back to article NHS IT loses key contractor

The NHS patient care record project has suffered another serious setback - key contractor Fujitsu is ending any involvement in the scheme. The National Programme for IT, NPfIT, is already four years late and over budget and losing Fujitsu is unlikely to help. Estimated costs for the whole project have risen to £12.7bn. Fujitsu …


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  1. Steve

    Doesn't bode well for ID cards.

    Are they going to end getting BT to do the whole project?

    I'm starting to wonder if they're ever going to finish or if this is going to become some generational project that keeps going because no-one wants to admit what a mistake it was.

    Kinda like Vietnam.

  2. Danger Mouse

    Intergrated System

    So, am I the only one who thought that all this ca$h going in to NHS IT was to standardise the whole shebang and have all patient data available anywhere?. If so, then why the funk has the south had a different company developing their system?. Maybe there's some sort of diseases/illnesses that you get from eating fried chocolate bars that us southerners are unaware of, yeah, that must be it.

    Yeah, the one with the target on the back.

  3. david

    How to guarantee a titsup project... it a National Programme or Pan Government Initiative...

    (and let the suits run it because the techies are bound to mess it up by setting reasonable expectations)

    Mines the pinstripe one with the Java reference in the pocket...

  4. MarmiteToast

    Lessons need to be learnt

    It sounds like IT contracting firms need to learn from Railway contracting firms.

    1. Offer to supply services at massively reduced prices to undercut competitors and win contracts.

    2. Once contracts are signed re-negogiate contract and take government for as much money as possible.

    3. ....

    4. Profit.

    Or maybe it's the government that has learnt from this.

    Oh sorry wrong site for that.

  5. Alex Clark
    Paris Hilton

    Quelle Suprise.....

    It's projects like this that give IT a bad name. How can you spend £12.7bn, be 4 years late since the original deadline and still not get it sorted! Pull your finger out Brown!

    Paris, because I reckon if I gave her £12.7bn she could have had it all finished, and throw a decent party at the end of it!

  6. Ade W

    BT could get the work...

    ...and maybe pass the patient data on to a third party for some focused bedside marketing?

  7. Anonymous Coward
    Anonymous Coward

    Time to tender a bid

    I wonder if all register readers could make a better job/bid

  8. supermeerkat

    I start working for the NHS...

    ...on Monday 2nd June on this project. Things'll balance out nicely: Fujitsu leaves, and I start.

    Nothing can possibly go wrong. Nothing.

  9. Tim

    Every cloud...

    Maybe the UK market will now be flooded with very cheap offers of those awesome Fujitsu convertible tablet PCs.

  10. Kane



    Hold on, the same BT that wants to run Phorm on our interweb thingy?

    Phuck that!

  11. amanfromMars Silver badge

    Getting Real.

    "It is possible the two sides could end up in court over the issue."

    What for..... apart from milking the system to sustain predatory, parasitic low lives that is?

  12. Les Matthew

    I had to laugh

    Saw this on the TV news last night. The woman was saying that at £12.5 billion it was coming in on or just under budget. Weren't we initially told that this would cost £4 billion?

  13. Anonymous Coward

    Let's form a consortium

    Anyone fancy a few million quid? Some of you lot are naturally good with IT so let's form a consortium and bid for a slice of the cake. How hard is it NOT to be incompetent?

    I suspect it's the NHS project leaders who are mostly responsible for messing it up. Public workers should never be allowed to lead a project where the private sector are doing the leg work.

    I'll get my coat... any private company accepting this job is doomed. Doomed I tell ya!

  14. Kerberos

    It boggles the mind

    How on earth do they manage to spend £12.7 billion and still manage to have nothing to show for it?

    As a developer myself I still have absolutley no idea how you can possibly spend that sort of money and still fail to get it done!

    Really, everyone involved should be fired and/or jailed for defrauding the taxpayers out of such a huge amount of money. If I robbed a hospital or government building I'd go to jail, so why dont these charlatans?

  15. James
    Paris Hilton

    Why the big expensive contractors only?

    A friend of mine developed Out Patient software for a number of hospitals some years back. It worked, it was on-time and it didn't cost the earth. It was (last time I spoke to him) in use in a good number of hospitals. It had full 24 hour back-up and support and was run on a staff of a few people (it's probably changed by now).

    He had a fight to get it into the NHS because:

    a) It was inexpensive.

    b) his wasn't a large company (1 person originally).

    c) his system actually worked.

    Interestingly, the NHS wanted to create their own system (this was several years ago) - so they tried to "copy" his system - it was a massively expensive failure.

