Audit Office praises progress but warns of delivery
challenges.
MPs and IT experts have renewed their calls for an independent
review of the NHS’s national IT scheme following the publication of
the long-delayed report on its progress by public spending watchdog
the National Audit Office.
The report found that the National Programme for IT (NPfIT) has
made “substantial progress” since the scheme was launched in 2002,
but warned that important parts of the modernisation plan had
fallen behind schedule.
The National Audit Office said it was too early to tell if the
project would give value for money and highlighted “significant
challenges ahead” around systems delivery and the need to win
support from medical professionals and the public.
Despite the positive tone of much of the report, Edward Leigh,
chairman of the Public Accounts Committee, which will hold a
hearing on the NPfIT on 26 June, warned, “Already the signs are
ominous.”
If the project is to succeed, he said, “It not only has to be
delivered on time and to budget, but also win the hearts and minds
of the staff who work daily in the NHS. This is not happening at
the moment. Many staff, including GPs, are alarmed and dispirited
by having the new systems imposed by diktat from above.”
Paul Cundy, a spokesman for the British Medical Association’s
GPs Committee, said, “The report appears to have been largely drawn
up about six months ago. In the light of information that has come
out since then, the National Audit Office report looks benign.”
Martyn Thomas, one of 23 experts in computer-related sciences
who signed an open letter to the House of Commons Health Committee
which called for an independent review of the programme, said after
the publication of the National Audit Office report, “It is more
important than ever that the current status of the programme is
examined independently to decide whether the right systems are
being built, as well as whether they are being built
correctly.”
MP Richard Bacon, a member of the Public Accounts Committee,
said some clinicians and hospital managers would be reassured by
the wording in the generally positive report. But others,
struggling with delayed implementations, poorly functioning
software and budget uncertainties would be surprised by the
tone.
“I am aware there has been hand-to-hand fighting over the
wording of this report. This shows the extraordinary sensitivity of
Connecting for Health and the Department of Health to any objective
criticism of the national programme and highlights the need for an
independent review to supplement the work of the National Audit
Office.
“Nobody wants this scheme to fail and the questions raised by
the National Audit Office, to which we do not always have clear
answers, justify an independent review to supplement the NAO’s
work.”
His concerns were echoed by MP Tom Brake, a former consultant at
Capgemini who has signed an early day motion calling for an
independent review of the NPfIT.
“We need to take stock and assess the programme’s viability
before many more billions have been spent. The National Audit
Office’s report I believe strengthens the calls for an independent
review,” he said.
“Work on the programme could continue in parallel with a review,
and still give the taxpayer the reassurance we need that this is a
sound and cost-effective programme.”
MP Mike Penning, a member of the Health Select Committee and
co-sponsor of an early day motion in support of an independent
inquiry, said, “This is a massive project which will cost millions
and will have a massive effect on healthcare in the country. With
that in mind, it is obvious there should be an independent audit of
the whole project. I will be continuing to push for this and,
particularly in the light the National Audit Office report, for a
major inquiry by the Health Committee.”
Will NHS project cost £37bn?
The National Audit Office report has added to confusion
surrounding the total cost of the National Programme for IT in the
NHS. The report identified an extra £3bn centrally funded spending
on the programme, in addition to the £6.2bn price of the initial
contracts let in 2003 and 2004.
On top of the £9.2bn central spending on the programme, the
National Audit Office suggested that, based on 2003/2004 estimates,
the costs of implementing the programme across the country, which
are born locally, would be £3.4bn.
This would bring the total programme costs to £12.6bn.
This figure appears to contradict an October 2004 statement from
health officials after Computer Weekly said that the programme
could cost a minimum of £18.6bn – at least three times more than
the announced figure.
“It is generally accepted in the IT industry that implementation
costs are some three to five times the cost of procurements. That
is reflected in the business case that was made for the national
programme,” said a Department of Health spokesman in 2004, who
maintained that the initiative would “undoubtedly deliver benefits
and savings beyond its costs”.
If this formula still applies, with central costs now at £9.2bn,
the total cost of the programme could be more than £37bn, said
Richard Bacon, an MP on the Public Accounts Committee.
Challenges facing the project
The National Audit Office report said that successful
implementation of the National Programme for IT continues to
present significant challenges for the Department of Health, 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 play a full part in
implementing systems.
● Winning the support of NHS staff and the public in making the
best use of the systems to improve services.
Source: Department of Health: The National Programme for IT
in the NHS, National Audit Office, HC 1173