Better to act now than conduct post mortem, says
MP
The National Audit Office is launching a full-scale
investigation into the £2.3bn national programme for IT in the NHS,
the world’s biggest civil technology project, while it is still in
its early stages.
The inquiry is unusual because past NAO investigations of this
size into government IT projects, including those at the Department
of Health, Inland Revenue, Passport Service, Criminal Records
Bureau, Immigration and Nationality Directorate and Ministry of
Defence, have focused on schemes that have gone awry.
The public spending watchdog told Computer Weekly, "It is to be
expected that such an important programme will be the subject of an
NAO report to Parliament. The fact that we are starting work does
not imply any particular concern with the way the programme is
going.
"We are starting now because it appears to us that, with the
letting of the major contracts and the beginning of the inevitably
long process of implementation, it is a good moment for Parliament
to be given a stocktake and a forward look."
Shadow health minister and former GP Andrew Murrison said, "Well
done to the NAO on its timely intervention. Better to act now than
to conduct a post-mortem."
The NAO study "will examine the procurement processes used for
placing the contracts; whether contracts are likely to deliver good
value for money; how the [Department of Health] is implementing the
programme, and the progress made so far".
It has taken the audit office a year to decide to launch an
investigation. Last August it confirmed that it was to ask
questions about the project, drawing on its earlier work and
concerns raised by Computer Weekly and other observers.
The national programme is in the second year of an eight-year
timetable. A national Care Records Service, which includes a
national data spine of patient details, and a separate electronic
bookings scheme, were due to start going live at the end of June.
No evidence that either of these schemes have gone live has been
produced by health officials, although they insist that the new
systems are operational at some sites.
There has been strong support from healthcare IT professionals
for the aims of the national programme which, as well as a care
records and e-booking service, include e-prescriptions and a
broadband infrastructure.
But there has also been criticism that contracts worth £6bn have
been signed with a small number of large companies while there are
many uncertainties over the design of the systems; how much the
local implementations of national systems will cost; whether there
is enough money for training; and whether doctors will support the
new technology or changes in their business processes.
GPs who attended the local medical committee conference of the
British Medical Association in June, voted not to engage with the
care records service until their concerns about system
uncertainties and lack of consultation are answered.
Last week Manpreet Pujara, head of a group which represents
thousands of GPs who use the end-to-end IT medical system Emis,
added to criticisms of aspects of the national programme and
suggested that the National Audit Office investigate it.
In a letter to about 5,000 GP practices, Pujara expressed
concern about plans to replace existing tried and tested clinical
systems with new products supplied by the Department of Health’s
selected local service providers.
"Do we really want a new clinical system developed in
recordbreaking time with little clinical involvement and no proven
track record?
"The government does not need to spend millions of pounds to
replace GP systems that are working well for practices and
will continue to do so for the foreseeable future," Pujara
wrote. Emis users comprise 55% of GPs in England.
In preparing for its investigation, the NAO has asked the
national programme how it had identified high-level risks and what
arrangements exist for managing them. Auditors have also asked what
local arrangements exist for gaining the commitment of clinicians
to use new systems.
There has been evidence from surveys by online researcher Medix
that most clinicians support the aims of the national programme but
fewer than 5% believe that there has been adequate
consultation.
The audit office expects to publish its report next summer. But
it could be delayed by health officials taking time to answer NAO
queries. In the mid-1990s the Department of Health was accused by
MPs of delaying by a year a critical NAO report into Read Codes, an
IT-based thesaurus of medical terms.
The NAO inquiry’s findings may not necessarily be critical:
auditors could give a positive endorsement of the national
programme.
A spokesman for the national programme for IT said the projects
will affect everyone in England. "It is only natural, and it has
always been expected, that such an important programme should be
the subject of an NAO report. Having largely completed our
procurement phase and being well into initial implementation, this
is naturally an appropriate time for such a report to be done and
we welcome it," he said.
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