The National Programme for IT in the NHS: an update on the delivery of detailed care records systems - Public Accounts Committee Contents

2  Future risks to value for money

12. The Department and the NHS expect to spend a further £4.3 billion on the delivery of care records systems by 2015-16.[40] This estimate assumes that the Department will manage to reduce the cost of the CSC contracts to deliver systems in the North, Midlands and East by at least £500 million, which it is currently negotiating with CSC. These negotiations began in November 2009 but have not yet been concluded. CSC accepted that the contract renegotiations were necessary because the contract as it stands is not working for either the NHS or for CSC.[41] The Government has also initiated a review of the Programme by the Major Projects Authority, the joint Cabinet Office-Treasury body which oversees large public sector projects. The Prime Minister has stated that no new contract can be concluded with CSC until this review is completed.[42]

13. To achieve a reduction in the value of the CSC contract of at least £500 million, the Department will have to agree a substantial reduction in the number of systems to be provided under the contract and in the functionality that they will provide.[43] This revised contract is being considered even though the Department believes CSC to be in breach of contract.[44] CSC reported that the focus of its negotiations with the Department had not been around terminating the contract but had focused on moving forward with the delivery of systems.[45] The Department stated that if it was to terminate the CSC contract it could be exposed to a higher cost than the cost of completing the contract as it stands.[46]

14. To secure greater clinical support for the systems, the Department undertook an engagement exercise with clinicians in 2008 asking them what they wanted from their IT systems in the acute care setting.[47] This review identified five clinical areas of functionality and certain departmental systems, such as maternity or A&E, as being the minimum specification that would be acceptable to clinicians.[48] The original vision will not be delivered and the Department is now focused on delivering these five areas of functionality from a 'menu of modules' which enables each NHS acute trust to select those aspects of the system they need most.[49] The Department is therefore funding the development of modules which may not be taken by all acute trusts within the Programme and is now creating a patchwork system which builds upon trusts' existing systems.[50]

15. One of the key aims of the Programme was to avoid each NHS organisation procuring its own system. The Programme had originally been set up to address these issues, but organisations within the Programme are now tailoring systems locally with different levels of functionality being provided, and the many NHS organisations now outside the Programme are again responsible for procuring their own systems.[51]

16. The Department believes that its compromise of a 'networked' approach of locally tailored systems will still enable the Programme's aims to be achieved, but it has no means by which to ensure interoperability between locally procured systems and those delivered through the Programme.[52] This approach, however, will require trusts outside the Programme to fund the development of their own systems at a time when they are being asked to make significant efficiency savings.[53] The Department stated that it had made no assessment of the costs to trusts outside the Programme of developing their own systems.[54] In effect, some trusts will be getting systems that cost £31 million through the Programme, while others may or may not be in a position to fund the development of their systems to the same extent.[55] The Department told us it did not expect differences in the funding and development of systems to lead to any noticeable differences in service from the patient perspective.[56]

17. The contracts for delivering care records systems expire in 2015-16, by which time the strategic health authorities that are responsible for the local delivery of systems will no longer exist.[57] The risks will transfer to individual NHS trusts.[58] With all trusts expected to become foundation trusts responsible for their own governance, the Department stated that it would be difficult to shift management of the contracts into that environment. It anticipated that, as an interim step, a body similar to Connecting for Health would be created to manage the transition.[59]

18. It is not clear what implications the forthcoming health reforms will have on how care records system will be managed and governed in future, and who will take over from Connecting for Health.[60] Those NHS organisations receiving systems through the Programme currently have no direct contractual relationship with the providers or the subcontractors supplying care records systems.[61] There is also considerable uncertainty about the mechanism for transferring services from the Programme to new suppliers, and in particular whether the costs of doing so will be prohibitive. This could mean trusts will in effect be tied to using the system they have taken through the Programme.[62]

40   Q 111 Back

41   Qq 60, 42-44, 208, 315 Back

42   Q 285; HC Deb, 11 May 2011, col 1163 Back

43   Qq 41-48 Back

44   Qq 310-313 Back

45   Q 41 Back

46   Qq 234-235 Back

47   Qq 130, 315 Back

48   Q153 Back

49   Qq 155, 315 Back

50   Qq 221-222, 291, 300 Back

51   Qq 214, 306 Back

52   Qq 212, 270, 298 Back

53   Q 288 Back

54   Qq 291-295 Back

55   Qq 286, 292, 296, 299 Back

56   Qq 213-219 Back

57   Qq 257-258 Back

58   Q 259 Back

59   Qq 262-265 Back

60   Qq 262-265, 273 Back

61   Q 242 Back

62   Qq 231, 316 Back

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© Parliamentary copyright 2011
Prepared 3 August 2011