The National Audit Office has issued a coruscating report on the delivery of integrated care records by the National Programme for IT in the NHS.
It concludes that the £2.7 billion spent by the Department of Health and trusts on care records systems and implementation “does not represent value for money”.
“Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different,” it adds.
The report - 'The National Programme for IT in the NHS: an update on the delivery of detailed care records systems' - examines the contracts placed and renegotiated for the five English NPfIT regions and the progress made in delivering contracted systems to trusts.
It tells a consistent story of reduced delivery for barely reduced prices, and says that the original vision of an integrated system cannot now be delivered.
Amyas Morse, head of the NAO, said: “The original vision for the National Programme for IT in the NHS will not be realised.
"The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money.
“The Department of Health needs to admit it is in damage limitation mode. I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help prevent further loss of public value from future expenditure on the Programme.”
The report says delivery of electronic patient records across the health service has been extremely patchy. Particular criticism is directed at CSC for its failure to deliver the iSoft’s Lorenzo care record system.
This is contrasted with BT’s limited delivery of hospital and community systems in London and parts of the South.
However, the NAO says repeated revisions to the BT contracts have resulted in fairly small reductions in cost for drastic reductions in delivery on what was originally planned.
In the case of Cerner Millennium for acute trusts in London, the report says that prices appear to have increased by 18% - although some trusts in the South are paying around 22% more.
Where care records systems have been delivered, they are not yet doing what the Department had expected.
“In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals.”
The report questions whether there is any chance the far more limited delivery now intended is likely to happen before the end of the BT and CSC contracts in 2015-16, five years later than originally planned.
“Based on performance so far, it is unlikely that the remaining work in the North, Midlands and East, where just four of 97 systems have been delivered to acute trusts in seven years, can be completed by 2016 when the contract with CSC expires,” it says.
“Indeed, in order to meet the revised deadline, over two systems a month would need to be delivered in this Programme area over the next five years.”
The report notes that the Department adopted a new approach in December 2009, which encourages trusts to build on and integrate existing systems.
However, it says the cost and benefits have not been evaluated. “The Department estimates that achieving interoperability will cost at least £220m.”
Richard Bacon, the MP and member of the Commons’ public accounts committee, who triggered the NAO report by questioning the value for money of the BT deals and subsequently lobbying for a stop on a new NME deal, said: “This report could not be clearer.
“The NPfIT in the NHS will not deliver its central aim of a detailed electronic care record for every patient in England. This was the raison d’etre for the Programme and the main justification for its extremely high price.
“It is perfectly clear that throwing more money at the problem will not work. This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.”
However, a DH spokesperson said: “We agree change is needed and that the original vision was flawed. This is why last year we announced a move away from a centralised, national approach to IT to localised responsibility and decision making.
“However we do think the investment made so far in the NPfIT will potentially deliver value for money now that we have a more flexible approach that allows the local NHS to be in charge of its own requirements.”
© 2011 EHealth Media.
ShamefulSunking 208 weeks ago
As a more than interested bystander (SHA Manager) I have watched with growing concern as the National Program for IT has become unravelled, smiled sadly at the failings of the NLOP (No Longer Our Problem) initiatives that Sir David instigated and even worse, stood by helplessly as so called expert Informaticions argued over the detail whilst completely missing the big picture.
But what really disappoints me most is that here we are in 2011, now talking about the perpetuation of "Interim Solutions" - eg: Maternity, Theatres, Child Health, etc, known as “emergency bundles” which were meant to have a maximum 2 year life span before the said functionality was delivered in "Lorenzo" as though this is a good thing. (C. Connolly PAC – 23:05:2011).
It would seem that we are in reality absolutely no further forward that we would have been had NHS Trusts been allowed to go to the market place, procure local solutions to meet local needs, the caveat being that any such solution would need to be able to communicate with the NHS Data Spine, a process which could have been realised by the publication of a set of interoperability and interface standards, such as those described by Jeremy Thorp (Ruthless Standardisation) way back in 2002/3.
I’m not one of the “I told you so” brigade, and I get no pleasure from observing the stagnation that has resulted in NHS Informatics from the over ambitious and overblown CFH programme, but surely to God, it’s time to finally put this Frankenstein’s monster down.
Let’s all agree that the initial idea had merit, the execution has been appalling and let’s cut the umbilical cord to CSC et al.
