The UK National Health Service (NHS) ought to terminate and replace contractors if they don’t meet deadlines for its massive upgrade of England’s healthcare IT systems, a recent UK government audit report says.
The recommendation, from the National Audit Office (NAO), reinforces moves by the NHS to put pressure on contractors for prompt delivery of products and services for the ten-year programme, the largest civilian IT project under way in the world.
It means additional scrutiny for the four main contractors to the project, which is divided into five geographic areas in England. BT, Fujitsu and CSC have one region each, while Accenture has two.
Those companies have subcontracted with other suppliers, which have struggled to meet deadlines and fallen under financial pressure. Richard Granger, director general of Connecting for Health, which oversees the IT project, has warned suppliers and cancelled a £90 million (NZ$272 million) email contract with EDS two years ago for underperformance.
The four main contractors haven’t been afraid to make their own strategic moves. In April 2005, Fujitsu dumped IDX Systems as its main subcontractor, switching to Cerner.
BT, responsible for the London region, has retained GE Healthcare, which acquired IDX in January. But the Financial Times reported in May that BT may be considering replacing GE Healthcare with Cerner.
A change by BT would mean the programme would be dependent on two main software application providers while a third, ISoft Group, is having financial difficulties, according to Tola Sargeant, an analyst at Ovum.
The NHS says it is holding prime contractors responsible for delays and won’t pay suppliers until services are delivered and working.
“The suppliers have borne the cost of overcoming difficulties in delivering the software and not the taxpayer,” the NAO says in its report.
The NAO estimates the total cost of the National Programme for IT at £12.4 billion. The figure is nearly double earlier government estimates.
The modernisation plan is built around the Care Records Service, which will make electronic patient records accessible through a nationwide network called the National Data Spine, both of which BT is contracted to build.
The National Data Spine went live in June 2004, but is about ten months behind in development, the NAO says. The Care Records Service will be deployed in a pilot programme at the end of this year, about two years later than planned.
BT is also building the New National Network (N3), an enterprise-class WAN with broadband DSL and fibre-based ethernet.
Despite a few delays, the NAO cites increased use of other new systems, such as “Choose and Book”, which allows patients to electronically book appointments. About 12% of bookings are now made using the system.
Also, an electronic drug prescription system is running in about 15% of doctor offices in total, the NAO says.
But the speed of the IT revamp is at risk due to a shortage of IT skills, and training is recommended, the NAO says.