’ button on contracts are proof power shifting from the centre. But it was the centre, in the shape of Connecting for Health, which originally negotiated local service provider contracts, and remains “the owner of the contract and the commercials”. To get change through the Southern NHS IT programme will need CfH’s co-operation.

Only at the end of the current reset period will it be clear whether NPfIT Local Ownership Programme (NLOP) is made of straw or whether the reins have either been surrendered or wrested from the centre.

Before taking up the new role in June Elmendorf was the CIO for South Central SHA. Previously she held senior IT positions in telecoms and banking, roles in which she says the focus was always on ‘delivery’ and staying close to customers and suppliers.

She confirmed to EHI that one of the first steps taken by the Southern Programme for IT has been to ‘reset’ the contract with Fujitsu the culmination of mounting pressures and NHS frustrations over many months. This is a far reaching review of the detail of Connecting for Health’s contract with Fujitsu, including revisiting the requirements of what is to be delivered and how and when this is done.

Elmendorf suggested the current ‘reset’ may just be the last opportunity to get NPfIT to work for the NHS. A previous contract ‘reset’ was completed in November 2006, but failed to draw a line under implementation problems and delays.

The difference this time is that it the process is being led by SHAs and trusts. “This reset is being led by the NHS, we have a group of NHS individuals in each of the main areas working on this and driving requirements.”

Fujitsu declined to comment on the ‘reset’ in the south. Fujitsu’s public sector boss Peter Hutchinson said “We don’t comment on commercial matters.”

Although Elmendorf declines to be drawn on details and says that the ‘reset’ is “not a contract re-negotiation”, she stresses that major change is needed if the programme is to be a success. “I need flexibility and I need speed at a local level,” she stresses.

“We need fundamental change and our suppliers are supportive that we need to work much more closely with the NHS.” She said that change is required both from Fujitsu to deliver their contract and on the part of the NHS.

Priority areas requiring immediate attention in Millennium include: outpatients, waiting lists, A+E and reporting. Elmendorf says that this has already begun with agreement already in place for “smaller incremental releases that will bring functionality quicker to the NHS”.

On reporting she says that it is essential that Millennium has the necessary fields required to capture data for reporting, but trusts are urged to look at data warehouse solutions.

To achieve these goals will require greater flexibility, and a more incremental software release strategy that will provide trusts with the key clinical functionality they want earlier than current plans envisage.

Elmendorf says that what she needs is ‘flexibility and speed’. “We must increase the flexibility of the system. In the US Cerner is very flexible, but here it’s not. I’m going to be exploring that in the next few months.” She indicates that achieving greater flexibility is likely to require greater scope for local configuration in the LSP-delivered product.

But to get the necessary speed and flexibility will require ensuring that the key contracts and ‘interests’ – between Connecting for Health, the NHS and Fujitsu, and between Fujitsu and Cerner – are correctly aligned.

Ensuring that all interests are aligned to achieve the necessary speed and flexibility is, she adds, one of the biggest challenges of the current ‘reset’. Whether this can be achieved remains to be seen. “The proof, the test, is in the ‘reset’, once we come out of the other side,” says Elmendorf.

Asked whether the clock is ticking Elmendorf pauses and replies: “There is pressure on all of us and the pressure is coming from the NHS for us to deliver. We want to get this right now and that will require significant change.”

The absolute priority she says has to be getting the product right. “What do I think about at night? What do you have to do to get the product right and ready to deploy.”