BT and CSC: the National Programmers

NPfIT has seen the departure of Accenture and Fujitsu Services, but BT and CSC remain as its two key suppliers. In financial terms, they both take the lead role in contracts worth close to £3bn, where they have picked their own subcontractors and have a wide degree of control - although data released by the Department of Health on NHS Connecting for Health spending shows that BT received more than twice as much as CSC in the in 2009-10 financial year. BT is handling infrastructure and London, where it has made reasonable progress. CSC acts wholly as the local service provider to 60% of the country, where it has struggled to get iSoft's Lorenzo implemented across any acute trust. But both are clearly in the firing line if the new government wants to make further cuts to NHS IT. BT The only UK based firm among the prime suppliers to NPfIT, British Telecommunications can claim to have worked with the NHS for its entire history – although until its privatisation in 1984 it was part of the same civil service. Figures released by the government in September 2010 revealed that, in the 2009-10 financial year, BT was by far the biggest supplier to NHS Connecting for Health, with income of £470m, 43% of the organisation's spending with suppliers ( article ). BT Health acts as the prime contractor for three NPfIT contracts worth a total of £2.99bn. It is the local service provider for London, now worth £1.57bn over a decade. In April, it agreed to cut its charges for this by £112m, deterring some acute trusts from moving to Cerner Millennium, which was meant to be London's standard software for hospitals. As part of a wider range of cuts, BT will no longer provide systems for ambulances or GPs. The company has installed CSE's RiO software for mental health and community care in around 85% of trusts, including 29 primary care and eight mental health trusts, but progress has been much slower in acute trusts. Following the painful introduction of Cerner Millennium at Royal Free and Hampstead in 2008, which the trust claimed had cost it £10m in extra spending and hindered patient care, BT has managed further implementations in six acute trusts, including Kingston Hospital in November and St George's Healthcare NHS trust in March. The firm plays to its telecoms background in running N3 (for New National Network), a broadband data service connecting more than 47,000 locations in England and Scotland. The latter decided, despite being outside NPfIT, to take advantage of the system, while Wales has a separate network. This deal is worth £530m over seven years, and the firm boasts that it went live two months earlier than planned in January 2007. More than 100 NHS organisations have started using N3 for voice calls, and BT is also offering video over the network. More controversially, BT also runs the Spine, the central store for patient data which now holds more than 1m Summary Care Records as well as demographic information. It is also used as the registry for the staff smart card system, used for access to data on the Spine, with 770,000 cards issued. This contract is worth £889m over a decade. Beyond its original contracts, the government has awarded BT work in the south of England, following Fujitsu's departure, for a fee of £546m. This includes installing Millennium at North Bristol, Oxford Radcliffe Hospitals and Royal United Hospitals Bath acute trusts, managing existing Cerner installations at eight more acute trusts and installing new systems at 25 community and mental health trusts, with Surrey and Borders Partnership trust going live with CSE's RiO in December 2009. In August 2010, MP Richard Bacon criticised the deal, saying it should have cost around £100m and calling for a National Audit Office investigation ( article ). Away from NPfIT, BT is keen to provide more NHS organisations with mobile working facilities for staff, either for home working or to help medical staff work more efficiently in the community, and expand its work on telehealth and telecare. BT is reported to have taken financial hits from its NPfIT work, being paid only when systems are in place. But it has delivered much of what it was contracted to do, has recently won lucrative extra work in the south and struck a hard bargain over the recent package of cuts in London. Its management of working systems, such as N3 and software installations in many trusts across London and the south, will ensure the firm will be serving the NHS in England into the foreseeable future. Latest SmartHealthcare.com articles on BT CSC The departure of other suppliers has left the CSC Alliance, headed by US based Computer Science Corporation, acting as local service provider for 60% of England known as the North, Midlands and East (NME). Its three local service provider contracts, covering six strategic health authorities, are worth a total of £3bn over a decade. It was the second largest supplier to Connecting for Health in the 2009-10 financial year, receiving £213m. In the same financial year, it also provided the Department of Health with £20.2m of services, although the department said there may be overlap between the two amounts ( news article ). Unlike BT, CSC is purely a local service provider to NPfIT. However, providing health IT services is one of its core businesses, with many customers in the US, as well as business in countries including Denmark and the Netherlands. As part of its local service provider work it has introduced TPP's SystmOne software to more than 120 primary care trusts and 1,100 GP practices. But also unlike BT, CSC does not have any acute trust-wide implementations of iSoft's Lorenzo suite, its chosen software. Although Lorenzo is running departments at some trusts within the NME region, the first trust-wide implementation at University Hospitals of Morecambe Bay missed an end of March target set by the Department of Health, and as of late May is still to go live.* In April, the Department of Health's chief information officer Christine Connelly said that – again, unlike BT – it has not signed a new memorandum of understanding with CSC. It expects to do so once Morecambe Bay goes live with Lorenzo, and Connelly told the Financial Times that the trust was keen to continue with the project, while adding ominously: "We cannot wait forever." The trust has put a lot of work put into the project – including dozens of its staff travelling to India to advise developers on usability and test the software – and it already uses Lorenzo on a small scale. This suggests the system will almost certainly go live across Morecambe Bay Hospitals in the near future. But the idea that CSC will implement it across the NME region is increasingly unlikely. Also in April, the Department of Health did a deal with McKesson to support existing implementations of its software in 26 trusts – and 18 of these are in the NME region. Separately, several NME foundation trusts have chosen alternative suppliers, including Newcastle Hospitals' use of Cerner Millennium and Blackpool, Fylde and Wyre Hospitals choice of Alert. CSC is building new business with the NHS. The firm has sold automated touch screen check-in kiosks, which can check in patients by scanning a barcode on their appointment letters, print a map to the correct hospital room and carry out surveys on patients, to several acute trusts including Blackpool, Fylde and Wyre. NHS Oxfordshire (outside the NME region) signed a £728,000 deal in January to use CSC's OmniLocation system to track its mobile staff, becoming the first health service customer to use software normally used to manage mobile utility engineers. The company also plans to introduce systems including a Clinical Information Portal, which will join up data on patients in the manner of customer relationship management systems using software with CareFX, and an Electronic Patient Folder document management system, using software from EMC Documentum. CSC's local service provider deal for the NME region looks to have an uncertain future, particularly given its lack of a new memorandum of understanding with the Department of Health. But as well as supporting existing implementations, the firm has a pipeline of new products that are likely to be of interest to trusts. Like BT, it is likely to be involved with the NHS for a long time to come. * Update: Morecambe Bay said it went live with Lorenzo on 3 June 2010 - full story . Latest SmartHealthcare.com articles on CSC The NHS's service provider challengers: Atos Origin, Steria and McKesson This article was revised on 15 September 2010.