The delivery of electronic patient records to hospitals by the NHS National Programme for IT is now running four years late and, according to the National Audit Office is unlikely to be completed before 2015, five years later than originally planned.

The NAO tacitly acknowledges even these dates may prove optimistic, as it later states. “There is considerable uncertainty about when the care records system will be fully deployed and working across the country.”

It warns the timeframe of current Lorenzo roll-out plans: three pilots in summer 2008, with full roll-out from autumn 2008, “may prove over-ambitious”.

By March some £3.5 billion had been spent on the NHS IT programme, total programme costs are now projected at £12.7bn, an increase of £500 million since 2006.

Although much had been achieved in other areas it has largely failed to deliver on its central objective of detailed Care Records Systems (CRS) to acute trusts, with the strategic Lorenzo CRS software still to be delivered to three-fifths of England, states a new National Audit Office report.

It says the programme has proved far more challenging than initially envisaged, and “the original timescales proved to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk”.

The report notes “planned ‘go live’ dates have been missed in most of the Trusts we visited, in some cases more than once…”. It says this has had an impact on securing clinical buy-in, which overall is said to have improved along with communication by Connecting for Health.

Where hospital systems have been delivered in some instances, they offered less functionality than the ones they replaced. “Although increased functionality is planned for later releases, the limited clinical functionality provided to date had made engagement more difficult,” says the NAO.

The report says that although early versions of the ‘strategic’ Cerner Millennium CRS system have been delivered to a small number of trusts in London and the South, the failure of iSoft to complete and deliver the ‘strategic’ Lorenzo software means that no hospitals in the North, West and East of England have received the contracted CRS system.

The NAO’s examination of NPfIT progress since 2006, revisiting the programme it first reported on in June 2006, states: “Current indications are that it is likely to take some four years planned, until 2014-15, before every NHS Trust has fully deployed the care records system. Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East.” It adds that good progress is being made in other parts of the programme.

Overall the report offers a positive view of the programme, concluding that despite the problems with progress on CRS the costs of the programme have not spiralled out of control and its objectives remain achievable.

“The original vision for the Programme nevertheless remains intact and still appears to feasible. The major outstanding challenge is to finish developing and deploying the care records systems that will help NHS trusts to achieve the Programme’s intended benefits of improved services and better patient care.”

A less sanguine view was offered by, Richard Bacon MP, a member of the Commons Public Accounts Committee, who said: “The latest National Audit Office report could not be clearer. The £12.7 billion national programme for IT in the National health Service is in crisis. The report shows that key systems are late and show little or no sign of ever being produced in any useful form.”

Bacon added while national procurement had worked for PACS and the NHS secure network (N3) it had not worked for it had not worked for more complex hospital systems, inadvertently locking the NHS into contracts with suppliers unable to deliver.

“The crisis is a direct result of the original foolish decision made on a No 10 sofa – to allow the programme to be held hostage by a tiny group of Local Service Providers and their preferred software suppliers.”

The report makes a series of recommendations, focused on CRS, to strengthen the programme and ensure value for money. They make clear that CRS delivery remains the Achilles heal of the NPfIT programme, with Lorenzo being a particular concern.

“The North, Midlands and East area does not yet have the strategic system to support its care record service because of the time taken to develop Lorenzo. The delays in developing Lorenzo make it even more important to get the product right and win the confidence of NHS staff.”

While the software is late it must be fit for purpose before being implemented beyond pilot sites. Based on trust’s experience of early CRS deployments the NAO advises. “Before the system is rolled out to the rest of the North, Midlands and East, NHS Connecting for Health and the Strategic Health Authorities should carry out rigorous testing to make sure the system deployed in the early adopters works as required…”


NPfIT: Project Progress Reports

The National Programme for IT in the NHS: Progress since 2006