3. SYSTEM REFORM
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)
Answer
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.
Delays
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.
Outputs
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
NATIONAL PROGRAMME FOR IT BY KEY ELEMENTS:
PROJECTED LIFETIME COSTS AND EXPENDITURE TO 31 MARCH 2009
|
| |
| | £ millions
|
|
| | Category
| Projected lilfetime costs (1)
| Expenditure to 31 March 2009 (1)
|
|
| Core Contracts |
| |
|
| | London | 1,021
| 326 |
| | South | 1,104
| 133 |
| | North East |
1,035 | 276
|
| | East | 930
| 237 |
| | North West & West Midlands
| 1,042 | 271
|
| | Spine | 889
| 791 |
| | N3 Network |
554 | 554
|
| | Choose and Book
| 144 | 133
|
| | Amount retained by Accenture (2)
| 110 | -52
|
| Total core contracts |
| 6,829 |
|
| | Products added to scope
| 666 | 420
|
| | Other central costs
| 1,599 | 615
|
| Total central costs |
| 9,094 |
|
| | Local costs (estimated) (3)
| 3,562 | 772
|
| Total | | 12,656
| 4,476 |
|
| Source: |
Connecting for Health
|
| Footnotes: |
| 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
PROGRAMME OUTPUTS AS AT SEPTEMBER 2009
|
| Programme | Status
|
|
| LSP strategic solutions | 14 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 Book | Some 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 Service | Over 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 network | Some 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.
|
| NHSmail | There 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 transfer | Some 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 babies | Before 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.
|
|
| Source: |
| Connecting for Health |
|
