National Audit Office

From Nhs It Info

Contents

Suggested questions for the NAO audit of NPfIT (Nov 2004)

UKCRC

http://www.ukcrc.org.uk/resource/reports/nhs_it.pdf

". . .UKCRC believes that: (1) No existing system can meet the current, detailed operational requirements of the NHS, therefore it is essential that a complete and unambiguous specification of the system’s requirements is drawn up, and that this specification is analysed rigorously to uncover any omissions or contradictions. We know this is technically feasible even for a system of this complexity; to fail to carry out this analysis before placing contracts would be unprofessional, and a serious waste of public funds. (2) Any system that is implemented will be novel, complex, and will require the use of the best available software engineering incorporating good computer science. This requires a significant change to current procurement practices but, without such changes, the project will fail."

Contribution to NAO Investigation of NPfIT (4 Jan 2005)

BCS

http://www.bcs.org/upload/pdf/auditofficejan05.pdf

Summary:
1. NPfIT is damaging the UK healthcare IT Industry by excluding many small but innovative players. Steps must be taken to make systems more open.
2. NPfIT operates in an unnecessarily secretive manner. Its contracts and other documentation need to be made public to allay suspicion and encourage trust.
3. NPfIT is too top down in its approach. It now needs to be made bottom up: owned, understood and made affordable locally.
4. Current experience in the UK is not being exploited.
5. There needs to be confidence in the quality of staff developing NPfIT. Qualified informatics staff should be the norm..
6. More staff are required at all levels to implement NPfIT at the pace planned. Education is needed in health informatics to develop a larger pool of skilled workers.
7. Centralised solutions may not perform well enough for clinical use. Consideration should be given to distributed solutions.
8. Patient care is at risk from a loss in functionality. Much current healthcare is built around and depends upon current IT solutions.
9. There are risks to physical security and privacy of content from the NPfIT approach. Rigorous but practical user access controls are essential.
10. Confidentiality constraints must not interfere with patient care by limiting what information is documented and what is available to whom.
11. Without user ownership, NPfIT systems will not be used. Clinicians need to be consulted about integrating IT systems with operational clinical services.
12. NPfIT is primarily about business change, not information technology. There needs to be an extensive education and training initiative.
13. There are risks to the integrity of data with the concept of one “fat” National Data Spine.
14. NPfIT relies on the successful use of the Snomed CT clinical terminology. It needs more development by skilled staff, piloting and user training.
15. Guidance is needed on operational convergence with Social Services and the Voluntary sector which have very diverse informatics environments.

NHS Connecting for Health Process Capability Appraisal (25 Apr 2005)

Qinetiq (Contribution to NAO Report on NPfIT)

http://www.nao.org.uk/publications/nao_reports/05-06/05061173_qinetiq.pdf

Among the "Improvement Opportunities" listed:

"- Individual stakeholder requirements cannot be explicitly traced back to specific stakeholders or stakeholder classes
- Arrangements for stakeholder requirements definition were not defined within a documented process
- Stakeholder requirements definition had proceeded directly to the production of the OBS without the production of an analyzed statement of stakeholder requirements
- There was no evidence that an architectural design process had been defined, documented or deployed.
- The authority’s integration strategy - of accepting or allocating responsibility for overall integration of the NPfIT principal sub-systems – did not demonstrably minimize the risk associated with integrating a large and complex system1."

Health IT Report (5 May 2005)

http://www.lightbluetouchpaper.org/2006/07/28/health-it-report/

Document produced by Ross Anderson "for the National Audit Office on the health IT expenditure, strategies and goals of the UK and a number of other developed countries. This showed that our National Program for IT is in many ways an outlier, and high-risk." (The contents of this document were used in the first draft NAO report, but did not feature at all in the final published version.).

Knowledge of the Choose and Book Programme Amongst GPs in England (Sep 2005)

National Audit Office

http://www.nao.org.uk/publications/gp_survey_2005.pdf

"The overall perception of Choose and Book was negative – 78% of respondents said the prospect of Choose and Book would be very negative or a little negative."

A Safer Place for Patients (Nov 2005)

National Audit Office

[http://www.nao.org.uk/publications/nao_reports/05-06/0506456.pdf

"NHS Connecting for Health, has begun to roll out its National Care Record system and expects it to have full functionality by 2010. Most trusts foresee that this will help them in ensuring that patient records are no longer lost and there are better controls over prescribing (both issues have led to significant numbers of patient safety incidents)."

