MPs call for NHS care records system rollout to be scrapped as scathing report dubs it a waste of money

In a scathing report, entitled The National Programme for IT in the NHS: an update on the delivery of detailed care records systems, members of the parliamentary public accounts committee described the system - an integral part of the £11.4billion Department of Health (DH) informatics plan - as 'unworkable'.

The department has been unable to deliver its original aim of a fully-integrated care records system across the NHS

The panel heard that, since the national programme was first launched in 2002, £2.7billion has been spent on the delivery of care records, but the aim of connecting all organisations across England has not been realised. The report states: "The department has been unable to deliver its original aim of a fully-integrated care records system across the NHS. Many organisations will now not receive a system through the programme, which will not provide for the transmission of individual case records across the whole NHS." And it has called on DH chiefs to cut their losses and scrap the plan altogether.

The document states: "The department should review urgently whether it is worth continuing with all elements of the care records system to determine whether the remaining £4.3billion could be used to better effect to buy systems that work, are good value, and deliver demonstrable benefits for the NHS."

The department should review urgently whether it is worth continuing with all elements of the care records system to determine whether the remaining £4.3billion could be used to better effect to buy systems that work, are good value, and deliver demonstrable benefits for the NHS

One of the problems leading to the failure was the department's relationship with its key suppliers, MPs claimed. "This casts the department's negotiating capability in a very poor light," the report states. When one supplier, BT, proved unable to deliver against its original contract, the department agreed a revised deal that would reduce the number of systems deployed, but increase the price paid for each. MPs are now concerned the deal with CSC will be similarly renegotiated, leading to further losses and are calling for an updated statement of benefits to be submitted by the end of September, which the committee will ask the National Audit Office to investigate.

In 2003, if one had built the system that was envisioned versus the system that is needed today, I think they would have approached it differently.

And they also hit out at the lack of information provided to trusts, which, under the original plan, will take over responsibility for the care records systems from 2015/16. The report states: "After the implementation of the 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.

"The department should write to every NHS trust making clear the detailed implications of their future responsibilities and in particularly the financial liability to which each trust will be exposed. This information should include information about exit costs from the local service provider contracts and future maintenance and running costs for those trusts that continue with the programme and this information must be provided within two months.

"It should also specify the support the centre will provide to trusts procuring outside the programme, particularly where such systems can be shown to represent value for money to the NHS or greater functionality."

In 2003, if one had built the system that was envisioned versus the system that is needed today, I think they would have approached it differently

During a committee debate on the subject earlier this year, prior to the publication of the report, MP Ian Swales said: " We seem to have built this massive superstructure that is never likely to deliver clear, simple, straightforward systems to the NHS."

And Patrick O'Connell, president of BT Health, admitted that the goalposts had changed since contracts were first signed. He told members: " One of the things that has changed is the need of the users. In 2003, if one had built the system that was envisioned versus the system that is needed today, in the sense of a centrally-located system versus a clinically-led system, I think they would have approached it differently. It looks like the need has evolved."

Quite where this leaves trusts which have deployed systems, or are yet to roll them out, is for now still unknown. Responding to the criticism, a DH spokesman said the budget for the national programme had already been cut by £1.3billion, adding: "The Government recognises the weaknesses of a top-down, centrally-imposed system. Although elements of the programme have been delivered successfully, the policy approach previously taken has failed to engage the NHS sufficiently. We are determined to deliver even more value for money from the programme."

At present trusts have no direct contractual relationship with existing suppliers and no information about the likely cost of using care records systems beyond 2015

When we spoke to industry expert Andrew Wilcox, civil government divisional director of UK-based software development and consultancy company, IPL, he admitted the failure of the project came as no surprise. He added: "There were three fundamental issues at the outset. There was next to no engagement with the stakeholder or potential end user as to what goals they were aiming to achieve from the project and as such suppliers had insufficient direction as to precisely what end goal was required and being aimed for. The project was therefore so large it has become unmanageable." He said detailed engagement was needed for the off to ensure progress could be constantly assessed according to specific need, adding: "The public sector procurement approach makes the adoption of this - the most suitable methodology for many public sector projects, difficult."