Public Expenditure on Health and Personal Social Services 2009 - Health Committee Contents


3.1.4  Could the Department detail expenditure and projected expenditure on the National Programme for IT? Is the Department yet able to provide a more reliable estimate of the programme's local costs? Could the Department comment on any cost overruns and delays? What outputs has the Programme delivered to date? (Q23)


  1.  Financial information is given in table 23a.

  2.  Projected expenditure, estimated by the National Audit Office (NAO) in their May 2008 report on the programme, amounts to some £12.65 billions (at 2004-05 prices). However, this is a gross cost figure. It does not take account of the financial values of benefits that will be realised from the programme, or of the known and estimated difference between the cost of central procurements and the cost of equivalent procurements by individual NHS bodies.

  3.  A figure for local cost additions has been included in the table, based on the 2007-08 figure, but it is recognised that this is unsatisfactory. The devolved management structure of the NHS makes it extremely difficult to determine locally and capture actual local implementation costs. The difficulty of producing a reliable estimate of local costs was recognised in the May 2008 NAO report on the programme. Furthermore, though the Department had envisaged being able to arrive at a more reliable estimate via its annual survey of NHS local investment in IT, responding to the survey is not mandatory on NHS foundation trusts, and over time, more NHS foundation trusts are choosing not to respond.

  4.  The Department therefore decided not to refine the survey as originally proposed, but supported additional research in a sample of NHS sites in the 2008 survey. This has been extended to a broader consultation in the 2009 survey, with a review of the results by SHA chief information officers planned for later this year.

  5.  The May 2008 NAO report confirmed that there had been no cost overruns up to 31 March 2008, and changes that had occurred in projected costs were attributable mainly to additional functionality. This remains the case. Other increases have resulted from supplier and subcontractor changes. There has also been some reclassification between local/national costs, but this does not impact the programme total.


  6.  Many of the programme's systems and most of the infrastructure have been successfully delivered. It is regrettable that progress has been slower than anticipated with the NHS Care Records Service at the acute trust level. Implementation of the programme was designed to be gradual rather than `big bang' so that major problems associated with new IT systems were avoided even if delays occurred. The cost of any delays is being met by suppliers rather than the taxpayer.

  7.  The Department continues to work closely with suppliers to ensure that software is fit for purpose before deployment, and remains confident in the potential of both the Cerner Millennium and Lorenzo strategic solutions to be able to support the NHS in the longer term. Meanwhile, the Department has made clear it's commitment to opening up the healthcare IT market to new suppliers and new technological developments in order to inject more pace into the programme. The aim is to help trusts configure systems to best meet their local needs, as well as taking advantage of market developments to make more use of the information they hold. Officials are working closely with the NHS and current suppliers to improve the pace of delivery. The Department has said that it will be prepared to consider alternative arrangements in the event that significant progress has not been demonstrated before the end of November 2009.


  8.  An overview of progress in delivery by key programme area is given in table 23b. In terms of services currently routinely being used by clinicians and patients, on any typical day in the NHS the national programme already enables:

    — Over 500,000 prescriptions to be transmitted electronically (33% of average total daily prescriptions), reducing errors and inefficiencies.

    — 30,000 Choose & Book electronic bookings to be made, over 50% of NHS referral activity from GP surgery to first outpatient appointment, putting patients in charge of their care.

    — The Personal Demographic Service, now fully operational, to be used by hundreds of primary, community, mental health and acute care organisations across the NHS every day, processing over two million transactions daily.

    — Over 1.5 million digital images to be stored, to support faster and more accurate diagnosis. The Picture Archiving and Communications System is now used for 100% of X-rays.

    — Some 668,000 users are now registered to access the NHS Care Record "spine", enabling them to access information that is relevant to their care role.

    — All acute trusts and over 90% of primary care trusts have at least one system delivered through the National Programme for IT, and all GPs in England are using systems delivered as part of the programme.

  9.  In all, over 35,000 instances of new IT deployments of all types are now live.

Table 23a


£ millions

Projected lilfetime costs (1)
Expenditure to 31 March 2009 (1)

Core Contracts
  North East
  North West & West Midlands
  N3 Network
  Choose and Book
  Amount retained by Accenture (2)
Total core contracts  
  Products added to scope
  Other central costs
Total central costs  
  Local costs (estimated) (3)

Connecting for Health
1.  Figures in the two columns are not directly comparable. The projected lifetime costs are shown at 2004-05 prices, and final outturn will be higher due to inflation in subsequent years. Those for expenditure to 31 March 2009 are resource outturn figures.
2.  In 2006, Accenture made arrangements to voluntarily novate the company's contract to another existing supplier under the programme. Of the £179 million Accenture had received to that point the company retained £110 million for work completed. £52 milion represents the value, for accounting purposes, of moneys repaid as at 31 March 2009.
3.  No figures have been received to date for local costs for period 2008-09 and therefore the figure is retained as per 2008 return.

Table 23b



LSP strategic solutions14 Cerner Millenium acute PAS systems deployed in London and the South.
Summary Care Record (SCR)To date, 74 GP practices have gone live with the SCR, and 475,526 patients' clinical records have been updated to form SCRs.
Choose and BookSome 53% of new outpatient appointments are being booked through Choose and Book (this is steadily increasing). All NHS hospitals in England are now using Choose and Book, along with 96% of GP practices.
Electronic Prescription ServiceOver 242 million prescription messages have been issued electronically and 33% of all prescriptions are now electronic.
Picture and Archiving Communications System (PACS) The PACS programme is now fully deployed, leaving behind the old technology of wet film and X-rays. The NHS is the first healthcare system in the G8 nations to deliver universal coverage of digital X-rays. Previously 5,000 procedures were cancelled every year due to patient scans and X-rays not being available. On average, repeat X-rays have been reduced by 50%.
Secondary Uses Service (SUS)Over 1.5 million records are entering SUS each day and there are now over 1.5 billion records stored.
N3 networkSome 44,054 NHS National Network (N3) secure broadband connections have been installed. 100% of existing GP sites who require a connection have had this delivered. Clinicians are able to securely connect to access information on patients including scans and images from any location, at any time.
NHSmailThere are now over 360,000 registered users of NHSmail. One million messages are transmitted across the NHS email system each day, one third of which contain clinical information.
GP2GP transferSome 5,181 (62%) GP practices now live with systems enabling GP to GP record transfer. Some 771,872 electronic medical records have now been transferred using GP to GP.
NHS numbers for babiesBefore NHS Number for Babies it used to take six weeks to issue an NHS number to a child: now issued at birth.
Personal Demographics Service (PDS)The PDS is now a fully operational, successful system. It is used by hundreds of organisations across the NHS every day, including primary, community, mental health and acute care. The PDS processes almost 60 million transactions in a typical month.

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