My pick of the best parts of yesterday’s debate in the House of Commons on the NPfIT is below. Several things struck me:
– £600m in savings is less than the increase in the costs of the central NPfIT contracts, which have risen from £6.2bn to about £7.5bn.
– Andy Burnham, the Health Secretary, refused repeatedly to answer questions about the added costs of varying the contracts with the local service providers BT and CSC to achieve some of the announced savings.
– Why did the Chancellor Alistair Darling say the that the NPfIT was not essential to the frontline while Andy Burnham gave the opposite impression? Is it simply that the Treasury has a negative view of the costly NPfIT and the Department of Health is defending its biggest project? [One MP says the NPfIT cuts are a way for the Government to remove from the Tories any scope for using savings from the NPfIT as as means to fund a new Tory proposal in the run-up to an election.]
From yesterday’s debate:
Andy Burnham, Secretary of State for Health:
“I can give the House this update. My aim in conducting this [cost-cutting] exercise has been to ensure that the elements of the IT programme that can deliver most benefit to patients and front-line staff are taken forward, while cancelling certain additions to the system where it makes sense to do so.
“Let me be absolutely clear: we have no intention whatsoever of cancelling the programme overall, not least because it is already making the NHS safer, more efficient and more convenient for patients.
“However, we are discussing with our suppliers [BT and CSC] potential reductions to the scope of the systems and the cost savings that could be generated.
“In addition, we are looking seriously into the internal savings that can be made from the costs of running the programme.
“In the light of that work, I can confirm to the House that we are working towards achieving a reduction of £600 million in the lifetime costs of the programme.
“That means that we will now pare back the programme to the core elements that have been identified as critical by clinicians. Our aim is to give trusts more flexibility and choice of IT systems, within a framework provided by existing contracts, to keep the benefits of a national approach.
“Specifically, that could include the IT systems that clinicians have told us are most important to them, such as electronic prescribing; enabling local innovation to take place by linking national systems with those provided by local service providers; and allowing the NHS to design IT systems to fit its local needs…
“The hon. Gentleman asked about the care records system. That will be a matter for local choice. I said in my statement that we wanted to create a system in which acute hospitals had more choice and flexibility in relation to their IT requirements within a national system.
“He seems to reject the benefits of a national system across the NHS, but we do not. We believe that there are significant benefits from a national health service having a programme of IT that can link up clinicians across the system. We further believe that it is safer for patients if their records can be accessed across the system.
“We can make savings and pare the system down to the core elements that have been identified as important by the clinical community. If I may, let me give the hon. Gentleman a specific example of those changes. We have made a big investment in GP systems. GP systems are working well across the country and have high levels of satisfaction. GPs are happy with them and they are internationally recognised.
“Recognising that, we have agreed that we will not now go ahead with the replacement of further enhancements to that system, because people are happy with it. It is working well, and technology makes it possible for those parts of the system to talk to other parts…
“My hon. Friend is right to focus on the potential benefit of electronic prescribing. In my view, it could be further developed. He cites a figure for electronic transfer between GP surgeries and pharmacies, and I think that there is scope for further progress so that we could move to a paperless system for prescriptions. I will give him an update in due course, but this is an important area that is working. As I said in my statement, where the system is working, we will press on and ensure that we derive full benefits for the NHS front line.
Richard Bacon, Conservative, a member of the Public Accounts Committee:
“Can the Secretary of State explain how the NHS could not operate without the system, as he says, while at the same time the Chancellor of the Exchequer says that it is of no value to the front line? Which is it?”
Burnham: [no direct answer]
John Baron, Conservative:
“Can the Secretary of State explain why this major IT programme was imposed from the top, rather than being user led?”
“It was both. There was a clear drive to improve IT across the NHS, and I make no apology for that. To support the reform in the NHS that this Government wanted to see, we needed a better IT system that reflected a national health service, and could be interoperable across the huge NHS system.”
Andrew Lansley, Conservative, Shadow Health Secretary:
“Will the Secretary of State have the grace to acknowledge the Government’s failure, the billions of pounds spent without delivery, the spiralling opportunity costs of delays, the confusion and frustrations over IT and choose and book, but-worst of all-the resulting lack of IT innovation in our hospitals, when it has the potential to be of such benefit to patients in managing their care and minimising errors in treatment? Will the Secretary of State just admit that they got it hopelessly wrong?
Burnham [no direct answer]
David Heath, Liberal Democrat:
“Do the enormous compensation counter-claims by suppliers of which we read represent a contingent liability against the NHS? If so, does that mean that they will be paid at the expense of front-line services? The Government’s dithering over cancellations of quite large elements of the scheme has resulted in eye-wateringly large amounts of money being sunk in a scheme that has produced nothing like the benefits claimed for it, but which has, I am afraid, used a great deal of NHS money for very little result.”
Burnham [no direct answer to Health’s point about supplier counter-claims]
David Evennett, Conservative:
“Can he advise us whether the taxpayer is likely to face any contractual penalties after his statement today?”
“We have relationships with the commercial sector here, and as I said in my statement, some are commercially sensitive. We want to deliver a successful system, while also recognising that the companies involved have contractual commitments. We are working through those issues; that is why I gave a broad update on the discussions.
“I am sure that the hon. Gentleman would accept that I cannot go into much more detail. Let me make one further point: this is about delivering a system that is affordable, but also does a good job. We are not going to do it on the cheap, as Mr. Lansley suggests.
“I fear that the proposal to hand over the job to Google or Microsoft, or whoever else the Opposition have in mind, would simply not do a secure job for the NHS. If the hon. Gentleman wanted to do things on the cheap, I think that he would pay the price later.”
Peter Bone, Conservative:
“It is absolutely unbelievable that the Secretary of State can come to this House without knowledge of the contingent liability to the NHS resulting from the cancellation of the contracts. Will he please say now what the contingent liability is, and stop dodging the question?”
“That is not what I said …We have a contractual commitment and … the discussions are commercially sensitive. I am afraid that I am not going to go into those details on the Floor of the House today, although if I can provide the hon. Gentleman with any further details through correspondence, I will do so.”
Yesterday’s House of Commons debate on the NPfIT – Theyworkforyou.com
Health Secretary announces savings of £600m and more NHS choice of IT – ComputerWeekly.com
NHS IT scheme to be scaled back – ComputerWeekly.com
What’s happening with the NPfIT? – IT Projects blog
NPfIT e-prescriptions – an important step – IT Projects blog
Turmoil over NHS IT scheme – Australian Health IT
IEEE comment on Alistair Darling’s NPfIT announcement – Risk Factor
Darling and Burnham are sayin different things – Downing St says