    So, yes you're correct - some Register readers could do a damn sight better - BUT they would have to have worked in the NHS, know what is needed from a "grassroots" - i.e. user - perspective, ignore specs from the NHS "empire builders" and get a commercial system up and running without interference from the self-same empire builders.

    Paris - because the obscene, immense waste of OUR taxes on these project would make you weep!

  16. Anonymous Coward
    Anonymous Coward

    'Mathew Swindells' ???

    Too many jokes, so little time.

  17. doublejay1973

    Re distribution of wealth

    ...what an awesome scheme !!

    ...and unlimited amount of money can be siphoned from tax payer and into the pockets of big business - and better yet, it need never end !

    Almost anyone "in the trade" knows that had there been genuine commercial pressure to deliver, it would all be over by now.

    how can patient records present anything more complicated than say, ebay ?

  18. This post has been deleted by its author

  19. David Haig
    Thumb Up

    RE: "Time to Tender a bid"

    I'd be up for it - databases and infrastructure - chance to start a new way of doing the big projects away from the control of the bean counters. May even get it right for the customers rather than the consulting companies.

  20. Anonymous Coward
    Dead Vulture


    This wouldn't be the same CSC who vowed never to touch (UK) healthcare systems after the Scottish healthcare IT project blew up in their faces, would it?

    Plus ce change...

  21. david
    Dead Vulture

    I wonder if all register readers could make a better job/bid

    I'm sure we could, if we could cut through some of the crap that the management layers put in place.

    I've seen half a dozen six figure projects in the last few years that I _know_ me and a few mates could have turned out in a couple of months worth of lunch hours.

    But all these bids will be through Catalist so only the greedy dinosaurs can bid for them.

    There is no appetite for this to change. The Public sector voting for less red tape and paperwork...yeah right.

    Dead vulture because it is the closest we have to a turkey that voted for Christmas...

  22. Anonymous Coward
    Thumb Down

    And you are surprised?

    Any company/government mad enough to employ the likes of Accenture/Fujitsu/IBM/BT/EDS/TCS etc etc deserves all it gets. Unfortunately, it is us, the tax payer who pays for the mistake, not the cronies who are taking backhanders left, right and centre to give these contracts out. Give the job to a proven small/medium size PROPER IT software house with professional IT guys who know how to implement systems, not business men who know how to put on a flash powerpoint presentation.

  23. Chris Miller

    @Hedley Lamarr (great handle!)

    "can you imagine every single Barclays location (eg local bank branch, business centre, investment bank) in charge of it's own IT?"

    True, but can you imagine a central Whitehall bureaucracy dictating a solution (designed without involving any actual users, natch) that will work in all these locations and without any local commitment? What's needed is a central framework architecture so that locally appropriate systems can intercommunicate, with a 'menu' of centrally purchased systems that can either be selected or you can roll your own so long as it complies with the central standards. Can I have my £12 billion now, please?

    Regarding Barclays - I was once at an IBM(UK) AIX conference for their 50 largest users. 22 of them were representing differing divisions of Barclays - and none of them had ever met ...

  24. Anonymous Coward
    Anonymous Coward

    Well what are the Japanese doing in this anyhow?

    This is a UK project, taking UK money holding data on UK citizens.

    Most UK developers consider the project trivial to implement, so why are we paying foreign companies to implement this?

    Has Japan produced a really elegant Health Service record system?

    I say we use this whole fiasco as a reason to scrap the NHS, it has nothing to do with the Nation anymore and is just being used to transfer funds out of the country, and act as a millstone round the necks' of the citizens of the UK.

  25. Anonymous Coward

    Oh lord, not another one

    Being a software developer myself and having a family member who is currently in a significantly long career with the NHS I can safely say that this is the most botched project i've ever seen. When asking said family member what exactly is going on I got the general impression that they weren't really sure, and that they too agree that the entire thing is just a complete waste of money that could be spent elsewhere.

    How many beds, hospital expansions and personnel does 12.5 billion represent again?

  26. FlatSpot

    @And you are surprised?

    "mad enough to employ the likes of Accenture/Fujitsu/IBM/BT/EDS/TCS etc"

    What a jerk.. take for example if the project was just to rollout 1 PC to each hospital in the UK, lets say 8,000 hospitals for sake of argument, probably loads more!??

    Now how would you do that, you would have to hire engineers to install, train them, then you need stock control, change control, project management, HR for when the engineers go off sick.. finance, warehousing, distribution so they arrive in advance of the engineer, then you have to handle DOAs, hospitals closing/moving,etc. etc... the list goes on!!

