News
National Audit Office reviews the NHS National Programme for IT
16 May 2008
The National Audit Office (NAO) has published a review of progress in the
NHS National Programme for IT since 2006 [1].
The NAO says that all elements of the Programme are advancing and
some are complete, but the original timescales for the electronic Care
Records Service, one of the central elements of the Programme, turned
out to be unachievable, raised unrealistic expectations and put
confidence in the Programme at risk.
The report concludes that the original vision remains intact and
still appears feasible. However, it is likely to take until 2014-15
before every NHS trust in England has fully deployed the care records
systems, four years later than planned.
In the North, Midlands and East area, the software has taken much
longer to develop than planned, so some trusts have had to take an
interim system. Completing development and deployment of the system and
introducing it in this area "are significant challenges still to be
addressed". In these regions the software to be deployed is iSOFT’s
Lorenzo. The NAO says the the delays are attributed in part to an
underestimation by all parties of the scale and complexity involved in
building a new system from scratch.
The NAO says that there remains considerable uncertainty over the
delivery schedule for Lorenzo. In March 2008, NHS Connecting for Health
and CSC, the Local Service Provider for the area, agreed a memorandum of
understanding, "with a view to achieving greater certainty over the
delivery timescales for Lorenzo". The first release of the software is
expected to be available for deployment at three early adopter trusts
this summer, with full roll-out planned from autumn 2008.
The report notes that 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 of Health is recommended to review with
suppliers their capacity to deliver, and use the results of the review
to engage, or to get suppliers to engage, additional capacity where
required. The NAO recommends the Department should commission an urgent
and independent review of the performance of Local Service Providers
against their contractual obligations.
The NAO expressed concern that the use of only two major software
suppliers could inhibit innovation, progress and competition. It says
the Department of Health should seek to modify the procurement process
under the Programme so that NHS organisation are able to select from a
wider range of patient administration systems and clinical systems than
are currently available, provided that these conform to national
standards.
The NHS has already issued framework contracts for Additional Supply
Capability and Capacity (ASCC). In January 2008 contracts were signed
with 38 suppliers for non-clinical systems and services, and earlier
this month it was announced that contracts had been signed with 61
suppliers for clinical information technology services [2].
The estimated cost of the Programme is £12.7 billion. The costs of
the main contracts have remained broadly unchanged, aside from the
purchase of increased functionality. Because of the delay in
deployments, actual expenditure to date (£3.6 billion by 31 March 2008)
has been much lower than expected. Planned ‘go live’ dates were missed
for many of the first NHS trusts to take the new care records systems
and the NHS and suppliers are now increasing their emphasis on
establishing realistic timelines for deployments, reflecting the
circumstances of each individual trust.
The NAO expressed concern that leadership of the Programme has
focused too narrowly on the delivery of IT systems, at the expense of
optimising use of IT to deliver the process of business change. It says
frequent changes in the leadership of the Department’s work to engage
NHS organisations and staff have damaged the Programme and convey that
the Department attaches a low priority to this task.
According to the report, the success of the Programme will depend on
the commitment of NHS staff. The Department’s latest survey, conducted
in spring 2007, showed that 67% of nurses and 62% of doctors expected
the new systems to improve patient care (though 16% of nurses and 7% of
doctors had never heard of the Programme). Identifying and realising the
benefits of the systems are essential to raising confidence further and
convincing all staff of the value of the Programme. The Department
reported on the benefits of the Programme for the first time in March
2008.
Tim Burr, head of the National Audit Office, said: "The scale of the
challenge involved in delivering the National Programme for IT has
proved to be far greater than envisaged at the start, with serious
delays in delivering the new care records systems. Progress is being
made, however, and financial savings and other benefits are beginning to
emerge. The priority now is to finish developing and deploying care
records systems that will help NHS Trusts to achieve the Programme’s
intended benefits of improved services and better patient care."
References
1. The National Audit Office. The National Programme for IT in the
NHS: Progress since 2006. London, The Stationery Office. May 2008.
(Vol 1) :
www.nao.org.uk/publications/nao_reports/07-08/0708484i.pdf
The National Audit Office. The National Programme for IT in the
NHS: Project Progress Reports. London, The Stationery Office. May
2008.
(Vol 2):
www.nao.org.uk/publications/nao_reports/07-08/0708484ii.pdf
2. NHS Connecting for Health Additional Supply Capability and
Capacity (ASCC) website:
www.connectingforhealth.nhs.uk/industry/ascc
|
