NAO warns on NHS IT systems two years late and £20bn cost climbs

The National Audit Office reported to Parliament the results of its examination of the National Programme for IT in the NHS. It found key parts of the NPfIT were running at least 2 years late and that the total cost of the project may be as much as £20 billion once all the elements are included.

The Programme’s scope, vision and complexity are wider and more extensive than any ongoing or planned healthcare IT programme in the world and it represents the largest single IT investment in the UK to date. It is designed to deliver important financial, patient safety and service benefits.

According to the report by head of the NAO Sir John Bourn, the main implementation phase of the Programme and the realisation of benefits are mainly a matter for the future and it will therefore be some time before it is possible fully to assess the value for money of the Programme, as this will depend on the progress made in developing and using the systems it is intended to provide.

It is therefore important for taxpayers and patients that this investment pays off, and for the Programme to be well managed and open to public scrutiny. Accordingly, the NAO has examined the progress to date in delivering the systems against the original plans and the costs of the Programme; the steps taken by the Department, NHS Connecting for Health and the NHS to deliver the Programme; how the IT systems have been procured; and how the NHS is preparing to use the systems delivered.

The NAO found that the Department and NHS Connecting for Health have made substantial progress with the Programme. Successful implementation of the Programme nevertheless continues to present significant challenges for the Department, NHS Connecting for Health and the NHS, especially in three key areas:

* Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS, and to agreed timescales without further slippage.

* Ensuring that NHS organisations can and do fully play their part in implementing the Programme’s systems.

* Winning the support of NHS staff and the public in making the best use of the systems to improve services.

Sir John Bourn said “Substantial progress has been made with the National Programme for IT. The Programme promises to revolutionise the way in which the NHS uses information to improve services and patient care. But significant challenges remain for the Department and NHS Connecting for Health.”

THE NATIONAL PROGRAMME FOR IT IN THE NHS
Achievement of the following milestones has been deferred:
The National Data Spine first went live on time, in June 2004, but achievement of later milestones for building up its functionality has been delayed by up to ten months.

Local Service Providers’ delivery of the first phases of the NHS Care Records Service and the advanced integrated IT systems that are central to the long-term vision for the Programme will now be later than originally planned.

Deployment of the national clinical record is now planned in pilot form from late 2006, compared to the original plan of December 2004, and in its full form from late 2007. In the interim, Local Service Providers have provided Patient Administration Systems; these are linked to the Spine for security, single sign-on, Choose and Book, Personal Demographic Services (PDS), Electronic Prescribing Service and together with other Programme systems, to support NHS organisations in urgent need of new or replacement IT systems. However, the plan remains for the entire implementation to be completed by 2010 in accordance with originally contracted timescales.

While the software for Choose and Book was delivered on time, the take up of the system to support patient choice has been slower than initially planned as a result, amongst other things, of an extension of the scope of the system to support the introduction of patient choice and the time needed by suppliers of existing IT systems to make their systems compliant.

Deployment of the Electronic Prescribing Service and PACS (which was added to the Programme in September 2004) has also started more slowly than initially planned, but NHS Connecting for Health expects Ministerial targets for the later stages of deployment to be achieved.

In May 2005 the Department published the NHS Care Record Guarantee setting out the principles it intends to apply to protect the confidentiality of electronic patient records. Work continues on a number of important practical issues, including sharing information with non-NHS bodies, such as local authority social services, and the working of ‘sealed envelopes’ intended to allow patients to limit the sharing of information about themselves.

The full gross cost of the Programme includes the nationally agreed contracts, including approved additions, other central expenditure and the local implementation costs. Whilst some of this expenditure is directly managed by NHS Connecting for Health, management of local IT expenditure is a matter for the local NHS bodies concerned.

NHS Connecting for Health does not seek to maintain a detailed estimate of overall expenditure on the Programme but makes broad projections of expenditure. Our analysis of these projections indicated that provision had been made for total spending on the Programme (at a gross level, i.e. without deduction for possible savings or benefits) of £12.4 billion (at 2004-5 prices)6 over the ten year life of the main contracts, to 2013-14. This is not a budget but an amalgamation of fixed price contracts, extrapolation of costs beyond the contract periods and provisional forecasts of other costs.

The elements comprising this total are:

£6.2 billion by NHS Connecting for Health on the fixed price contracts let in 2003 and 2004, in line with the announcements made at the time of contract awards. These contracts are being managed within this total.
£382 million contracted expenditure on new projects added to the original scope of the Programme, predominantly PACS, where the cost of providing central data stores is £245 million.

£239 million on additional services to be purchased beyond the scope of the original core contracts (a mixture of contracted expenditure and estimated costs).

http://www.nao.org.uk/pn/05-06/05061173.htm

Health Direct notes that the NAO has three key worries for the future strategy of the NPfIT project:

Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS,
Ensuring that NHS organisations can and do fully play their part in implementing the Programme’s systems.
Winning the support of NHS staff and the public in making the best use of the systems to improve services.

Yes the NAO is right on every count. Unfortunately, their report does nothing to address these issues.

On the first point, Health Direct pointed out on Monday, March 20, 2006 that the NPfIT NHS plan is evolving but one-size-fits-all is a fundamental flaw, says hospital chief “When the NHS is fragmenting as Sir Jonathan Michael, a top NHS executive, who spoke at a healthcare symposium at London's City University pointed out there is a fundamental flaw in the NHS's IT-driven modernisation. The flaw Michael sees in the National Programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising.”

On the second and third points the NHS front line staff are now so over stretched that they cannot afford the extra time that the NpfIT programme needs:on Thursday, June 08, 2006 we warned that Trusts pay to end NPfIT staff supply contracts in red tape chaos " National Health Service trusts are having to buy themselves out of a commitment to supply staff to companies building the NPfIT electronic patient record system. Trusts in the south are paying Fujitsu £19m after the service found it could not provide 50 NHS employees to help with the programme."