Press Comments on Delayed Report on NPfIT

Audit Office report on CfH delayed again (26 Jan 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=1666

“. . . the eagerly awaited report, originally due to be published in July 2005, is now not expected to be released until “summer 2006” at the earliest, a publication date that may yet slip further.”

NHS IT probe useless (24 Mar 2006)

The Register

http://www.theregister.co.uk/2006/03/24/nao_npfit_too_late/

“By the time the official audit of the government’s £6.1bn NHS IT modernisation is published in the summer it will be too late to be of any [use to] the cash-strapped NHS, said a leading contributor to the investigation. However, the National Audit Office report might contain a valuable lesson for other arms of the public sector undergoing programmes of modernisation similar to the ambitious NHS National Programme for IT, said Glyn Hayes, chairman of the Health Informatics Committee of the British Computer Society.”

MPs to probe IT fiasco at health service (7 May 2006)

Observer

http://observer.guardian.co.uk/business/story/0,,1769248,00.html

“Parliament’s spending watchdog is to investigate the National Health Service’s £6.2bn IT modernisation amid fears that the massive project is overbudget and behind schedule.”

NAO Report: National Programme for IT in the NHS (16 Jun 2006)

National Audit Office

http://www.nao.org.uk/publications/nao_reports/05-06/05061173.pdf

From the Summary: "The Programme’s scope, vision and complexity is wider and more extensive than any ongoing or planned healthcare IT programme in the world, and it represents the largest single IT investment in the UK to date. If successful, it will deliver important financial, patient safety and service benefits. The main implementation phase of the Programme and the realisation of benefits is mainly a matter for the future and it will therefore be some time before it is possible fully to assess the value for money of the Programme, as this will depend on the progress made in developing and using the systems it is intended to provide."

From the Conclusions and Recommendations: "Successful implementation of the Programme nevertheless continues to present significant challenges for the Department, NHS Connecting for Health and the NHS, especially in three key areas: ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS, and to agreed timescales without further slippage; ensuring that NHS organisations can and do fully play their part in implementing the Programme’s systems; winning the support of NHS staff and the public in making the best use of the systems to improve services."

NHS CFH response to the National Audit Office outline findings - 16 Jun 2006

Media Reactions to the Jun NAO Report

NHS computer upgrade "too slow" says report (16 Jun 2006)

Reuters

http://today.reuters.co.uk/news/newsArticle.aspx?type=topNews&storyID=2006-06-16T112131Z_01_L16439520_RTRUKOC_0_UK-BRITAIN-HEALTH-COMPUTERS.xml

Cost of NHS IT programme 'to double' (16 Jun 2006)

The Guardian

http://politics.guardian.co.uk/egovernment/story/0,,1799352,00.html

NHS computer system haemorrhaging cash (16 Jun 2006)

ITV News

http://www.itv.com/news/britain_de01caeded53f917a3d480620bc730f8.html

Major NHS IT upgrade hit by delay (16 Jun 2006)

BBC News

http://news.bbc.co.uk/1/hi/5086060.stm?ls

NHS computer scheme under fire (16 Jun 2006)

Daily Telegraph

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/06/16/uit.xml

NHS computer upgrade ‘behind schedule’ (16 Jun 2006)

Financial Times

http://news.ft.com/cms/s/0a1f062a-fd31-11da-9b2d-0000779e2340.html

Analysis: NHS IT costs 'not disproportionate' (16 Jun 2006)

The Times

http://www.timesonline.co.uk/article/0,,2-2229189,00.html

£12.4bn NHS computer 'years behind' (16 Jun 2006)

The Guardian

http://www.guardian.co.uk/uklatest/story/0,,-5891785,00.html

NHS IT project is doing OK, says Audit Office (16 Jun 2006)

ZDNet UK

http://news.zdnet.co.uk/business/0,39020645,39275487,00.htm

Can government run IT projects? (16 Jun 2006)

BBC News

http://news.bbc.co.uk/1/hi/business/5088260.stm

NAO gives positive account of NHS CfH (16 Jun 2006)

E-Health insider

http://www.e-health-insider.com/news/item.cfm?ID=1951

NHS risks £20bn white elephant, say auditors (16 Jun 2006)

