Better to act now than conduct post mortem, says MP
The National Audit Office is launching a full-scale investigation into the £2.3bn national programme for IT in the NHS, the world’s biggest civil technology project, while it is still in its early stages.
The inquiry is unusual because past NAO investigations of this size into government IT projects, including those at the Department of Health, Inland Revenue, Passport Service, Criminal Records Bureau, Immigration and Nationality Directorate and Ministry of Defence, have focused on schemes that have gone awry.
The public spending watchdog told Computer Weekly, "It is to be expected that such an important programme will be the subject of an NAO report to Parliament. The fact that we are starting work does not imply any particular concern with the way the programme is going.
"We are starting now because it appears to us that, with the letting of the major contracts and the beginning of the inevitably long process of implementation, it is a good moment for Parliament to be given a stocktake and a forward look."
Shadow health minister and former GP Andrew Murrison said, "Well done to the NAO on its timely intervention. Better to act now than to conduct a post-mortem."
The NAO study "will examine the procurement processes used for placing the contracts; whether contracts are likely to deliver good value for money; how the [Department of Health] is implementing the programme, and the progress made so far".
It has taken the audit office a year to decide to launch an investigation. Last August it confirmed that it was to ask questions about the project, drawing on its earlier work and concerns raised by Computer Weekly and other observers.
The national programme is in the second year of an eight-year timetable. A national Care Records Service, which includes a national data spine of patient details, and a separate electronic bookings scheme, were due to start going live at the end of June. No evidence that either of these schemes have gone live has been produced by health officials, although they insist that the new systems are operational at some sites.
There has been strong support from healthcare IT professionals for the aims of the national programme which, as well as a care records and e-booking service, include e-prescriptions and a broadband infrastructure.
But there has also been criticism that contracts worth £6bn have been signed with a small number of large companies while there are many uncertainties over the design of the systems; how much the local implementations of national systems will cost; whether there is enough money for training; and whether doctors will support the new technology or changes in their business processes.
GPs who attended the local medical committee conference of the British Medical Association in June, voted not to engage with the care records service until their concerns about system uncertainties and lack of consultation are answered.
Last week Manpreet Pujara, head of a group which represents thousands of GPs who use the end-to-end IT medical system Emis, added to criticisms of aspects of the national programme and suggested that the National Audit Office investigate it.
In a letter to about 5,000 GP practices, Pujara expressed concern about plans to replace existing tried and tested clinical systems with new products supplied by the Department of Health’s selected local service providers.
"Do we really want a new clinical system developed in recordbreaking time with little clinical involvement and no proven track record?
"The government does not need to spend millions of pounds to replace GP systems that are working well for practices and
will continue to do so for the foreseeable future," Pujara wrote. Emis users comprise 55% of GPs in England.
In preparing for its investigation, the NAO has asked the national programme how it had identified high-level risks and what arrangements exist for managing them. Auditors have also asked what local arrangements exist for gaining the commitment of clinicians to use new systems.
There has been evidence from surveys by online researcher Medix that most clinicians support the aims of the national programme but fewer than 5% believe that there has been adequate consultation.
The audit office expects to publish its report next summer. But it could be delayed by health officials taking time to answer NAO queries. In the mid-1990s the Department of Health was accused by MPs of delaying by a year a critical NAO report into Read Codes, an IT-based thesaurus of medical terms.
The NAO inquiry’s findings may not necessarily be critical: auditors could give a positive endorsement of the national programme.
A spokesman for the national programme for IT said the projects will affect everyone in England. "It is only natural, and it has always been expected, that such an important programme should be the subject of an NAO report. Having largely completed our procurement phase and being well into initial implementation, this is naturally an appropriate time for such a report to be done and we welcome it," he said.