Final score: NPfIT in mental health and community services

One area in which the National Programme for IT is widely judged to have been a success is the delivery of electronic patient record systems to community and mental health trusts in London and the South.

As part of its contracts to roll-out systems in the capital and, after Fujitsu left the programme in the South of England, BT managed to deliver Servelec’s RiO EPR to at least 39 organisations. And, while they have used the system to a varying degree, none could imagine moving back to the world of paper.

All of these trusts needed to be out of the BT data centre and to have individual contracts in place with a systems supplier by the end of October.

The deadline was very nearly met – just one trust, Guys and St Thomas' NHS Foundation Trust – is still running two instances of RiO, and it is due to exit on 30 November.

Community and mental health trusts formed a massive consortium to help them get the best deal when re-procuring systems.

Following a series of mini-competitions, six each chose to switch to Emis Web, TPP SystmOne and Advanced Health and Care’s CareNotes, while the remaining 21 moved to individual contracts with Servelec to keep RiO.

Consortium benefits

Chair of the ‘2015 consortium’ Peter Gooch is pleased that its approach opened up the market place while delivering costs savings that have been estimated at around £110 million.

This includes savings of around £80 million on the cost of electronic patient records versus what the Department of Health was paying and a further £30 million from the mini-competitions which, Gooch says, drove prices down from the "already low" framework costs.

Having migrated successfully, the trusts involved are now quietly getting on with deploying and using their new systems, he says.

“Now people control their own destiny. They have their own contracts, so they can prioritise their own needs rather than wait for other participants. It’s a much more dynamic and responsive environment and more manageable at a local level. The big, macro-level, national approach didn’t work for complex organisations like NHS trusts.”

While everyone managed to exit on time, Gooch says that having a single deadline put unnecessary stress on everyone involved – and it would have helped to have a staggered exit plan.

Despite this, he says the DH did put in place clear responsibilities around the exit and made it clear who would be responsible for what.

Although trusts now have more control over the contracts for their systems, they also have to shoulder the costs of hosting, running and supporting them. However, Gooch says this is not as big a pressure as might be expected.

While the national programme systems were nominally ‘free’, in reality they required a lot of additional, local spending.“They did come at a cost because of the constraints of the contract. All the trusts had to come up with work-arounds, which required extra people and data collection.”

Sticking with RiO

The community and mental health market was undoubtedly opened up by the 2015 consortium framework, but the majority of trusts involved chose to stick with their RiO EPR.

Twenty-one organisations had to migrate 32 instances of the system and Servelec managing director Sue Hawkswell describes the process as “very smooth”, with all exiting according to their original time scales.

Providers are able to buy additional modules under their individual contracts that were not available under the national contracts.

“They can use more aspects of RiO Mobile now. The product has moved on since the national programme and mobile is a big driver. Information sharing with other agencies is also a big driver,” says Hawkswell.

Alan Stubbs, Servelec chief executive, says all trusts were given the same “one-size-fits-all” solution under NPfIT, but: “Now they can dictate how to configure RiO community or mental health.

“They can add additional requirements, data collection forms or assessments to meet their business requirements – and we can then work with those organisations to support them in whatever they need going forward.

“Everyone has said that moving into an open environment, where they can talk directly to the supplier and use the system in an effective way, is a breath of fresh air.”

Advancing change

Advanced Health and Care built new systems to get onto the 2015 framework, so the six organisations that have switched to CareNotes are the first to try them out. Managing director George Thaw says feedback from go-lives has been positive.

He describes the move to CareNotes as different from the move onto systems under NPfIT. Previously, most providers were moving from paper to electronic records, but this time they were switching from digital to digital.

The focus was on data migration and the company spent a significant amount of time analysing the data to ensure it was in shape. “It continues to amaze me how complicated it is,” Thaw says. “You think it will be easier than a paper to digital transition, but in fact it’s not.”

Having a finite date by which the trusts had to switch meant there was “no wriggle room” and that focused everyone on what they had to do, he adds. Yet: “The vast majority are using this as an opportunity to do things better.”

Looking to primary care

Those organisations that have switched to Emis Web are using a platform that has been used in primary care for many years – and one that is promoted as enabling easy information sharing with GP colleagues.

Matt Murphy, Emis Health’s managing director, acknowledges that the company has had most success in converting trusts that already have a lot of Emis users among their local GPs. There are now 14 areas of the country that have 100% Emis users in primary care and the community.

However, Emis Health has also developed new modules for the community mental health sector: adults and children community care; child health; and mental health.

Murphy says the company had to do a considerable amount of work in order to meet the consortium’s requirements. This included developing the patient administration system and technology necessary to report referral to treatment targets.

The community care module is complete and the child health module is 80% complete, he says. Emis Web mental health is being rolled out over time and, while it is already in use, the functionality is 60% complete.

He adds that the transitions to Emis have been smooth, but the company cannot take all the credit for that. “There’s some credit to be paid to the centre, to the HSCIC and the framework guys.

“It was very well organised well in advance. There was a lot of work on coordinating it and making sure that the suppliers were cooperating – because it’s quite easy to be uncooperative when you are being replaced.”

*East London NHS FT moved its community services to Emis, kept RiO for mental health

All Systms go

TPP account manager Adele Cotter agrees that the HSCIC’s involvement was “really good” and says: “They have helped coordinate things and it’s been useful, from a supplier perspective, to understand what’s involved for all the trusts.”

She says the HSCIC is trying to reflect that involvement in the North, Midlands and East, where it has been engaged from an earlier point in the exit programme (the national contracts held by CSC for these regions don’t expire until next July, so trusts in the NME are still going through the exit process).

She adds that all of the functionality in the framework specification is live and TPP is now working with trusts on where to focus development work.

The good, the bad, the not quite as good as it might have been

Looking back, Gooch believes NPfIT was a “mixed bag of success and then some failures”.

He says he was “happily putting in EPRs” before the national programme came along and many trusts would have got there in the end whether it existed or not. Indeed, he feels that in some cases the programme actually prevented trusts from implementing EPRs earlier than they did.

“An awful lot of money was spent on the national programme but it’s hard to see the full value from that expenditure,” he adds. “A lot of good did come out of it.

“It raised the quality of technical infrastructure at trusts and got them using a single EPR record. But the systems didn’t talk to each other and other things didn’t gel as they should have done.”