The Guardian

http://www.guardian.co.uk/guardianpolitics/story/0,,1799064,00.html

NAO reports slams NHS IT delays (16 Jun 2006)

VNUNet

http://www.vnunet.com/vnunet/news/2158474/nhs-rollout-slow

Mealy-mouthed NAO pampers NHS IT (16 Jun 2006)

The Register

http://www.theregister.co.uk/2006/06/16/nao_npfit_whitewash/

NHS National Programme for IT faces ‘significant challenges’ (16 Jun 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/06/16/216489/NHS+National+Programme+for+IT+faces+%e2%80%98significant+challenges%e2%80%99.htm

BMA: Report on IT upgrade raises concerns (16 Jun 2006)

Politics.co.uk

http://www.politics.co.uk/issueoftheday/bma-report-on-it-upgrade-raises-concerns-$442706$442644.htm

U.K. Health Service Computer System to Cost 12.4 Billion Pounds (16 Jun 2006)

Blomberg

http://www.bloomberg.com/apps/news?pid=10000102&sid=aj5ksKUAua8c&refer=uk

NHS computer project needs backing of health staff to succeed (16 Jun 2006)

Computing

http://www.computing.co.uk/computing/news/2158428/nhs-needs-backing-health-staff

NHS IT delays: National Audit Office publishes tough report (16 Jun 2006)

PublicTechnology.net

http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=5217

Partnership not penalties will deliver successful NHS IT (16 Jun 2006)

Intellect

http://www.intellectuk.org/databases/press/press_details.asp?id=29

Bugs in the system - The world’s biggest IT project has yet to prove it is good for the health (17 Jun 2006)

The Times

http://www.timesonline.co.uk/article/0,,542-2229686,00.html

£12bn IT system passes health check – for now (17 Jun 2006)

The Times

http://www.timesonline.co.uk/article/0,,2-2229434,00.html

£14BN OVER BUDGET ..TWO YEARS LATE Yes.. it's ANOTHER government computer fiasco (17 Jun 2006)

The Mirror

http://www.mirror.co.uk/news/tm_objectid=17245884&method=full&siteid=94762&headline=-pound-14bn-over-budget---two-years-late--name_page.html

Watchdog criticises delays over '£20bn' NHS computer system (17 Jun 2006)

Independent

http://news.independent.co.uk/business/news/article1089764.ece

True cost of delayed NHS system is £12.4bn (17 Jun 2007)

Daily Telegraph

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/06/17/nhs17.xml&sSheet=/news/2006/06/17/ixuknews.html

New NHS e-system 'behind' (17 Jun 2006)

Scotsman

http://news.scotsman.com/uk.cfm?id=889552006

NHS £14billion mega-byte (17 Jun 2006)

The Sun

http://www.thesun.co.uk/article/0,,2-2006271020,,00.html

NHS Transformation Proceeds: Despite iSoft debacle, the U.K.'s National Health Service is doing a good job with IT transformation; damage control (19 Jun 2006)

Line56.com

http://www.line56.com/articles/default.asp?ArticleID=7695

NHS IT system slammed (19 Jun 2006)

OneStopClick

http://www.onestopclick.com/news/NHS-IT-system-slammed_17193636.html

NHS IT project hit by rising costs (19 Jun 2006)

Computer Business Review

http://www.cbronline.com/article_news.asp?guid=0AA8ADC1-251D-406E-9027-7B04F34C7091

Report fuels calls for new NHS IT review (20 Jun 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/06/20/216497/Report+fuels+calls+for+new+NHS+IT+review.htm

NHS IT needs balanced view: There is good and bad in every project (22 Jun 2006)

Computing

http://www.computing.co.uk/computing/comment/2158768/nhs-needs-balanced-view

Between fact and fiction: The NHS report (22 Jun 2006)

Consultant News.com

http://www.consultant-news.com/article_display.aspx?p=adp&id=2882

Involve nurses in IT input (27 Jun 2006)

The Times (Letter)

http://www.timesonline.co.uk/article/0,,59-2244112,00.html

This examination of NHS IT scheme has failed to probe the painful facts (11 Jul 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/07/11/216832/This+examination+of+NHS+IT+scheme+has+failed+to+probe+the+painful.htm

NHS report 'criticisms deleted' (18 Aug 2006)

BBC News

http://news.bbc.co.uk/1/hi/health/5263316.stm

"A report into the £6.8bn NHS IT upgrade had criticisms removed and toned down before publication, the BBC learns. BBC Radio 4's World At One programme has obtained documents showing passages were removed from a National Audit Office report during consultation. The June study was circulated to various consultees, including the government, from January. The watchdog said its main conclusions were unaltered, but others said the report was weaker than expected."

