NHS IT Programme: a waste a money - official!

The Department of Health has wasted nearly three billion pounds on a core
element of the National Programme for IT - and risks failing to get any real
benefit for patients or the NHS as a whole out of the £4.3bn it still plans to
throw at the problem.

This is the damning verdict out of an in-depth report by the National Audit
Office (NAO) on the failure of the project to create an electronic patient
record (EPR), the core aim of the whole NPfIT - an aim the auditors say is now
impossible to achieve under the Programme before it finishes in 2015.
 
Not only has money been spent ineffectively - the NHS may actually be, if not no
further than it was before 2002 when NPfIT started, it may even be worse off:
 
"The NHS is now getting far fewer systems than planned despite the Department
[of Health] paying almost the same amount of money [despite changing
contractors]," Amyas Morse, NAO head, revealed.
 
The central focus of the report is the state of play on the delivery of Detailed
Care Records. These were originally meant to form the core of a national
NHS-wide EPR where each patient would have a DCR, containing their full medical
history details and treatment that would be available to both a patient's GP and
any Trust treating them, and the simpler Summary Care Record, with a more
limited dataset, e.g. allergies they may suffer, which would complement it. In
the original NPfIT vision as set out nine years ago, this was supposed to be
fully operational nationally by last year.
 
But despite a £2.7bn outlay that target has been missed, the two main Care
Records suppliers BT and CSC are being installed at a glacial and ever-expensive
rate - and even with revised deadlines and contracts, the NAO doubts the pair
can meet their delivery targets of 2015-16.
 
Gone is the vision of all parts of the NHS having access to EPRs, as not only
have plans for a national rollout been effectively abandoned, even where care
records are in place they are not delivering the expected clinical benefits,
most merely improving administration.
 
This curbing of ambitions, meanwhile, has not even saved the taxpayer money:
"The number of systems delivered through the Programme has been significantly
reduced, without a commensurate reduction in the cost," says the study.
 
Thus its conclusion that "The £2.7 billion spent so far does not represent value
for money and, based on performance so far, [we] have no grounds for confidence
that the remaining planned spending of £4.4 billion on care records systems will
be any different."
 
The report is the third in a series of audits of the Programme by the NAO that,
in the words of Mark Davies, author of the study and Director of the Health
Value for Money Audit, "have gone from green to amber-red and now red" in terms
of concerns over the project.
 
"There was a very laudable vision at the start of all this. But we are worried
that given the scale of the problems identified and a lack of clear benefits, to
continue would to risk throwing good money after bad," he added.
 
Davies cites issues around disparities of cost, where systems from the same
package maker are being delivered for £1m in London hospitals but £9m in
equivalents in the South by supplier BT, delivery, with delays and problems in
those being delivered by CSC in the North, Midlands and East, the fact that
where Records are working they are mostly examples of older releases of the
software in question, and implementation, where it seems that an unwarranted
assumption was made that a trial in one Trust would result in a cascade of
successful rollouts elsewhere but which has come unstuck as insufficient
attention was given to variations and customisations each NHS site in practice
is demanding to make the stuff work, as part of why the report is so pessimistic
about any hope of success.
 
But that's not to ignore contractual challenges, too - with Health apparently
being in negotiation to change its deal with CSC and reduce contract size by
£500m since December 2009, with no end in sight, and two suppliers, Accenture
and Fujitsu, already out, with the latter apparently still in legal dispute and
seeking damages from DoH for its termination.
 
There are a few good spots - the study notes that the overall final bill of
NPfIT seems to have dipped, from the projected £12.7bn feared in 2008 to
£11.4bn; around £6.4bn has already been spent (as of end of March just gone), of
which the Audit Office singles out the £2bn spent on nine successful
infrastructure systems that are providing measurable value, like NHS broadband
and an X-ray sharing system.
 
But so badly have things slipped, it believes, that even with the Coalition's
change of emphasis to more use of existing ICT rather than replacement, more
money - at least £220m - will still have to be found to do what the Programme
was supposed to do - link together various sites patient databases.
 
"This is yet another example of a Department fundamentally underestimating the
scale and complexity of a major IT-enabled change programme," added Morse.
 
"The Programme has delivered less than promised and to far too few organisations
across the NHS," added Margaret Hodge, the chair of the Parliamentary Committee
of Public Accounts.
 
"It is deeply worrying to hear that the NAO has no 'grounds for confidence' that
the remaining planned spending of £4.3 billion on care records will provide
value for money.
 
"The report also raises questions as to who will be responsible and accountable
for this huge Programme and this massive expenditure after NHS reorganisation.
This issue must be addressed urgently. We cannot and will not sit back and allow
more public money to be spent with ever diminishing returns."