The Department of Health will not achieve its original plan for a fully-integrated NHS-wide care records system, and has been unable to demonstrate what benefits have been delivered from the £2.7 billion spent on the project so far, say MPs.
Trying to create a one-size-fits-all system of care records under the National Programme for IT in the NHS was a massive risk and has proven to be unworkable, and the Department should now urgently review whether it is worth continuing with the remaining elements of the system, says the House of Commons Committee of Public Accounts, in a damning new report.
"The £4.3 billion which the Department expects to spend might be better used to buy systems that are proven to work, that are good value for money and which deliver demonstrable benefits to the NHS," commented Committee chair Margaret Hodge, Labour MP for Barking.
The establishment of a fully-integrated electronic care records system, costing around £7 billion in total, was a central goal of the £11.4 billion National Programme for IT in the NHS. It sought to ensure that every NHS patient had an individual electronic care record which could be transmitted rapidly between different parts of the Service, so that accurate patient records would be available to NHS staff at all times.
But this has proved to be beyond the Department, say the MPs. A universal system is no longer being delivered, and implementation of alternative up-to-date IT systems have fallen significantly behind schedule, with escalating costs, they note, adding: “the Department could have avoided some of the pitfalls and waste if they had consulted earlier with health professionals."
Moreover, the fact that the substantial reduction in the number of NHS bodies in London receiving new systems from one of its contractors, BT - the other being Computer Sciences Corporation (CSC) - has not been matched by a commensurate cut in fees casts the Department's negotiating abilities "in a very poor light." say the MPs. It is "essential" that the government's Major Projects Authority should now closely scrutinise the Department's continuing negotiations with CSC, which has so far delivered very few of the systems it was contracted to supply, they add.
"We are concerned that CSC should not be rewarded for its failure with an effective monopoly in the provision of care records system in the North, Easter and Midlands cluster, since this could leave many Trusts with little choice but to continue with outdated interim systems that could be very expensive to maintain and upgrade," they say.
The MPs are also highly critical of the information supplied by the Department for their inquiry - this, they say, has frequently been late, contained inconsistencies and contradicted other evidence. Moreover, it is “unacceptable” that in a memo received from the Department which had specifically mentioned advanced payments, no mention was made of a £200 million advance payment made to CSC in April 2011.
The Department has accepted that it is unable to deliver its original vision, and it is now relying on individual NHS Trusts to develop systems compatible with those in the Programme, which means different parts of the country will have different systems. But the MPs say they are "very concerned" that the Department has been unable to tell them how potential inconsistencies will be dealt with or what it will cost local NHS organisations to connect up.
Nor has the Department got the best out of its suppliers, despite having paid them some £1.8 billion so far. CSC has yet to deliver the bulk of the systems it is contracted to supply and has instead implemented a large number of interim systems as a stopgap, but the Department had conceded that it could be more expensive to terminate the contract than to complete it.
BT has also proved unable to deliver against its original contract and is "clearly" being overpaid by the Department to implement systems, the MPs add. "BT is paid £9 million to implement systems at each NHS site even though the same systems have been purchased for under £2 million by NHS organisations outside the Programme," they write.
The report goes on to condemn the Department's "weak" programme management; the fact that NHS chief executive Sir David Nicholson has not fully discharged his responsibilities as the Senior Responsible Owner for this project - given his significant other responsibilities - has resulted in poor accountability for project performance, it says.
Nor has the Department been able to explain to the panel how the wider health reforms and NHS restructuring will affect the future management and governance of the care records system, or what the likely financial implications would be for NHS Trusts taking over care records system contracts. "It needs to make clear how the Programme will be managed in future, given the fundamental NHS restructuring that is expected over coming years," they say.