NHS IT 'secrets' exposed: A National Audit Office PDF cock-up (23 Aug 2006)

The Inquirer

http://www.theinquirer.net/default.aspx?article=33883

"THE NATIONAL Audit Office has accidentally revealed details of the NHS’s troubled multi-billion-pound IT programme "Connecting for Health". The watchdog released a PDF report with passages electronically blacked out to hide sensitive information. The only problem was that by highlighting the hidden text, and then copying and pasting it into a text editor, all was revealed. Amongst the details were the 'estimated costs' for each part of the NHS Connecting for Health programme. It also said that EDS's contract to provide an NHS-wide email system would have cost £212m if it had not been cancelled. It also said that BT was 'fined' £11.6 million for under-performance. The blacked out bits also contained unreported criticisms from NAO officials about the Connecting for Health. . ."

NAO report - a journey from criticism to praise (29 Aug 2006)

Computer Weekly

http://www.computerweekly.com/articles/article.aspx?liArticleID=218034

"When a report was published in June by the National Audit Office into the NHS's National Programme for IT (NPfIT), it was seen by ministers as a vindication of the UK's decision to spend £12.4bn on the world's largest civil computer scheme. The report was strongly supportive of the scheme and replete with praise for the Department of Health and NHS Connecting for Health, its agency which runs the NPfIT. But earlier drafts seen by Computer Weekly tell a different story to the final NAO report. Comparing the earlier drafts against the final version of the NAO's report shows that there has been a cover-up, with passages critical of the programme removed or substantially altered."

[Page proofs of full story]

Unhealthy tale of NAO report (29 Aug 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/08/29/217947/Unhealthy+tale+of+NAO+report.htm

"The National Audit Office is a great British institution - or was. It was set up by Gladstone, in part to authorise the issuing of public money to government from the Bank of England, and it now has the express power to report to parliament at its discretion on how departments spend our taxes. This is one reason why on its website, it says that anyone concerned about the way public money is being spent should write in - which is exactly what IT specialists, suppliers, MPs, and organisations did over the NHS's £12.4bn National Programme for IT (NPfIT). These correspondents were then surprised that when the NAO published its report on the NPfIT their concerns were not reflected in the main text. Now we know why. Three draft NAO reports on the NPfIT released to Computer Weekly under the Freedom of Information Act show that many of the most serious criticisms of the NPfIT were omitted from the final publication (see NAO report: a journey from criticism to praise). Between the drafts there had been a "clearance" process with health officials in Whitehall. We recognise that facts have to be checked with departments. But changing wording in such a way as to give a more favourable impression of the programme, and removing entire passages of criticisms that had sound, quoted sources, is not the same as fact checking. We hope the Public Accounts Committee will take the unusual step of holding another hearing on the NPfIT - and that the Public Accounts Commission, which oversees the work of the NAO, will take a hard look at the specific reasons for the changes to the draft reports."

NAO Report: National Programme for IT in the NHS (Leaked First Draft)

National Audit Office

http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/18_08_06_nhs_auditreport.pdf

From the Summary: "There is support amongst NHS staff for what the Programme is seeking to achieve, but also significant concerns: that the Programme is moving slower than expected, that transparency is lacking as to when systems will be delivered and what they will do, and that the confidentiality of patient information may be at risk. Relations with GPs have also been damaged by concerns that they will be forced to give up their existing IT systems."

NAO Report: National Programme for IT in the NHS (Unexpurgated Leaked First Draft) (This version has reinstated the text that has been blanked out in the draft that had been obtained by the BBC.)

