After a nine-month inquiry into the NHS's
National Programme for IT, the House of Commons Public Accounts
Committee has today (17 April) published a
forceful and authoritative report, the ramifications of which
could be felt for years.
The committee's concerns contrast with the
comments in January of David Nicholson, chief executive of the
NHS. He told an invited audience that though there were some big
issues to tackle on the NPfIT, the programme was "not widely off
course".
He added that he saw no evidence of a need for an independent
review of the scheme - as called for by
23 leading academics last year.
Now, however, there is that evidence.
The committee's report - which was drafted initially by the
National Audit Office - depicts the NPfIT as a failure so far. It
also finds that in some respects the programme might have done more
harm than good, by inhibiting innovation and progress.
The strongest criticisms are left to the report's final
paragraph. It simply questions whether the 10-year contracts -
which could cost taxpayers £6.2bn - will bring significant clinical
benefits by the time they expire.
This single conclusion undermines the credibility of the
programme.
The main component of the NPfIT is a national Care Records
Service, which should allow authorised clinicians to access an
accurate and informative electronic patient record wherever and
whenever it is needed. Local service providers BT, Fujitsu, CSC and
Accenture have signed contracts to supply a
Care Records Service.
But that last paragraph of the report says, "The local service
providers were contracted to deliver local Care Records Systems to
NHS organisations in three phases. Phases two and three are the key
to the delivery of clinical benefits and are the core of the
business case for the high-cost local service providers'
contracts
"Phase one - the least important from a clinical point of view
because it contains mainly administrative functionality - is
already late, with no published dates for its completion. The
implementation of phases two and three, may, therefore, scarcely
have begun by the time the local service providers were originally
contracted to have implemented completely all three phases to all
hospitals and trusts in England."
Elsewhere in its 175 pages, the report says:
● A considerable number of trusts that previously had no
corporate patient administration system have been supplied with
iSoft's old patient administration system, which pre-dates the
programme.
● Serious problems with systems that have been deployed "will be
contributing to resistance from clinicians". Clinical professions
should be asked if they are satisfied that the systems have been
specified adequately.
● Given the slippage on delivery of systems against contracts,
the Department of Health should "commission an urgent independent
review of the performance of local service providers against their
contractual obligations".
● The programme has "focused too narrowly on the delivery of IT
systems at the expense of the proper consideration of how best to
use IT within a broader process of business change".
● Trusts should be able to buy from a wider range of suppliers
of administration and clinical systems built to national
standards.
● The business case for the programme should be assessed in the
light of what has happened so far.
The report includes quotes from papers submitted by experts.
Anthony Nowlan, formerly a director of the NHS Information
Authority, says the specification for national systems was produced
at "breakneck speed".
Thomas Brooks, a member of the all-party Parliamentary IT
Committee, is quoted in a personal capacity. He criticises the idea
that central procurement can produce systems that meet local
requirements.
"There is no evidence to date that local service providers have
added any value to the national programme," he says.
A paper submitted by David Kwo, former NPfIT director for
London, and others, including NHS staff, says that, with the delays
in the delivery of the Care Records Service, "Local service
provider schedules are being down-scoped behind the NHS's back and
without any accountability to the local NHS trust chief executives
to whom the original vision was promised."
That paper also claims that Whitehall officials seem to be
colluding with local service providers to "make sure that the LSPs
get paid". Officials are "respraying a failure" by making trusts
responsible for local implementation.
It also says that there is a "general climate of fear resulting
from the bullying that is occurring on the ground" and trust chief
executives are being "leaned on" to implement the local service
provider products.
The Public Accounts Committee report is not wholly negative. It
acknowledges that if the NPfIT succeeds, it could "revolutionise
the way the NHS in England uses information, and make significant
improvements to the quality of patient care". But if it fails, says
the report, it could "set back IT developments in the NHS for
years, and divert money and staff time from frontline patient
services".
In defence of the programme, the Department of Health submitted
a great deal of written material to the committee, much of which is
published on the website of
Connecting for
Health, which runs the NPfIT.
The government is expected to respond to the report and its
recommendations by July.
Criticism and opportunity for NHS IT
More about the National Programme for IT in the
NHS
Tony Collins' project management blog