Whitehall spending watchdog examines £2.3bn NHS IT plan

The National Audit Office wants to know how the Department of Health will manage risks.

The National Audit Office wants to know how the Department of Health will manage risks.

The Department of Health's £2.3bn national programme for IT is under scrutiny by government spending watchdog the National Audit Office.

The NAO plans to question how the department has identified high-level risks for the IT programme and what arrangements exist for managing them. It also wants to see what local arrangements exist for gaining the commitment of clinicians to use new systems.

The NAO has already been in discussions with the Department of Health over the national programme for IT and now says it plans to ask a series of questions drawn from its earlier work and concerns raised by Computer Weekly and other observers.

Its enquiries could lead to no further action. But should the NAO decide to produce a report for Parliament, this would be a highly unusual step. The agency does not normally report on a project that is still in its early stages. Any findings by the NAO may not necessarily be critical: auditors could give a positive endorsement of the national programme.

Charles Hughes, director of eManagement, a consultancy specialising in the public sector, said it was rare for the NAO to report in the early stages of a project and its involvement was "good news".

He said, "I would like to see the NAO involved at earlier stages in projects. In its reports are lessons of great import but usually these are studied retrospectively."

Among the 20,000 IT professionals in the NHS, many have welcomed the national programme for IT, which comprises four main elements: electronic booking of appointments, electronic records, e-prescriptions and a new infrastructure.

But because previous national IT schemes have failed, there are concerns that the new projects will not achieve their goal of making a major difference to the quality of healthcare to patients.

In a new joint position paper on the national programme, the British Computer Society's Health Informatics Committee and the Association for ICT Professionals in Health and Social Care said, "We must work together or risk spending the money but not delivering the solutions. We are faced with a once-in-a-lifetime opportunity; we must not just plan to avoid failure."

Last week the NAO said, "We have asked the department [of Health] to demonstrate to us how it has incorporated the lessons drawn from earlier projects, focusing on the overall strategy for the national programme and the department's preparations for the programme's implementation." The NAO also wants to examine the "robustness of the business case" and funding requirements.

A spokesman for the NHS national programme denied that the NAO is conducting an investigation.

However, the NAO confirmed it is asking questions about the national programme for IT.

It said it had highlighted important lessons from health and other IT projects, including the 1992 and 1998 Information Management and Technology Strategy for the NHS. "Since then we have seen continuing problems in IT projects, most recently the Libra project for magistrates courts," said the NAO.

In its report on the failure of Libra to provide a national caseworking system, the NAO found that officials had been unable to force business change on end-users and it criticised the Lord Chancellor's Department, which had "sought automation as a priority before questioning the existing business processes".

Responding to this, the Department of Health said of the national programme for IT, "Prior planning and preparation will allow business change to be implemented alongside the introduction of IT. Business change can be planned for but not implemented in advance as the new IT systems are needed to enable the change in processes."

The NAO report published in 1999 on the NHS' 1992 and 1998 IT strategies found that there had been business cases for individual national schemes but no overarching justification for all of the projects.

On this, a spokesman for the NHS national programme for IT said, "There is a high-level, overarching business justification for the national programme that is supplemented by detailed business cases for each individual area of the programme". The spokesman confirmed that the overarching business case has not been published.

The NAO also found in its reports on past health IT projects that there had been a reluctance by clinicians to use some systems.

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