New inquiry into NHS IT upgrade (4 Sep 2006)

BBC News

http://news.bbc.co.uk/1/hi/health/5313974.stm

"Auditors are to launch another inquiry into the £6.8bn NHS IT upgrade project. The National Audit Office only reported in June on the scheme to link 30,000 GPs with 300 hospitals in England, Computer Weekly magazine says. The programme, run by a government agency called Connecting for Health, has proved controversial. The original NAO report criticised delays in the project and said it was facing a challenging future, but was not as hard-hitting as expected. Last month, the BBC revealed that a number of alterations had been made to the original draft after it was circulated to officials involved in the 10-year project. The NAO insisted the overall findings had not been changed amid criticism from opposition MPs. The project has also been dogged by criticisms from doctors, who say they were not consulted properly and that the new systems are a risk to patient confidentiality. . . The NAO said the exact remit and timescale of the new investigation had not been decided yet. "When we published the report we said we may revisit it and that is what we are doing," said a spokesperson. . ."

Audit Office pledges new report on NHS (5 Sep 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/09/05/218205/Audit+Office+pledges+new+report+on+NHS+.htm

"The National Audit Office is to publish a new report into the UK's largest IT investment, the £12.4bn National Programme for IT in the NHS. Its decision follows criticism by MPs of the Audit Office's June 2006 report on the NHS programme. Greg Clark, a member of the House of Commons Public Accounts Committee, said the June report was "the most gushing" of all NAO reports he had read. Another member of the Public Accounts Committee, Richard Bacon, said the NAO's report on the NPfIT was not up to the organisation's usual high standards. The NAO's value for money reports on IT projects are usually one-offs. So its decision to produce two reports on the NPfIT is an unusual step. . . Clark said that in the light of recent events the published NAO report "raises more questions than it answers". He added his committee would hold a new hearing on the NPfIT, based on a new NAO report. He expected the hearing to occur next year. In its June report the NAO said it "may return to carry out a further examination at a later date should this appear necessary". But last week its spokesman told Computer Weekly that the NAO had decided to publish a new report, though no date has been set. . ."

Was NAO report truly independent? (19 Sep 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/09/19/218551/Was+NAO+report+truly+independent.htm

"The National Audit Office's final report on the NPfIT was very different to earlier drafts, which criticised the programme. Was it influenced along the way? In the first few words on its website, public spending watchdog the National Audit Office declares, "We are totally independent of government." But last year the NAO went on the defensive after receiving a letter from Connecting for Health, which is running the NHS's National Programme for IT (NPfIT), the UK's largest computer-related investment, costing £12.4bn. Under the Freedom of Information Act the NAO has released some correspondence between one of its senior auditors, Chris Shapcott, and Richard Granger, IT head of the NPfIT who is chief executive of NHS Connecting for Health and also director general of NHS IT. In his letter dated 17 March 2005, Granger shows an apparent disapproval of the possibility that the NAO had been actively engaging and encouraging third parties to examine the work of the NPfIT. . . Granger wrote the letter after Connecting for Health received an independent paper on the NPfIT. The paper was written by the UK Computing Research Committee, which comprises an expert panel of computing researchers from academia and industry who are members of the Institution of Engineering and Technology and the British Computer Society. The health minister Lord Warner had received the committee's paper and passed it to Connecting for Health. The paper raised some awkward questions about the NPfIT, some of which have not been answered even today. . . Warner said he is pleased with the final NAO report. So is Connecting for Health, which has cited the final NAO report as an endorsement of its work on the NPfIT. But some may be left questioning whether the NAO's final report on the NPfIT was as robustly independent as the audit office's reputation. They may also ask why Connecting for Health seemed so concerned about a third party review of the NPfIT. The NAO is to publish a new report on the NPfIT."

National Duplicate Registration Initiative (Sep 2006)

National Audit Office

http://www.audit-commission.gov.uk/Products/NATIONAL-REPORT/009F4715-3D93-4586-A3A0-7BF69405A449/NationalDuplicateRegistrationInitiative02Aug06REP.pdf

Commentary from e-Health Insider: "There's some interesting stuff buried in the detail of this report. For instance, look at para 34 on page 15, about asylum seekers: "The introduction of Home Office data enabled NDRI to identify patient registrations which related to persons who had been removed from the UK by the Home Office. In the majority of cases the registration has now been cancelled. However, the NHAIS sites identified some cases where the person appeared to have subsequently returned to the UK. Details of these were passed to the Home Office for them to consider what, if any, action should be taken. Based on this information the Home Office has made a number of deportations." In other words, health records were used to identify undesirables who were deported. Whilst I'm sure the numbers involved here are small, ethically this has big implications for patient confidentiality - and if data started to be "shared" with the Home Office for people in other categories - for instance, criminals on the run - the numbers affected could be much larger. Whilst from a societal perspective this use of health record data makes perfect sense, as a GP tasked with treating the patient in front of you this raises questions as to whether it's in that patient's best interests to be registered on your system. And this is before the NCRS spine is properly up and running. I don't think this is going to encourage GPs who are concerned regarding data confidentiality to upload their practice lists..."

