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Department of Health: the National Programme for IT in the NHS

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Department of Health: the National Programme for IT in the NHS House of Commons Committee of Public Accounts Department of Health: The National Programme for IT in the NHS Twentieth Report of Session 2006–07 Report, together with formal minutes, oral and written evidence Ordered by The House of Commons to be printed 26 March 2007 HC 390 [Incorporating HC 1360-i of Session 2005-06] Published on 11 April 2007 by authority of the House of Commons London: The Stationery Office Limited £20.00 The Committee of Public Accounts The Committee of Public Accounts is appointed by the House of Commons to examine “the accounts showing the appropriation of the sums granted by Parliament to meet the public expenditure, and of such other accounts laid before Parliament as the committee may think fit” (Standing Order No 148). Current membership Mr Richard Bacon MP (Conservative, South Norfolk) Annette Brooke MP (Liberal Democrat, Mid Dorset and Poole North) Greg Clark MP (Conservative, Tunbridge Wells) Rt Hon David Curry MP (Conservative, Skipton and Ripon) Mr Ian Davidson MP (Labour, Glasgow South West) Mr Philip Dunne MP (Conservative, Ludlow) Helen Goodman MP (Labour, Bishop Auckland) Mr John Healey MP (Labour, Wentworth) Mr Sadiq Khan MP (Labour, Tooting) Mr Edward Leigh MP (Conservative, Gainsborough) (Chairman) Sarah McCarthy-Fry MP (Labour, Portsmouth North) Mr Austin Mitchell MP (Labour, Great Grimsby) Dr John Pugh MP (Liberal Democrat, Southport) Don Touhig MP (Labour, Islwyn) Rt Hon Alan Williams MP (Labour, Swansea West) Iain Wright MP (Labour, Hartlepool) The following were also Members of the Committee during the period of the inquiry: Angela Browning MP (Conservative, Tiverton and Honiton) Kitty Ussher MP (Labour, Burnley) Powers Powers of the Committee of Public Accounts are set out in House of Commons Standing Orders, principally in SO No 148. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at http://www.parliament.uk/pac. A list of Reports of the Committee in the present Session is at the back of this volume. Committee staff The current staff of the Committee is Mark Etherton (Clerk), Philip Jones (Committee Assistant), Emma Sawyer (Committee Assistant), Anna Browning (Secretary), and Luke Robinson (Media Officer). Contacts All correspondence should be addressed to the Clerk, Committee of Public Accounts, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 5708; the Committee’s email address is [email protected]. 1 Contents Report Page Summary 3 Conclusions and Recommendations 5 1 The Programme’s vision 9 2 Delivering the systems 12 3Managing implementation and ensuring that the systems needs ofmeet the the NHS 16 4 Securing the benefits of the Programme 19 Formal Minutes 23 Witnesses 24 List of written evidence 24 List of Reports from the Committee of Public Accounts Session 2006–07 25 3 Summary The National Health Service (NHS) needs modern Information Technology (IT) to help it to provide high quality services to patients. The National Programme for IT in the NHS (“the Programme” or NPfIT) was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale. It constitutes the largest single IT investment in the UK to date, with expenditure on the Programme expected to be £12.4 billion over ten years to 2013–14. The central vision of the Programme is the NHS Care Records Service, which is designed to replace local NHS computer systems with more modern integrated systems and make key elements of a patient’s clinical record available electronically throughout England (e.g. NHS number, date of birth, name and address, allergies, adverse drug reactions and major treatments) so that it can be shared by all those needing to use it in the patient’s care. The Programme also includes other services, such as electronic prescriptions, an email and directory service for all NHS staff (NHSmail), computer accessible X-rays (Picture Archiving Communication Systems), and a facility for patients to book electronically first outpatient appointments. The stakes are high. If it succeeds in its aims, the Programme could revolutionise the way the NHS in England uses information, and make significant improvements to the quality of patient care. But if it fails, it could set back IT developments in the NHS for years, and divert money and staff time from front line patient services. On the basis of a report by the Comptroller and Auditor General,1 we examined the progress made by the Department of Health (the Department) in implementing the Programme. In particular we examined the current status of the shared electronic patient clinical record; the costs of the Programme; the local management and implementation of the systems within the NHS; the extent to which clinicians were involved in developing the systems; the management of suppliers; and patient confidentiality. We took evidence both from the Department of Health, including its agency NHS Connecting for Health; from two former senior members of the Programme, Dr Anthony Nowlan, formerly a Director of the NHS Information Authority, and Professor Peter Hutton, former Chairman of the National Clinical Advisory Board; and from Mr Andrew Rollerson, a senior manager within Fujitsu, one of the main suppliers to the Programme, but speaking in a personal capacity. We have also received and reviewed a number of written submissions. In summary, we draw four overall conclusions: x The piloting and deployment of the shared electronic patient clinical record is already running two years behind schedule. In the meantime the Department has been deploying patient administration systems to help Trusts urgently requiring new systems, but these systems are not a 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. 1 C&AG’s Report, Department of Health: The National Programme for IT in the NHS, HC (2005–06) 1173 4 x The suppliers to the Programme are clearly struggling to deliver, and one of the largest, Accenture, has now withdrawn. The Department is unlikely to complete the Programme anywhere near its original schedule. x The Department has much still to do to win hearts and minds in the NHS, especially among clinicians. It needs to show that it can deliver on its promises, supply solutions that are fit for purpose, learn from its mistakes, respond constructively to feedback from users in the NHS, and win the respect of a highly skilled and independently minded workforce. x 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. The conclusions and recommendations in this report need to be addressed and implemented by the Department if the significant public funds being invested in the Programme are to deliver the services expected by the NHS for the benefit of patients. 5 Conclusions and Recommendations 1. The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number was 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be a further twenty-two. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. The Department should develop with its suppliers a robust timetable which they are capable of delivering, and communicate it to local NHS organisations who may then have greater confidence as to when systems will be delivered. 2. The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. Total expenditure on the Programme so far is over £2 billion. The Department should publish an annual statement outlining the costs and benefits of the Programme. The statement should include at both a national and local level original and current estimates of total costs and benefits, costs and benefits to date, including both cash savings and service improvements, and any advances made to suppliers. 3. The Department’s investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost. The main justification for the Programme is to improve patient services, and the Department put a financial value on benefits where it could. The Department should also quantify non-financial benefits, even if they are not valued, to better inform decision making and to provide a baseline for work after implementation to ensure that the intended benefits are being fully realised. The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date. 4. The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. The Department should review with suppliers their capacity to deliver, and use the results of this review to engage, or to get suppliers to engage, additional capacity where required.
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