NHS IT to benefit Southern England - at last

The National Programme for IT has had its ups and downs. But Alan Brown says mental health care in one region is set to benefit from an application which is ready to deploy.

The National Programme for IT seems to be the equivalent of marmite for IT in the NHS - you either love it or hate it.

Those that hate it (otherwise known as taxpayers) think £6bn is too much money to pay for an electronic patient record. Those that love it (otherwise known as patients) think having a joined-up electronic patient record across the NHS is a no-brainer.

Without doubt, the programme has seen some successes as well as its share of delays and problems.

One area that has had little success so far is in the southern part of the UK - but it now has hope thanks to a proven application for mental health already deployed in London.

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Fujitsu was originally chosen as the prime contractor for the southern region in January 2004 with a proposal based on the IDX CareCast patient record product - and then switched to the Cerner Millennium product in summer 2005 (as did BT in London).

Then in May 2008 it was reported that the contract between the NHS and Fujitsu would be terminated due to problems during contract reset negotiations.

Both the Cerner Millennium product, and its contractual predecessor IDX CareCast, were proposed as suitable applications in all care settings - including mental health.

In the end BT decided to take a 'best of breed' approach in London and deploy Rio from CSE Servelec for the mental health and community sector. Six of the 10 mental health trusts in London were happy with this approach - and are now live on Rio and preparing to upgrade to the next version.

By the end of 2009, 80 per cent of London's mental health trusts could be on the same application - and Rio has a long-term roadmap including integration with other national applications.

Mental health in the NHS is quite different to the delivery of acute care. Mental health trusts usually cover larger geographical areas than general hospitals and provide a broad range of services.

A healthcare professional in a mental health team needs to know a lot about a patient too: what their diagnosis is; what risks they pose to themselves or others; who their carer is; and what their plan of care is.

Before the termination of the Fujitsu contract, there were rumours Fujitsu was going to adopt the same approach as BT and deploy Rio to mental health trusts. After the contact termination, there has been speculation that BT or CSC (the prime contractor in the North of England) would take over the contract for the South.

This has not yet formally materialised but trusts are beginning to take control of their destiny and put together business cases for the implementation of applications such as Rio.

Now is the ideal time for them to do so: three years on from Rio implementations in London and the rest of the country, there is a lot of expertise out there on how to deploy and implement it. These include:

• Writing the full business case requires a good understanding of the challenges ahead and ensuring that key stakeholders are on board at the start. As has so often been said, this is not an IT project and a clinical lead needs identifying at the start.

• Clinical transformation involves a review of many processes - clinical and non-clinical - and redesigning them so they can benefit from the features of new applications.
• Data migration is key and there are some important decisions to take on what data to migrate and what to leave in an archive. Data migration is also one of the riskier areas in that it needs excellent change control and lots of testing.

• Training is fundamental to the success of the project - both training people on how to use the application and on how changed processes impact on their jobs.
• Information management is something the NHS understands well. Implementing a new application puts reporting at risk and a lot of work is needed up front to prepare for the new environment.

The good news is that staff from the NHS, suppliers and independent consultancies have seen the project and got the T-shirt (literally, in the case of one trust). They have learnt what usually works and what doesn't. They have also learnt where it is best to utilise trust resources and where outside help is beneficial.

Mental health in London has benefited from the National Programme for IT, now it is the turn of the South.

Alan Brown is managing consultant at Apira. He was formerly director of IM and technology at the West London Mental Health Trust