The National Audit Office (NAO) has delivered a damning verdict on the £11.4 billion National Programme for IT in the NHS (NPfIT) in its third report on the troubled programme. The words of Amyas Morse, head of the NAO, say it all: “The original vision for the National Programme for IT in the NHS will not be realised. The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme.”
The government watchdog concludes that the £2.7 billion spent on care records systems so far does not represent value for money and it does “not find grounds for confidence that the remaining planned spend of £4.3 billion will be different.” It goes on to state: “there is a compelling case for the recently announced Whitehall-wide review to re-evaluate the business case for the Programme to determine what should happen now to safeguard against further loss of public value.”
We have yet to digest all the detail in the report, but it is hard to argue with the NAO’s verdict on the deployment of care record systems under NPfIT. The facts speak for themselves. Nine years into the Programme, a year after all care record deployments were due to have been completed, the specified systems have yet to be delivered to 84% of acute trusts, 27% of community health services and 63% of mental health trusts in England. CSC comes out of the report particularly badly. The NAO disregards its deployments of interim systems (which are due to be replaced by iSOFT’s more advanced Lorenzo software), which means that in the North, Midlands and East of England – the region covered by CSC and iSOFT – 96% of acute trusts and 100% of mental health trusts are still waiting for NPfIT care records systems.
CSC in particular must now be very nervous. It has yet to conclude its latest NPfIT contract renegotiations (see HotViews archive), through which the government is already hoping to save some £500m, and it now has to wait for a review by the Cabinet Office and Treasury. With the NAO’s words ringing in its ears, it will be harder for Whitehall to look favourably on the Local Service Providers’ efforts to date and the chances of the DoH being forced to use one of the other options it has been holding in reserve (“including the termination or a significant reduction in both scope and functionality” of the contracts) must surely have increased.
As a footnote, it’s important to remember we’re talking about just one element of the National Programme here – the delivery of care record systems. As ever it’s important not to tar all aspects of the programme with the same brush – some parts, such as N3 (BT) or Choose and Book (Atos and Cerner), have been delivered more or less on time and to budget and are working more or less as intended. But unfortunately acute care records are the largest part of the programme in monetary terms, and arguably the part that should have had the biggest benefits for patient care.