Delivering successful IT-enabled business change (17 Nov 2006)

National Audit Office

http://www.nao.org.uk/publications/nao_reports/06-07/060733es.pdf - Executive Summary

http://www.nao.org.uk/publications/nao_reports/06-07/060733-i.pdf - Vol 1: Full Report

http://www.nao.org.uk/publications/nao_reports/06-07/060733-ii.pdf - Vol 2: Case Studies

"The successful delivery of IT-enabled business change is essential for improving major public services, but experience in the public sector in Britain also shows that achieving such change is particularly complex and challenging in terms of the scale of the changes required, the cross-government co-ordination needed, and the technical issues around joining bew and old systems. . . Analysis of our case studies identified three key and recurring themes in successful programmes and projects: the level of engagement by senior decision makers of the organisations concerned; organisations’ understanding of what they needed to do to be an “intelligent client”; and their understanding of the importance of determining at the outset what benefits they were aiming to achieve and, importantly, how programmes and projects could be actively managed to ensure these benefits were optimised. . ."

Blair's barmy army (26 Nov 2006)

The Sunday Times

http://www.timesonline.co.uk/article/0,,2099-2456064_1,00.html

"Next month the National Audit Office is due to produce a report on government use of management consultants. “Don’t hold your breath,” says Neil Glass. Glass, writing as David Craig, is a whistleblower. His book, Plundering the Public Sector, paints a uniformly bleak picture of consultant greed and government incompetence. Since 1997, he says, consultants have cost the taxpayer £70 billion with either zero or negative returns. He doesn’t expect much from the NAO report because the audit manager, the key figure, of the study is Ron SirDeshpande. Accenture, one of the giant consultancy firms, employed SirDeshpande for almost eight years before he came to the NAO. . . On September 28, Accenture pulled out of its £1.9 billion contract with the NHS. Connecting for Health (CfH), a huge computer system, was cutting into Accenture’s profits and threatening its balance sheet with up to $450m in write-offs. Launched in 2002 as a project lasting two years and nine months and costing £2.3 billion, CfH has become a 10-year project with a probable cost of £12.4 billion. But insiders and IT professionals now agree that it cannot work. If the government pulls the plug now, only about £1.5 billion will have been lost. But will it? Dare it admit that its multi-billion-pound gamble on the power of the consultants has failed? Meanwhile, despite the billions poured into the NHS, hospital trusts are still ending up in deficit. . . new Labour has spent £70 billion on consultants since 1997 – the equivalent of perhaps 150 hospitals or about 140m pieces of body armour . . . But perhaps more important is the astonishing blurring of the lines between consultancy and government. Patricia Hewitt, the health secretary, was head of research at Accenture when it was known as Andersen Consulting. Ian Watmore, head of the Downing Street Delivery Unit, was UK managing director of Accenture. David Bennett, chief policy adviser to the prime minister, is a former McKinsey partner. Richard Granger, head of the NHS IT programme, was with Deloitte. . . Tony Collins of Computer Weekly has studied the NHS computer project in depth. He has found that it is often impossible for anybody to question spending plans, however absurd they might be. . . At least half of the £1.5 billion spent so far on that project has gone to lawyers, consultants and PRs. The last are crucial because they are there to persuade GPs and hospitals to use the new system. The one thing the NHS fears most is professional rejection of the system. This is a bad case of a shot in the foot. Government gave GPs and hospitals autonomy in the hope that it would improve efficiency, but this also gives them the freedom to refuse a centrally imposed IT system. In addition, many hospitals already have sophisticated computer systems of their own that may not be compatible with the new system. . . “It is misleading to say that the scale is bigger than has ever been done before,” said Richard Granger, director-general of NHS IT, at a conference in March 2003. “The extra spending of £2.3 billion over three years is not such a terrifyingly large project – it is comparable to other mid-size projects in industry and government that are regularly completed in time.” And yet recently, Sir Ian Carruthers, acting head of the NHS, described it as the biggest project in the world. . ."

