MPs voice concerns over IT progress

The upgrade of the NHS IT programme, due to take place by 2014, is set to link more than 30,000 GPs with 300 hospitals and feature an electronic medical records system and provision for e-prescriptions.

The House of Commons Committee of Public Accounts, however, has stated that the part of the project focusing on electronic patient records is already running two years late and suggested that local Trusts should be given the opportunity to develop their own systems. The committee, headed by Conservative MP for Gainsborough, Edward Leigh, warned that the costs of the system upgrade could rise to at least £12.4 billion.

Edward Leigh said: “Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected. The programme is not looking good, and four years down the line, the costs and benefits for the local NHS are unclear.”

Edward Leigh added that the Department of Health should “get a grip” on what the NHS was spending. Fellow committee member Richard Bacon said that Connecting for Health, the agency responsible for the IT programme, “Is a nightmare organisation and I think the NHS would be better off without it.”

Further criticism

Other parliamentary figures have been quick to round on the programme, including shadow health minister Stephen O’Brien and Liberal Democrat health spokesman Norman Lamb. Stephen O’Brien said: “Doctors and nurses were left out of the planning and design of the NHS IT programme and that has been a huge problem.” Norman Lamb said that the report contained “damning evidence” about the failures of the programme.

The chairman of the British Medical Association, James Johnson, added: “Although much work has been done more recently to involve doctors, many remain unconvinced that the system will be fit for purpose.”

Defending the programme, health minister Lord Hunt criticised the report: “This is based on a National Audit Office Report that is now a year out of date. Since then, substantial progress has been made and the NAO recommendations have already been acted on.”

Lord Hunt also said that costs of the programme had not escalated, electronic prescriptions were available and digital X-rays were increasingly being used.

Committee conclusions

The Committee of Public Accounts is appointed by the House of Commons to examine “the accounts showing the appropriation of the sums granted by Parliament to meet the public expenditure, and of such other accounts laid before Parliament as the committee may think fit.”

The committee examined the progress made by the Department of Health (the Department) in implementing the programme. In particular, it examined the current status of the shared electronic patient clinical record; the costs of the programme; the local management and implementation of the systems within the NHS; the extent to which clinicians were involved in developing the systems; the management of suppliers; and patient confidentiality.

It took evidence both from the Department of Health, including its agency NHS Connecting for Health, before drawing nine conclusions and recommendations (see opposite).

“Committee conclusions

1 The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be 22. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. The Department should develop with its suppliers a robust timetable which they are capable of delivering, and communicate it to local NHS organisations which may then have greater confidence as to when systems will be delivered.

2 The Department has not sought to maintain a detailed record of overall expenditure on the programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. Total expenditure on the programme so far is more than £2 billion. The Department should publish an annual statement outlining the costs and benefits of the programme. The statement should include at both a national and local level original and current estimates of total costs and benefits, costs and benefits to date, including both cash savings and service improvements, and any advances made to suppliers.

3 The Department’s investment appraisal of the programme did not seek to demonstrate that its financial benefits outweighed its cost. The main justification for the programme is to improve patient services, and the Department put a financial value on benefits where it could. The Department should also quantify non-financial benefits, even if they are not valued, to better inform decision making and to provide a baseline for work after implementation to ensure that the intended benefits are being fully realised. The Department should commission and publish an independent assessment of the business case for the programme in the light of the progress and experience to date.

4 The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. The Department should review with suppliers their capacity to deliver, and use the results of this review to engage, or to get suppliers to engage, additional capacity where required. It should also regularly review suppliers’ performance for any signs of financial difficulties potentially affecting their ability or willingness to discharge their obligations. In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.

5 The Department needs to improve the way it communicates with NHS staff, especially clinicians. The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. It should ask the heads of the clinical professions within the Department, such as the Chief Medical Officer, to review the extent of clinical involvement in the specification of the systems, and to report on whether they are satisfied that the systems have been adequately specified to meet the needs of clinicians.

6 We are concerned that leadership of the programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change. The frequent changes in the leadership of the Department’s work to engage NHS organisations and staff have damaged the programme and convey that the Department attaches a low priority to this task. The Department should avoid further changes in the leadership of this work, beyond those necessary to improve its links with clinicians, and strengthen the links between the programme and the improvement of NHS services that the programme is intended to support.

7 The Department should clarify responsibility and accountability for the local implementation of the programme. At a time when many changes are taking place in the configuration of the local NHS and a range of other initiatives require implementation, it is essential that chief executives and senior managers in the NHS understand the role they need to play in the implementation of the programme. The Department should make clear to chief executives and senior managers their objectives and responsibilities for local implementation, and give them the authority and resources to allow local implementation to take place without adversely affecting patient services.

8 The use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition. In addition, the fact that the programme has lost Accenture, Commedica and IDX, three key suppliers, is running late and is having difficulty in meeting its objectives raises doubts over whether the contracts will deliver what is required. The Department should seek to modify the procurement process under the programme so that secondary care Trusts and others can, if they wish, select from a wider range of patient administration systems and clinical systems than are currently available, provided that these conform to national standards. This approach could have the benefit of speeding up the deployment of new systems and of making it easier to secure the support of clinicians and managers. We are concerned in particular that iSOFT’s flagship software product, “Lorenzo” – on which three fifths of the programme depends – is not yet available despite statements by the company in its 2005 annual report that the product was available from early 2004.

9 At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. As a matter of urgency the Department must define precisely which elements of functionality originally contracted for from the Local Service Providers will be available for implementation by the end of the contract period and in how many NHS organisations it will be possible to have this functionality fully operational. The Department should then give priority to the development and deployment of those systems of the greatest business benefit to the NHS, such as local administration and clinical systems.

The full report can be found online at: www.publications.parliament.uk/pa/cm/cmpubacc.htm “