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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:
- 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.
- 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.
- 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.
- 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.
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