The government's spending watchdog finds much to praise in its report on the NHS programme, but costs are predicted to be £6bn over original estimates
After an 18-month investigation, public spending watchdog the National Audit Office has published a 60-page report into the NHS’s National Programme for IT (NPfIT).
The findings are “very positive” said Lord Warner, the health minister responsible for the project. It is the UK’s largest ever IT investment and the world’s largest healthcare IT programme.
The long delayed report has been eagerly awaited, not least because it is one of the first published, independent overviews of this crucial project.
It commends Connecting for Health, an agency of the Department of Health that is running the IT part of the programme, for its strong management of the scheme.
It also lists the progress of the IT programme to April 2006 and some of the successes in the deployment of new systems in NHS trusts and GP practices.
The report looks at the programme’s origins, the support it has in Westminster and Whitehall, its procurement processes and preparations being made to roll out the core Connecting for Health systems across the NHS, and it makes recommendations.
The National Audit Office said Connecting for Health had learnt many lessons from previous public sector IT project failures and it praised the “tight control” exerted over the NPfIT’s contractors.
The report said, “The department and NHS Connecting for Health have made substantial progress with the programme. They have established management systems and structures to match the scale of the challenge. They successfully placed contracts very quickly, after securing large reductions in prices from bidders and contract terms that include important safeguards to secure value for money for the taxpayer.”
The National Audit Office said the programme had strong ministerial and senior management support and had the potential to deliver considerable benefits to patients and the NHS.
It praised the continuity in the leadership of the programme, but noted, “National leadership of engagement with NHS organisations and staff in implementing and making best use of the systems has changed a number of times and resource constraints limited the scale of early engagement efforts.”
While highlighting NHS staff support for the aims of the programme, the National Audit Office also noted “significant concerns among some staff that the programme is moving slower than expected, that clarity is lacking as to when systems will be delivered and what they will do”
The report noted that some parts of the programme have already been delivered and highlighted a new NHS-wide directory with 500,000 entries and an e-mail system (NHSmail) with 80,000 active users. It praised the progress of a new national broadband network. It also reported good progress on electronic prescribing services and the deployment of x-ray and diagnostic imaging systems and the Choose and Book appointments booking system.
Delays to systems were also noted, including a 10-month delay in the national data spine and up to two years’ delay in the delivery of the fully integrated NHS Care Records. Slow take up of Choose and Book and an electronic prescribing service was highlighted, but the National Audit Office said, “Connecting for Health expects ministerial targets for the later stages of deployment to be achieved.”
The report praised Connecting for Health for adopting “the highest security standards for access to patient information”.
Finally, the National Audit Office reported on the predicted costs of the project, which it put at £12.4bn at 2004-2005 prices over the 10 years of the main contracts to 2013-2014. This includes an extra £3bn of central costs over the previously announced £6.2bn contract price and an estimated £3.4bn costs to be borne by local NHS organisations to implement nationally delivered systems.
The audit office said it was “satisfied that central expenditure was being managed within budget”, adding, “Other organisations could learn lessons from NHS Connecting for Health’s experience so far, in particular… the swift procurement exercise, the incentives and penalties included in the contracts and the robust management of the suppliers.”
The National Audit Office report pointed to “significant challenges” for the Department of Health, NHS Connecting for Health and the wider NHS:
- 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 their part fully in implementing the programme’s systems.
- Winning the support of NHS staff and the public in making the best use of the systems to improve services.
In response to this warning Connecting for Health said, “We accept that these are real challenges and have work under way to meet them.”