Public Accounts Committee

From Nhs It Info

Contents

The 1992 and 1998 Information Management and Technology Strategies of the NHS Executive (30 Apr 2000)

Public Accounts Committee

http://www.publications.parliament.uk/pa/cm199900/cmselect/cmpubacc/406/40603.htm

"Our Key Conclusions on Improving the Delivery of Government IT Projects:
- Decisions about IT must be treated as business decisions rather than technical ones, and have senior management involvement and commitment.
- End users must be identified before the project commences so that their needs are taken into account fully during design and development of IT projects.
- Departments should consider carefully whether projects are too ambitious to undertake in one go, particularly if a project connects with the business operations of other parties, or depends on the development of IT undertaken by other parties.
- Successful implementation of IT systems calls for imagination and well-conceived risk management, in addition to skilled and sound project management.
- It is essential that public sector bodies place IT contracts that avoid any lack of clarity, or debatable interpretation, which can lead to expensive misunderstandings and the need for possible resolution in the courts. . ."

NHS IT report plays too safe (27 Jun 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/06/27/216596/NHS+IT+report+plays+too+safe.htm

"The National Audit Office’s report on the NHS National Programme for IT (NPfIT) should be the start, not the end, of independent scrutiny of the UK’s largest ever IT investment.

The report was expected to be the centre of discussion yesterday (26 June) at the House of Commons Public Accounts Committee hearing and is certain to feature strongly in hearings expected to be held by the Health Select Committee into the project this autumn. But the purpose of the NAO report, or an independent technical audit like that called for by 23 academics and supported by MPs of all parties, is not to provide a club to batter an opponent. Nor is it to act as a fig leaf to hide the shame of individuals or organisations that have not delivered on time or to budget. It is to give real practical guidance on how to get the best for patients, for NHS staff and the taxpayer, while giving a fair rate of return to the suppliers involved in such a high risk project. By its own admission the NAO did not look at the programme’s technical feasibility. So the plan to enable doctors to access online the health records of everyone in England remains untested."

PAC Hearing

(Oral evidence at, and published reactions to, the hearing of 26 June 2006)

MPs prescribe 'rescue' plan for NHS IT project (18 Aug 2004)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2104

"The government has been urged to rethink its £12.4bn NHS IT project, and replace its current highly centralised national strategy with a more flexible locally-based approach based on standards. Such an overhaul is prescribed as the only way to reduce the risks of the programme, enable useful local clinical systems to be delivered and prevent costs from mushrooming and delays mounting. The call comes from two leading members of the Commons Public Accounts Committee, which reviewed the programme in June. They urge the government to rethink its plans to avoid the programme "sleepwalking into disaster" and wasting billions of pounds. Richard Bacon, the Conservative MP for South Norfolk, and John Pugh, the Liberal Democrat MP for Southport, argue the Connecting for Health (CfH) programme should be reformed to allow hospital trusts to purchase systems locally that can then be linked into the national network. . ."

MPs condemn NHS IT (8 Sep 2006)

The Register

http://www.theregister.co.uk/2006/09/08/mps_condemn_npfit/

"Two members of the Public Accounts Committee have condemned the centrally-run management of the National Programme for IT and called for a return to local decision making and procurement. Conservative MP for South Norfolk Richard Bacon and Liberal Democrat MP for Southport John Pugh picked the programme to pieces in a paper they published yesterday."

Uncorrected transcript of Oral Evidence given by Mr Andrew Rollerson (7 Mar 2007)

