CSC will radically overhaul its struggling multi-billion pound NHS IT implementations, if it is not removed from the programme following unprecedented comments by the prime minister last week.
David Cameron told parliament he was “very concerned” at progress on the project, and that he was considering "all available options under the current contract including the option of terminating some or indeed all of the contract".
If CSC keeps its contract, the US-based outsourcer is planing to change its deployment method to roll out patient administration systems into smaller deployments of more standard and modular components.
Nine years into the programme, the supplier has insisted it will involve doctors at an earlier stage in IT development and implementation from now on.
The strategy was revealed at CSC’s annual investor day, which began two hours after prime minister David Cameron told parliament he may consider cancelling all or part of the supplier’s contract. A series of parliamentary reviews beginning next week are expected to deliver a dim outlook for parts of the project, which is also being led by BT in other areas of the country.
CSC investors were looking for updates on the company’s £3 billion NHS contract – which forms a significant chunk of company revenues – after it admitted the delayed rollout was leading to the late receipt of large payments.
Guy Hains, healthcare president at CSC, said the supplier had been “learning with the NHS about the better way” it can deliver useful frontline systems.
Firstly, a more modular approach to the rollout would be taken. “We’re doing it in smaller chunks – we’re doing it in ten smaller delivery units rather than two major releases. And we’ll be able to deploy those in a separable, incremented way,” said Hains.
“There’s no question that that will help digestion as it goes into the NHS.”
Secondly, a more standardised approach would be taken, instead of highly-specific deployments in each hospital. For ‘early’ adopters, with which CSC is still working, Hains said there would be “not just a rebranding but a radical change in development”, where NHS frontline expertise is taken to inform future work.
“Rather than develop the software and then go through extended testing, we are bringing the engagement of those lead clinicians and lead trusts upstream right into the requirements, refinement and capture stage, so that will allow us to shorten the time to market for the whole programme,” he said.
Hains said “common requirement” would be set by an “expert user group”, in order that “one single trust doesn’t dominate in its requirements”.
CSC has insisted it is on the “cusp of success” with the programme, adding that it expects to commence a “volume” rollout of standardised chunks in the near future.
The supplier had drawn up a draft Memorandum of Understanding with the Department of Health, following months of difficult discussions as the parties struggled to reach agreement. But it remains uncertain whether this deal will be signed in its current form, or at all, following the prime minister’s assertion that he will consider committee reviews before allowing any signature.
Silvia Piai, research manager at analyst firm IDC Health Insights, said CSC “looks optimistic” with its expectations around the MoU, considering the comments made by the prime minister. But she added that the supplier has many other systems in the NHS that could be impacted by a cancellation, and that the government needed to be clear on the “real consequences” of such a move.
Piai said she supported the ideas of breaking down the deployment into more manageable chunks, and not allowing individual trusts to dominate specifications.
But she asked: “What about the work that has been done already? How will the changes be made and who will pay for them?” With trusts having already taken different approaches, she warned, “it will be difficult to develop the economies of scale that would have been in the original financial plan”.
The move to involve more clinicians in the decision process was “obviously a positive thing”, she said, because a purely top-down approach “is almost invariably wrong”, especially in such a decentralised organisation as the NHS. A top down approach in the 1980s on a London Ambulance Service project had turned into a "fiasco" when it failed to meet front line support, she said.
“One of the reasons that clinical engagement has not happened, or has not happened enough [on the current programme], is that the original contracts left investments in change management to individual trusts,” she said. “That failure to engage enough with clinicians was a major mistake whose consequences have continued to haunt the programme, and it must be reversed.”
The National Audit Office will report on the project on Wednesday. Following this, the Public Accounts Committee will hold hearings, and the Major Projects Authority will initiate a thorough investigation of the work. The prime minister has said no contract will be signed, if at all, until these reviews are complete.