Few answers for NHS IT questions

The war of words between Department of Heath CIO Christine Connelly and MP Richard Bacon shows no signs of abating with Connelly failing to answer Bacon's direct questions on the value for money of NHS IT contracts. 

Bacon, a trenchant critic of the National Programme for IT (NPfIT), has been demanding more information from Connelly about contractual negotiations with NHS providers BT and CSC and how much value for money for the taxpayer is being delivered, but doesn't seem to be getting very far. 

Bacon, a member of the Public Accounts Committee, wrote to Connelly in January asking for assurance that renegotiations of contracts with BT and CSC under the NPfIT could be justified as value for money. He told her: "We should explore whether value is in fact being delivered for the NHS and for taxpayers."

Connelly has now replied to Bacon in a response stretching to 2400 words, but which singularly fails to address his question directly.  

Direct questions

Bacon had asked: "In London, the new contract signed with BT in April cuts £112m from the original £1.1 billion contract signed in 2003. Of the 32 acute trusts in London, around half will not now get Cerner Millennium as BT will offer at most 10 more Cerner deployments to add to the 8 already in place; fewer community trusts will get RiO; and the requirement for BT to deliver around 1,500 new GP systems across the capital has been dropped. New software for the London Ambulance Service has also been abandoned. This would seem to amount to delivering half the original contract for a small reduction in charges. In your opinion, is this really delivering value?"

Connelly's reply admits that the "number of acute Trusts scheduled to receive the Cerner product has been reduced", but adds: "However this quantitative change needs to be considered in the context of the qualitative, ie functional, enhancements and improvements that have also been agreed...The organisation of the NHS has changed and is anticipated to change further and even more radically in the future. Thus the NHS need was for a highly configurable, more modular approach to delivery of the product, supported for longer in the deployment and rollout phase."

Bacon questioned what he called the reduced functionality of the Cerner Millennium package, dubbing it "out of date technically". Connelly is having none of this, stating: "I am afraid you are misinformed about the level of Cerner functionality. Functionality has not been reduced. Indeed the exact opposite is the case, and at the request of NHS in London, access to the full scope of the Cerner product has been made available for those Trusts where it has or will be deployed to meet their clinical and patient needs."

A simple refusal

Bacon asked explicitly for copies of any value for money comparisons carried out by the DoH, but Connelly refuses this request: "We have provided copious information on these matters to the NAO in the course of their latest, and previous value for money studies. I do not think it is appropriate or necessary to provide this information separately to yourself (albeit a member of the Public Accounts Committee), particularly as it contains commercial and confidential information, whose public disclosure may be prejudicial to the Department's ongoing negotiations."

Bacon asked specifically about the fees due to be paid to BT and compared those numbers (unfavourably) to far lower costs for the implementation of the RiO system from CSE Healthcare as well as the apparently lower price paid for Cerner Millennium by NHS Trusts who bought it directly from the supplier rather than the 'greenfield sites' who would take delivery from BT. 

On these points, Connelly appears to stall: "It is difficult to comment meaningfully on the financial comparisons you make about the RiO product, since it is not clear what scope, duration of terms apply to Trusts that you say have taken delivery of RiO for between £0.5m and £1m and how, if at all, these compare with the product for which we have contracted... In respect of the 'greenfield sites' in the South of England, I am aware that you raised a number of queries with the National Audit Office and they are providing a full analysis based on advice and information provided by the Department. I therefore do no feel that it would be appropriate for me to comment on this particular issue until the work with the NAO is completed."

Contact negotiations

Moving on to CSC, Bacon questioned the principle that even if a Trust chooses to opt out of the National Programme with its own ICT solutions, it must still pay the approved Programme providers such as CSC for the software it has decided not to use. 

In her reply, Connelly appears to have no issue with the idea of Trusts paying for software they don't use, stating: "Volume commitments were made to CSC (and all other LSPs) to ensure best value for money was obtained...if a Trust takes an alternate solution which could have been delivered by the incumbent LSP, then in those circumstances it is appropriate that the supplier is recompensed."

With CSC in negotiations with NHS execs about its future role in the National Programme, Connelly was unwilling to discuss the firm's contract in detail: "It would be inappropriate for me to make more general comment at this stage that might be detrimental to the Department's negotiating position."

She did however admit that the DoH did have an option to break away from its contractually obligated purchase of minimum volumes of software if it chose to do so: "The removal of exclusivity, and thus the volume commitment, is an option available to the Department where the contractor commits a breach of contract which cannot be remedied in an acceptable way or timescale. This is, correctly, a high threshold but is an option under constant and current review."

For his part, Bacon is clearly not happy with the replies - or lack of replies - to his questions. "You seem to remain committed to the delivery of systems through LSPs that have been shown to be unreliable, subject to serious delays and, even after contract renegotiations, unreasonably expensive," he said in his own reply to Connelly.  "Quite apart from the burden this places on taxpayers at a time of exception stringency in public spending, it is also surely not in the interests of the NHS and its patients."