Public Accounts Committee

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/uc390-i/uc39002.htm

". . . I believe in this programme philosophically and intellectually, and have from a very early date, and have been very committed personally to doing everything in my power to make it succeed and, in fact, the talk I gave at the conference was aimed at assisting that process. I believe that there are certain elements of the deployment that could be done better but, given one cannot re�write history, the track we are going down can be made to succeed. . . My view is that there is a natural tendency to apply the techniques that one understands in any given situation, so standard project management techniques, even relatively low level programme management techniques, are applied to programmes in general. This programme is on a scale beyond anything attempted before and I believe, therefore, requires some innovative thinking and some of the best minds to be applied in terms of structuring it so that it can succeed over the long-term. It is naive to assume, in my view, that because something may go well in the early stages when things are relatively simple, crossing the foothills, if you like, as you start to climb what is going to be an enormous mountain that those techniques will still work. Therefore, I believe this needs to be carefully thought out. . . An implementation programme of this scale and complexity continually runs into challenges and this was one of the aspects of the talk that I gave the other day, that there is a tendency to start shooting the alligators closest to the canoe in order to ensure that something at least is achieved, and this is the right thing to do provided that one does not lose sight of what one is trying to achieve overall. To extend the analogy, I suppose, if you are shooting alligators but fail to observe that you are about to go over a 300-foot waterfall, then you have essentially wasted your time by pursuing these immediate tactical goals, addressing tactical problems. In a programme this size you need to keep your eye on both. . ."

Suspended Fujitsu exec tells MPs NPfIT needs visionary leadership (8 Mar 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2529

"The senior manager at Fujitsu who said the National Programme for IT was in danger of delivering “a camel, and not the racehorse that we might try to produce”, has told a parliamentary committee that this can only be solved with more ‘visionary and proactive leadership from the NHS.’ Andrew Rollerson, who was credited as ‘formerly practice lead of the healthcare consultancy at Fujitsu’, told the Commons Public Accounts Committee that he had faith in NPfIT but felt some issues needed correcting first. “I believe certain elements [of the programme] that need to be deployed could be done better. The current track for NPfIT can be achieved, but it is ambitious and risky.” . . . Rollerson told the committee that he was not aware of Computer Weekly’s intention to publish a controversial presentation he made last month until the day before the magazine published its edition. He has since been suspended from his duties by the company, pending an internal inquiry which could lead to disciplinary procedures. He revealed to the committee that Fujitsu, local service provider for the Southern cluster, had found NPfIT a difficult project to manage. “There has been ongoing debate in Fujitsu about the situation with the national programme,” he said. Rollerson blamed the delays in the national programme on resistance from trusts to go live with systems that had come under scrutiny from others. “There is already resistance from trusts, and there will be more if systems are just deployed on an IT path. It is essential that trusts are engaged with procurements, it could be true that trusts would be happier if they got the systems they actually want but I believe that such a fragmented approach would not have led to what we are about to achieve.” He added that the programme would not be any more successful if IT departments were left to procure and deploy systems themselves. “If NPfIT was left to IT departments to control, it would fail because the end users would not be engaged. If we’re not careful the driver will become the technology itself.” Rollerson spent all of his time away from the hearing surrounded by senior colleagues from Fujitsu. He told the committee that he felt reporting in Computer Weekly was out of context from what he thought was a presentation intended to be supportive of the national programme. He acknowledged that he did actually say what was reported by the magazine, but said he was discomforted by later coverage suggesting that he was a heroic whistleblower. This included reader comments read out to him in the PAC session taken from E-Health Insider’s coverage of the presentation. Despite not being a developer himself, he dismissed concerns from a committee member that his presentation was a “marketing gimmick”. Instead, he told the committee that in his decade with the company, he had been in daily contact with developers chosen for the project himself and has seen and learnt the issues first-hand. Asked why the LSP had not implemented in the 12 trusts it told the PAC it would by October 31 last year, Rollerson said Fujitsu had to work on changes from its initial supplier IDX and ensure Cerner was a success. . . He welcomed proposals for a catalogue of additional suppliers, but said it would not affect the LSP’s role in the NPfIT. . . He added that the national programme “requires some innovative thinking and some structure to succeed in the long term. It would be naïve to assume that systems will go well in the early stages.” , , Rollerson said that his presentation was approved by Fujitsu and he did not believe that his comments have damaged the credibility of what should be a huge success. The hearing was the second into the National Programme for IT by the House of Commons PAC following the National Audit Office Report, The National Programme for IT in the NHS, published on 16 June 2006."