Only then can we begin to put information and clinical information systems on a footing which will allow the bold objectives of a “seamless” care record, available at the point of need to become anything more than an expensive and embarrassing failure. But that would require “someone” to grow a pair of Cojones as described so aptly by Mr Bacon in the PAC on Monday.
On paper its easy!simmy 208 weeks ago
I think the concept of national or wide spread record sharing and.or integration is simple on paper - we take these systems and then centrally they do this. Now the practical side, I migrate GP clinical systems for a living and this is far from easy. The clinical systems database structure is different, its functionality is different, local coding and mapping needs to be accounted for, downtime, medication mapping, non mappable data, audit trails etc etc etc. The key to an migration or integration is not if we move all the data across, its to ensure the meaning of the data is reflective of the information on the previous system - data without meaning or concept is not information nor can we gaurantee its clinically safe for the future clinicians using this data.
Now the complexities of migrating a single GP system are only a drop in the ocean to the npfit remit which is involving vast amounts of data from systems which all store the data differently and we need to ensure the data is clinically appropriate. If the MPs can find a teenager who can do this is a few days then please introduce them to us as I feel they may have a global monopoly on IT/IM&T in the near future. CfH have struggled with this remit and as of yet no private company as produced much more in this field, the only different is cfh as to lead all the system suppliers to the table to play ball
Secondary care migration is differenteohl 206 weeks ago
Understand your points about primary care migrations but to a certain extent many of the mappings are now well proven (however you do seem to migrate to a lower level).
But, having worked in secondary care migrations - the biggest change for me was validating date rules for admin procedure X and Y and .... the near total absence of clinical data!
Ignorance that beggars belief!Paul L 208 weeks ago
The Public Accounts Committee did a great job today in speaking to the public gallergy of Daily Mail opinion. Here are just a couple of the comments made by MP's who obvioulsy don't have a clue about the complexity of software development or it's implementation. Thank God that it's not the MP's who are undertaking this work!
On the complexity of the programme - “the people in this room could design the systems that were talking about here in a few days”
On the complexities of interoperability and integration -
“a teenager in a bedroom can automate an email from one system to another or to a mobile phone or whatever, all that’s trivial nowadays”
Oh and why does every potential saving have to be calculated in the number of nurses that could be 'bought'. The simplistic nature of the debate was totally embarrassing. Some valid points were made but overall there was a clear lack of understanding amongst the MP's as to difficulties experienced in a typcial IT implementation within an NHS organisation, not to mention the software design, build, testing, migration of legacy data etc...
As for the amibitous nature of the contract, it was Margaret Hodges boss who set the goal posts back in 2002 and as usual, this was found to be influeced by the ballot box. Computer Weekly disclosed under the Freedom of Information Act back in 2008 that Tony Blair "repeatedly sought to shorten the time period projected for an IT-based modernisation of the NHS - which if achieved could have allowed patients to access their health records online in time for a general election in 2005."
Somewhere else fingers should pointjust_instantiate 209 weeks ago
The NAO report is damning, but hardly surprising. That NPfIT will not deliver value approaching anywhere near the expenditure incurred has been known for years. In that sense this is old history. However, someone to whom questions should be put is the NAO itself. It isn't the case that the National Programme started well but then went wrong. It was misconceived from the start and slippage started on virtually day one of the implementation. There is little about the failure of the National Programme that isn't the consequence of decisions made right at the beginning. And yet the NAO has previously given the project green and amber lights. Funny that only after a change of government did it turn red. Was the NAO too busy ticking boxes to notice how badly wrong things were going, or were its previous conclusions rigged for reasons of political expediency? A systemic failure either way.
responsePaul Cundy 209 weeks ago
"My experience is that the majority of GPs (though very far from all) are extremely parochial about THEIR system. They fail to see their system as part of a wider record of patient care. This is changing but it is changing much more slowly than it should. Trying to impose systems on the acute, mental health or community services from this limited view will have no greater success that imposing systems designed for admin purposes onto clinical staff. They need systems which work efffectivly with the grain of their day to day practice"
Happy to be skoffed at. The essecnce of what I meant was that "users should design the tools they use". Of course I'm not suggesting that a GP should choose what system an A/E or a diabetologist should use. You are are absolutely right that "They need systems which work efffectivly with the grain of their day to day practice" and my posting was making that exact point. But on this pint we have to disagree; GP systems are great for GPs and their teams. An anaesthetist would find a GP system totally useless as would a radiologist, a breast oncologist or a psychiatrist. We all need systems that reflect the different ways and modaulities in which we work (radiology = pictures, psychiatrist = narrative, pathologist = numbers) so I do not beleive that GP systems can ever be the nidus for a pan service record. Yes secondary care clinicians need to have systems that will work for them but based on past experience they will never get them unless something quite radical changes, my reasons for putting the GPs in charge is not for us to buy your systems for you but for you to learn how we did it.
