Health service faces up to costly IT operations

The National Health Service is likely to spend close to £20bn over the next decade on its ambitious programme to create an electronic record for every patient in England, Lord Warner, the health minister in charge of the programme, has said yesterday.

The service has awarded national contracts worth £6.2bn over 10 years to create the broadband links and other infrastructure that will allow electronic records largely to replace paper ones. The programme is also steadily allowing digital images to replace old fashioned film for X-rays and scans, outpatient appointments to be booked online, and prescriptions to be transmitted electronically.

But ahead of a report on the national programme due next month from the National Audit Office, Lord Warner said he wanted to clear up “confusion in the public arena” about what the £6.2bn “does and does not cover”.

The national contracts remained on budget, he said. But they essentially covered the infrastructure and applications and not the additional local spending needed to train staff, buy computer screens, assimilate existing systems and convert data and other costs.

This, he said, “has always been the case”. To meet the cost of implementing the programme, hospitals and other parts of the system would have to use their existing spending on IT – around £1.2bn a year and rising. As a result “spending over the next decade is going to be up nearer £20bn,” Lord Warner said. “But that’s not all new money because if we did not have Connecting for Health [the national programme] the NHS would have been spending about £1bn anyway on old systems” that provided nothing like the functionality that the programme will eventually deliver.

In addition, the NHS could take advantage of a whole set of agreements covering software and hardware that allowed it to replace local systems far more cheaply than it had been able to in the past.

The minister’s offer of “clarity” on the full cost of the programme came as he conceded that plans for the national summary electronic record were between two and 2½ years late. The first deployments of the clinical record were originally due last year. But now that would not happen until “late 2007 or early 2008”, Lord Warner said.

The programme was also at a “pivotal point”, he conceded, with the government – three years in – still to get agreement with the medical profession over what would be included in the summary record, and how patients’ data would be added.

Sir John Bourn, head of the National Audit Office, has already indicated that its report will criticise the national programme for failing to engage effectively with staff.

Lord Warner said: “That is probably a fair criticism in part. We possibly could have got into the game earlier, and we could probably have done it better earlier on.”

But a large proportion of the medical profession were “in the understandable mind set – and this is not a criticism of them – of seeing is believing”.

Given the past history of attempts to computerise the NHS, doctors wanted “to see the reality” before they fully engaged, he said. This was now happening and detailed discussions were underway “about how we build up the summary record” and “what goes on to it”.?The argument, he said, “is about how we do it, not should we do it”.

The programme has been working on the assumption that patient data will be uploaded to the summary record on the basis of assumed consent, but with patients retaining the right to opt out.

The British Medical Association’s family doctors committee is now arguing that patients should be consulted individually before any data are uploaded – an approach that would make the adoption of a national clinical record much slower.

Lord Warner said family doctors “need to think about this very, very carefully because of what it means to them in the time that they will have to take with each patient to actually do that”.

He said he was confident “that we will get there”, and “good sense will prevail with the profession” with negotiations still under way on how pilots of the summary record, now planned for early next year, will operate.

Lord Warner conceded that some parts of the programme were running slower than had been hoped, partly because NHS policy had changed since the programme was conceived. However, he said they were now making good progress.

“I don’t feel apologetic about some of the missed targets,” he said. “If you don’t set some ambitious timetables you will not drive a big project of this kind. We owed it to people and the NHS to try to move as quickly as we could.” It was also inevitable “in any complex, contracting process as big as this there are going to be some tiffs with suppliers” – such as those that have delayed the care record and installation of digital imagery in parts of the country. “That’s the real world.”

http://news.ft.com/cms/s/0d6a68c6-ef4c-11da-b435-0000779e2340.html

The admission from the Labour govt that the Connecting for Health (the national programme aka CfH) will cost three times the original estimate- a whopping £13.8 billion isn't a surprise given Labour's past IT expensive failures like the Passport Office, the Child Support Agency and the Tax Credit Agency.

Even taking the reduced IT cost savings which Lord Warner quotes into account, this leaves a £3.8 billion funding shortfall.

Given that there is still considerable debate about the opt- out approach to data entry further delays will only increase full development costs.

Bear also in mind that many NHS doctors and consultants do not use NHS facilities for personal privacy reasons. So will their reluctance to fully use the system may only increase their scepticism.

As few of the users- the Doctors themselves have been contacted to guage their own requirements, another train crash looks in the offing.

Given that Labour admitted in only April that it had "miscalculated" this year's staff pay awards by £610 million, the new NHS IT backbone looks to be in another league for expensive IT mistakes.