PAC Report of 17 Apr 2007

Department of Health: The National Programme for IT in the NHS (17 Apr 2007)

Public Accounts Committee

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf

"Conclusions and Recommendations:
1. The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. . .
2. The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. . .
3. The Department’s investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost. . .
4. The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. . .
5. The Department needs to improve the way it communicates with NHS staff, especially clinicians. . .
6. We are concerned that leadership of the Programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change. . .
7. The Department should clarify responsibility and accountability for the local implementation of the Programme. . .
8. The use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition. . .
9. At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. . ."

MPs dissect NHS IT plan's failings (17 Apr 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/04/17/223034/mps-dissect-nhs-it-plans-failings.htm

"After a nine-month inquiry into the NHS's National Programme for IT, the House of Commons Public Accounts Committee has today (17 April) published a forceful and authoritative report, the ramifications of which could be felt for years. The committee's concerns contrast with the comments in January of David Nicholson, chief executive of the NHS. He told an invited audience that though there were some big issues to tackle on the NPfIT, the programme was "not widely off course". He added that he saw no evidence of a need for an independent review of the scheme - as called for by 23 leading academics last year. Now, however, there is that evidence. The committee's report - which was drafted initially by the National Audit Office - depicts the NPfIT as a failure so far. It also finds that in some respects the programme might have done more harm than good, by inhibiting innovation and progress. The strongest criticisms are left to the report's final paragraph. It simply questions whether the 10-year contracts - which could cost taxpayers £6.2bn - will bring significant clinical benefits by the time they expire. This single conclusion undermines the credibility of the programme. . . The report includes quotes from papers submitted by experts. Anthony Nowlan, formerly a director of the NHS Information Authority, says the specification for national systems was produced at "breakneck speed". Thomas Brooks, a member of the all-party Parliamentary IT Committee, is quoted in a personal capacity. He criticises the idea that central procurement can produce systems that meet local requirements. . . A paper submitted by David Kwo, former NPfIT director for London, and others, including NHS staff, says that, with the delays in the delivery of the Care Records Service, "Local service provider schedules are being down-scoped behind the NHS's back and without any accountability to the local NHS trust chief executives to whom the original vision was promised." . . . The government is expected to respond to the report and its recommendations by July."

PAC says NPfIT suppliers are 'struggling to deliver' (17 Apr 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2617

A damning new report by the influential House of Commons Public Accounts Committee (PAC) questions the basic business case behind and contracts awarded for England’s £12.4bn NHS National Programme for IT. The report focuses on the lack of progress on implementing electronic patient records which it says "suppliers are struggling to deliver" and calls for an urgent independent review. . . Edward Leigh, chair of the PAC, said the programme, if successfully delivered, still offered huge benefits, but today warned that if it fails "it could set back IT developments in the NHS for years". . . Leigh summarised the conclusions reached by the PAC: "There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected." Leigh called for "resolute action". "The department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including NHS organisations, can have more confidence." He added that if advanced electronic patient record systems cannot be delivered by current suppliers within the framework of the programme, "then the local NHS should be given greater freedom to look for alternative systems which do work." Leigh warned that "the stakes are high" saying that the programme, if successful could revolutionise the way the NHS in England uses information, significantly improving patient care. . ."

The sickening £12 billion NHS fiasco (17 Apr 2007)