A fair challangeNick Tordoff 209 weeks ago
I think we fundementally agree. I wasn't intending to say that the GP system should be duplicated accross all care. In fact I believe exactly the opposite and you express some prime examples of why that is the case
What I was trying to say is that the Primary Care record should act as the starting point for understanding all the care that a patient has received. (I hate to use the word "summary" because it has become so distored by SRC). This is not so far from what the GPs currently have access to through Hospital Discharge letters but would need to be
1 more comprehensive so as to include all areas of care not just consultant care
2 more regularly updated so that information about extended episodes of care are reflected into the record on a regular basis
3 accessible by any clinician who has the patients consent in order to provide apropriate care
I can here several of my local GPs exploding with rage about letting other people input into THEIR record and there are data ownership and information governance issues to be addressed but I believe these can be addressed more easily with in the Primary Care record, which is intended to be a holistic view of the patients care, rather than trying either to build that view by winging data hither and thither on the fly, by creating a national summary record which is the lowest commonn denominator or, as seems to be the government flavour of the month, dumping the problem on the patient and telling them to go put on their Facebook Health tab.
ASCC framework deals - time running outJon Hoeksma 209 weeks ago
Another interesting detail from the NAO report was the factoid that the ASCC Framework deal expires at the end of 2011. Which basically means that the DH needs to get on and use it - three deals perpetually meant to be in pipeline for: child and community, acute and ambulance - or lose it and have to start over again.
The clock really is ticking down on this one...
ASCC Contract ExpiryDaniel Defoe 209 weeks ago
Jon, a slight correction. In fact the ASCC Framework Agreements in Lot 2 (the Lot which is most appropriate to and contains nearly all the Services required for an EPR) expire on 1st May 2012. But time is still running out because anybody who is serious about using it for an EPR should realise that it will take six months at the minimum to get to signature. Which I guess could be why there are so many ASCC procurements in the starting blocks at the moment. The trouble will be that the suppliers who are Framework Contract holders will soon be in a position to pick and choose...
Vision vs ExecutionJames from Midlands 209 weeks ago
To the comment re Myopic - the Vision was integrated health records, and that is still very valid - the approach was wrong in that it should have been incremental and yes consistent - so we agree. There is nothing wrong with Cerner for instance - it is already in use in over 8000 hospitals - there will be a considerable amount of blame gaming going on but the reality is that many parts of the private sector have already lost substantial sums over NPfIT and Health IT, it is only a very tiny minority that have made good profits.
The question I have where is everyone who put all this into place, where are those responsibe??
The vision of single detailed care records was - and is - impossible and dangerousMary Hawking 209 weeks ago
The original vision - rapidly suppressed in planning - was for a single detailed record for each individual patient spread across all sectors of the NHS i.e. a SSEPR - Single Shared Electronic Patient Record.
Cerner as a system is used in different countries, and may well be very suitable as a secondary care EPR in a single or intergrated groups of organisations: I don't think that, unlike Lorenzo, it was ever considered to be a record which would be used equally as the record of prime entry by everyone - hospitals (all departments) GPs, mental and sexual health, community, podiatry etc.
The RCGP report SRPG (Shared Record Professional Guidance) shows why it could never have worked.
If anyone can explain how the Lorenzo Regional Care SSEPR would have worked, could they tell me?
It is time the pretence was ended so that rational communications and records can be developed..
Get Outbobkhan 209 weeks ago
How do the signatories get out of the contracts? Will CCN4 be put on hold? will the National programme stop? Is it now the voice of the masses that will be heard after so many years of silent screaming?
I still feel that trusts will still pursue the bigger picture and press ahead with the roll out of further releases..
I should start to offer my legal skills out.....
Its sad to see the failure as I have been part of it since its inception...
Vision vs ExecutionJames from Midlands 209 weeks ago
There was never a problem with the vision, but the execution was seriously flawed and sadly a real problem of the Emperor and his Clothes (or lack of). Integrated health records is still possible, and can be achieved at relatively low cost. Let us not forget some of the very significant success's and yes there have been some!!!!