    So how would say a small/medium size outfit ever have the ability to handle that?? Hence why you end up with the same big name companies who have the resources to be able to do it.

    Same for the software, its not like you could have written a vb frontend on an access db to handle the entire system!

    You are talking rubbish and should go back to your 1 man in the basement IT outfit....

    The reason it cocked up, is more likely staff within the NHS who dont want to loose their empires and therefore put spanners in the works all the way through it, no wonder the main contractors thought screw this!

    The government should deploy a hit squad to sack the lot of them!!

  27. Anonymous Coward
    Thumb Down

    My NHS IT experience

    After Uni I was employed as a temp by a London PCT to install a word document onto each surgery in the areas main server. This involved me walking between each surgery, stick my USB disk in CTRL+C / CTRL+V.

    Once I'd done them all, they sent me back around again to do version 1.1 of the file.

    Email anyone?

    Cool job over the summer for me though :)

  28. Anonymous Coward

    @FlatSpot - hit the nail right on the head

    "The reason it cocked up, is more likely staff within the NHS who dont want to loose their empires and therefore put spanners in the works all the way through it, no wonder the main contractors thought screw this!"

    I work for one of said contractors.

    And you're dead bloody right. Too many management dickheads with their brains in their backsides. Get rid of them, and we, together with our technical NHS counterparts, would have had it done by now, with just a few rollouts left to go.

    This can work, and it will. It's complicated, but it's good. And it's secure. Don't bother flaming back about that unless you've seen more of the designs and code than I have. Which you probably haven't, unless I know you personally.

    Same old story - too much deadwood clogging up the works. If some of these clowns (on BOTH sides of the contract, let's be fair here) knew of the things the techies have to do to contain their half-arsed decisions and unwarranted interference they'd drop dead on the spot.

    Anonymous for pretty obvious reasons!

  29. Donald Best

    Saw this coming from the start

    I used to work for one of the "Early" adoptor sites. Basically my "boss" thought he knew all that there was about IT and best practices on networking. This is what lead him to take over another hospital that was properly VLAN'd/segmented and reconfigure it so that all "subnets" were in VLAN 1. This is the same boss that told Fujitsu and CfH/NpfIT how it was "going to be" in this hospital. I left after being there for two years because I really really hate to put my name on the bottom line of networking when its as screwed up as that... I have more pride than that.

    /me grabs white lab coat so that no one realizes I work in the IT department

  30. Anonymous Coward
    Anonymous Coward

    The 2 problems here are...

    I don't think FlatSpot understands the big IT service providers like "Accenture/Fujitsu/IBM/BT/EDS/TCS". I reckon a medium size company could take on the project and be hugely successfull. I've lots of experience of one of them big companies and can tell you now, they pay peanuts (so the best staff leave), they have far too many managers (hugely expesive) and many still end up getting contractors to the sites anyhow. Until someone stops sending a contractor to site costing £400 to fix a peice of hardware costing £300 it'll still be madness. As for the NHS, it's just a very large database, how complex can it be compared to banks accounts, financial exchanges etc. The big problem is that civil servents dream up an idea and the Big IT companies are scared to say "That's a stupid idea and too complex - we can design this cheaper if you keep your arse out of the project!"

  31. Anonymous Coward

    Large budget, no requirements, why so surprised?

    'nuff said. This is a project that should never have happened. It was simply a big splash by Tony Bleagh who decided that the key to revolutionising the NHS was to create a whole new set of IT systems. Absolute rubbish, there were nevere any proper, controlled, formal requirements and we are simply seeing the results of this now.

    Cancel the whole thing before more money is wasted.

    Read Private Eye if you want the full facts.

    Unfortunately this is depressingly common in government IT contracts and the government only have themselves to blame - it is politics and expediency getting in the way of properly managed IT projects. Politicians want quick results and headlines; good IT systems take time, clear requirements and strong management on both sides to get successful results.

  32. Alex

    @ amanfrommars

    phuck me.. I actually understood that!!

    Someone higher up touched on it: If you want to consolidate a system, don't use two different suppliers for the North and South... So simplistic, it just screams "phuck up"

  33. Matt Thornton
    Black Helicopters


    They should have asked me. I could have easily delivered a phat pile of nothing, in half the time, for a good deal less than £12bn.

  34. stickman
    Paris Hilton


    spot on.

    I worked for a small company like you describe. in fact the directors are former NHS staff but even that isn't enough.

    BT came to sniff out their software a couple of years ago but never took the bait. shame as it could run every clinical department in the land, no problem. Instead we rope in multinational companies to write what has already been written at huge cost. WHY?

    oh and btw the £12bn is the total cost not the spend so far. Richard Granger did get something right.