Daily Telegraph

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/04/17/do1702.xml

". . . The project is costing more than £12 billion, enough to pay for 60,000 nurses for 10 years, or for Britain's participation in Iraq and Afghanistan twice over. . . By now, almost every hospital in England is supposed to have key administrative software deployed as the essential first step in introducing the shiny new electronic patient record. They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days. This is a truly grim tale. More than £2 billion has been spent, and although there is no detailed record of overall expenditure on the programme, estimates of its total cost have ranged from £6.2 billion up to £20 billion. There have been six bosses in five years. Timetables are fictitious and the programme is now years behind. Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier called iSoft, which is currently under investigation by the Financial Services Authority and whose flagship software product, "Lorenzo", does not exist yet (even though the company said it was available three years ago). In the meantime, iSoft has been merrily selling old software that pre-dates the national programme. Today, Parliament's spending watchdog publishes a report on this multi-billion-pound fiasco, which concludes: "At the present rate of progress, it is unlikely that significant clinical benefits will be delivered by the end of the contract period." The whole project has been an object lesson in how not do it. There are some basic rules of thumb that apply to successful IT projects: start small, do it in stages, learn from your mistakes, resist the grand vision thing, scale up only when you know what you are doing, and - above all - talk to the people who will use it. . . If Connecting for Health had been created by one of this country's enemies with the specific task of wasting as much money as possible while causing maximum anger and resentment among doctors, nurses and hospital managers, it could hardly have done a better job. Having been given responsibility for the largest sum of money ever allocated to a health IT programme anywhere in the world, at least £12.4 billion, which incidentally dwarfs the entire NHS deficit, it has failed to deliver. This disastrous agency should be put out of its misery, but most of its budget - £10 billion is still unspent - and its purchasing functions should be handed over to local hospital bosses. Any remaining functions could be handled by the Department of Health directly. IT has a tremendous role to play in healthcare and it saves lives. . ." [Richard Bacon MP]

PAC report brings brickbats and bouquets for NPfIT (18 Apr 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2619

"Mixed reaction greeted the House of Commons Public Accounts Committee’s report on the National Programme for IT with critics and supporters dividing on predictable lines and the NHS Confederation saying the programme must be made to work, despite its problems. Health minister Lord Hunt, claimed the evidence taken to produce the report was outdated. “This PAC Report is based on a NAO [National Audit Office] report that is now a year out of date. Since then substantial progress has been made and the NAO recommendations have already been acted on. Costs of the programme have not escalated. In fact, the NAO acknowledged that costs were under control and the strength of the contracts means that payment is not made until systems are delivered which protects the taxpayer. The NHS IT programme is already being used by clinicians and bringing benefits for patients with digital technology transforming diagnosis and treatment every day. Electronic prescriptions are now available and digital x-rays are increasingly in use across the country.” . . . Dr Gill Morgan, chief executive of the NHS Confederation which represents over 90% of NHS organisations, told EHI that it was essential that NPfIT was made to work and the government should resolve any outstanding issues. . . James Johnson, chairman of the BMA, agreed with the proposal for a review of clinical involvement in NPfIT. . . Liberal Democrat health spokesperson, Norman Lamb, said: “There can be no doubt that the ministers’ plans have gone badly wrong. The government has put IT in the NHS in a centrally controlled strait jacket. “The damning evidence in this report is that delays in implementation and a lack of compatibility with local systems is proving disruptive to local hospitals. How soon will it be before another technical glitch puts patients’ lives at risk? Any discussion with people working in the NHS leaves an overwhelming sense of loss of confidence in the project. The government cannot continue to charge ahead with the system, blind to ever more stark warnings.” Lamb said that his party felt that there should be no further spending on NPfIT until a resolution to the problems raised is found. . ."

Why won’t DoH heed criticism of IT policy? (18 Apr 2007)

Healthcare Republic

http://www.healthcarerepublic.com/news/Opinion/651308/Why-won%E2%80%99t-DoH-heed-criticism-policy/

"Why is the DoH behaving like a spoilt child over the National Programme for IT (NPfIT)? Its reaction to any criticism of the great IT plan or any suggestion for change is the political equivalent of sticking its fingers in its ears and going ‘la la la’ before declaring ‘No! Shan’t!’ repeatedly. Widespread criticism from experts and stakeholders in other areas has seen major government projects dropped, ministers resigning and in one case the wholesale reform of a government department. But not so with Connecting for Health and the NPfIT. It seems to have ignored calls for change by IT experts and survey findings, including some of GP’s own, that clinicians have not been engaged in the programme and remain unconvinced of its clinical benefit. Concerns over the value of Choose and Book, the amount of time it takes up and whether the software works, have been dismissed as the rantings of luddites. Yet it is difficult to find anyone connected with it to say any thing positive about the Connecting for Health projects. Now even MPs are voicing concerns, with the Public Accounts Committee (PAC) producing what even the most generous souls would describe as a damning report, which includes evidence from the GP survey. The PAC criticises the DoH for the lack of any analysis of the benefits of NPfIT against its costs, the lack of a coherent timetable and its failure to engage clinicians in the project. In fact it says there is no sign that the programme will deliver tangible benefits during the the current contract period. Such are the criticisms of the programme that one member of the PAC has called for it to be wound up immediately, although the report merely asks for an urgent review. This time, the DoH has no excuse for another sulk. The MPs on the PAC are neither users of the system nor ‘disgruntled’ IT experts — perhaps it is time to listen to the facts."

