House of Commons - Public Accounts

Select Committee on Public Accounts Minutes of Evidence

Supplementary memorandum submitted by the Department of Health

Questions 21 (Chairman) & 217 (Mr Alan Williams):

Consultation on the Output-Based Specification for the NHS Care Record Service

INTRODUCTION

This paper summarises the consultation process undertaken during the development of the Output-Based Specification (OBS) for the NHS Care Record Service.

There were three main stages to the development process:

(1) in the summer of 2002, an initial draft of the specification was put out to public consultation;

(2) over the winter of 2002-03 a revised draft was developed;

(3) during the spring of 2003 a comprehensive review process was undertaken.

Each stage is described in more detail below.

1. Initial draft specification

The original National Specification for Integrated Care Records Service (Consultation Draft) was issued in July 2002. The specification drew on documents from other procurements, building on work on the Electronic Health Records and Electronic Patient Records following the 1998 Information for Health strategy. However, the concept of the ICRS was to build a service around the needs of the patient, different from the traditional organisation-based approach. In view of the importance of this document, the first specification was then published for formal consultation.

Over 190 responses to this document were received from suppliers, clinicians, Information Management and Technology (IM&T) departments and others, commenting on such aspects as architecture, functional omissions and the realisation of benefits that such a system would produce. A number of the comments were provided on behalf of representative bodies, including the NHS Confederation, the Royal College of Physicians, the Royal College of Surgeons, the Royal Pharmaceutical Society, the British Medical Association (BMA), Junior Hospital Doctors' Committee, Diabetes UK, the Association of British Pharmaceutical Industries (ABPI), the Association for Informatics Professionals in Health and Social Care (ASSIST) and the British Computer Society Health Informatics Committee.

Annex A is the summary, produced at the time, of the main points arising from the consultation exercise. These comments were included and formed the base document for the early draft of the OBS.

2. Revised draft output-based specification

In early 2003. invitations were sent to a number of key stakeholder groups (the Chief Information Officer, the IT Directors' Forum, the Electronic Record Demonstrator (ERDIP) sites and the clinical information groups such as the Academy of Colleges Information Group and the Medical Information Group) and other known individuals and sites, seeking assistance in three areas: provision of source material for the OBS; hands-on help with OBS development; and quality assurance and review input.

The intention was to make best use of the best experience from across the NHS. Source material was provided by many sites, including:

— South West Shires' schedules;

— Preston Electronic Patient Record (EPR);

— Kings' EPR;

— Brighton EPR;

— Wirral Screening;

— Thames Valley Mental Health;

— South West London Picture Archiving and Communications System (PACS);

— Academy of Royal Colleges Information Group (ACIG) Clinical Specification; and

— South Staffordshire Community.

In addition some specific work had been commissioned, following the initial consultation exercise, from:

— Birmingham and the Black Country (Blackberd) Consortium Acute EPR OBS;

— North West Ambulance; and

— Solihull Children's Services.

The clinical input was provided by almost 300 individuals and the IM&T community numbered a further 100.

3. Review of the output-based specification

A broad spectrum of NHS stakeholders was then engaged to review the revised draft of the OBS. The review group encompassed leading clinicians, practitioners, policy advisors, health informaticians and managers and included representatives from the Department of Health, NHS Information Authority, Strategic Health Authorities, NHS Trusts, Primary Care Trusts, GPs, academic groups and other government departments.

It is known that many of these people also sought input from colleagues and we estimate that this cascade has resulted in many thousands having had a material effect on the content and quality of the product.

A final list of 239 people was invited to review the OBS, from which a total of 105 formal review documents were received. These are listed in Annex B.

From the 900 pages reviewed there were 1,175 comments of substance. These comments resulted in a further refined version of the OBS which was then distributed for any final comment. A response to every individual comment was returned to the reviewer in question.

After formal sign-off the OBS was issued to potential suppliers on 1 May 2003. It was published in July 2003.