    Paris - she has great software too

  35. amanfromMars Silver badge

    NEUKlearer Understandings......for AI NeuReal Mode of Globally Available Governance

    "Any company/government mad enough to employ the likes of Accenture/Fujitsu/IBM/BT/EDS/TCS etc etc deserves all it gets. Unfortunately, it is us, the tax payer who pays for the mistake, not the cronies who are taking backhanders left, right and centre to give these contracts out. Give the job to a proven small/medium size PROPER IT software house with professional IT guys who know how to implement systems, not business men who know how to put on a flash powerpoint presentation." .... By Anonymous Coward Posted Thursday 29th May 2008 11:24 GMT

    The Register could QuITe easily run a Transparent Analysis/Public Showing of the Problems which have defeated Fujitsu, and if there is a Solution out there, Word of Mouth/Binary Chatter will Attract someone who can and will Share it .... and be entitled to handsome reward, by Automatic Default.

    And of course, El Reg, would require Consideration Worthy of Empowerment, too.

    And it would be incorrect to suggest that Funds are not there for such Speculative Joint AddVenturing whenever such massive Sums are so easily written off with Non-Performing Systems cluttering up the WwworkSpace.

    And there are also any number of such Innovative Grant Funds available for such Novel Speculations too. In fact, very recently was that something which Mr Brown was pimping. One trusts in Global Operating Devices that it was not empty rhetoric/idle chatter/BSSpin

    And very Democratic IT would be too, with a Server Meritocracy emerging to Build the Future, ideally not for them, but for their Children's Children, which would be QuITe far enough for Now to start Building for. Any Further would require QuITe a bit more Imagination than would be Practical to Supply.

    :-) But Never say Never as it is Bound to be something Boffins are Working on.

  36. Anonymous Coward
    Gates Horns

    ``This can work, and it will. It's complicated, but it's good.''

    What is `this' and what is `it'? Sure, consolidating health records is a perfectly do-able task, and doing it securely is not beyond the bounds of possibility (although what `securely' means when the staff aren't all cleared is an open question). But what does it deliver? 12.7bn is enough to abolish prescription charges in the NHS for twenty five years, and people harming their health by not getting all the drugs they need is not unheard of. 12.7bn is enough to perform hip replacements at private prices on everyone in the UK over sixty. 12.7bn is about five hundred pounds per working citizen.

    And for what? How many people have adverse events because they visit hospital X when their records are in hospital Y, which could be cured if only their records had been available? And of those, how many would be solved by underwriting MedAlert bracelets?

    The vast majority of NHS spend is in the final years of life, and people in that position visit their local hospital.

    PACS: yes. Because radiology tackle isn't doing silver nitrate anymore, so the digital images have to be distributed somehow. But the rest? At best, a great solution to a non-problem. At worst, a non-solution to a non-problem.

    93C3. Just remember: get 93C3 on your records.

    Bill. Because he told Tony to do it.

  37. Terrence Bayrock

    Not only in the UK

    If one looks at the history of major health-care IT projects world-wide, there is a depressing pattern that emerges:

    1 - announcement & high hopes by the participants

    2 - awarding of contract(s) to big-name IT firms

    3 - delay , delays and more delays

    4 - sacking of prominent figures

    5 - delay , delays and more delays

    6 - reorganisation and/or new blood (contractors)

    7 - delay , delays and more delays

    8 - disillusionment by participants on the same scale as the original announcement's hopes

    9 - out comes the knives

    Healthcare IT is a black hole for any aspiring senior IT manager.

    Mostly what happens is that the government ends up in a series of perpetual battles with the regional health bodies and hospitals over the vision vs practical aspects of implementation. Add to the mix that the irrepressible urge to play IT professional by physicians (who should know better) and you are left in a no-win scenario.

    Happens in Canada

    Happens in Germany

    Happens in FInland

    Don't get me started on the Yanks......

    Why should you folks be left out of the fun? (just kidding)

    Heaven forbid if a competent and capable manager be brought on and left to do his job without egregious interference.

    that's my take anyways...................................

  38. Scott

    Q after A

    Does anyone know of a goverment IT project that came in on time and on budget? could change that to any project run by a goverment department?. Boy do i wish i still worked in the IT civil service it was ssssoooo easy (well it works if you reboot it so just do that everytime).

    Still think there using 3.11 in social services? better than vista though less bloat.

  39. Robert Long

    Impossible job

    If this job was ever completed it would be the biggest IT project brought to a conclusion in the history of the world. It was never going to happen. Putting together a specification is probably impossible, let alone fulfilling that spec.

