The National Audit Office wants to know how the Department of
Health will manage risks.
The Department of Health's £2.3bn national programme for IT is
under scrutiny by government spending watchdog the National Audit
Office.
The NAO plans to question how the department has identified
high-level risks for the IT programme and what arrangements exist
for managing them. It also wants to see what local arrangements
exist for gaining the commitment of clinicians to use new systems.
The NAO has already been in discussions with the Department of
Health over the national programme for IT and now says it plans to
ask a series of questions drawn from its earlier work and concerns
raised by Computer Weekly and other observers.
Its enquiries could lead to no further action. But should the NAO
decide to produce a report for Parliament, this would be a highly
unusual step. The agency does not normally report on a project that
is still in its early stages. Any findings by the NAO may not
necessarily be critical: auditors could give a positive endorsement
of the national programme.
Charles Hughes, director of eManagement, a consultancy specialising
in the public sector, said it was rare for the NAO to report in the
early stages of a project and its involvement was "good
news".
He said, "I would like to see the NAO involved at earlier stages in
projects. In its reports are lessons of great import but usually
these are studied retrospectively."
Among the 20,000 IT professionals in the NHS, many have welcomed
the national programme for IT, which comprises four main elements:
electronic booking of appointments, electronic records,
e-prescriptions and a new infrastructure.
But because previous national IT schemes have failed, there are
concerns that the new projects will not achieve their goal of
making a major difference to the quality of healthcare to patients.
In a new joint position paper on the national programme, the
British Computer Society's Health Informatics Committee and the
Association for ICT Professionals in Health and Social Care said,
"We must work together or risk spending the money but not
delivering the solutions. We are faced with a once-in-a-lifetime
opportunity; we must not just plan to avoid failure."
Last week the NAO said, "We have asked the department [of Health]
to demonstrate to us how it has incorporated the lessons drawn from
earlier projects, focusing on the overall strategy for the national
programme and the department's preparations for the programme's
implementation." The NAO also wants to examine the "robustness of
the business case" and funding requirements.
A spokesman for the NHS national programme denied that the NAO is
conducting an investigation.
However, the NAO confirmed it is asking questions about the
national programme for IT.
It said it had highlighted important lessons from health and other
IT projects, including the 1992 and 1998 Information Management and
Technology Strategy for the NHS. "Since then we have seen
continuing problems in IT projects, most recently the Libra project
for magistrates courts," said the NAO.
In its report on the failure of Libra to provide a national
caseworking system, the NAO found that officials had been unable to
force business change on end-users and it criticised the Lord
Chancellor's Department, which had "sought automation as a priority
before questioning the existing business processes".
Responding to this, the Department of Health said of the national
programme for IT, "Prior planning and preparation will allow
business change to be implemented alongside the introduction of IT.
Business change can be planned for but not implemented in advance
as the new IT systems are needed to enable the change in
processes."
The NAO report published in 1999 on the NHS' 1992 and 1998 IT
strategies found that there had been business cases for individual
national schemes but no overarching justification for all of the
projects.
On this, a spokesman for the NHS national programme for IT said,
"There is a high-level, overarching business justification for the
national programme that is supplemented by detailed business cases
for each individual area of the programme". The spokesman confirmed
that the overarching business case has not been published.
The NAO also found in its reports on past health IT projects that
there had been a reluctance by clinicians to use some systems.