SOUTH NORFOLK MP Richard Bacon said today that the health service would be better off without Connecting for Health, the Department of Health agency responsible for the national programme for IT in the NHS.
Mr Bacon was speaking as the Commons public accounts committee published a damning report on the multi-billion pound programme which concludes that “at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period”.
He has called for the agency to be wound up, with most of its budget handed over to local hospital bosses and any remaining functions handled by the Department of Health.
Mr Bacon, a member of the committee, said: “Connecting for Health has produced exceptional anger and frustration among doctors, nurses, and hospital managers. It is a nightmare organisation and I think the NHS would be better off without it”.
“The bulk of the programme should be handled by local hospital chief executives in consultation with their own clinicians, who all have a direct interest in delivering IT that works. Local hospitals should have freedom to buy from a wide range of suppliers whose technology conforms to national standards. Functions such as setting common standards could be transferred to the Department of Health. There is no need for an expensive separate agency”.
“This is a truly grim tale. The NHS IT programme has already cost over £2 billion, with five times more than that in the pipeline, and yet the programme is unlikely to deliver significant clinical benefits by the end of the contract. There have been six bosses in five years. The programme has left doctors, nurses and hospital managers spitting with rage. Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier, iSoft, which is under investigation by the Financial Services Authority and whose flagship software product, ‘Lorenzo’, does not yet exist even though the company said it was available three years ago, and which in the meantime has been merrily selling old software which pre-dates the national programme. You just couldn’t make this up”.
“The limited deployment of administrative systems which has taken place so far has caused havoc in various hospitals, leading to significant delays in providing inoculations to children, waiting list breaches, missing patient records, extended shut downs of some systems and the inability to report activity statistics”.
“The central problem arises from a set of huge contracts which were signed in great haste, before either the government had understood properly what it wanted to buy or the suppliers had understood what it was they were expected to supply. It is impossible to avoid the conclusion that this project has been an expensive failure. It will continue to fail unless there are drastic changes”.
The report calls on the Department of Health to commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.
In view of the slippage in the deployment of local systems, the MPs also recommend that the Department of Health should commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.
You can read the Public Accounts Committee's report by clicking here
17 April 2007
See below for key references in the Report to the following topics:
1. CLINICAL BENEFITS
UNLIKELY TO BE DELIVERED
At the present rate of progress it is
unlikely that significant clinical benefits will be delivered by the end
of the contract period. SEE PAC
REPORT PAGE 6, PARAGRAPH 9.
No published plans exist for implementing
shared electronic patient clinical records in line with the original
vision for the Programme. SEE PAC
REPORT PAGE 13, PARAGRAPH 10.
The report notes that the delivery of phase 1 of the programme, the least important from a clinical point of view because it contains mainly administrative functionality, is already late with no published dates for its completion; and concludes that the implementation of phases 2 and 3, which are the key to the delivery of clinical benefits and which were the core of the business case for the high cost contracts, may scarcely have begun by the time the Local Service Providers were originally contracted to have implemented completely all three phases to all hospitals and Trusts in England. SEE PAC REPORT PAGE 22, PARAGRAPH 34.
2. NO FIRM DATES FOR PATIENT CLINICAL RECORD
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. SEE PAC REPORT PAGE 5, PARAGRAPH 1
3. CLINICIANS NOT PERSUADED OF BENEFITS
The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. SEE PAC REPORT PAGE 6, PARAGRAPH 5.
4. FREQUENT CHANGES OF LEADERSHIP
The 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. SEE PAC REPORT PAGE 6,
PARAGRAPH 6.
Leadership in securing support from NHS staff and organisations has changed several times over the life of the Programme: at the time of our examination, responsibility for this task had passed between six Senior Responsible Owners. SEE PAC REPORT PAGE 20, PARAGRAPH 26.
5. HIGH COSTS YET NO DETAILED RECORD OF EXPENDITURE
The National Programme has already cost
taxpayers at least £2.074 billion SEE PAC REPORT PAGE EV 82; AND PAGES
14 AND 15, PARAGRAPH 16.
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. SEE PAC REPORT PAGE 5, PARAGRAPH 2. Note that £20 billion was quoted by
Lord Warner in an interview with the Financial Times on Tuesday 30 May
2006, although the £20 billion figure was later qualified. Connecting
for Health has separately acknowledged that costs could rise to £15
billion.
The Department of Health has paid at least £639 million in advance payments to suppliers despite its supposed approach of payment only on successful delivery. SEE PAC REPORT PAGE 14, PARAGRAPH 15.
The company is now under investigation by the
Financial Services Authority, while its former directors and former
auditors are under investigation by the Financial Reporting Council’s
disciplinary body, the Accountancy Investigation and Discipline Board.
Although iSOFT has received loan support from its banks, there is a
continuing risk to the National Programme if it is overly dependent on
the future stability
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 by the
company in its 2005 Annual report that the product was available from
early 2004. PAC REPORT PAGE 6,
PARAGRAPH 8.
At the time of our hearing in June 2006,
some 13 acute Trusts had had their Patient Administration System (PAS)
replaced, which itself provides no care record functionality beyond what
they already had. In those regions where iSOFT is the main software
supplier, the replacement has been an old iSOFT PAS which pre-dates the
Programme because the PAS element of the new system, Lorenzo—which is
being developed for the Programme and which the company stated was
available from early 2004 — is not yet available. PAC REPORT PAGE 13, PARAGRAPH 10.
SEE ALSO iSOFT GROUP
PLC 2005 ANNUAL REPORT AND ACCOUNTS, PAGE 6, PARAGRAPH 2, where it
states that the Lorenzo software system was “available from early 2004”
There are five regional clusters each with
a main regional contractor or ‘Local Services Provider’. iSoft is the
main software supplier for three of the five main clusters. See below
for the five clusters and their main suppliers:
REGIONAL CLUSTER |
LOCAL SERVICE PROVIDER |
MAIN SOFTWARE SUPPLIER |
North West & |
CSC |
iSOFT |
|
North East |
CSC |
iSOFT |
Eastern |
CSC |
iSOFT |
|
London |
BT |
Cerner |
|
Southern |
Fujitsu |
Cerner (previously IDX) |
7. CALL FOR INDEPENDENT ASSESSMENT OF BUSINESS CASE
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. SEE PAC REPORT PAGE 5, PARAGRAPH 3.
8. URGENT REVIEW OF CONTRACTORS’ PERFORMANCE AGAINST CONTRACTUAL OBLIGATIONS
In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations. SEE PAC REPORT PAGE 5, PARAGRAPH 4.
PAC REPORT: NHS CfH invites bids from new computer suppliers PARLIAMENT: NHS CfH invites bids from new computer suppliers PARLIAMENT: Chance for rethink on NHS computers
missed PARLIAMENT: NHS computers cause 110 major incidents PARLIAMENT: MP receives admission of £82m paid to iSoft PARLIAMENT: MPs prescribe antidote for NHS computer crash PARLIAMENT: NHS computer chaos deepens PARLIAMENT: MP says
Blair's NHS computer dream "won't work" PARLIAMENT: MP concerned over spiralling NHS IT costs PARLIAMENT: MP asks Health Secretary to block IT contract PARLIAMENT: NHS 'fined' millions by computer companies
SPEECHES: The National Programme for IT in the NHS SPEECHES: IT in the NHS - 29 June 2004 SPEECHES: IT in the NHS - 12 February 2004 PARLIAMENT: MP says NHS overspend on IT
may hurt patients
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