MPs urgently demand a new IT strategy (19 Apr 2007)

Health Service Journal

http://www.hsj.co.uk/healthservicejournal/pages/n1/p9/070419

"A Commons scrutiny committee has said 'urgent' action is needed to rescue the national IT programme. In a damning 188-page report the public accounts committee said it was 'unlikely that significant clinical benefits will be delivered by the end of the contract'. The Department of Health should instead determine what will be ready by then 'as a matter of urgency', it said. But the DoH criticised this week's report as 'a year out of date' and a spokesman said 'substantial progress has been made' in IT development. The report said the shared patient record is two years behind schedule and alternative patient administration systems were 'not a substitute'. As the DoH is 'unlikely to complete the programme anywhere near its original schedule', providers should be able to 'select from a wider range' of PAS systems, it concluded. This was important, the report said, as only two major software providers remain on the programme after the departure of Accenture, ComMedica and IDX. Having only two suppliers 'may have the effect of inhibiting innovation, progress and competition' it said. This meant a higher burden was now on the remaining suppliers, who were suffering from 'a shortage of appropriate and skilled capacity'. It added: 'It is essential that chief executives and senior managers in the NHS understand the role they need to play in the implementation of the programme.' . . . Committee chair Edward Leigh MP called for a 'robust delivery timetable' from the DoH. He said: 'Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.' But health minister Lord Hunt said the findings were based on last June's National Audit Office report on the programme and therefore out of date. . ."

Report exposes stark reality of NHS IT (24 Apr 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/04/24/223391/report-exposes-stark-reality-of-nhs-it.htm

"The Public Accounts Committee has done us a service by directing attention to the poor progress being made on the central plank of the NHS's National Programme for IT. It has reminded us that most of the benefits of the scheme will be obtained by creating detailed electronic care records at the local level, and that it is the local Care Records Service which, together with central overheads, accounts for 82% of the NPfIT's total expenditure. To their credit, the MPs on the committee have not allowed themselves to be diverted by the high profile that has been created for national services and the digital x-ray programme. The report makes grim reading. We are told that the first phase of delivering local care records is already two years behind schedule, with no firm completion date identified. This is despite acute trusts needing to do no more than replace the existing patient administration system with one from the NPfIT. By February 2007 only 18 trusts out of 150 had done this. Or had they? Well, no, actually. Not really. For in delving a little deeper, it transpires that due to delays in software development, no NPfIT patient administration systems are yet available in the three clusters served by iSoft, and in fact only old, pre-NPfIT systems have been implemented. But it gets worse. What of phases two and three, the addition of NPfIT clinical functionality to patient administration systems, which are "the key to the delivery of clinical benefits"? We are told that their implementation may scarcely have begun by the time the original local service provider contracts expire in 2014. What do we make of Lord Hunt's statement that the Public Accounts Committee's report is out-of-date? Alas, the situation described above is only too up to the moment. The committee's report is out of date only in that the latest problems, such as those encountered by Milton Keynes General Hospital, came too late to be included. . . So what is to be done? The report makes two sensible recommendations. It endorses the current move to make local chief executives accountable for implementation of NPfIT, but with one absolutely crucial proviso: that they are not merely given responsibility, but also "authority and resources." In other words, that budgetary responsibility and control of suppliers must also be delegated. The report then recommends that additional suppliers of core Care Records Service software are brought in to create an element of local choice." [About the author: Alan Shackman is a contributor to a paper published in the Public Accounts Committee's report on the NPfIT. He is an independent consultant who has worked on electronic patient record-connected matters for more than 15 years, directly for NHS trusts. He was also an interim NPfIT programme director. He has been involved in a number of Electronic Patient Record procurements.]

