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Cambridge University trust to end 10-year £200m outsourcing deal early?
By Tony Collins
Two years after going live with an electronic patient record system as part of a 10-year IT outsourcing contract – one of the biggest in the NHS – Cambridge University Hospitals is going out to tender for similar services.
The Trust, which runs Addenbrook's and the Rosie hospitals in Cambridge, describes the exercise as "market testing", according to Government Computing.
Last year trust regulator Monitor put the trust into special measures after it over-spent an average of £1.2m a week, in part because of the huge costs of eHospital.
"The Trust underestimated the scale and challenges of implementing its new electronic patient record system, e-Hospital, and the impact this would have on its provision of healthcare for its patients. These issues led to significant cost increases and a failure to realise the benefits the system could provide," Monitor said.
A Care Quality Commission report last year also criticised the implementation of the trust's eHospital systems.
But in July this year the trust was shortlisted in three categories of a national award for using IT to improve patient care.
The trust went through to the finals in three categories: digital NHS trust or health board of the year; best use of IT to support integrated healthcare services, and the CCIO award for clinical informatics leadership.
Epic and HP
On 26 October 2014 that the trust went live with the "eHospital" project, which allowed clinicians to access patient information wherever they were in the hospital.
Clinicians use hand-held devices and computers on wheels to record care at the bedside. The devices enable the trust to record details of care in real-time into the new electronic patient record system.
The cost of the eHospital project over 10 years was expected to be £200m. The project involves software from US-based electronic patient records supplier Epic and hardware, services, infrastructure and support from Hewlett Packard Enterprise.
The trust's board decided to spend the equivalent of a substantial new hospital building in an attempt to get the IT to match its reputation.
The eHospital project began in 2012, though the go-live of the patient records system was not until 2014.
In a statement to Government Computing, Zafar Chaudry, Chief Information Officer at Cambridge University Hospitals, said of the latest tender,
"Almost four years into the eHospital programme, CUH [Cambridge University Hospitals] has exponentially increased the use of its Electronic Patient Records and seen a growing demand in the size and types of commodity IT services needed by the Trust.
"As such, we are market testing to ensure best value for public money to meet these needs, whilst recognising our partners, HP, have and continue to meet their contractual obligations."
The trust's tender dated 14 September 2016 says it is looking for "outsourced commodity IT services for enterprise infrastructure, service desk and end user computing including the provision of server, storage, electronic patient record application, LAN and WAN".
The estimated contract value is £140m over seven years, with an option to renew for a further three years. From the tender document it does not appear that the trust is seeking to replace the Epic software.
In its 2015/2016 annual report, the trust was positive about the results of the Epic eHospital project.
"We are also now in our second year of operating with a comprehensive electronic patient record system in the form of Epic, as part of a ten year eHospital programme.
"The period following deployment saw a number of significant challenges, but we are now entering a phase where Epic has become very much a part of daily life and, as we consolidate our position, we are settling to the task of ensuring that we realise the many benefits of the system."
Although there are still challenges – mainly a shortage of staff and money, with the trust anticipating a budget deficit of £74m in 2016/17 – eHospital's benefits so far include:
the deployment of "business grade wifi in all clinical areas.
a refresh of the desktop estate of 6,750 PCs and 500 laptops.
the deployment of "workstations on wheels" and 420 "rover" devices (iPod touch with a barcode) for mobile working in clinical areas.
direct integration of physiological monitors and ventilators in all theatres and critical care areas, along with connectivity of point-of-care testing devices for integrated near-patient testing.
electronic patient record in full use for all aspects of care across all clinical areas in-patient and outpatient areas, typically with 3,200 concurrent users in the system at peak times, apart from paediatric chemotherapy.
On the face of it, Cambridge University Hospitals NHS Foundation Trust is seeking to replace its 10-year £200m outsourcing deal long before it's even half way through.
But all of its literature implies it is happy – indeed proud – of the Epic system. It also seems content with Hewlett Packard Enterprise's infrastructure and other services, though it's not so clear whether it's happy with its prices.
The tender could be merely an exercise to compare the prices it is paying with the prices available on the market, which could leave Hewlett Packard Enterprise, in essence, competing to keep its work at the trust.
The trust's CIO told Government Computing that Hewlett Packard Enterprise has and continues to meet its contractual obligations. That's not in dispute, but it's possible for users to be unhappy about suppliers even when contractual obligations are being met. The trust could have discovered that a new or revised contract is needed.
On the other hand, the tender could be the trust's way of proving to the regulators that it is paying market prices for its patient record systems, outsourcing and ICT services.
The trust may have nothing to lose and everything to gain by an open tender while it's only three years into a £200m 10-year outsourcing deal.
On the other hand, will IT companies want to spend large sums on bids none may be able to win?
Cambridge University Hospitals £140m market test – Government Computing, September 2016
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