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An NHS IT system that will play a central role in the controversial Care.data patient records database has been “significantly delayed” and run nearly three times over budget.
A report by the National Audit Office (NAO) revealed that the GP Extraction Service (GPES) increased in cost from £14m to £40m with £5.5m of work being written off. The system, intended to allow the NHS to pull data from GPs’ electronic patient records, was due to go live in 2010 but did not provide its first data extract until April 2014.
GPES will be used to copy patient data from GP systems for Care.data, the troubled project to create a central database of medical records in England for research and analysis of healthcare trends. However, Care.data is only one of the uses for GPES – it was designed as an NHS-wide service, but the NAO said that only one intended customer has been able to use it.
The service is run by the Health and Social Care Information Centre (HSCIC), which inherited the project in April 2013 from the now-defunct NHS Information Centre (NHS IC).
“Only one customer, NHS England, has so far received data from GPES. The time needed to design a new type of extract and restrictions in the contracts severely limit HSCIC's ability to provide data to those who request it. It is unlikely that GPES in its current form can provide the NHS-wide service planned,” said the NAO.
“Mistakes in the original procurement and contract management contributed to losses of public funds, through asset write-offs and settlements with suppliers. The need for the service remains and further public expenditure is needed to improve GPES or replace it.”
HSCIC has acknowledged that much of the GPES system has no long-term future, but hopes to use parts of the system to develop a new data extraction service.
“We are maximising the working aspects of GPES and replacing those parts that do not work. Our focus is on developing a suitable service that meets the needs of the NHS and patients,” said an HSCIC spokeswoman.
IT service provider Atos was awarded an £8m contract in 2011 to support GPES. The NHS IC accepted the system from Atos in March 2013, but on its transfer to HSCIC, it was found to have “fundamental design flaws” and “did not work”, according to the NAO.
The spending watchdog found that NHS IC changed the technical designs and procurement strategy part way through the project, and that NHS IC and Atos “found it difficult to agree the requirements”. The plan suffered from attempting to combine agile development principles with a fixed-price contract, meaning that requirements were not clear when the deal with Atos was signed.
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Difficulties with agreeing requirements were also made worse by the use of offshore development and traditional “waterfall” project management techniques. Even then, acceptance testing by NHS IC failed to identify design flaws that meant it would be impossible to extract data from all GP practices.
“These problems were severe and required Atos and HSCIC technical staff to carry out remedial work, taking six months to complete... It is still not certain that all aspects of GPES work,” said the NAO report. This led to an additional payment to Atos of £1.9m for remedial work to fix the problems, which could not be recovered from the supplier because NHS IC had tested and signed-off the system. In total, £40m has been spent on GPES, but the asset value in the HSCIC accounts is just £12.9m.
HSCIC said that, despite the problems, GPES is now being used to support services such as payments to more than 8,000 GPs in England worth £1.7bn, and that having stabilised the service it is now working with other health organisations to see how GPES could still be used to support their needs.
“We are working hard with system suppliers to ensure that together we ensure GPES runs at full capacity and that new contract negotiations move forward in a positive way. We are exploiting all technological aspects of the current service and are expanding on this with our technical expertise to make the extraction process faster,” said the HSCIC spokeswoman.
Meg Hillier MP, the new chair of the Public Accounts Committee, said that GPES is another example of a public sector IT project wasting taxpayers’ money.
“Failed government IT projects have long been an expensive cliché and, sadly for the taxpayer and service user, this is no exception. The expected cost of GPES ballooned from £14m to £40m during planning, with at least £5.5m wasted on write-offs and delay costs,” she said.
“GPES has managed to provide data for just one customer – NHS England – and the data was received four years later than originally planned. While taxpayers are left picking up the tab for this failure, customers who could benefit, such as research and clinical audit organisations, are waiting around for the system to deliver what they need to improve our health service.”
The Care.data service was originally due to be launched in April l2014, but was put on hold in February 2014 after a public outcry over confidentiality of patient data. The findings of the NAO report suggest that even if Care.data had gone ahead as planned, GPES would not have been able support the necessary data extraction.
Care.data is set to restart with trials in four regions beginning in the coming months. GPES will be used to support the programme going forward.