The National Programme for IT in the NHS (the Programme) was an ambitious £11.4 billion programme of investment designed to reform how the NHS in England uses information to improve services and patient care. The Programme was launched in 2002, and the Department of Health (the Department) has spent some £6.4 billion on the Programme so far. This report is concerned with a central part of the Programme, where the aim was to create a fully integrated electronic care records system, which is expected to cost around £7 billion in total. The original objective was to ensure every NHS patient had an individual electronic care record which could be rapidly transmitted between different parts of the NHS, in order to make accurate patient records available to NHS staff at all times.
This intention has proved beyond the capacity of the Department to deliver and the department is no longer delivering a universal system. Implementation of alternative up-to-date IT systems has fallen significantly behind schedule and costs have escalated. The Department could have avoided some of the pitfalls and waste if they had consulted at the start of the process with health professionals. The Department has failed to demonstrate the benefits achieved for the £2.7 billion spent to date on care records systems.
The Department has accepted it is unable to deliver its original vision of a standardised care records system with an electronic record for every NHS patient. It is now relying on individual NHS Trusts to develop systems compatible with those in the Programme, which means that different parts of the country will have different systems. However, we are concerned at potential inconsistencies, and the Department should address how they should be dealt with, and what it will cost local NHS organisations to connect up. The Department should review whether to continue the programme and consider whether the remaining £4.3 billion would be better spent elsewhere. The Department has not got the best out of its suppliers, despite having paid them some £1.8 billion since 2002. One supplier, Computer Sciences Corporation (CSC), has yet to deliver the bulk of the systems it is contracted to supply and has instead implemented a large number of interim systems as a stopgap. The Department has been in negotiations with CSC for over a year, and told us that it may be more expensive to terminate the contract than to complete it, although we also note that CSC has informed the United States Securities and Exchange Commission that it may receive materially less than the net asset value of its contract if the NHS exercises its right to terminate the contract for convenience.
The other supplier, BT, has also proved unable to deliver against its original contract. The Department agreed a revised contract reducing the number of systems and increasing the price for each system BT had to deliver. The Department is clearly overpaying BT to implement systems: BT is paid £9 million to implement systems at each NHS site, even though the same systems have been purchased for under £2 million by NHS organisations outside the Programme.
One factor which contributed to these failings is the Department's weak programme management. We are concerned that, given his significant other responsibilities, David Nicholson has not fully discharged his responsibilities as the Senior Responsible Owner for this project. This has resulted in poor accountability for project performance.
NHS trusts will take over responsibility for care records systems from 2015-16, but they do not currently have the information they need about potential future costs. After the implementation of forthcoming health reforms, the organisations currently managing the Programme will no longer exist and the risks will transfer to NHS trusts. However, at present these trusts have no direct contractual relationship with existing suppliers and no information about the likely cost of using care records systems beyond 2015.
We are further concerned about the problems we and the National Audit Office have faced in getting timely and reliable information from the Department. Information provided has frequently been late, has contained inconsistencies and has contradicted other evidence. This has hampered our ability to scrutinise the Programme on behalf of Parliament.
On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Department of Health and its contractors BT and CSC on the delivery of care records systems under the National Programme for IT in the NHS.