MP "looking into" how NAO report was drafted (30 Nov 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2307

"Commons Public Accounts Committee member and outspoken scrutiniser of the National Programme for IT, Richard Bacon MP, says he is trying to find out what happened during the drafting process of the controversial National Audit Office (NAO) report on the programme. . . Speaking to a meeting of the IT trade association, Intellect, Bacon, who is Conservative MP for South Norfolk, said: “I have been spending a little while trying to find out what happened. We will be coming up with a report in due course.” He said papers obtained under the Freedom of Information Act by the Sunday Times, Computer Weekly and the BBC’s World at One showed that earlier drafts were more critical. During his speech to Intellect he criticised the programme for its “high speed contract letting” done without seeking the views of clinicians and before understanding what the government wanted to buy. “Patient systems are being put into acute hospitals before they are ready, in a way that damages trust locally,” he said. Bacon also challenged the idea of making records available all over the country. “Of course everyone can see tremendous benefits if you are run over by a bus in Cornwall, but I do not see that any assessment has been made of the cost versus the benefit.” Costs to confidentiality could be high too, he said. He concluded: “I can see no point in throwing rocks. I’d like to see an informed debate. My understanding of the role of IT can play in healthcare is that it can achieve the most extraordinary transformational change.” “My question is how do we get from where we are to where we want to be?”

Public spending on consultants reaches record £3bn (15 Dec 2006)

The Guardian

http://www.guardian.co.uk/guardianpolitics/story/0,,1972671,00.html

"Spending on consultants across the public sector has reached a record £3bn - an increase of over a third in two years - according to the first authoritative investigation into their costs, released today by the National Audit Office. The huge increase is almost entirely caused by the NHS, where spending on consultants has jumped more than 15-fold from £31m to more than £500m in two years - mirroring almost the entire deficit in the hospital and GP services. The report reveals that Whitehall alone spent some £1.8bn on consultants until the end of March last year, down from £2bn the previous financial year. Another £1bn was spent by the NHS and local government. Most of the cash went on consultancy work for IT schemes, project management and new strategies for Whitehall departments. The NAO says that many of the schemes do not represent value for money and estimates that if proper controls over consultants were introduced the government could save well over £1bn over the next three years. . ."

[The NAO Report referred to is at: http://www.nao.org.uk/publications/nao_reports/06-07/0607128.pdf]

Second full NAO review of NPfIT to be carried out (26 Apr 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2641

"The Commons Public Accounts Committee has ordered a second full review of the NHS IT programme to be carried out public spending watchdog the National Audit Office, to check that the recommendations of its report into the NHS IT project are followed. Chairman of the PAC Edward Leigh said he planned to "call the Government's bluff" after health minister Lord Hunt said that the Government was already acting on the PAC's recommendations. Last week's PAC report provided a detailed highly critical analysis of the management and progress of the £12.4bn programme which said "suppliers are struggling to deliver" shared electronic medical records and made recommendations including a call for an urgent independent review and annual review of progress. The government responded last week by saying many of the recommendations were already being acted on, adding that the report was based on out of date information, based on last summer's NAO report. This despite the PAC taking detailed new evidence and calling its own witnesses. Speaking in the Commons on 19 April, Edward Leigh, chair of the PAC, said: "I notice that the Government's response this week says, "Well, excellent report by the PAC, but we're doing all thisâ��it's an out-of-date report. "I am going to call the Government's bluff. I have talked to the Comptroller and Auditor General about the matter and, following my encouragement, we are to have another NAO report on the NHS computer in the next year so that we can have an update to check whether all the excellent recommendations of the NAO and the PAC on this £12 billion computer systemâ��that amount is equivalent to the entire cost of the Olympic gamesâ��are being carried out.""

National Audit Office due to publish 2nd report on NPfIT by May 2008 (19 Feb 2008)

Computer Weekly - Tony Collins IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/02/national-audit-office-due-to-p-1.html

"The National Audit Office is at a draft report stage after a second investigation into the NHS's National Programme for IT [NPfIT]. It's expected the National Audit Office will publish its second report on the NPfIT by May 2008. The first NAO into the NPfIT in June 2006 report was memorably described by a BBC correspondent as a whitewash. Greg Clark of the Public Accounts Committee called it "gushing". This time the NAO is not relying quite so heavily on information supplied by NHS Connecting for Health which runs part of the NPfIT. NAO auditors have been visiting NHS trusts where patient administration systems from CSC and Isoft - and particularly Fujitsu and Cerner - have been installed. . ."