Myopic visiondesperado 209 weeks ago
I am sorry, there was a problem with the vision, as previously well documented in 'Crash' by Tony Collins. There was too grand a vision, which was always undeliverable (and pretty much all of the 10 deadly sins that he summarised in that book).
The private briefing to Tony Blair for the 20 minute meeting that set this train crash in motion (available to us thanks to WikiLeaks) wanted the whole thing delivered faster (and 3 years was always a barking mad timescale), and raised the 'how will you avoid it all going horribly wrong' question.
An incremental and consistent vision would have delivered far more across the country by now (as scandanavian countries have done). HMG always seem to lurch between incompatible ways of running public services which waste huge amounts of taxpayers money, and driven by grand visions of management consultants and other vested interests.
I heard on the radio this morning for example that the management overhead for British Rail was £1Bn, and with the plethora of companies is now £5Bn.
Plea to keep politics out of the debate...nota bene 209 weeks ago
A damning report. Another damning report. And some great comments.
But can we please stop bringing our personal prejudices into the argument. Yes, let's argue about actual delivery in real hospitals etc, and let's argue about crap contracts. But can we try to avoid implying that if only NPfIT had been delivered, still as a national programme mind, by NHS doctors and IT staff then all would have been well?
Phrases like "massive profits for the private sector" and "feather the beds of large corporation shareholders" show either a leftward political leaning (profit bad, even if service good) which belongs elswhere or a deep naivete about capability and scale.
If we mean this should never have been a national programme in the first place then let's say that. That's about governance, culture, and all the other things which demonstrate that "the NHS" hardly exists - it's a federal system of entities many of which are private sector even if we don't think of them that way: GP practices are businesses, not government agencies, which make profits in all but the fiscal sense) and Trusts employ loads of folk who work for the government purse AND for the private (BUPA etc) competition!
If we mean the private sector should never have been involved then let's say that. Where else would we get the systems and the capability to configure and deliver these? As I type this, I can imagine people up and down the country hammering angrily at their keyboards writing "but they didn't deliver, they don't have the capability". But neither does the NHS! If some hospital somewhere is sitting on an in-house developed fully functioning PAS combined with the capability and capacity to roll this out nationally then they've kept very quiet about it for the past ten years.
Please let's not turn this into a simplistic private-public sector dualistic debate. Let's focus on how private and public sectors might get us to somewhere very different a few years from here. And do so, by the way, in a "mixed economy" of healthcare which makes just about every aspect more challenging,
PS. Let me finish by saying the unsayable - well the unsayable-by-CfH.
We could run up massive bills by making a politically (big and small P) impactful statement about canning the NPfIT contracts. This would clearly teach the big corporate fat-cat profit-harvesting companies (etc etc) a lesson... No it wouldn't. EU procurement rules are intended to ensure objective evaluation of bids, so eg. the Home Office could not say "well your bid offers the best VfM but you cocked health up so you're not getting any business from us". Hitting the suppliers hard would cost £Nbn and their boards would tell them not go near Health again.
An alternative, which we couldn't possibly say if we were CfH, would be that we intended to let the current contracts wither on the vine. We might even go as far as to communicate "a new approach in December 2009, which encourages trusts to build on and integrate existing systems". If the suppliers wanted to walk, without compensation, then that would be their call. Not a recipe for attractive headlines about being bold, of course, but cheap, tidy and humane.
PPS. My lawyers have advised me to point out that I have no connection with CfH or any other party involved in NPfIT, that all views expressed are personal, and that any resemblance to parties lvining or dead is entirely unintentional.
PPPS. I'm lying about the lawyers.
Practical objection, not personal prejudice...WLMD 209 weeks ago
"...Phrases like "massive profits for the private sector" and "feather the beds of large corporation shareholders" show either a leftward political leaning (profit bad, even if service good) which belongs elswhere or a deep naivete about capability and scale..."
Sorry, I know this is only part of your point, but the Programme and the LSPs most definitely DID rip NHS organisations off: Granger's laughable contracts which obliged us to buy PACS screens at twice the price we'd pay from an ordinary supplier and made us pay for each LSP representative's attendance at meetings until we found out (We wondered why they were sending so many people to the meetings in the early days, sitting there doing nothing). I've got lots of similar examples.