A damning new report by the influential House of Commons Public Accounts Committee (PAC) questions the basic business case behind and contracts awarded for England’s £12.4bn NHS National Programme for IT.
The report focuses on the lack of progress on implementing electronic patient records which it says "suppliers are struggling to deliver" and calls for an urgent independent review.
The committee says the programme is running two years late so far on its core objective of developing electronic patient clinical records, has lost three key suppliers and continues to struggle to engage with clinicians.
"At the current rate of progress it is unlikely that significant clinical benefit will be delivered by the end of the contract period," states the report which says delivery of clinical and electronic records rather than patient administrative software has barely begun.
Edward Leigh, chair of the PAC, said the programme, if successfully delivered, still offered huge benefits, but today warned that if it fails "it could set back IT developments in the NHS for years".
Improved communication with clinicians is identified as a priority area, with the report being blunt about the current position. "The department has failed to carry an important body of clinical opinion with it, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians."
The report continues: "Four years after the start of the programme, there is still much uncertainty about the costs of the programme for the local NHS and the value of the benefits it should achieve." It says the performance to date "raises questions over whether the contracts will deliver what is required".
Today’s report calls on the Department of Health (DH) to publish an annual statement outlining the costs and benefits of the programme.
It also calls on the DH to commission and publish an independent review of the business case for the programme "in light of the progress and experience to date". A review of local service providers’ (LSP) performance is also called for: "In view of the slippage in the deployment of local systems, the department should also commission an urgent independent review of the performance of the local service providers against their contractual obligations".
The report notes that there "is a shortage of appropriate and skilled capacity to deliver the systems required by the programme", a situation exacerbated by the withdrawal of Accenture.
Despite the £2bn spent so far on the programme the MPs say they have been unable to find a published plan for the delivery of the shared electronic records that are at its heart.
In the absence of electronic patient clinical records the report says that the DH, through its Connecting for Health agency and its LSP suppliers, has been deploying patient administration systems, "but these systems are no substitute for the vision of a shared electronic patient clinical record and no firm plans have been published for deploying software to achieve this vision."
The report spells out how far behind original delivery schedule the programme is just on acute hospital PAS deployments. "Plans published by NHS Connecting for Health in January 2005 indicated that by April 2007, 151 acute hospital trusts would have implemented patient administration systems of varying degrees of sophistication. As of 18 April only 18 had been deployed."
In June 2006 the DH said it would deliver 22 to acute trusts between June and October 2006, it managed five. Commenting on the failure to meet its own revised targets for delivery of PAS systems, the report says this suggests "that the programme is still unable to meet short term targets".
In light of the failure of suppliers to meet delivery objectives the report recommends that the DH "should seek to modify the procurement process" to allow acute trusts and others "to select from a wider range of PAS and clinical systems than are currently available". Such a move it is argued would speed up deployments and help secure clinical buy-in.
Noting the number of suppliers – ComMedica, IDX and Accenture – that the programme has lost the PAC report expresses serious concern about the very heavy reliance on iSoft. "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 from the company in its 2005 annual report that the product was available from early 2004."
Leigh summarised the conclusions reached by the PAC: "There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected."
Leigh called for "resolute action". "The department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including NHS organisations, can have more confidence."
He added that if advanced electronic patient record systems cannot be delivered by current suppliers within the framework of the programme, "then the local NHS should be given greater freedom to look for alternative systems which do work."
Leigh warned that "the stakes are high" saying that the programme, if successful could revolutionise the way the NHS in England uses information, significantly improving patient care. "But if it fails it could set back IT developments in the NHS for years, and divert money and time from front line patient services."
Today’s report, follows last summer’s National Audit Office report on the NHS IT programme, and is the product of months of work which has seen the PAC take and assess written and oral evidence, together with detailed questioning of the DH.
Link
Related article