Plans for the NHS’s national IT scheme are feasible – but the main software is running four years behind, and may not be fully rolled out until 2015, according to a report published today [16 May 2008] by the National Audit Office.
Angela Hands, an author of the NAO report, told Computer Weekly that there is a risk the care records service – which includes plans to give 50 million people in England an electronic medical record – may not be complete even by 2015.
The original plans discussed at Downing Street in February 2002 were for the National Programme for IT [NPfIT] to run for three years, until 2006. Later ministers said the aim was to have the programme completed by 2010.
In today’s report (16 May 2008) the National Audit Office (NAO) said: “Current indications are that it is likely to take some four years more than planned – until 2014-15 – before every NHS trust has fully deployed the Care Records Service.”
But this projection is based on the “Lorenzo” software supplied by CSC and its subcontractor IBA Health being fit for purpose when it is first delivered this summer. The NAO report said: “There remains considerable uncertainty over the delivery schedule for Lorenzo.”
The House of Commons’ Public Accounts Committee is expected to question civil servants on the NAO’s report next month. Richard Bacon MP, a member of the committee, said:
“The latest National Audit Office report could not be clearer. The £12.7 billion national programme for IT in the National Health Service is in crisis. The report shows that key systems are late and show little or no sign of ever being produced in any useful form.
“While systems that are suitable for central deployment such as the N3 broadband link and the Picture Archiving Communications Systems for digital x-rays have made good progress, the serious problems lie with the really complex systems for acute hospitals where central control is manifestly not working”.
The NAO report praised NHS staff for their hard work and commitment so far to installing national systems. It said original timescales for the Care Records Service proved unachievable, raised expectations and “put confidence in the programme at risk”. It added that the original vision for the Programme remains intact and still appears feasible.
One of the questions raised by the report is whether more trusts – particularly foundation trusts – will be concerned about the quality, reliability or functionality of some national systems and buy core products outside the NPfIT – although the national programme was set up largely to counteract fragmented buying in the NHS.
The NAO report said that Whitehall may have to pay fines to local service providers, BT, Fujitsu and CSC, if trusts do not buy from them. The contracts with local service providers are based on their systems being deployed at all NHS trusts at some point.
“Foundation trusts cannot now be forced to take the [NPfIT] systems and should any elect not to do so there will be financial implications for both the trusts concerned and the Programme,” said the NAO.
But David Nicholson the NHS’s Chief Executive and senior responsible owner of the NPfIT, has “directed the Strategic Health Authorities to ensure that other NHS organisations meet the expectations of the contracts”, said the NAO.
Auditors criticised communications about the programme which have “tended to date to focus on achievements rather than what remains to be done”.
In February 2007 the Department of Health gave a confidential written briefing to Downing Street on the state of the NPfIT. It said: ” … the key challenges and risks to delivery are now not about the technology to support NPfIT but about attitudes and behaviours which need to be the focus of senior management and ministerial attention as we move forward ….much of the programme is complete with software delivered to time and to budget.”