CONSULTATION AND INFORMATION DISSEMINATION

In addition to the many hundreds of internal meetings there were forty-four meetings held by the clinicians from the Design Authority with important stakeholders and stakeholder groups. These included several chairs of the Royal Colleges, the majority of the Tsars and presentations to many hundred clinicians at various locations around the country.

The feedback from those meetings held during the first quarter of the year helped in the production of the OBS and those during the second quarter were used to inform these senior stakeholders.

The current version of the OBS has been extremely well received by all parties. There have been very few changes.

SUMMARY OF 2002 CONSULTATION ON ICRS SPECIFICATION (AS PRODUCED AT THE TIME)

INTRODUCTION

The formal consultation period for Integrated Care Record Service (ICRS) and the Procurement Strategy closed at the end of August. A few responses continue to be sent in, but as at 27 September, 186 comments had been received. In addition other comments have been received by the NHS Purchasing and Supplies Authority on the overview of the procurement strategy and these are summarised in a separate document.

The breakdown of respondents is as follows: 74 from the NHS, 62 from suppliers and 50 from others (including the Department of Health, NHS Information Authority and other bodies such as universities, etc).

From the point of view of wishing to generate comments, this has been a successful exercise. In particular, a number of respondents clearly took a lot of time and trouble to provide some very thoughtful submissions and we are grateful for their comments and co-operation.

We were fully aware that we needed to flesh out our own understanding of the scoping, procurement, phasing and implementation of ICRS, and this has been a very helpful means of doing so. However, there is a strong sense that we have given insufficient time for consultation, and the proposed next steps are designed to address this.

ISSUES RAISED

Although it is difficult to summarise so many responses, there are four broad categories of comment which have been made:

Vision and description

A number of respondents felt that the document was not yet capturing or describing the vision of integrated records. This relates partly to the overview (which may need to be less technical) and partly to the content, where it was felt that the integrated vision was not consistently reflected in the detailed sub-sections.

We have been discussing with some of the Electronic Record Development and Implementation Project sites (eg South West Devon and Durham) how to illustrate the benefits and outcomes from integrated records. This will relate also to the communication and dissemination of the principles and objectives of ICRS to a wider audience.

Clarification of procurement and implementation

A large number of the comments were seeking clarification over the procurement process. Because we only published the synopsis there was little for people to look at in this area. Those who understood the specification were worried that the scope was too big—but there were few practical suggestions in response to the questions about phasing.

It is necessary to develop the detailed plans for procurement and implementation of ICRS. This would help bring together the two consultation documents, and explain the next steps in a more pragmatic context.

Functional Requirements

There were a number of comments around specific functional areas (and a number of detailed source documents were also submitted). Some of the comments highlighted known gap areas (eg other National Service Framework areas, ambulance, public health) where work is already in hand. A significant number were asking for more work to be done for social services, with support for this to be taken forward more quickly.

One specific suggestion from the Royal Pharmaceutical Society was that we should create "focus groups" of clinical experts to review relevant sections of the specification—in their case prescribing. This constructive idea will be considered, as it would help in informing specification and building ownership; it would be necessary to ensure that such work remained consistent to the overall vision of ICRS and the structure of the specification.

Design and architecture

There were a number of comments suggesting that more work was needed on the underlying design and architecture for ICRS. A lot of comments highlighted the importance of standards, and the need to provide more specific detail. Many felt that the specification as it currently stands is not yet detailed enough to form the basis for ICRS contracts with suppliers.

This last point is accepted, and through exemplar sites we will be seeking to find out the appropriate level of detail needed for initial long and shortlisting, and for detailed contract schedules. It is also agreed that for standards and national services it is critical that a national design authority is established. A consultancy exercise now underway, will make recommendations for the objectives, outputs and management of such a service.

NEXT STEPS

We are working towards the Office of Government Commerce's Gateway 1 and 2 review and will be firming up on ICRS architecture, the phasing of implementation and implications for future Prime Service (and product) Providers. The overall objective is to ensure that we have a procurement process for ICRS that provides a coherent national and strategic approach that is also sensitive to local requirements in terms of both business priorities and legacy systems.

By November 2002 we will have completed the review and will then provide further detail on procuring and implementing ICRS.

PARTICIPANTS IN OBS REVIEW PROCESS

Prof Aidan Halligan Department of Health

Prof Underwood President, Royal College of Pathologists

Nigel Edwards
Gareth Fereday NHS Confederation

Prof Tom Treasure IT Lead, Council of Royal College of Surgeons

Prof G Alberti Emergency Care Tzar

Louise Silverton Deputy Chair, Royal College of Midwives

Sue Williams President, National Patient Safety Agency

Prof Peter Dawson President, Royal College of Radiologists

Prof William Dunlop President, Royal College of Gynaecologists

Ian Shepherd IT Lead, Royal Pharmaceutical Society

About 120 Clinicians Attendees at Clinician Engagement Workshop

Prof Philp Chair, Regional Older Peoples' Leeds Meeting

Dr David Colin Thome Primary Care Tzar

Prof Ian Philp Care of the Elderly Tzar

Roger Staton
Mike Custance
Simon Lowles
Jim Smith
Felicity Harvey
Dr Philip Leech
Ian Dodge
Rob Webster
Karin Sowerby
Jeff Pearson Department of Health

Ruth Holland BMA General Practitioner Committee (GPC) IT Group

Dr Beverley Castleton Consultant Geriatrician and IT Coordinator for NSF for the Elderly

Ian Barnes Chair, Federation of Health Care Scientists

Prof David Haslam President, Royal College of General Practitioners

Peter Hutton (and various members) Chair, Clinical Care Advisory Group (CCAG) and members

Dr Mike Richards Cancer Tzar

Dr Louis Appleby Mental Health Tzar

Dr Sue Roberts Diabetes Tzar

Pharmacy Advisory Group including:

David Pink
Jonathan Ellis
Eve Knight
Thuvia Jones
Myra Davidson
Alistair Kent
Simon Williams
Gerard Murray
Kaye McIntosh
Patricia Wilkie Long term Medical Condition Alliance
Help the Aged
British Cardiac Patients Association
Islington Health and Race Forum
Carers UK
Genetic Interest Group
Patient Association
NHS Direct, MyHealthspace
Health Which
Academy of Medical Royal Colleges, Patient Observer

Betty Kershaw Director, Royal College of Nursing

Anne Casey IT Lead, Royal College of Nursing

Prof Roger Boyle Heart Disease Tzar

Noel Skivington
Kamini Gadhok Allied Health Professionals Forum

Mark Jones Community Practitioners and Health Visitors' Association

Prof Peter Hutton Chair, Academy Royal Colleges

Prof Carol Black President, Royal College of Physicians (RCP)

David Pencheon Public Health

Prof Sir Muir Grey Director, National Electronic Library of Health

Prof Sian Griffiths President Faculty of Public Health

Other corporate contributors:

BMA GPC

Royal College of General Practitioners

Prescribing Support Unit

Primary Healthcare Specialist Group Committee

National Patient Safety Association

PRIMIS Board and 300 facilitators

Public Health Special Interest Clinical Computing Group

Question 80 (Mr Sadiq Khan): Public Service Agreements (PSA) targets

Public Service Agreement (PSA) targets set out the key improvements that the public can expect from Government expenditure, with each PSA target setting out a Department's high-level aim, priority objectives and key outcome-based performance targets.

Like all government departments, the Department is working on PSA targets that are outcome focused, that are designed to capture the outcomes that matter most to people and that demonstrate the key improvements the public can expect. All our PSA targets are about the results to be delivered—shorter waiting times for treatment, fewer preventable deaths, better experience—not about inputs like IT systems.

  As an agency of the Department of Health, NHS Connecting for Health's strategic targets contribute to the achievement of the Department's strategic objectives, as shown in the following table:

Department of Health Objectives*

   Improve and protect the health of the population Enhance the quality and safety of services for patients & users Deliver a better experience for patients and users Improve capacity, capability and efficiency of health and social care systems Ensure system reform, service modernisation, IT investment and new staff contracts deliver improved value for money and higher quality

NHS CFH Strategic Target

To deliver Spine programme releases to introduce Secondary User Services and the Clinical Spine Application by March 2007, allowing secure direct access to patient demographic records.    √    √ √



To continue to deliver the national Choose and Book IT system and provide new functionality in Release 3.0 so that patients can be offered more choice when referred to a specialist, in line with the Government's Extended Choice policy.    √ √ √ √



To ensure that the 2nd stage of the Electronic Prescription Service is available for development and testing by GP and pharmacy system suppliers by the end of September 2006. √ √ √ √



To connect 18,000 NHS sites to the National Network (N3), providing IT infrastructure, network services and broadband connectivity to meet current and future NHS needs. √ √ √ √



To fulfil our commitment to the Department of Health programme to complete the bulk of Picture Archiving and Communications Systems deployments by March 2007, in order to finish deployment throughout the NHS in England by the end of 2007. √ √ √ √ √


To ensure that software remains available throughout the rollout of the National Bowel Screening Service. √ √ √ √ √


To develop, with the Department of Health, an approach to maximising benefits from the use of NHS CFH systems by March 2007. √ √ √ √



To ensure that declared service availability targets for our national critical systems are met, as agreed with the NHS. √ √ √ √

* Department of Health Objectives taken from the Department of Health: Departmental Report 2006.

Question 90 (Mr Sadiq Khan): Article in The Observer newspaper

The Observer article on 25 June raised issues of patient safety and risks of patients not receiving treatment.

The National Programme for IT in the NHS is not just an IT delivery programme but a transformational patient safety and clinical governance programme. Its mission is to contribute to wider Transformational Government objectives by modernising the NHS and to deliver a 21st century health service through the efficient use of IT. Key aims are to maximise the benefits of patient safety from new technology and, at the same time, minimise any risks that the new technology itself could introduce so that NHS IT systems can support clinicians in providing better, safer patient care.

Governance for patient safety within NHS Connecting for Health is provided by the Clinical Risk and Safety Board. This Board is comprised of clinical directors of NHS Trusts and clinical professionals working in the NHS. The Board provides a decision making forum and an escalation mechanism for resolution of safety problems and also advises on clinical safety issues and policies. The accountable officer for patient safety issues within NHS Connecting for Health is the Chief Clinical Officer (CCO). In line management terms, the CCO reports to the Chief Executive of the Agency and in professional terms, reports to the Deputy Chief Medical Officer of the Department of Health.

Central to NHS Connecting for Health's safety management approach is a robust patient safety assessment process. The process applies to all new and upgraded IT products and services being introduced under the National Programme. The patient safety assessment process, developed in partnership with the National Patient Safety Agency (NPSA), involves three key steps:

— products are risk-assessed in the context in which they will be used;

— a safety case sets out how identified hazards would be mitigated;

— a safety closure report provides evidence that hazards have been addressed satisfactorily.

The patient safety assessment process includes:

— a fortnightly Clinical Safety Group meeting, chaired by the National Clinical Safety Officer, where suppliers can raise clinical safety issues and seek guidance;

— a monthly Clinical Risk and Safety meeting chaired by the Director of Knowledge, Process and Safety;

(http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/engagement/clinical_connections_part2.pdf);

— safety incident reporting procedures to ensure visibility of any clinical safety issues;

— before they can be connected to the Spine, systems contracted under the Programme must receive a "Clinical Authority to Release" from the NHS Connecting for Health National Clinical Safety Officer.

NPSA is also a stakeholder on the GP2GP Project, recognising that this will improve patient safety by making the health record available to the new GP within 24 hours. There is a good working relationship between the GP2GP project team, Joint GP IT Committee and the NPSA.

The National Programme for IT also provides an opportunity to address patient safety problems that can be solved by using technology. Safer management of blood products, systems to ensure "right patient, right care", safer prescribing and safer handover between clinical teams within and across health and social care organisations are all examples of issues being investigated as part of the drive to minimise risks to patients.

The Observer article also mentioned the particular implementation problems experienced by the Nuffield Orthopaedic Centre, which have been acknowledged. The Trust's then Chief Executive confirmed that the issues were resolved and that it had been essential to install the new system as the old one was on the point of collapse. The Trust's medical staff confirmed that, while there was some inconvenience, no individual patient's care was affected adversely.

The article also suggested that Trusts are dispensing with the new systems because of fears of the impact on patients. That is not the case. A small number of Trusts which had no pressing need for new systems have indicated that they wish to continue with their existing systems until those provided under the Programme have more capability than those they use currently. NHS Connecting for Health has facilitated these Trusts continuing with their existing systems and is content for them to install the new systems at a later date. The Trusts have confirmed that they are committed to the Programme.

The article claimed that there is a daily stream of problems accessing the system. In practice, service availability levels for systems implemented by NHS Connecting for Health are invariably better than 99%. Details are published on the NHS Connecting for Health website. A further note to the Committee provides more information.

There is a large body of international research into the impact of Information Technology on clinical safety, conducted by the RAND Corporation for example. RAND is a non-profit research organisation providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. Some examples of this research are:

— information technology supporting computerised physician order entry;

— the benefits of widespread adoption of Health Information Technology;

— electronic prescribing making it safer to take medicine; and

— health Information technology can lower costs and improve quality.

Other experience also points to the benefits of IT systems to support the clinical process. In the UK, the Wirral Hospital NHS Trust implemented electronic prescribing and demonstrated improvements to patient care and cost savings. In the US, the Brigham and Women's Hospital, Boston and the Montefiore Medical Center, New York City, showed a decrease in medical errors with the introduction of computerised physician order entry.

Question 91 (Mr Sadiq Khan): Security and confidentiality of patient records

Patient records are a mixture of data, facts, opinion and observations from and for a wide range of clinical professionals and purposes. Handling and assessing this wide variety of information safely in its proper context is possible only with modern information technology. Electronic records are more complete, more legible, contain more diagnostic data, and lead to the delivery of better patient care. The NAO Report recorded that "NHS Connecting for Health has adopted the highest security standards for access to patient information and the NHS is the only public sector organisation to implement the Electronic Government Interoperability Framework (e-GIF) standard level 3 to verify the identity of users".

All NHS organisations are required to establish a Registration Authority as part of the Information Governance structures to operate their registration activities, for which they hold total responsibility. As well as the probity of processes, those governance arrangements are concerned with the management of user behaviour and the implementation of changes to business processes. The organisations are required to produce annual information governance compliance reports.

Confirmation of identity at e-GIF standard level 3 requires evidence of two types: existing identity with a photograph, such as a passport or driving licence; and two evidences of place in the community, such as a utility bill. These evidences must be presented at a face to face meeting.

Role Based Access Controls allows NHS organisations to restrict the type of access to the Personal Demographics System (PDS) and what may be done within it, for example to read records but not to change them. Control of the consent flag is restricted to a limited section of the users who have access to the PDS.

Access privileges must be approved by a sponsor, a trusted person authorised by the registering organisation to perform that role, typically a senior clinician or manager responsible for the area in which the user will work.

The user must acknowledge their acceptance of the terms and conditions under which they may operate eg no card sharing, no leaving Smartcards or logged-on PCs unattended and conformation to the NHS Code of Confidentiality.

DH policies and NHS Connecting for Health guidance to all organisations is specific and explicit in describing how staff, as users of the systems, must behave. The conditions are described in the registration forms that all users must complete and, as a record of their acceptance of those conditions, must sign. This applies to all non-NHS users as well.

There are ongoing discussions with the professional bodies and regulators around the reinforcement of these behaviours via codes of conduct etc including the position of students.

This contrasts sharply with the position of paper records. The BMA has said "A great deal of evidence points to a widespread concern among patients that relevant data are just not available when needed."

Paper records:

— are inherently unreliable, insecure and cannot easily be shared;

— can be lost, difficult to read, or inaccessible when they are needed;

— cannot have different confidentiality ratings for different parts to meet patients' wishes;

— if poorly kept, can contribute to missed appointments.

It has been estimated that 5% of patient safety incidents in acute hospitals are due to documentation errors. Medical record staff cost the NHS £120 million in 2002.

Question 93 (Mr Sadiq Khan): Sale of the benefits of the Programme

We do not accept that we have been poor at selling the benefits of the programme. The majority of staff have positive views about both the aims of the Programme and the potential impact on their daily working lives. This position has been achieved through concerted communication and engagement effort. However, this position cannot be taken for granted and we agree with the NAO that there will always be more to do as the Programme moves through its different phases and expectations change. But, as our medical witnesses explained at the hearing, there are two distinct views on the new technology, emanating from those who use it and those who do not. As the rollout progresses more people will move into the former category.

The following comments have been made by users of the Programme's products:

Gytha McBirney, radiology manager Hillingdon Hospitals NHS Trust:

"We were delighted to be chosen to go first with the new system. We'd had problems with old and unreliable wet processors, which are like giant photograph developers, for a while, so there was already a drive for us to go digital.

"Doctors I've never met before are coming up to me and saying how great the system is, and how good it is to have quick access to images. The system has proved very reliable and the quality of the images is superb."

Oxleas NHS Foundation Trust—Mental health system:

We've experienced no major hiccups and colleagues across all disciplines are using the system very enthusiastically. In fact, requests to use the system are rising impressively on a daily basis.

"We've implemented the new systems in one directorate and look forward to rolling it out over the next few months across the remainder of a large mental health trust. "As you'd expect, staff are asking how to best use the system as they become familiar with it. This is normal and proves that it's being used to improve the service we provide for clients. The biggest advantage noted by all clinicians is the ready availability of clearly written notes to all members of the clinical teams."

Barnet PCT—Community system:

Barnet PCT recently became the first in London to use the new community health computer system, part of the NHS Care Records Service (NHS CRS). The community system is an integral part of much larger change for the podiatry team, supporting the team to reduce waiting lists and improve processes.

In the first few weeks of operating the new system, consultation times were extended to give staff time to get used to the new systems.

While the waiting list initially grew, due to the extended consultation times, they have now fallen. Fiona Jackson, head of allied health professionals, said: "The new community system has definitely supported this, and helped it happen much faster."

"In the new world of commissioning, being able to demonstrate what we're doing will be invaluable. The team deliver real value for money but before we had no evidence of that, so the new system puts us in a much stronger position."

Dr William Saywell, Consultant Radiologist, Yeovil, Somerset:

"PACS has transformed the way we work in the radiology department. As well as almost eliminating the problems of film filing and retrieval, it has dramatically improved reporting efficiency and throughput. This means that not only are the images instantly viewable from anywhere in the hospital, but also that examination reports are available much earlier than previously. Patients benefit from an earlier diagnosis to facilitate prompter treatment and an earlier return home.

"We are eagerly awaiting the next step in the programme, which will enable the sharing of images between hospitals, making it unnecessary to send films or CD-ROMs with patients who are transferred to specialist centres, and giving access to previous examinations wherever the patient may attend for treatment."

Andrew Fearn, Director, ICT Services, Nottingham University Hospitals NHS Trust:

"Although some products have only been deployed recently, the simple fact is, we now have better NHS IT systems in our city than we've ever had before and have an opportunity, over time, to exploit the technology to deliver real patient care benefits—something that without these products we wouldn't even have been able to have considered."

Question 122 (Dr John Pugh): Termination of EDS contract

The total payments made to EDS from May 2003 until the termination of the contract were £11,535,737.

The replacement service, the NHSmail service provided by Cable and Wireless, now has 203,420 users at an average monthly cost of £2.56 each. Over 750,000 messages are sent each day and 7.5 terabytes of data are stored, growing by 0.5 terabytes a month. A survey of users revealed that some 30% were using the system to transmit clinical information.

The value of both contracts was variable depending on the level of take up. However, as an example to illustrate the relative the value for money, the EDS price for 100,000 users was £57 million whereas the Cable and Wireless price for the same number of users is £29 million. This provided an immediate saving to the NHS.

Question 130 (Dr John Pugh): Expenditure by Trusts on additional infrastructure

Expenditure by individual Trusts for additional desktop and infrastructure where full-scale upgrades have taken place vary considerably depending on both the size of the Trust and the state of its local IT infrastructure. To date, this expenditure has ranged from £120k to £900k.

However, it is misleading to equate gross expenditure with overall costs, as the deployments generate savings for local NHS organisations, as follows:

— Some IT products no longer have to be purchased locally.

— Switching off redundant IT removes their running costs.

— Efficiency gains arise from the move from paper to electronic records.

— Further efficiencies arise from improved business processes.

— Ultimately, gains are made through the transformation programme that the IT has enabled.

The assumption made in the investment appraisals two years ago was that gross local expenditure of £3.4 billion would reduce to £1.2 billion net. Some of these savings are for the future but, as was expected in the investment appraisals, substantial savings are being identified already.

We now have information from the early deployments. Experience so far has been that, if anything, expenditure by the local NHS has been less, and the benefits more, than estimated in the investment appraisals. The following case studies illustrate this.

Case study 1:
Primary Care Trust—North Sheffield
Two GP Practices in the North Sheffield PCT elected to change from their Existing System Programme (ESP) GP supplier to the Programme solution. The ESP solution was costing £13,000 a year across the two practices, equating to £130,000 over a 10 year term.

The local implementation costs of the new systems across the two practices were £36,000.

The overall financial impact on the PCT of transferring to the Programme solution in these two GP practices was a saving of £94,000 over the 10 year term. Moreover, the functionality of the new system will increase over time at no additional cost.

Case study 2:
Acute Trust—University Trust Hospitals Birmingham (UHB)
The UHB Trust sought prices from suppliers for the purchase of an EPR Level 3 Patient Administration System. The lowest cost bid was in the region of £25 million over a 10 year term.

The wide functionality of the Programme solution, with its impact on a broad range of staff, will result in implementation costs of £1.7 million.

By taking the Programme solution providing the same level of functionality, the Trust would incur only the implementation cost ie £1.7 million, saving £23.3 million over the 10 year term, excluding the savings from avoiding the need for the procurement exercise. Moreover, the functionality of the new system will increase over time at no additional cost.

Question 147-149 (Mr Richard Bacon): Total costs of the programme

The NAO Report estimated the total gross costs of the Programme over 10 years as £12.4 billion. At the hearing, Richard Granger was asked how much of this total had been spent to March 2006. He estimated £1.5 billion and agreed to send a note. The note was to include both a breakdown and an explanation of the difference between this £1.5 billion and the £654 million mentioned in paragraph 1.22 of the NAO Report.

The £654 million relates to payments to suppliers under the core contracts.

Richard Granger's estimate related to total expenditure, including the £654 million. The total spend to March 2006 was £1,542 million, comprising: the core contracts (£654 million); new projects added to the original scope of the Programme (£70 million); additional services beyond the scope of the original core contracts (£48 million); non-core projects and contracts added to the Programme (£75 million); Programme support for local NHS implementation (£43 million); central administrative expenditure (£193 million); and expenditure by local NHS organisations, including NHS Connecting for Health's contribution to local costs (£459 million). These costs are shown at 2004-05 base prices.

Question 198 (Mr Richard Bacon): Target dates contained in LSP contracts

A summary of the original target dates contained in the LSP contracts is attached as Enclosure 2. This comprises a series of diagrams. The first diagram shows the full functionality of the Programme. The following three diagrams show the same information but also indicate, through yellow highlighting, what was planned to be available at phases 1, 2 and 3 respectively. The dates refer to the initial planned availability of the functionality, not to its full implementation.



© Parliamentary copyright 2007	Prepared 17 April 2007