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.
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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.