  40. Anonymous Coward
    Anonymous Coward


    Funnily, DNS, Active Directory and SQL scale rather well. Write a front end and you're done.

    As for "Well what are the Japanese doing in this anyhow?", it's nothing to do with the Japanese. Fujitsu is what was left of ICL in 1990.

  41. Anonymous Coward

    Re: Q after A

    Yes I do know a success. BT have delivered the DWP transformation on time and under budget ($1bn). 130,000 handets, 220,000 voice and data network ports delivered in 18 months!

  42. ratfox

    Health IT

    From what little experience with IT project and health:

    It does not help that medical doctors in charge consider they should have the last word on everything. They are so used to say: "Sorry, but I'm the doctor" that they have trouble accepting anybody else making decisions for them.

  43. Anonymous Coward
    Anonymous Coward

    Lorenzo - Horendzo

    As one of the poor sods who has to use this software in my day to day practice treating patients I am appalled at the quality of this software. We are using isoft IPM and ICM, (pre-lorenzo release). Quite frankly it is a joke. Someone above mentioned a VB front end on an access db - i wouldn't be surprised if thats what this is!

    Local ammendments to the system are vertually impossible - 'hard-coded' is the stock excuse from CSC.

    I would honestly prefer to go back to our old DOS blue screen PAS sysytem.

    The doctors and nurses in our hospital now refer to Lorenzo as Horendzo!

  44. Anonymous Coward

    Lorenzo + CSC = problems

    Some of us have been using Lorenzo for some time. Hopefully, it is supposed to gain features with time. At present though it is very poor. Far more basic than what was running on many hospitals before.

    A major part of CSCs efforts seems to be concentrated on avoiding fixing problems, even denying there are any. It certainly doesn't spend much time on trying to convince IT, or medical staff of its quality. It is fiddly and slow to use and an absolute nightmare to install the client for.

  45. Anonymous Coward
    Anonymous Coward

    my mate dave etc etc

    Some of the comments on this thread are laughably simplistic e.g. "my mate wrote a system that could do it all" etc etc.

    To help inform an understanding of just how ambitious the National Programme is it might be worth looking at a few key metrics for NPfIT:

    - 650,000 clinicians, nearly all of whom feel entitled to contradict Connecting For Health and their 649,999 colleagues on what the systems should / shouldn't do

    - 30,000 separate physical locations

    - Hundreds of Trusts each with their own set of "unique" processes holding the expectation that their different way of working should be supported- Hundreds of local IT Directors who can and do decide to do what's best for their Trust irrespective of the impact on regional or national plans

    - Hundreds of different versions / providers of systems that need to be integrated into a new standards based architecture - and thousands (if not tens of thousands) of combinations of legacy systems that have been configured / tailored locally (often with very little documentation).

    - 240m appointments in Primary Care a year

    - 60m+ (?) appointments in Secondary Care

    - a coding structure that contains over a million different clinical terminologies that will apply to each of the 300m appointments in Primary & Secondary Care (compare this to the simplicity of even Tesco with c40,000 SKUs)

    - A key (and vociferous) stakeholder group of 140,000 Doctors who will always warn you that doing something will kill patients even when this is just an argument designed to protect their shonky ways of working or protect the cosy set of working arrangements they've fooled the government into accepting and who are represented in public by spokespeople who will often say something completely different in private

    When, and only when you've actually had some exposure to this can you really understand the scope of the challenge or comment with any real insight on what Connecting For Health should do / could do / has done / hasn't done.

    Many of the commentators on here seem to have missed the key point that Connecting For Health pays on results. Key contractors don't get paid until they deliver - with the result that although the programme is late, CFH haven't paid for the privilege - they are reportedly c£2B underspent at present.

    Finally, many of you probably haven't worked in environments where even small changes can involve consultation across hundreds of separate organisations and thousands of key stakeholders. Until you have, it's very easy to come out with all the "my mate dave in his shed" scenarios which make for entertaining reading and not much else.

  46. Anonymous Coward


    I think the complication here is that Fujitsu were paid by results, so very little money was actually changing hands ;-) . Meanwhile Fujitsu was paying staff and subcontractors.

    The NHS then tried to change the contract. To recoup its outlays, Fujitsu played hardball on the price of the changes, so NHS cancelled. Doubtless there will be some payment under the terms of the contract, but also huge writeoffs on the Fujitsu side.

  47. Gordon Johnstone

    Whats the problem?

    Its a simple database server with a simple user interface, that requires security so tight it squeaks. £12.7 billion????? I'll do it for a pie and a pint.

