PAC turns spotlight on NHS civil servants

The Public Accounts Committee's (PAC) latest foray into the tangled mess of the NHS National Programme for IT focused on suppliers and civil servants - but didn't get much further than it had before.

Up in front of the PAC yesterday were representatives of the two remaining Local Service Providers BT and CSC, followed by the head of the NHS Sir David Nicholson and the NHS CIO Christine Connelly. Also in attendance were representatives of the National Audit Office whose scathing report on the impossibility for success of the patient care records was the jumping off point for this latest interrogation.

The vendors

With CSC's contract up for potential cancellation, Sheri Thureen, President of UK Healthcare at the firm, offered no apology for the failure to meet deadlines, instead staking a claim that the past ten years had put the NHS in a position where the foundation for moving forward towards delivering systems was in place. "It will take time to see benefits realisation," said Thureen, arguing that by 2016 while the company might not be in a position to deliver a fully integrated records systems, there would be a foundation in place from which to work.  "We are still on track to deliver. I believe we have made significant progress."

She did concede that "on the Lorenzo side there have been some delays", but added that some of these were "issues with our supplier [iSoft]...we had to step in and address their financial and managerial issues".

Thureen alluded several times to the ongoing contract renegotiations between CSC and the DoH, but declined to speculate on the prospect of termination ("We have been focusing on moving forward rather than on termination") or any proposed reduction of scope or lower functional requirements ("I wouldn't be able to talk to that."). She did concede: "We have a joint understanding [with the DoH] that this contract as it stands today is not working for anyone."

All of this was too much for Tory MP Richard Bacon, the long term critic of the National Programme in general and of CSC and iSoft in particular. He accused CSC of working towards getting a  monopoly hold on the NHS through its planned acquisition of iSoft. "You've got your foot in the door," he accused a seemingly unflappable Thureen. "You have become three fifths of the NHS [following Accenture's departure from the Programme]. In seven years you have deployed in three hospitals and you've caused chaos...Are you not just actually using [the purchase of iSoft] .as a way to control the market? You're going to get into a position where it would be dangerous to get rid of you."

For BT, Patrick Connell, President of BT Health, insisted under questioning that he thought that the current contracts represented value for money despite the costs in the South region being almost 9 times higher than the costs in London. BT inherited the South from Fujistu when it was canned from the project - although it later emerged in the hearing that Fujitisu had still been paid support costs after the parting of the ways for systems that were longer to be used. He protested that it was not a simple case of apples and apples: "We're mixing significant one offs with business as usual. When we went int to take over from Fujitsu, there were one off costs."

Quizzed further on the cost disparity, the conversation diverged into a surreal discussion about the difference between buying the RIO software a la carte "from somebody in a pub" compared to the "packaged offering" that you get from BT. Disaster recovery was offered up as one of the additional services BT gave, although members of the PAC seemed to struggle with the maths here.

The civil servants

With the suppliers let out, it was time for main attraction as Connelly and Nicholson took to the hot seats. The contrast in their styles was interesting to observe. Connelly wanted to talk technology and deliverables while Nicholson, the senior civil servant, reached for the comfort of smooth civil service eloquency. Neither, it must be said, went down well with the Committee.

Nicholson started by trying to postion the Programme as "a laudable ambition" into which a "huge amount of work was done around working out how you might put that into practice". There were, he conceded "big risks in the middle of it"  but that the DoH had been working through those and "adapting to the circumstance in which we found ourselves."

Nicholson was forced to concede that the original vision of having a product for the acute sector that would be implemented across the country hospital by hospital had "proved difficult to do". 

"Impossible to do," snorted PAC chair Margaret Hodge who argued that every billion pounds spend on the National Programme would pay for 50,000 nurses. But Nicholson was undeterred - last time he'd appeared before the PAC the money planned to be spent was higher, he argued, which didn't seem to convince a PAC more interested in discussing what hadn't been delivered for any of the money spent.

Nicholson and Connelly would clearly have preferred to talk about the Spine or the ability to send x-rays electronically - "the bits we're not allowed to talk about," said Nicholson somewhat mournfully. Instead the Committee insisted on talking about the care records and value for money for the taxpayers.

When challenged to agree or disagree with the words of Health Minister Simon Burns who last week described the National Programme as "a farce". Nicholson's response  was : "In terms of trying to deliver a top down programme spending huge amounts of taxpayers money for no benefit, anyone would describe that as  a farce."

Asked by Hodge whether there would ever be a universal care record accessible from anywhere at anytime - one of the original intentions - Nicholson responded: "We will get what you just described, but it means different things to different people."

Several times Nicholson and Connelly claimed that they had supplied the NAO with information on figures, disputed by the NAO's Mark Davies. When Bacon decided to dig deeper into the risk assessments carried out in the early stages of the Programme, Nicholson claimed lack of awareness of the numbers, which caused the MP to explode: "You should know this stuff...I have 50 other things to do and I know it."

Nicholson was unabashed. " I did say I thought the systems and contracts were high risk," he offered.

He also had to admit to not providing a benefits note requested by the PAC on a previous occasion. "All I can say is I apologise," he told the PAC. "We said we'd do it, but we didn't. We did do the work, we did it on time but then it got mixed up with the new government coming in...that's an excuse."

The MPs

For many on the Committee, enough was clearly enough: CSC was clearly in breach of contract, so why not just can it now demanded one member?  Connelly outlined the cost of such a course of action although declined to put specific numbers on it. It would however mean meeting contractual caps, paying "several hundreds million pounds to terminate for convenience", followed by the (likely) possibility that CSC would sue for damages.

Then there's the cost of sourcing and moving to new systems while also having to pay for support for any systems already in place that you no longer want to use anyway. "We would then be over a barrel running something that some supplier has provided that we are no longer running," she concluded, noting that all this could add up to more cost than simply trying to complete the programe.

But she was at pains to note that the DoH believes that CSC is in breach of contract, although adding: "CSC dispute they are in breach of contract. They have informed us of this. We believe they are in breach of contract. CSC themselves do not accept that." It was a response that seemed to blur the question of who was the buyer of services and who the provider, but Connelly wasn't prepared to go into too much detail on negotiations in order to keep her powder dry.

She insisted: "We don't believe any money has been wasted....we agree the situation with CSC is not all that we want it to be. We are looking at options around that."

The two and a half hour session was a timely insight into the bizzarre situation that the NHS has found itself in. The DoH can't seem to reconcile its facts and numbers with the NAO or with some of its suppliers. Contracts have been signed that make it most likely to be too expensive to break them while ten years of work has led the NHS to a situation where it's seriously put forward as an achievement that it might finally have a foundation on which to proceed. And the senior reporting officer for the programme and his CIO seem to be intent on defending what the MPs on the PAC clearly thought was the indefensible.