Derek Wanless, a founding father of the world’s largest civil IT-based programme, has questioned whether it should continue without an audit of technical aspects, finances and benefits.
Representatives of Derek Wanless, former Group Chief Executive of Natwest bank, had attended a seminar at 10 Downing Street in February 2002, chaired by Tony Blair, which led to the NHS’s National Programme for IT [NPfIT], the UK’s largest technology investment.
A report by Wanless in 2002 has been cited by NHS Connecting for Health, which runs large parts of the NPfIT, as a document that lay behind the drawing up of 21st Century IT – the strategy paper which launched the national programme. The Wanless report had called for a large increase in spending on IT to support improvements in productivity, self-help for patients and NHS treatment.
Now Wanless, five years on, has published a report on how the NHS has spent extra billions of pounds allotted to IT and other parts of the health service. Embarking on the report’s research he had said: “We want to get the facts on the table.”
He had also said he wanted his report to take political points scoring out of the NHS.
The new report makes points that mirror those made by 23 leading academics and by Computer Weekly in its campaign for an independent review of the NPfIT.
Wanless called for NHS Connecting for Health to be “subject to detailed external scrutiny – and reporting”.
“There is a need for an audit of the technical aspects of the Connecting for Health programme and the financial costs and benefits before deciding whether or not to continue with the implementation of current plans.
“Unless there is greater clarity about the costs and benefits of the programme, it will be difficult to make assessments of the long-term costs and investment needs of the NHS.
“It is recommended that Connecting for Health is subject to detailed external scrutiny and reporting so that forecasting of long-term costs and benefits can be made with more confidence.”
But the findings of the latest Wanless report conflict directly with the government’s repeated announcements that it has no intention of commissioning an external published review of the NPfIT.
And the government rejected a recommendation of the all-party Public Accounts Committee in April 2007 that there should be an independent review of the business case for the NPfIT in the light of progress and experience to date.
Wanless criticised the government’s “apparent reluctance to audit and evaluate the programme”.
He said that NHS Connecting for Health “has so far made negligible investments of less than £0.5 million in evaluation, a fraction of the projected £12.4 billion costs”.
Wanless also covered the point made in Computer Weekly’s campaign that those running the programme cannot be credited with a success or held to account for a failure because the programme has no end date and so does not reach a point at which its outcome can be judged.
Wanless said: “There seems a real risk that the costs and benefits of NPfIT will never be accurately assessed.”
The report found that the NHS is now in better share than in 2002 to deliver improved quality and increased productivity but “huge challenges” remain.
He said: “It is difficult to understand why Connecting for Health is being allowed to pursue a high-cost, high-risk strategy that cannot be supported by a business case.”
He also said that the national programme may create monopolies of suppliers.
“Connecting for Health chose to award a small number of large contracts to consortia charged with designing and implementing the technologies. But they could instead have set out to create a competitive market for IT goods and services. Is it possible that a robust business case could be created, even now, with a focus on strategies for encouraging a healthy market?”
The Wanless report will give add much extra credibility to the campaign for an independent review. Its contents will be drawn to the attention of MPs when Parliament returns this autumn.