Granger says 'consultation' led to records delays (26 Apr 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2643

"Richard Granger, the director general of IT for the NHS today (26 April) told the House of Commons Health Select Committee that he blames the two year delay in delivery the electronic patient record system at the heart of the NHS IT programme on ‘consultations’ taking longer than anticipated, He said: “Some aspects have been delayed by 24 months because the consultation schedule on these aspects has gone on far longer than was originally scheduled. Significant further work was necessary in the task of creating an environment where the necessary specification was stable. It would be inappropriate to roll it out as it was because it would later need serious re-working at a cost to the taxpayer.” Granger was giving oral evidence as part of the committee’s investigation into the electronic patient record, just a week after the Commons Public Accounts Committee issued a damning reports on the delayed programme. The NHS IT boss began by making a statement of benefits delivered, reeling off statistics on systems delivered. . . “The main problem we are facing are two extremities – waiting patients and privacy fascists and we are trying to find a pathway for the middle of the two.” Explaining the reasons behind difficulties in implementing systems in the acute sector, he said: “It is very difficult to implement in brownfield sites but we are making progress. Last week we did three simultaneous deployments in Surrey and Sussex, Ipswich and Northampton.” . . In a later session, Dr Paul Cundy, chair of the General Practitioner’s Joint IT Committee, Dr Martyn Thomas representing the UK Computing Research Committee and Andrew Hawker, a former system developer and an NHS patient dismissed Granger’s comments and called for an independent hearing into NPfIT. Dr Thomas said: “As the specification is still evolving, the plan for delivery is built on sand. This project has all the hallmarks of a massive failure, when it is meant to transform the way of working.” Dr Cundy added: “The failure to consult with us has led to the amount of consultations that have been mentioned. We would have had a much more incremental process if we had our views dealt with from the start.” When asked if he felt an independent review was necessary, Granger said: “Are the people calling for it themselves independent? We have a programme under immense scrutiny, and the minister took a decision last year that such a review was not necessary.” The hearing follows the submission of 68 pieces of written evidence compiled in a 192 page document submitted to the committee."

From Private Eye (27 Apr 2007)

Private Eye

"The government still has its head in the sand over the NHS National Programme for IT, even after last week's disastrous report from the Public Accounts Committee -- probably its most comprehensive demolition job on a major government project. MPs called for a root and branch review, yet health minister Lord Hunt claimed that the PAC was "based on a National Audit Office report that is now a year out of date. Since then substantial progress has been made and the NAO recommendations have already been acted on." Alas, there were few serious NAO recommendations to act on as it was bullied by the agency running the programme, Connecting for Health, into producing a whitewash. And the PAC report was actually based more on information submitted by experts since the NAO reported, plus 49 questions posed by Tory MP Richard Bacon that should have been put by the NAO in the first place. And progress has been anything but "substantial" - and where there has been action "progress" is not quite the word. Milton Keynes hospital installed a new system in February, since when thousands of patient records have gone missing. Seventy-nine members of staff have written an open letter declaring the system "not fit for purpose". The future looks no brighter as the plan to shift responsibility from the woeful CfH to strategic health authorities is already behind schedule -- partly, perhaps, because of the admin costs they would have to take on. One of Bacon's questions revealed there were 471 consultants at work in CfH at daily pay rates up to £2,493. As the Eye might have mentioned before, the same consultancy industry now getting even richer from the programme had a big hand in bringing it about in the first place."

