NHS trusts face potential funding gap as they struggle to meet patient care commitments
The IT-led modernisation of the health service could cost a minimum of £18.6bn - at least three times more than the announced figure - with a large part of the bill falling locally, on NHS trusts.
The estimated 10-year cost of the NHS' national programme for IT (NPfIT) raises questions over whether trusts, some of which are in the red, will be able to fund all their commitments to make the initiative a success.
Trust staff and GPs throughout England want the programme to succeed. But some trusts are warning that money for the NPfIT may eat into local budgets that are for direct patient care.
Computer Weekly has learned that officials at the Department of Health have estimated the total implementation costs of the national programme at between £18.6bn and £31bn. The programme includes a care records service to give 50 million patients in England an electronic health record, Choose and Book to allow people to select hospital appointments from a choice of dates and locations, and new local IT infrastructures.
After the programme was announced in 2002, the government allocated £2.3bn central funding for the national systems over three years. Since then the procurement figure has risen to £6.2bn over 10 years. But now it has emerged that a further £12bn to £24bn may need to be spent, a large part of it locally. Much of this extra money has yet to be found and there is no clarity over whether it will materialise.
If the resources are not found, and trusts cannot afford local implementation costs, there is a risk that some of the £6.2bn procurement will be spent on advanced systems that go largely unused by doctors and nurses.
The latest figures came to light after a senior official on the national programme told a private meeting in August that the total cost of implementation could reach five to eight times that of the procurement costs.
After Computer Weekly put this to the NPfIT, a spokesman said the official had based his estimates on US experiences. The spokesman added, "[The official's comment] relates to a study by the Institute of Healthcare Improvement in the US. It has some relevance for the UK but is not comparing like with like."
The spokesman confirmed, however, that the business case for the NPfIT estimates the total cost to be three to five times that of the procurement costs, which are £6.2bn so far.
"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 the spokesman, who maintained that the initiative will "undoubtedly deliver benefits and savings beyond its costs."
The NPfIT, backed by Tony Blair, is one of the UK's biggest engineering projects, with an estimated lifetime cost of 1.5 times that of the Channel Tunnel. But if the initiative does not live up to expectations, it would be one of the biggest technological failures in history.
Who will pay?
MP Richard Bacon, a member of the House of Commons Public Accounts Committee, said, "Most hospital trusts are very stretched. Many already have big deficits. I would like to know where all the money is coming from to pay for this project. "If trusts are not given the money to pay for the programme, how are they going fund it? Will this mean patients waiting even longer for treatment while billions of pounds are spent on unproven systems?"