1 The Programme's vision
1. The Programme is the most extensive IT healthcare
development of its kind in the world and constitutes the largest
single IT investment in the UK to date.[2]
Its aim is to enable the NHS in England to treat patients more
effectively by, for example, making accurate patient records available
at all times, transferring information rapidly between different
parts of the NHS, and accurately transmitting prescriptions to
pharmacies.[3]
2. At present, NHS patient records are primarily
retained on paper; and even when information is stored electronically,
the large number of incompatible NHS IT systems makes the sharing
of information difficult.[4]
The central vision of the Programme is therefore to introduce
an integrated system called the NHS Care Records Service.[5]
This consists of two elements. The first is the local detailed
clinical record, for use within local healthcare communities where
the overwhelming majority of patient care is delivered. It contains
the information which needs to be available to GPs, community
clinicians and hospitals (such as pathology test results, drugs
prescribed or hospital discharge notification) and it enables
clinicians to record diagnoses, order tests and prescribe drugs.
The second element is the national summary clinical record which
aims, for example, to support emergency care for people injured
or taken ill while away from home. The Programme will also provide
additional services, such as electronic transmission of prescriptions,
an email and directory service for all NHS staff (NHSmail), computer
accessible X-rays (Picture Archiving Communications Systems),
a facility for patients to book first outpatient appointments
electronically (Choose & Book) and a broadband network (N3).[6]
3. Most of the planned expenditure on the Programme
is on local systems (Figure 1). The Department believes
that the Programme's integrated national IT system will deliver
significant financial, service and patient safety benefits.[7]
Figure 1: Planned local and national expenditure
on the Programme
Source: C&AG's Report, paras 1.19-1.26
4. The National Programme was established in 2002
and follows Information Technology Strategies for the NHS in 1992
and 1998 which were examined by our predecessors in 2000.[8]
In their examination our predecessors noted that the NHS Executive
had recognised the need to take a stronger lead in the procurement
of core NHS IT systems and were in discussions with suppliers
and government advisory bodies about drawing on government catalogues
for systems and were thinking about piloting a collaborative procurement
for an agreed short list of suppliers so that local organisations
would have some form of limited discretion[9].
With the National Programme, the contracts for the Programme were
procured centrally rather than locally. This change in practice
was driven by the Department's desire to overcome the past poor
track record of the NHS in procuring and delivering IT systems,
to get value for money and to deliver integrated systems that
could be upgraded in the future at reduced costs.[10]
5. The Department recognised that this approach carried
many risks and that implementation needed to be local and tailored
to local characteristics. Moreover, whilst other countries are
seeking to adopt elements of the services within the National
Programme, such as electronic patient records, these are not being
introduced on a country-wide basis elsewhere.[11]
6. The Department estimated that the central procurement
of the contracts through the Programme would result in a saving
of £4.5 billion,[12]
although any final figure for savings is contingent on the successful
implementation of the Programme. Competition for the IT contracts
was secured by avoiding a preferred bidder stage and procurement
of the contracts was completed in under a year, and in most cases
within ten months.[13]
The Department's aim from this speed of procurement was to reduce
risks from technology obsolescence and from higher costs as suppliers
attempt to recover the cost of lengthy procurements.[14]
However, Dr Nowlan told us that the production of the specification
was done at breakneck speed, and largely by putting together,
and then reducing, a wide range of previous specifications. Professor
Hutton had been concerned at the safety of the process, and that
it might result in a product that would not fulfil the Department's
goals.[15] In a submission
to us Mr Thomas Brooks, a member of the Worshipful Company of
Information Technologists and of the all party Parliamentary IT
Committee, stated that he considered the view that central procurement
would produce systems that met local requirements was a fundamental
error.[16]
2 Q 9; C&AG's Report, para 4 Back
3
C&AG's Report, para 1.4 Back
4
C&AG's Report, paras 1.1, 1.2 Back
5
C&AG's Report, para 1 Back
6
C&AG's Report, paras 1 Back
7
Q 7 Back
8
Committee of Public Accounts, Thirteenth Report of Session 1999-2000,
The 1992 and 1998 Information Management and Technology Strategies
of the NHS Executive, HC 406, para 9 (vi) Back
9
Op cit, para 9 (vi), paras 31, 34 Back
10
Q 8, C&AG's Report, para 2.5 Back
11
Q 10, C&AG's Report, para 1.8 Back
12
Q 120 Back
13
C&AG's Report, paras 3.1 and 3.4 Back
14
Q 116; C&AG's Report, para 3.4 Back
15
Qq 57, 189 Back
16
Ev 100 Back
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