NHS IT plan "is a success story" (30 Oct 2007)

Computing

http://www.computing.co.uk/computing/news/2202338/nhs-plan-success-story

"The NHS National Programme for IT (NPfIT) is now so well advanced that the health service "could no longer function" without it, the government has said. Exchequer secretary to the Treasury Angela Eagle told MPs last week that NPfIT is a success despite delays implementing key aspects of the strategy, including the Lorenzo next-generation hospital administration package. "Without the programme, the NHS could no longer function, and it is providing essential services and significant benefits to tens of thousands of clinicians and millions of patients," she said. Eagle was replying to a Commons debate on a series of reports from the Public Accounts Committee (PAC) on government computing disasters. Conservative MP Richard Bacon highlighted the PAC report on the NHS which said that Lorenzo - on which three-fifths of the programme was said to depend - was not yet available despite a claim in supplier iSoft's 2005 annual report that it was. He said a Treasury minute had stated the software was not expected until 2008 and he asked that a minister announce its arrival in Parliament when it happens. But Eagle said NPfIT "is a success story that ought to be acknowledged". "More than 5.5 million appointments have now been made using the Choose and Book system, representing 44 per cent of first referrals" she said. "In addition, 397 million diagnostic images are now stored centrally, and 42 million electronic prescriptions have been used in a service that is now available in 41 per cent of pharmacies and 47 per cent of GP surgeries. "Nearly 400,000 users are registered to use the NHS care records spine, with 45,000 NHS staff accessing it daily." Eagle said national leadership had been strengthened by the appointment of a chief clinical officer and national clinical leads.

MPs see Lorenzo demo amid new NPFIT delays (16 Jun 2008)

Computer Weekly

http://www.computerweekly.com/Articles/2008/06/16/231079/mps-see-lorenzo-demo-amid-new-npfit-delays.htm

"MPs on the Public Accounts Committee have seen a demonstration of the delayed "Lorenzo" software - a key part of the NHS's National Programme for IT - ahead of a hearing in the House of Commons today (16 June 2008) on the £12.7bn scheme. . . Morecambe Bay Hospitals NHS Trust and two other early adopters of the software, Bradford Teaching Hospitals NHS Foundation Trust and South Birmingham PCT, have issued a statement saying that "deployment testing is identifying technical issues which are being resolved on an ongoing basis". The three hope to go live this summer with Lorenzo Release 1, but they gave no commitment on any date in their statement. . . But the demonstration did not allay the concerns of all the MPs present. The Lorenzo software is already running four years behind schedule, according to the report of the National Audit Office which was published on 16 May 2008. Richard Bacon, one of the MPs present at the demonstration, said that seeing a system apparently working on a single large screen did not necessarily prove it would work when used by doctors and health staff across many PCs at various hospital sites that form an NHS trust. Ministers have tried to counter criticism of delays with the Care Records Service by giving series of dates when the first sites will go live. But the dates for go-lives have been deferred repeatedly. . ."

The National Programme for IT in the NHS: Progress since 2006 (14 Jan 2009)

House of Commons Public Accounts Committee

http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/153.pdf

Summary Conclusions and Recommendations:
1. Recent progress in deploying the new care records systems has been very disappointing, with just six deployments in total during the first five months of 2008-09.
2. By the end of 2008 the Lorenzo care records software had still not gone live throughout a single Acute Trust.
3. The planned approach to deploy elements of the clinical functionality of Lorenzo (release 1) ahead of the patient administration system (release 2) is untested, and therefore poses a higher risk than previous deployments under the Programme.
4. Of the four original Local Service Providers, two have left the Programme, and just two remain, both carrying large commitments.
5. The termination of Fujitsu's contract has caused uncertainty among Trusts in the South and new deployments have stopped.
6. The Programme is not providing value for money at present because there have been few successful deployments of the Millennium system and none of Lorenzo in any Acute Trust.
7. Despite our previous recommendation, the estimate of £3.6 billion for the Programme's local costs remains unreliable.
8. The Department hopes that the Programme will deliver benefits in the form of both financial savings and improvements in patient care and safety.
9. Little clinical functionality has been deployed to date, with the result that the expectations of clinical staff have not been met.
10. The Department has taken action to engage clinicians and other NHS staff but there remains some way to go in securing their support for the Programme.
11. Patients and doctors have understandable concerns about data security.
12. The Department does not have a full picture of data security across the NHS as Trusts and Strategic Health Authorities are required to report only the most serious incidents to the Department.
13. Confidentiality agreements that the Department made with CSC in respect of two reviews of the delivery arrangements for Lorenzo are unacceptable because they obstruct parliamentary scrutiny of the Department's expenditure.

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