Richard Bacon MP - Member of Parliament for South Norfolk

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NAO report shows continuing crisis in £13 billion NHS IT programme

Commenting on the NAO report on the NHS IT programme, Richard Bacon MP 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”.

The report shows that key systems
are late and show little or no sign
of ever being produced in any
useful form

“While systems that are suitable for central deployment such as the N3 broadband link and the Picture Archiving Communications Systems for digital x-rays have made good progress, the serious problems lie with the really complex systems for acute hospitals where central control is manifestly not working”.

“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 Government has recently produced a new list of additional suppliers – but NHS Trusts that choose their systems will still have to foot the bill themselves.

“This cannot be allowed to continue: billions of pounds of taxpayers’ money will be wasted and the consequences for our health service and for patient care will be dire. The best suppliers must be allowed to compete to sell their systems directly to NHS Trusts, without penalty. The Government must then make sure that these systems are connected to National Data Spine, one of the few parts of the programme that seems to be working”.

“This flagship project, born in No 10, is now in grave danger of sinking with all hands. But does the Prime Minister have the nerve to change course?”

The latest National Audit Office (NAO) report into the National Programme for IT in the NHS shows why this huge and vital programme is in crisis. Richard Bacon MP has been a strong critic of the over-centralised programme since it was announced by then Prime Minister Tony Blair in 2002. He is calling for Gordon Brown to “find the nerve to change course” and rescue the Programme, by ensuring that NHS Trusts get the freedom they need to install IT systems that meet the needs of patients, clinicians and managers.

The NPfIT is now estimated to cost £12.7bn at 2004/5 prices. However, since deployment of systems has been delayed and savings could therefore be expected, the underlying cost overrun may be greater.

The NAO report shows that there are continuing major problems with the main “Local Service Providers (LSPs)” in the Programme, and with their software suppliers [1]. “While some parts of the Programme are complete or well advanced, the original timescales for the Care Records Service – one of the key components of the Programme – have not been met”. (paragraph 5, page 7) These systems would connect to the National Data Spine, the core infrastructure of the NPfIT. According to the NAO report, deployment of the National Data Spine is proceeding to schedule (paragraph 12, page 8).

However, there are serious concerns about whether the LSPs and their software suppliers can deliver working systems with acceptable functionality in any reasonable time period. The release of iSOFT’s Lorenzo system, for example, has been repeatedly delayed. On 22^nd February, Health Minister Ben Bradshaw promised June delivery to three NHS sites of the first Lorenzo release. The first Lorenzo release is likely to have very limited functions and to be less advanced than existing systems already deployed in the NHS. [2]

There are also reasons for concern about the Millennium system offered by Cerner. For example, Cerner is two years late with deployment of the system in Victoria, Australia. An independent review has reported that the £150 million project will not be finished by 2009 [3]. Where deployed in the NHS, Millennium appears to require more staff than previous systems, and has serious limitations, for in producing relevant management records (with the result that trusts using Millennium have problems with billing for clinical procedures).

The iron grip of LSPs and their preferred software suppliers over the NPfIT has been its principal weakness from the beginning. From January 2008, the Department of Health has begun adding additional IT suppliers to its contractors’ list, under the Additional Supply Capability and Capacity framework.

However, any Trust procuring from this list must still find the cost from its own resources. For NPfIT to work, the Government will need to relax the grip of LSPs further, allow Trusts to buy software from a full range of suppliers with costs centrally refunded, and ensure that these systems are connected to the NHS “spine”. [4]

16 May 2008

BT has the London regional LSP contract, Fujitsu the Southern contract, and CSC the contract for the North, the Midlands the East. Cerner is the software supplier for BT and Fujitsu (producing the Millennium patient administration system) and iSOFT is the supplier for CSC (producing the Lorenzo system).
According to the NAO: “in the North, Midlands and East, development of iSOFT’s Lorenzo system has taken much longer than originally planned… At 31 March 2008, a total of 128 deployments had taken place, including 34 in Acute Trusts. While the most deployments have been made by CSC in the North, Midlands and East, these are of the interim systems that will be used until Lorenzo is available”. (paragraph 9, page 8) In other words, most of the system deployments reported as successes for the National Programme are in fact of old-fashioned systems that will need to be replaced again if and when the Lorenzo system is finally delivered.
www.e-health-insider.com
The NAO also report that: “Many of the care records systems deployed to date offer limited clinical functionality, though they do bring administrative and other benefits and increased clinical functionality is planned for later releases. In some cases, Trusts have decided to wait for the later releases and not take the limited clinical functionality available in the first release.”

NHS Connecting for Health has committed that Trusts will not be expected to take the Programme’s systems until they are at least as good as the systems they currently have. In practice, however, if existing systems are old and/or no longer being supported by the supplier concerned, Trusts may have little choice but to take the systems offered under the Programme and this can result in a loss of functionality, at least in the short term. Two Trusts we visited in the South described how the first release of Millennium had less functionality than their previous systems and how this had made it particularly difficult to engage with clinical staff…” (paragraphs 2.16 to 2.18, page 23).

See also: