The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee Contents

1  Progress in implementing the systems

1.  The National Programme for IT is designed to reform the way the NHS in England uses information, and hence to improve services and the quality of patient care. The Programme's aims are ambitious, and the scale and complexity make delivery more challenging than similar projects elsewhere in the world. The Programme requires substantial organisational and cultural change to be successful and it is dependent on the deployment of systems in an increasingly devolved NHS.[3]

2.  At the outset of the Programme, the aim was for implementation of the systems to be complete by 2010. While some aspects, such as the N3 broadband network and the Spine, are complete or well advanced, the original timescales for introducing the Care Records Service have not been met. The Department's latest forecasts are that it is likely to take some four years more than planned—until 2014-15—before every Trust has fully deployed the new care records systems which will support the creation of Detailed Care Records. The introduction of the Summary Care Record is also behind schedule, though deployment in five early adopter areas began in March 2007.[4]

3.  The Department pointed to three factors to explain why the original timescales had proved unachievable. These were the technically ambitious nature of the Programme; the need to agree how consent would be handled in order to retain public confidence; and customisation, where suppliers were having to do more to meet the needs of individual NHS organisations than was envisaged at the start of the Programme. Fujitsu agreed that the need to tailor the systems to meet local requirements had been a major cause of delay.[5]

4.  The new care records systems are being deployed in Trusts, but much more slowly than originally planned. At 31 August 2008, a total of 133 deployments had been made, including 37 in Acute Trusts (Figure 1). In the first five months of 2008-09, just six deployments were made, two each in Acute Trusts in London and in the North, Midlands and East, and two in Mental Health Trusts in the North, Midlands and East. There were no further deployments in Primary Care Trusts or in the South.[6]

5.  Cerner's Millennium product has been deployed in Acute Trusts in London and the South. Deployment of the first release began in December 2005 in the South and in July 2007 in London. Since April 2007, responsibility for developing plans for implementing systems in all Trusts has rested with the local NHS, working with the Local Service Providers. London has outline plans, but deployment of the later releases of Millennium will not be complete for several years.[7]
Figure 1: Deployments of electronic care records systems under the Programme at 31 August 2008

Acute Trusts
Mental Health Trusts
Primary Care Trusts
Local Service Provider
Number of Trusts
Number of deployments
Number of Trusts
Number of deployments
Number of Trusts
Number of deployments
LondonBT 316 106 3120
SouthFujitsu (to 28.05.08) 418 141 317
North, Midlands and East CSC97 2335 1590 47
Total 16937 5922 15274


1. Two of the deployments in Acute Trusts in London pre-date the Programme but have since been integrated into the Programme, with services now provided by the Local Service Provider.

2. The deployments in the North, Midlands and East are of iPM, the interim solution, which will be replaced later by releases of Lorenzo.

3. This Figure does not include deployments of GP systems.

Source: Department of Health

6.  Trusts generally experience some technical problems with the new care records systems, and the hospitals in London and the South which have deployed Millennium have had considerable problems. For example, in summer 2008 the Royal Free Hampstead NHS Trust identified problems associated with data entry, system processing, data management and reporting that were having a significant impact in relation to waiting list management and patient bookings, and on the finances of the Trust.[8]

7.  Least progress has been made in the North, Midlands and East because the Lorenzo care records software, the strategic solution, has not been available. As a result, in the meantime Trusts have been deploying iPM, an interim system. To implement Lorenzo, these Trusts will have to go through a further deployment in due course, with the attendant substantial additional work. The Department acknowledges that the delivery of Lorenzo has not gone smoothly and has taken much longer than planned. In addition, the software developer, iSOFT, has experienced a series of financial, accounting and governance difficulties. In the light of concerns about progress, in summer 2007 the Department and CSC (the Local Service Provider) jointly commissioned two reviews of the delivery arrangements for Lorenzo. Among other things, the reviews drew attention to deficiencies in programme management, which has since been strengthened. The Committee requested copies of the reviews, but the Department responded that it could not release them because CSC had agreed to the reviews only on the basis of strict confidentiality agreements, advising that the information supplied was commercially sensitive to third parties.[9]

8.  Despite the delays, the Department is optimistic about the prospects for Lorenzo, which is now being demonstrated to the clinical community. At the time of our hearing in June 2008, the first release of Lorenzo was in pre-deployment testing in three early adopter sites. (The first release is solely clinical and functionality for the patient administration system will follow in the second release.) Trusts will not go ahead with a deployment until they are satisfied that the system will not put patient safety or the running of the hospital at risk. It can be very disruptive if a system is deployed too early and a Trust has to revert to clerical records. Decisions about 'go live' dates are therefore a matter for individual Trusts, rather than being determined centrally.[10]

9.  The Department had expected that Lorenzo would be deployed first at University Hospitals of Morecambe Bay NHS Trust at around the end of September 2008. In the event, the planned 'go live' date at Morecambe Bay was not met, and the first Trust to deploy Lorenzo was South Birmingham Primary Care Trust, on 3 September 2008, where the system is supporting the podiatry service. Roll-out of the first release of Lorenzo across the North, Midlands and East, to follow implementation in the early adopters, was expected to begin later in 2008 but was not achieved. As for Millennium, further releases are planned to be implemented over several years.[11]

10.  Progress on two other key components of the Programme—Choose and Book and the Electronic Prescription Service—is mixed. Choose and Book incorporates an electronic booking service, although not all Trusts can take direct bookings and utilisation has been lower than expected. Although on average around 98% of GPs use the Choose and Book system at some stage in a week, in total only around half of new outpatient appointments were being made in this way. Choose and Book involves significant change in the way people work and it is taking time to train, educate and support GPs to use the system. The Department is also planning to publicise patients' rights in order to increase awareness of Choose and Book.[12]

11.  In relation to the Electronic Prescription Service, over 70% of GPs and pharmacies have the first release of the software, which enables them to handle electronic prescriptions. But as the GPs and pharmacies are not necessarily in the same areas, only around 40% of prescriptions are issued with readable barcodes. Paper prescriptions will continue to be required until the second release of the software is deployed, which cannot begin until GP and pharmacy systems have been accredited. The Department expects that most suppliers of GP systems will be accredited by the middle of 2009. After the introduction of the second release of the software, paper prescriptions will continue only in certain limited circumstances, for example, when a patient requests a paper prescription or when the prescription is a private prescription.[13]

3   Q 72; C&AG's Report, para 1 Back

4   C&AG's Report, paras 5-6, 2.16 Back

5   Qq 11-12, 150 Back

6   C&AG's Report, para 2.14, Figure 1; Ev 29 Back

7   C&AG's Report, paras 2.8, 2.15-2.16 Back

8   C&AG's Report, para 3.85; Royal Free Hampstead NHS Trust, Chief Executive's Report to the Board on 6 November 2008, Back

9   Q 44; C&AG's Report, paras 2.10-2.12, 2.14; Ev 24 Back

10   C&AG's Report, para 2.13; Qq 16-17, 46-48, 58 Back

11   Ev 29 Back

12   Q 31; C&AG's Report, paras 3.92-3.93, Figure 5 Back

13   Qq 24-26; Ev 22-23 Back

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Prepared 27 January 2009