Today's
report of the Public Accounts Committee on the £12.7bn National
Programme for IT, the world's largest civilian computer scheme,
says it is not yet providing value for money - though the project
has existed for nearly seven years.
The all-party committee finds that there have been few
successful deployments of the scheme's two main hospital systems:
the Millennium system from Cerner and BT, and the
Lorenzo product from CSC and IBA Health.
The delays are despite the programme's having spent £2.4bn by
March 2007, about £700m of which went on the central costs of
supporting the programme. The committee said that the letting of
central contracts to local service providers to cover the NHS as a
whole might not have secured good value for money.
The central contracts are proving an encumbrance for the
government and to some extent the main NPfIT local service
providers BT and CSC. BT is reviewing its local service provider
contract and may write off hundreds of millions of pounds as a
result.
The contracts commit the suppliers to deliver unified systems to
the NHS, which some say is impossible in part because each trust
has different requirements. The contracts have been set up
centrally although decisions on IT deployments are taken
locally.
A further problem with the contracts is that they commit the
Department of Health to pay compensation to the suppliers if trusts
do not buy their main hospital systems from BT and CSC. Purchases
outside the NPfIT are indeed starting to happen: semi-autonomous
foundation trusts such as
Newcastle and Rotherham are not buying their patient administration
systems from CSC.
It is also possible that NHS trusts which have installed NPfIT
hospital systems may replace them with their own choice of IT.
Worthing hospital is reported by E-Health Insider to be
considering ditching its Cerner Millennium system.
The Public Accounts Committee said the department of Health
hopes that the NPfIT will make financial savings and improvements
in the care and safety of patients - but the annual statement of
benefits should be subject to an independent audit of the National
Audit Office. The annual statement has not been audited
independently.
These are some of committee main findings:
- If problems with Millennium cannot be resolved or the Lorenzo
system not satisfactorily developed it may be necessary to
"renegotiate or terminate the existing contracts with the Local
Service Providers - BT and CSC.
- Little clinical functionality has been deployed to date with
the result that the expectations of clinical staff have not been
met. This is despite the award of central contracts for the
programme five years ago.
- The department should publish surveys of NHS staff at regular
intervals [it has stopped doing so after NHS staff criticised the
NPfIT in an Ipsos-Mori survey commissioned by NHS Connecting for
Health].
- The department does not have a full picture of data security
breaches in the NHS as trusts are required to report only the most
serious incidents to the department. The committee recommends that
the department publish annually on the most serious incidents and
on any penalties imposed on suppliers for security breaches.
- The department denied the committee's request for reviews
commissioned by CSC on the delayed Lorenzo system for the NPfIT.
The committee said that confidentiality arrangements between the
department and CSC are "unacceptable" because they "obstruct
parliamentary scrutiny of the department's expenditure". The report
says, "The department made open-ended confidentiality agreements in
respect of these reviews, with the result that information will not
be disclosed even after commercial confidentiality has lapsed with
the passage of time. We believe this is improper. The department
should desist from entering into agreements of this kind."
- Trusts should not have to enter into agreements with CSC or BT
before existing problems with the deployments of Millennium have
been resolved and Lorenzo has been successfully implemented at the
pilot sites. Indeed the committee asks the department to consider
whether it would be wise for trusts to adopt Millennium or Lorenzo.
The committee says there are "considerable problems with existing
deployments of Millennium and "serious concerns about the prospects
for future deployments of Lorenzo".
Richard Bacon MP, a member of the Public Accounts Committee
whose questions have brought out much of the information in today's
report, says of the document:
"It questions the feasibility of delivering the
Care Records Service [electronic health records for up to 50
million patients] according to the original plan." He went on to
attack the NPfIT's most passionate defender, the 1,000-strong NHS
Connecting for Health, which is part of the Department of
Health.
"There has to come a point where Connecting for Health wakes up
and faces reality. After all, trusts have been facing reality for a
long time. It is not surprising some have walked away or are
considering doing so. In an environment where Lorenzo or Cerner are
not going ahead smoothly, trusts cannot take on the task of
deploying care records service where it does not work
properly."
Bacon adds, "The national programme has not provided value for
money. The time to hold on to the belief that it is possible to
make progress with Lorenzo and Cerner has gone." He said that
trusts should be allowed central funds to buy what they want,
within reason. In some cases trusts need systems badly, he
said.
Although the committee's report raises questions about the
feasibility of the NPfIT, the government is likely to reject the
main findings. A formal response by the government is expected
within two months.