Edward Leigh, chairman of Public Accounts Committee, on NHS National Programme for IT

It’s not generally realised that the National Audit Office quietly drafts press releases issued by the chairman of the Public Accounts Committee.

So it’s worth looking carefully at the wording of the press release issued by Edward Leigh, chairman of the Public Accounts Committee, over the publication of the committee’s report today [17 April 2007] on the NHS’s National Programme for IT [NPfIT].

Leigh’s press release says:

“There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected”.

So is the National Audit Office itself questioning the future of the programme? Lest there should be any doubt, Leigh’s press release adds:

“The Programme is not looking good…”

The reason the National Audit Office drafts press releases for the chairman of the Public Accounts Committee – and indeed drafts the reports of the Public Accounts Committee – is that public accounts MPs cannot be experts on every matter they scrutinise.

Unlike other committees of the House of Commons, the Public Accounts Committee sometimes has to deal with two lengthy NAO reports a week. The National Audit Office will produce a report based on a value-for-money investigation and MPs on the committee will be expected to question well-briefed civil servants on the nuances of the NAO’s report. So public accounts MPs are briefed in private by the NAO.

Leigh’s press release is in full below:

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

“There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.

“The Programme is not looking good. The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the Programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear.

“Given that the total cost of this hugely ambitious project is expected to top £12 billion – and who can be confident that even this massive sum will not be surpassed? The Department of Health is playing for high stakes indeed.

“Resolute action at this stage by the leaders of the Programme can do much to diminish the risks. The Department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including local NHS organisations, can have more confidence. It must also launch reviews of the ability of the suppliers and local service providers to deliver against their contracts.

“The leaders of the Programme have talked long and loud about the benefits which it will bring to the NHS. The time for talking has ended. If dissident clinicians are to be persuaded, then they will have to see the advanced electronic patient record systems up and running. And if these systems cannot be delivered within the framework of the Programme, then the local NHS should be given greater freedom to look for alternative systems which do work.”

Mr Leigh was speaking as the Committee published its 20th Report of this Session which examined the progress made by the Department of Health in implementing the National Programme for IT in the NHS.

In particular, the Committee examined the current status of the shared electronic patient clinical record; the costs of the Programme; the local management and implementation of the systems within the NHS; the extent to which clinicians were involved in developing the systems; the management of suppliers; and patient confidentiality.

The Committee took evidence both from the Department of Health, including its agency NHS Connecting for Health; from two former senior members of the Programme, Dr Anthony Nowlan, formerly a Director of the NHS Information Authority, and Professor Peter Hutton, former Chairman of the National Clinical Advisory Board; and from Mr Andrew Rollerson, a senior manager within Fujitsu, one of the main suppliers to the Programme, but speaking in a personal capacity.

The Committee has also received and reviewed a number of written submissions.

The National Health Service (NHS) needs modern Information Technology (IT) to help it to provide high quality services to patients. The National Programme for IT in the NHS (“the Programme”) was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale.

It constitutes the largest single IT investment in the UK to date, with expenditure on the Programme expected to be £12.4 billion over ten years to 2013-14.

The central vision of the Programme is the NHS Care Records Service, which is designed to replace local NHS computer systems with more modern integrated systems and make key elements of a patient’s clinical record available electronically throughout England (e.g. NHS number, date of birth, name and address, allergies, adverse drug reactions and major treatments) so that it can be shared by all those needing to use it in the patient’s care. The Programme also includes other services, such as electronic prescriptions, an email and directory service for all NHS staff (NHSmail), computer accessible X-rays (Picture Archiving Communication Systems), and a facility for patients to book electronically first outpatient appointments.

The stakes are high. If it succeeds in its aims, the Programme could revolutionise the way the NHS in England uses information, and make significant improvements to the quality of patient care. But if it fails, it could set back IT developments in the NHS for years, and divert money and staff time from front line patient services.

In summary, the Committee draws four overall conclusions:

• The piloting and deployment of the shared electronic patient clinical record is already running two years behind schedule. In the meantime the Department has been deploying patient administration systems to help Trusts urgently requiring new systems, but these systems are not a substitute for the vision of a shared electronic patient clinical record and no firm plans have been published for deploying software to achieve this vision.

• The suppliers to the Programme are clearly struggling to deliver, and one of the largest, Accenture, has now withdrawn. The Department is unlikely to complete the Programme anywhere near its original schedule.

• The Department has much still to do to win hearts and minds in the NHS, especially among clinicians. It needs to show that it can deliver on its promises, supply solutions that are fit for purpose, learn from its mistakes, respond constructively to feedback from users in the NHS, and win the respect of a highly skilled and independently minded workforce.

• Four years after the start of the Programme, there is still much uncertainty about the costs of the Programme for the local NHS and the value of the benefits it should achieve.

The conclusions and recommendations in this report need to be addressed and implemented by the Department if the significant public funds being invested in the Programme are to deliver the services expected by the NHS for the benefit of patients.