NHS IT will fail to deliver care records, says NAO

The ailing NPfIT cannot reach its target of delivering electronic care records for every patient in the UK and the work so far does not represent value for money, according to a National Audit Office report
Written by Tom Espiner, Contributor

The National Audit Office has published a damning report of NHS information technology, which it says is failing in a number of key areas.

National Audit Office

The National Audit Office (NAO) has published a damning report of NHS information technology. Photo credit: R4vi/Flickr

In the report, released on Wednesday, the audit office said the goal of providing every patient in the UK with an electronic care record will not be achieved. The initial date for the introduction of the NHS National Programme for IT (NPfIT) was 2010. The report found that failings in the implementation mean that the goal cannot be reached by 2016, when a key contract with systems supplier Computer Sciences Corp (CSC) expires.

In addition, the Department of Health (DoH) is not getting value for money for the £2.7bn it has spent so far on care records systems contracts, the National Audit Office (NAO) said. The remaining main suppliers are BT and CSC.

"The NHS is now getting far fewer systems than planned, despite the department paying contractors almost the same amount of money," NAO head Amyas Morse said in a statement. "This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme."

The NAO said it has "no grounds for confidence" that the remaining £4.3bn budget for care records will be spent any better.

This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme.
– Amyas Morse, NAO

Originally, the aim of the project was to roll out an integrated electronics system nationwide, to cut down on paper files and to allow details to follow patients wherever they received care. Each patient would have a detailed record with a full medical history and a summary care record that held key medical information.

One failing is the pace of introduction of systems. In seven years, only four out of 97 systems have been delivered to acute hospital trusts in the north, Midlands and east of England, according to the report. For the project to be completed before 2016, over two systems per month would need to be delivered.

Another problem is that where electronic care records systems are in place, they are not providing the benefits envisaged.

"In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals," Morse said.

Changed approach

In 2010, the DoH changed its approach to the project. Instead of introducing a completely new records system, it said it wanted to build on the local NHS systems in place. However, in its report on Wednesday, the NAO said getting those existing systems to work together will cost at least £220m.

The DoH said that the NPfIT records introduction as originally envisaged was flawed, but that its changed approach could be efficient.

"We do think the investment made so far in the NPfIT 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," a spokesperson for the department said.

The DoH is scheduled to respond to the NAO report at a Public Accounts Committee (PAC) hearing on 23 May. A week-long Major Projects Authority review will also begin on the same day. The government will take the decision to continue with NPfIT based on the outcome of these meetings.

On 11 May, prime minister David Cameron said that NPfIT could be discontinued.

"There are no plans to sign any new contract with Computer Sciences Corporation until the National Audit Office report has been reviewed, and until the Public Accounts Committee meetings and the Major Projects Authority reviews have taken place," said Cameron.

"The Department of Health and Cabinet Office will examine all the available options under the current contract, including the option of terminating some or all of the contracts," he added.

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