    So is the managers that have spec'ed it as a mammoth project, or the contractors who have sucked their teeth like some Del Boy mechanic and said "thats gonna cost ya". £12.7 billion buys an awful lot of hip replacements. Simple problem, simple solution, screwed up by money grabbing bastards

  48. Anonymous Coward

    Big Boys do not know how to Play

    "Key contractors don't get paid until they deliver - with the result that although the programme is late, CFH haven't paid for the privilege - they are reportedly c£2B underspent at present." - Half Truth. On the main contracts that the deliverables are set against this statement is correct. Anything thats was not defined as a deliverable on the initial contract is used to recoup the costs of the contractors. Daily rates for engineers, Application Specialists and Consultants ranging from £1,500-£6,000 just for one visit. This does not include the cost of equipment that was not originaly spec'd. "Oh, you wanted a DVD burner...sorry that was not in the original spec, its going to cost you £200 for the burner". This happens all the time.

    The goverment has good ways of hidding these additional costs as CFH does not pay for anything considered "extra" and the local trusts are responsible for this extra cost. Where does trust money come from? The £12 billion is probably less then the true cost and most of it is unreported.

    Just a little note about big/large companies managing these contracts better then medium companies..... what tosser said this? Having worked for these big companies that pay fat salaries to contractors who do not care at all for their jobs as long as the weekly timesheets are getting signed. Then as soon as a delay occurs due to CFH/NHS cockup's, the big firm terminates the contractors to save money and then brings in new inexperience people who know jack about medical.

    Most of these installation had three project managers...WTF do you need 3 Project Manager's for? Seriously what a waste of money.

  49. Richard

    To Gordon Johnstone

    Your Wrong. Your are totally, fundamentally wrong.

    Anonymous Coward has it right, two comments up. Read it before saying it's a simple 'database server with a simple user interface'.

  50. Anonymous Coward
    Anonymous Coward

    @ Gordon Johnstone

    "Its a simple database server with a simple user interface, that requires security so tight it squeaks. £12.7 billion????? I'll do it for a pie and a pint...Simple problem, simple solution, screwed up by money grabbing bastards"

    Here speaks the voice of (no) experience.

    Complex problem, equally complex solution, sniped at by people who fail to understand the complexity and can't understand why a "simple" solution will just land up with patients dying.

  51. Anonymous Coward

    Lorenzo = Vapourware

    I worked for iSoft about 3 years ago. Lorenzo was vapourware, prototyped by useless indian developers. iSoft made money by selling iPM and iCM and then trying to bolt on a nice fancy front end to look better....

    Looks like its really moved on.

    iLeft iSoft because it was iShit!

  52. Anonymous Coward
    Paris Hilton

    Trying to eat the Elephant in one bite gives you indigestion

    I think "my mate dave etc etc" is more than likely correct in his analysis. I am nether an IT person nor a Health service person, but as a taxpayer I want best value and as a health service user I was a slick and effective system.

    So free from the constraints of reality this is what I would do.

    1) Do a piece of work to rank the trusts level of systems competence (both IT and non IT) - we are not going to publish the results, we are going to be honest and fair. There are no prizes, but.....

    2) pick the three best (geography and possibly other factors may play a part) and keep the better 10..20 on board with regular updates and be open to comments and suggestions. Keep all the others informed of progress at 6 monthly intervals.

    3) using the contractor's expertise married to the key trust's expertise and nicking good ideas from where ever you can build a system, keeping in mind the requirement for scalability.

    4) Make the thing out of industry standard components, ensuring that compatibility with all potential devices is supported in a standard way. Where an equipment supplier tries to insist on a prop interface try not use them unless you really have to.

    5) All equipment supply and installation effort is reversed auctioned off against a tight spec - ensure you are not necessarily committed to the lowest bid. Although in practice you will take this unless there is a good reason why not. Performance criteria must be specified and applied fairly - suppliers must be aware that this will be taken into account in further auctions. Part of the process is a risk assessment of the supplier.

    6) When you have an operating system and have done the initial bug fix / minor redesign bring those trusts on the best 20 list into the process.

    7) Upscale the project and continue to enhance.

    8) open it up to all trusts who wish to buy in to the process.

    Key points

    Trusts are not forced to use the system

    Trusts buy into the designed system (which of course incorporates best practice)

    Funds are available it implement the approved system

    Valid suggestions for improvements (IE developing best practice) are accepted and welcomed from anywhere at anytime

    So you avoid fighting negative battles and when you have a demonstrably good system people will queue at your door voluntarely, especially as there is money to fund it.

