Audit Office praises progress but warns of delivery challenges.
MPs and IT experts have renewed their calls for an independent review of the NHS’s national IT scheme following the publication of the long-delayed report on its progress by public spending watchdog the National Audit Office.
The report found that the National Programme for IT (NPfIT) has made “substantial progress” since the scheme was launched in 2002, but warned that important parts of the modernisation plan had fallen behind schedule.
The National Audit Office said it was too early to tell if the project would give value for money and highlighted “significant challenges ahead” around systems delivery and the need to win support from medical professionals and the public.
Despite the positive tone of much of the report, Edward Leigh, chairman of the Public Accounts Committee, which will hold a hearing on the NPfIT on 26 June, warned, “Already the signs are ominous.”
If the project is to succeed, he said, “It not only has to be delivered on time and to budget, but also win the hearts and minds of the staff who work daily in the NHS. This is not happening at the moment. Many staff, including GPs, are alarmed and dispirited by having the new systems imposed by diktat from above.”
Paul Cundy, a spokesman for the British Medical Association’s GPs Committee, said, “The report appears to have been largely drawn up about six months ago. In the light of information that has come out since then, the National Audit Office report looks benign.”
Martyn Thomas, one of 23 experts in computer-related sciences who signed an open letter to the House of Commons Health Committee which called for an independent review of the programme, said after the publication of the National Audit Office report, “It is more important than ever that the current status of the programme is examined independently to decide whether the right systems are being built, as well as whether they are being built correctly.”
MP Richard Bacon, a member of the Public Accounts Committee, said some clinicians and hospital managers would be reassured by the wording in the generally positive report. But others, struggling with delayed implementations, poorly functioning software and budget uncertainties would be surprised by the tone.
“I am aware there has been hand-to-hand fighting over the wording of this report. This shows the extraordinary sensitivity of Connecting for Health and the Department of Health to any objective criticism of the national programme and highlights the need for an independent review to supplement the work of the National Audit Office.
“Nobody wants this scheme to fail and the questions raised by the National Audit Office, to which we do not always have clear answers, justify an independent review to supplement the NAO’s work.”
His concerns were echoed by MP Tom Brake, a former consultant at Capgemini who has signed an early day motion calling for an independent review of the NPfIT.
“We need to take stock and assess the programme’s viability before many more billions have been spent. The National Audit Office’s report I believe strengthens the calls for an independent review,” he said.
“Work on the programme could continue in parallel with a review, and still give the taxpayer the reassurance we need that this is a sound and cost-effective programme.”
MP Mike Penning, a member of the Health Select Committee and co-sponsor of an early day motion in support of an independent inquiry, said, “This is a massive project which will cost millions and will have a massive effect on healthcare in the country. With that in mind, it is obvious there should be an independent audit of the whole project. I will be continuing to push for this and, particularly in the light the National Audit Office report, for a major inquiry by the Health Committee.”
Will NHS project cost £37bn?
The National Audit Office report has added to confusion surrounding the total cost of the National Programme for IT in the NHS. The report identified an extra £3bn centrally funded spending on the programme, in addition to the £6.2bn price of the initial contracts let in 2003 and 2004.
On top of the £9.2bn central spending on the programme, the National Audit Office suggested that, based on 2003/2004 estimates, the costs of implementing the programme across the country, which are born locally, would be £3.4bn.
This would bring the total programme costs to £12.6bn.
This figure appears to contradict an October 2004 statement from health officials after Computer Weekly said that the programme could cost a minimum of £18.6bn – at least three times more than the announced figure.
“It is generally accepted in the IT industry that implementation costs are some three to five times the cost of procurements. That is reflected in the business case that was made for the national programme,” said a Department of Health spokesman in 2004, who maintained that the initiative would “undoubtedly deliver benefits and savings beyond its costs”.
If this formula still applies, with central costs now at £9.2bn, the total cost of the programme could be more than £37bn, said Richard Bacon, an MP on the Public Accounts Committee.
Challenges facing the project
The National Audit Office report said that successful implementation of the National Programme for IT continues to present significant challenges for the Department of Health, NHS Connecting for Health and the NHS, especially in three key areas:
● Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS, and to agreed timescales without further slippage.
● Ensuring that NHS organisations play a full part in implementing systems.
● Winning the support of NHS staff and the public in making the best use of the systems to improve services.
Source: Department of Health: The National Programme for IT in the NHS, National Audit Office, HC 1173