MPs dissect NHS IT plan's failings

Public Accounts Committee questions whether NHS IT contracts will bring significant clinical benefits and calls for National Programme for IT's business case to be reassessed

After a nine-month inquiry into the NHS's National Programme for IT, the House of Commons Public Accounts Committee has today (17 April) published a forceful and authoritative report, the ramifications of which could be felt for years.

The committee's concerns contrast with the comments in January of David Nicholson, chief executive of the NHS. He told an invited audience that though there were some big issues to tackle on the NPfIT, the programme was "not widely off course".

He added that he saw no evidence of a need for an independent review of the scheme - as called for by 23 leading academics last year.

Now, however, there is that evidence.

The committee's report - which was drafted initially by the National Audit Office - depicts the NPfIT as a failure so far. It also finds that in some respects the programme might have done more harm than good, by inhibiting innovation and progress.

The strongest criticisms are left to the report's final paragraph. It simply questions whether the 10-year contracts - which could cost taxpayers £6.2bn - will bring significant clinical benefits by the time they expire.

This single conclusion undermines the credibility of the programme.

The main component of the NPfIT is a national Care Records Service, which should allow authorised clinicians to access an accurate and informative electronic patient record wherever and whenever it is needed. Local service providers BT, Fujitsu, CSC and Accenture have signed contracts to supply a Care Records Service.

But that last paragraph of the report says, "The local service providers were contracted to deliver local Care Records Systems to NHS organisations in three phases. Phases two and three are the key to the delivery of clinical benefits and are the core of the business case for the high-cost local service providers' contracts

"Phase one - the least important from a clinical point of view because it contains mainly administrative functionality - is already late, with no published dates for its completion. The implementation of phases two and three, may, therefore, scarcely have begun by the time the local service providers were originally contracted to have implemented completely all three phases to all hospitals and trusts in England."

Elsewhere in its 175 pages, the report says:

● A considerable number of trusts that previously had no corporate patient administration system have been supplied with iSoft's old patient administration system, which pre-dates the programme.

● Serious problems with systems that have been deployed "will be contributing to resistance from clinicians". Clinical professions should be asked if they are satisfied that the systems have been specified adequately.

● Given the slippage on delivery of systems against contracts, the Department of Health should "commission an urgent independent review of the performance of local service providers against their contractual obligations".

● The programme has "focused too narrowly on the delivery of IT systems at the expense of the proper consideration of how best to use IT within a broader process of business change".

● Trusts should be able to buy from a wider range of suppliers of administration and clinical systems built to national standards.

● The business case for the programme should be assessed in the light of what has happened so far.

The report includes quotes from papers submitted by experts.

Anthony Nowlan, formerly a director of the NHS Information Authority, says the specification for national systems was produced at "breakneck speed".

Thomas Brooks, a member of the all-party Parliamentary IT Committee, is quoted in a personal capacity. He criticises the idea that central procurement can produce systems that meet local requirements.

"There is no evidence to date that local service providers have added any value to the national programme," he says.

A paper submitted by David Kwo, former NPfIT director for London, and others, including NHS staff, says that, with the delays in the delivery of the Care Records Service, "Local service provider schedules are being down-scoped behind the NHS's back and without any accountability to the local NHS trust chief executives to whom the original vision was promised."

That paper also claims that Whitehall officials seem to be colluding with local service providers to "make sure that the LSPs get paid". Officials are "respraying a failure" by making trusts responsible for local implementation.

It also says that there is a "general climate of fear resulting from the bullying that is occurring on the ground" and trust chief executives are being "leaned on" to implement the local service provider products.

The Public Accounts Committee report is not wholly negative. It acknowledges that if the NPfIT succeeds, it could "revolutionise the way the NHS in England uses information, and make significant improvements to the quality of patient care". But if it fails, says the report, it could "set back IT developments in the NHS for years, and divert money and staff time from frontline patient services".

In defence of the programme, the Department of Health submitted a great deal of written material to the committee, much of which is published on the website of Connecting for Health, which runs the NPfIT.

The government is expected to respond to the report and its recommendations by July.

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