‘Widespread concerns’ about NPfIT penalties

In a new survey NHS foundation trusts have reported ‘widespread concerns’ about the limited functionality of key systems  from the NHS National Programme for IT.

Some foundation trusts (FTs) that have sought to delay taking systems until problems are fixed say they have been told to expect fines running into many millions of pounds.  The FTs report that in many cases the nationally purchased software is incomplete or less capable than their current systems.

NHS Connecting for Health the agency running the £12bn NHS IT programme, and which drew up the contracts, including penalties termed ‘non-deployment charges’, confirmed to E-Health Insider that a number of trust chief executives had recently written expressing their concerns at the potential fines. The DH agency said no fines have yet been levied.

Carried out by the Foundation Trust Network, part of the NHS Confederation, the survey examined foundation trusts’ experiences of the National Programme for IT (NPfIT) and found “widespread concerns about the functionality of NPfIT systems as a whole”.

E-Health Insider has obtained a copy of the confidential June survey, which includes responses from 48 of the 54 FTs, representing the cream of the health service.

One acute FT reported being told that its local health community would have to pay a £20m fine if it decided not to take the early software offered for NHS Care Record System (CRS). Another reported facing a potential fine of £11m if it delayed installing software.

While national systems including e-booking and digital x-ray communication and storage are widely used, the report says ‘most’ FTs have opted out of certain parts of the national NHS IT system including the crucial CRS software required to develop electronic patient records.

Where some FTs have sought to opt out of using systems that only partly met their needs or were less capable than existing systems, they have been told they risk incurring penalty payments.

FTs reported being told they face penalty payments to Connecting for Health (CfH) and its prime contractors if they refuse to install software they don’t judge to be fit for purpose. The ‘non-deployment charges’ form part of the local service provider (LSP) contracts for the NHS IT programme to which the Department of Health committed all English NHS trusts in 2001.

The biggest concerns about the software on offer centre on problems with the CRS, mental health systems and maternity, but also extend to picture archiving and communications systems (PACS) – often cited as the great successes of the programme.

The survey results make damning reading, detailing FTs’ concerns about the limitations of key systems being provided by the NPfIT programme. “Almost every respondent had concerns about the functionality of some part of the system and most had opted out of certain parts of the NPfIT system,” says the survey report.

NPfIT systems identified as particularly problematic include patient administration systems (PAS), mental health and maternity. The greatest cause of concern was the CRS based on Cerner’s Millennium and iSoft’s Lorenzo software delivered by LSPs.

“Most problems reported were around the CRS systems where acute FTs reported that CRS represents poor value (even though it comes at zero cost as part of the core) as a result of key gaps in functionality.”

The report says that twelve FTs, a quarter of the total, reported “major problems in the PAS with one FT having identified 60 areas less efficient than current PAS where new processes will need to be introduced at significant additional costs.”

One FT quoted in the survey said: “We have concerns that the PAS solution Lorenzo will deliver less functionality than we currently have.”

According to the survey while most FTs are using elements of NPfIT systems “they have all needed to put in place additional systems to support those functions to make them more compatible with their needs.

One unidentified respondent is quoted as saying: “I have a great deal of concerns around the functionality of the product as do my other SRO colleagues I work with. It would appear this is now being seen as delivering a target rather than being seen as getting the product right before we start to deploy it into much larger organisations, the provider [Fujitsu] cannot get it right in places such as Weston and NOC – what is the hope for larger organisations?”

Another major area of concern is mental health where the report says: “The lack of mental health functionality, particularly with Cerner Millennium products is of great concern. Mental health FTs also report that PACS and other parts of NPfIT systems such as maternity, theatres and ambulance are not relevant to them.” Three trusts reported problems with maternity functionality as a reason for opting out of NPfIT – two have taken alternatives and one is planning to.

In addition, early implementers whose programmes had been halted as a result of development problems, reported having already spent heavily on staff teams and training and expect to need to invest even more “in the millions” at the next implementation date at the end of 2008.

According to the report: "Whilst the majority of trusts are using NPfIT, they have all needed to put in place additional systems to support those functions to make the system more compatible to their needs."

Despite the extent of the problems cited, FTs report that when they have sought to delay implementations until systems meet their needs or opt-out of taking NPfIT systems entirely they have been told they face fines running into millions or even tens of millions of pounds.

The report says: “The acute FT reporting problems with CRS wanted to opt for the later R2 phase has been told that it will have to pay the £20m that this will cost the local health community.”

Another acute trust seeking to opt out of CRS reported it had been told that although it would not face fines its decision “will cost the local health community £11m.”

“One acute trust was considering going outside for PACS and has been told they will not receive PDC [Public Dividend Capital] unless they go with Connecting for Health, and in addition will receive a fine of £3.5m. There have also been rumours of more significant fees/connectivity charges coming if they don’t fall in line which could push the figure to over £5m.”

Yet another FT, which chose to go with a non-NPfIT system said it "expects to incur penalties", though another that went outside NPfIT said it didn’t expect to face such charges.

Richard Bacon MP, and member of the Commons Public Accounts Committee, told EHI that the threat of penalties fitted with a pattern of bullying from the centre, with CfH telling trusts what they have to do. "It is extraordinary, as they are meant to be helping trusts not threatening to penalise them."

CfH confirmed the existence of the penalty payment clauses in LSP contracts designed to ensure trusts implement the centrally-purchased systems. The agency declined to provide details of the upper limits of potential non-deployment fines, which it is understood can be levied by either CfH or the LSPs.

Richard Jeavons, CfH’s director of service implementation, said in a statement to

E-Health Insider: "I’ve had enquiries from FT chief executives about the matter. We would certainly wish to address any concerns which the FT community has in our normal and ongoing dialogue with them.”

A CfH spokesperson confirmed that the provision for non-deployment charges existed in the LSP contracts, but declined to state how big such charges could be. They added: "To date no non-deployment charges have been enforced."

A senior LSP figure contacted by EHI described the fines in contracts as akin to a game played by the contracting parties "our fines cancel out their fines".

None of the three LSPs working on the programme – Computer Sciences Corporation, Fujitsu and BT – were willing to comment officially on non-deployment charges and whether they had been threatened or sought from trusts, saying the information was "commercially confidential."