Newly released Office of Government Commerce Gateway Reviews show the government was repeatedly warned that key elements of the National Programme for IT in the NHS faced severe problems from the outset.
The reviews show that the £12.7 billion programme was highly regarded in its procurement phases, but elements began to run into serious difficulties as they reached planning and implementation.
Although the Choose and Book and N3 network deals were favourably assessed, the local service provider contracts, which focus on the delivery of electronic patient record systems, are described as facing significant and persistent challenges.
The core electronic patient records to be delivered by the prime contractors – originally Accenture, CSC, Fujitsu and BT and currently just BT and CSC – are now up to four years late.
A red light was given to the October 2002 Gateway Review of the original business case for Integrated Care Records Services, later to become Care Records Services. This identified weaknesses in the project management framework, to the extent “that it will be impossible to complete all of the necessary work within any reasonable timescale.”
A subsequent review of ICRS procurement strategy said that clinical engagement was largely non-existant. “There is no formal machinery for gaining clinical input to the programme, even though there has been formal clinical input to the strategy and the development of the programme together with clinical members of the ICRS programme team.
“It is clear that clinical acceptability is critical to the delivery of programme benefits, but it should not be left purely to individual clinicians to determine acceptability during implementation.”
Late delivery is flagged as a signfiicant problem early in the NPfIT programme. In two OGC Gateway Reviews of BT’s delivery of CRS, a red traffic light is again given.
The 2005 Gateway 4 ‘readiness for service’ review states: “In overall terms, delivery of CRS has been a major disappointment so far, due in the main to poor supplier performance, although satisfactory progress has been made on the other elements of the overall NHS Connecting for Health programme.
“At this time, the programme has no commercially supported and agreed plan for the delivery of CRS products to meet the urgent business needs of acute trusts. The LSP CRS product is as yet unproven, as its development will not be completed for 3-4 months. This represents an overall delay in the programme of some 12 months.”
The original project plans for ICRS and NPfIT called for integrated care records to be fully implemented across England by 2010. This aim that remained in place up until the end of the period reviewed.
The reviews cover the period before the departure of prime contractors Fujitsu and Accenture; before Cerner replaced IDX as a sub-contractor; and before two critical Public Accounts Committee reports. Even so, they point to some significant problems in the LSP contracts, particularly in London and the South.
The Department of Health chose the week that details of MPs expenses were published to publish the OGC Gateway reviews NPfIT, which were carried out between 2001 and 2005.
Based on a traffic light system – red, amber or green – nine of the 31 reviews published were assigned red status, indicating immediate action should be taken before proceeding further. Two of the reviews of the London are scored red.
The majority of the reviews award an amber traffic light, indicating that urther work was needed but the project remained on track. Among the exemplars to score a green is the procurenent of the N3 NHS network. None of the OGC Gateway 5 ‘benefits realisation’ reviews have yet been carried out.