The government has been urged to rethink its £12.4bn NHS IT project, and replace its current highly centralised national strategy with a more flexible locally-based approach based on standards.
Such an overhaul is prescribed as the only way to reduce the risks of the programme, enable useful local clinical systems to be delivered and prevent costs from mushrooming and delays mounting.
The call comes from two leading members of the Commons Public Accounts Committee, which reviewed the programme in June. They urge the government to rethink its plans to avoid the programme "sleepwalking into disaster" and wasting billions of pounds.
Richard Bacon, the Conservative MP for South Norfolk, and John Pugh, the Liberal Democrat MP for Southport, argue the Connecting for Health (CfH) programme should be reformed to allow hospital trusts to purchase systems locally that can then be linked into the national network.
A joint paper from the pair calls for the programme to be revamped. One of their main criticisms is that, rather than deliver more advanced systems, the programme has instead become a local systems replacement project. They argue that the market can deliver a better result than the oligopoly engineered by the Department of Health (DH).
They add that local clinical records will remain the prime medical record, not shared electronic patient record compiled by many different staff. “It is inconceivable that clinicians will ever be persuaded to make important treatment decisions based on large amounts of data entered by dozens of unknown clinicians.”
The paper says that the central concept of the spine record, making patient data accessible all over the country, is misconceived and offers benefits to a “tiny percentage of patients” compared to local clinical and electronic patient records systems
High risk, centralised single systems should instead be replaced by local procurements, based on national standards, they argue. These would be 50% funded by the DH, and linked together through a simplified NHS-wide electronic spine. NHS chief executives would be mandated to procure mew systems.
The two MPs say a "fundamental error" had been made in trying to centralise the procurement of single systems across the NHS. They argue local systems choice and procurements backed by standards and central funding, provides the best chance to "rescue" the CfH programme.
"The complex, extremely expensive and high risk local systems replacement project should be reformed so that local hospital trusts can purchase locally systems which link to the national framework."
They add: "A reformed programme can still be rescued. Recent publicity and the shake-up already underway among local service providers (LSPs) and key contractors provide an opportunity to do this which not be missed.”
What is required, they say, is a proper balance between central standards and central procurement “where this offers demonstrable benefits”, and local autonomy and responsibility.
The paper points to the “chaos” currently affecting the supplier community, mean that CfH “is jumping from fire to fire” unless it rethinks the basic approach of the programme. It points out that Accenture has already written off £250m against the programme, IDX has been replaced as the main software developer in the South and now looks likely to be replaced in London.
It notes: “Accenture is now believed to be negotiating with CfH for its exit from the programme, and may hand over its regions for CSC. Such an announcement would provide an excellent opportunity to reconsider and reform the programme before current problems and errors become fixed.”
In addition the paper also highlights the extent of the mounting delivery delays affecting trusts waiting for core systems from the NPfIT programme. It says that of the more than 100 acute hospitals that were supposed to have a system installed by April 2006, only 12 did so.
Explaining why he they had written the paper co-author Richard Bacon MP said: “Since we completed the committee hearing at the end of June, there is much new information now publicly available. I am concerned that the public accounts committee may not have had the full facts available at the hearing.”
Pointing to key information that had since emerged, Bacon said: “Two of the prime contractors, CSC and Accenture, have stated that the largest software supplier to the NHS computer programme, iSoft, has ‘no believable plans’ for future releases of its key product, Lorenzo, while iSoft itself is under investigation for possible financial irregularities.”
He added that an Ipsos Mori opinion poll commissioned by CfH, which showed declining support among NHS staff, “was not made available to the committee”.
What next for NHS IT: Richard Bacon MP and John Pugh MP [rich textfile, 80K]