Behind the scenes of Public Accounts Committee report on NHS National Programme for IT

Behind the scenes experts at the National Audit Office have played a key role in helping to produce the report of the Public Accounts Committee on the National Programme for IT [NPfIT]

Last June the NAO produced a report on the NPfIT. In the same month MPs on the PAC then questioned senior civil servants on the NAO’s findings, including Sir Ian Carruthers, Acting Chief Executive of the NHS and Richard Granger, NHS Director General of IT.

Then officials at the Department of Health submitted papers to the committee to answer points raised by the committee’s MPs. Independent experts and others, too, submitted papers.

Several months later the NAO, weighing up all the evidence, produced a secret first draft of the PAC’s report. This draft was considered by the PAC in private. The NAO then reviewed for credibility and accuracy any changes to the first draft and the PAC’s final report was issued today [17 April].

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NHS IT plan's failings: I have read only some of the editorial regarding the above. I find myself asking some basic questions and making some general observations regarding this programme of work.

(1) Why were the key ICT supplier contracts designed to allow principle suppliers to leave a programme without any accountability? I recall a much smaller programme, which I was running which tied me into final delivery.

(2) Who's responsible for this folly?

(3) Was there clear endorsement form key stakeholders (MDs doctors who run surgeries) for this programme, because doctors I have spoken to were not on board with the programme.

(4) How much of the budget was spent on the key suppliers writing the benefits realisation documents, which now look very much like failing to deliver.

(5) Why has the Public Accounts Committee delivered their message so late in the programme diary?

(6) This programme of work always looked to my mind like the icing on top of an NHS cake, which had several layers missing. Surely, one gets the basics with the NHS right first. If you want to throw the public's purse at something worthwhile then consider purchasing more CT or MRI scanners and staff to run them. You may have a better chance of curing some cancers if you had thought about using the monies in that way.

Fundamentally, someone has at sometime gambled upon spending public funds on a programme, which on paper looked like getting approval, without carefully considering the risks, and the real benefits of this undertaking compared with other less sexy options.

Too much has been spent for too long on an ill thought out gamble.

This has been a runaway train without any accountability.

For the purpose of simplicity, you can consider a programme as being in one of three states:

(1) In Control: the pilot at the controls of the aircraft, flying straight and steady

(2) Not in control: the pilot at the controls, but asleep

(3) Out of control: an aeroplane without a pilot at the controls.

You can make your own mind up about which category this programme fits into!

Question: would the release of funds had been so quick, would the appropriate levels of control been missing if the minister administrating the funds lost their job and pension because of these catastrophic errors?