The National Programme for IT in the NHS: Progress since 2006

National Audit Office

http://www.nao.org.uk/pn/07-08/0708484.htm

From the NAO Press Notice: "Delivering the National Programme for IT in the NHS is proving to be an enormous challenge. All elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk. Today's progress report on the Programme by the National Audit Office concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS Trust in England has fully deployed the care records systems, four years later than planned. In the North, Midlands and East area, the software has taken much longer to develop than planned, so some Trusts have had to take an interim system. Completing the development of the system and introducing it in this area are significant challenges still to be addressed. The estimated cost of the Programme is £12.7 billion. The costs of the main contracts have remained broadly unchanged, aside from the purchase of increased functionality. Because of the delay in deployments, actual expenditure to date (£3.6 billion by 31 March 2008) has been much lower than expected. Planned â��go live' dates were missed for many of the first Trusts to take the new care records systems and the NHS and suppliers are now increasing their emphasis on establishing realistic timelines for deployments, reflecting the circumstances of each individual Trust. According to today's report, the success of the Programme will depend on the commitment of NHS staff. The Department's latest survey, conducted in spring 2007, showed that 67 per cent of nurses and 62 per cent of doctors expected the new systems to improve patient care. Identifying and realising the benefits of the systems are essential to raising confidence further and convincing all staff of the value of the Programme. The Department reported on the benefits of the Programme for the first time in March 2008."

The NHS: a question of trust (16 May 2008)

The Times

http://www.timesonline.co.uk/tol/comment/leading_article/article3941448.ece

"For the arthritic grandmother who divides her time between Yorkshire and her daughter's family in London, today's report by the National Audit Office on information technology in the NHS will make depressing reading. For the cancer sufferer seeking expert opinions at several different hospitals, it will be worse than that. The report estimates that the centrepiece of the National Programme for IT in the NHS (NPfIT) - a secure, shareable, constantly updated electronic medical records service for all 60 million NHS patients - will not be ready until 2014 at the earliest. Privately, experts worry that as presently designed it may never work at all. At the heart of the Care Records Service's well-documented problems are two costly software products that are custom-built, national in their intended application and, so far, unworkable. There is an alternative. It would run on software bought off the shelf, that can be chosen and customised by individual health authorities, and would not crash. Not only is it not too late to adopt this approach; it is already being used. An unmodernised NHS is unthinkable. Bold and intelligent use of information technology is inevitably at the heart of this modernisation, and not just by streamlining administration. In principle, electronic records will save lives, whether by cutting errors arising from doctors' scrawls or giving paramedics instant information on accident victims' blood types and allergies. They will also improve patient care. As digital downloads replace clipboards on hospital beds, nurses' efficiency will rise. As new drugs are approved, every patient who might benefit will know. The vision of a vast, beneficent healthcare computer network is not fanciful. It is what taxpayers have been paying for since 2002, and should expect. When first outlined, too hastily, to Tony Blair, the national programme was not only the biggest non-military IT project in history, but also uniquely complex. Hence the assumption that only bespoke software could make it work. As specifications evolved, budgets and timelines stretched. Early versions of the care records software proved inadequate, recriminations flew and far too little was accomplished. Taxpayers, at least, have not yet suffered ruinously: of the programme's projected total cost of £12.7 billion, only £3.6 billion has actually been spent. By no means all this has been wasted. The high-speed broadband network to which strategic health authorities must eventually connect their own systems is complete and working. The PACS system for sharing digital imaging is also up and running, as is the choose-and-book system designed to give meaning, at last, to patient choice. But the two main Care Records Service (CRS) programmes, known as Lorenzo and Cerner, are still years from full deployment. Pilot versions have been plagued with glitches, which few expect will all be solved by 2014. NHS trusts required to use them have been customising the bespoke software rather than adapt their own systems to a national standard. Some foundation trusts, meanwhile, are abandoning the standard altogether to buy database software on the open market, with no cost in confidentiality or performance. Other trusts would like to opt out, but under current rules cannot afford to. These rules must be changed. The national programme has been appallingly mismanaged. This does not invalidate the vision behind it, but it does oblige the NHS to trust its trusts to make it a reality."

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