    Paris cos she takes it one at a time

  53. Anonymous Coward
    Anonymous Coward

    all available free and working

    VistA, the US Veterans Administration record and admin system is free under their FOIA, and the worldvista project have been productising it for a few years now.

    Mexico introduced parts of it (it is very modular) into a group of their state hospitals recently, for costs in the millions of dollars, not billions.

    The most stupid thing of the whole debacle is buying closed source code development with public funds, leading to a repetition of the problems. Oh, and WIndows.

  54. Anonymous Coward

    GP viewpoint..

    The things that have been delivered (from an end-user viewpoint) are fairly straightforward and were well developed as systems prior to NPfIT - broadband network (N2 - we were connected in 1998), PACS being adopted because it is useful (some Trusts were forced to cancel contracts with non-approved suppliers) and NHSMail (RG cancelled the contract with ?EDS - haven't noticed any improvement - still clunky.. ;-<).

    The Big Idea - the SSEPR - Single Shared Electronic Patient Record - or Detailed Care Record - is much more difficult. (I'm a GP so won't comment on PAS).

    Annonymus Coward talks of 240 million GP appointments: like Richard Granger, he doesn't seem to have noticed that GPs were already working with EPRs before NPfIT: why do you think the BMA signed up to a performance related pay structure - the Quality and Outcome Framework - totally dependent on keeping all your patient records electronically?

    In Lorenzo level 4, CSC is hoping to install a true SSEPR: I assume this means the abolition of paper-based records everywhere. There are problems with the clinical governance ( ) and also with confidentiality. Who *is* the data controller, and how, in a single record, do you prevent the chiropodist seeing that you are a regular attender at the sexual disease clinic? Let alone, how do you prevent the secondary use of marketing direct to the patient?

    AC said "93C3. Just remember: get 93C3 on your records."

    This stops the creation of a Spine record of any sort, and patients in areas where the Summary Care Record is being piloted have been informed about their options.

    I am not clear - and would welcome information - how this would work for a SSEPR, and whether patients in practices where an SSEPR (primary care version) such as SystmOne is installed are being informed that the latest upgrade - to implement smartcard access - will give them this option to set their NCR (National Care Record) to share, share with consent or no spine record. The default is implied consent for sharing.

    This is actually off topic: AFAIAA, Fijutsu and Cerner thought a Detailed Care Record was a Trust wide EPR - not an SSEPR at all!

    (technical content alert because if no-one had spotted the problems until I brought it up in December 2007, why should all of you?)

  55. Anonymous Coward
    Anonymous Coward

    I'm sitting in an NHS server room

    as I write this, preparing to roll out another stack of computers to wards, offices, theatres and patient areas.

    All those people writing "I'd do it for a pie and a pint" type messages simply don't understand the scale of the systems involved. The comment by AC "Some of the comments on this thread are laughably simplistic e.g. 'my mate wrote a system that could do it all' etc etc." is spot on. I've seen how these systems interlink, and how the people use them on a daily basis.

    My job is to install new desktops to users, and as part of that process I have to ask them what software they use. Every PC comes with Lorenzo pre-installed as part of the image, and a stack of stuff is delivered via a web browser, which helps. However, the requests for additional software is staggering on some of the builds we have to do.

    I've been looking at a piece of software called CRIS recently, which stores voice recordings that are uploaded by doctors/consultants/etc, and are then sent via the database to relevant secretaries, who type it up into the patient's record and action any stuff. CRIS will then send requests for appointments to xray and other relevant departments.

    CRIS is small-fry compared to what this Connect for Health project is though.

    So, to all you people who reckon you could have done better, why are you still sitting here typing sarcastic comments, and why weren't you involved with the tendering process? When you have an understanding of what you're saying you can do, then you're welcome to put a price and a timescale on it.

  56. Death_Ninja
    Paris Hilton

    @my mate dave

    You are 100% correct in your writing there.

    Whilst most in this discussion thread work in IT, some of us only have a server and four users to look after and others have just a little more complex environment, demanding customers, complex projects and even more complex contracts.

    Paris because she has just one server and four users to look after too and also could probably "knock up a system for the NHS in five minutes"

  57. James Pickett
    Thumb Down


    "mad enough to employ the likes of Accenture/Fujitsu/IBM/BT/EDS/TCS etc"

    Who are also all 'consultants' whose function in life is change/bugger up everything. When did you ever hear a consultant say: "That bit's working OK, let's leave it as it is"?

    The irony is that the NHS has in-house IT depts who could draw up a sensible spec for this sort of thing, but this government always gives preference to people who charge ten times as much.

