IT news: Damning report reveals National Programme for IT has failed to revolutionise the NHS

The report from the National Audit Office (NAO), entitled The National Programme for IT in the NHS: an update on the delivery of details care records systems, reveals the widespread failure of the Government's vision to transform the way the NHS in England uses information to improve services and enhance the quality of patient care.

Launched in 2002, the NPfIT had hoped to create a national infrastructure across the NHS, effectively providing clinicians with access to vital patient records from anywhere in the country and bringing an end to paper records and written correspondence. This vision included the deployment of a national care records service, broadband system and secure email directory for staff. In addition, it was to deliver supplementary solutions including an electronic prescription service and picture archiving system.

Although the majority of organisations have now completed the installation of the broadband network and picture archiving system, at a cost of around £2billion, the major stumbling block has proved to be the patient care record, which it was hoped would be up and running by 2007.

But problems have plagued the rollout of both the summary care record and the detailed care record since the beginning, with issues surrounding the four contracted suppliers, the solutions themselves, and a general lack of support from NHS staff. This led to a report by the Committee of Public Affairs (CPA) in 2007 which revealed the plans were at least two years behind schedule and it would be at least 2014 before the whole system was in place and linked nationwide.

This report was followed by further problems with the suppliers, including the termination of the Government's contract with Fujitsu in 2008 and an admission by the Department of Health the following year that additional customisation of the system was needed. As a result, the CPA concluded the programme was not offering value for money.

This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme. The Department of Health needs to admit that it is now in damage-limitation mode

Since its launch the programme has cost around £6.3billion, with an expected final budget of more than £11.4billion. However, this week's report questions how effective this expenditure has been and will continue to be, with the authors concluding the original outcomes will not be achieved, however much cash is spent.

Amyas Morse, head of the National Audit Office, said: "The original vision for the National Programme for IT in the NHS will not be realised. The NHS is now getting far fewer systems than planned, despite the department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme. The Department of Health needs to admit that it is now in damage-limitation mode."

The report continues: "With fewer systems being provided through the programme and more use being made of a variety of existing systems, there is an increased risk of not achieving adequate compatibility across the NHS to effectively support joined-up healthcare."

On the care record systems, it adds: "At the outset of the programme, it was expected that systems would be introduced incrementally with each requiring a number of upgrades, releases, or enhancements after their initial delivery in order for the NHS to have access to the full extent of functionality expected through the programme. If progress is set against the original aims, the overall level of functionality provided to date is well below what the department contracted for.

"We are seeing a steady reduction in value delivered, not matched by a reduction in costs. On this basis we conclude that the £2.7billion spent on care records systems so far does not represent value for money and we do not find grounds for confidence that the remaining planned spend of £4.3billion will be different."

While deployment of the care record system is better within community health trusts, so far, in the London area, 47% of acute trusts have yet to introduce it. In the South 30% of acute trusts and 17% of community trusts are still outstanding; and in the North, Midlands and East, the situation is worse with 96% of acute 38% of community trusts having still not adopted the software. As a total, this leaves 84% of acute trusts and 27% of community trusts without systems.

With fewer systems being provided through the programme and more use being made of a variety of existing systems, there is an increased risk of not achieving adequate compatibility across the NHS to effectively support joined-up healthcare

In response to the report, the Prime Minister has announced a review by the Cabinet Office and Treasury to prevent any further loss of taxpayers' cash. A Department of Health spokesman said: "Improving information technology is a fundamental part of delivering a modern, world-class health service. This report from the National Audit Office highlights major concerns with the pace and scale of delivery of information systems under the national programme. We agree change is needed and that the original vision was flawed. This is why last year we announced a move away from a centralised, national approach to IT to localised responsibility and decision-making. However, we do think the investment made so far will potentially deliver value for money now that we have a more flexible approach that allows the local NHS to be in charge of its own requirements."

The healthcare IT industry has also been responding to the issue, with a spokesman from Cloud2 Computing commenting "The NHS simply cannot continue into the 21^st Century without fully implementing electronic patient records and document management systems. This conundrum is further compounded by the impending healthcare reform, as money remains a significant issue surrounding England's NHS.

"To begin to repair some of the damage inefficient projects have contributed to the healthcare IT solutions sector, purposeful ambiguity around projects, information storage and retrieval and navigation needs to be erased. By encouraging the notion that electronic systems are complex and unaffordable, projects are seen to be outside of the reach of many smaller NHS trusts and consortia.

By encouraging the notion that electronic systems are complex and unaffordable, projects are seen to be outside of the reach of many smaller NHS trusts and consortia

She added: "The computerisation of the NHS is grounded in principles that are, by their definition, in place to make information easier to input, store, find and share with minimal errors and data loss which cost the health service millions of pounds every year. By providing the NHS with efficient, cost-effective solutions, computerisation can continue, enabling the NHS to prepare for an electronically-based future.

"The NAO report was correct when it said that inefficiency was costing the NHS above and beyond what it could reasonably afford. However, inefficiency does not have to come hand-in-hand with IT solutions. Computerisation should not be viewed as a revenue-sapping augmentation to a normal working environment. It should, and can, revolutionise the way the NHS works, and should not cost the earth in order to do so."