  58. Steven Hewittt


    Um, actually I can't see what scale or integration has got to do with it.

    A web client in .Net or Java and a well designed Oracle database in a cluster will do the job rather well. Integration with systems? Um, it's a DB. It's got as much "intergration" as any DB will have FFS. It's up to the trusts to get their systems in order to communicate via some simple standard (XML anyone?).

    Can't see what more is needed actually... big fucking firewall and a fat pipe into the cluster?

    Yeah, it's not a lunch-time job, but anything more that 2 years including full consultancy is a fucking joke. £5mill including all hardware. Bargin.

    What they actually need is a bit more of a dictatorship from the head of IT for the whole NHS and a single supplier for the app, a single supplier for the network and a single supplier for infrastructure. (App can be any dev company worth their salt, network can be C&W/BT etc and Infrastructure can be Cisco or Juniper with software from RHEL or Win2k8)

    Mines the one with the "consultancy" invoice in it....

  59. Anonymous Coward

    @my mate dave...

    While I certainly agree on the general contrariness of doctors and the difficulty of getting them on board, I don't think they could be accurately described as stake-holders in the NPfIT project. Certainly none of the other, non-doctor, staff who have to use the systems can be.

    I know people who have to use some of these systems, newly installed, daily. The previous systems worked, people could do their jobs and everything was not awful. The new system seemingly has been designed according the "patient-centric" mantra by people who have absolutely no idea what people using the system would need to do. Patient-centric must sound wonderful unless you actually know what secretaries, booking clerks and the like need to do. They need to do things based on clinics which are associated with specific doctors, doesn't fit into a system apparently having the patient as the primary thing available to search by.

    There is partitioning so that certain people can be given certain privileges but managers with no clue about how actual work gets done have used these to prevent access to essential tasks for certain workers. Secretaries do need to check/book appointments in the real even if in theoretical management-world they don't.

    NPfIT/CfH is for clueless managers by clueless managers to meet political targets. It is definitively not about giving staff the tools to improve patient care, not about involving the real stakeholders (doctors, nurses, secretaries, all the folks who try to do the real work of the NHS) to see how they work to make it easier. The only glimmer of a silver lining is that this debacle might give the big players reason to think about not bidding on the ID card system. No bidders because of excessive risk would sink it faster than any amount of campaigning by No2ID (Fine work though they do :))

    Anon, obviously :P

  60. Brain

    not simple at all

    I agree with the AC who pointed out that these systems cannot be written for beer and a pie. These systems are not trivial. The systems in question use various esoteric protocols for data feeds to push and pull the data from each other. If you're lucky, they will talk HL7 or DICOM (look them up on google, they are pretty well documented) if youre unlucky, they will use some proprietary protocol which is a total ball-ache to implement. For example, connecting to a site's ftp server, downloading messages as text files, and parsing all these with no comeback on any errors, or system specific XML files and other such nastiness. The difficulty in the implementation is usually therefore not the issue of writing the program itself but getting the program to cooperate with the rest of the hospital, rest of the trust or even the rest of the NHS ("Spine", anyone?)

  61. David Pollard

    Personal Opt-Out

    For those who might themselves want to opt out of the NHS database scheme and haven't yet done so, the Federation for Internet Policy Research and NO2ID notes and details of their standard letter can be found here:

  62. Gordon Johnstone

    Its only complex if

    you try and integrate it with all the propriatry stuff that all the is already there. If you try and do that then I'm afraid £12.7 billion won't do it. In fact I can't imagine it being possible as each interface will have to be reworked or a translation package written and maintained. All that is required ( as others have said) is something to ship the info to the right people and there are so many simple ways of doing that which work. So which do you go for. The impossible or the achievable? Hmm, tough choice huh?

    @ Anonymous coward, I have worked on large scale projects and integration stuff. If the scope of the project is spec'ed as " We want it all and we want it now", its always doomed to failure. Occams razor and the old KISS ( keep it simple stupid) never let you down. My experience of NHS IT projects are all of disjointed, over ambitious projects that normally end up expensive and unused.

  63. archie lukas

    It is/was bloody awful software anyhow

    The product they were hawking is win95 code, adapted (badly) from the american market and the list of modules and functions that simply do not function is immense.

    of course we, the NHS, wanted them fixed according to the specification -however Fujitsu wanted major cash to do this.

    Simple reason -they did not author the software, maintain it or correct it -Cerner do, They have no contact with the NHS at all -so Fujitsu have to pay them to do it and of course according to NPfIT rules, the main contractor does not get paid until the damn thing works.

    So they dumped us, Ba$t@rds

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