A damning report by the National Audit Office may well have banged the final nail in coffin of the original vision for the NHS IT programme, with electronic care records now in dire straits.

According to the report, the primary goal of the programme that every patient should have an electronic care record will not now be achieved, and in a rather stark message it says the £2.7 billion spent so far on care records systems does not represent value for money.

Furthermore, the auditors have concluded that throwing further money at the scheme will not turnaround the situation. "Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different", it said.

Under the first version of the £11.4 billion National Programme for IT (NPfIT) - launched in 2002 as the largest civilian IT project in the world - every National Health Service patient was to have an electronic care record by 2010, but plans have fallen well behind schedule and are now unlikely to be realised even by 2016, six years over target.

Moreover, fewer systems will now be delivered to NHS organisations as GP practices and hospital trusts have pulled out of the scheme, but the cost of delivering care records systems remain substantially the same. For example, in London alone care records systems for 1,243 GP practices and the London Ambulance Service have been removed from the programme, while those being delivered in acute trusts has been cut by around half.

Electronic care records were intended to reduce the need for paper files, make accurate patient records available at all times, and facilitate quick access to information between different factions of the NHS. But even where systems are in place, they are not yet delivering on government expectations, the NAO said, with benefits being of an admin rather than clinical nature.

Clinical benefits, such as the ability to electronically manage the prescribing and administration of drugs in hospitals, won't be delivered until later releases of the systems are available, and as some of these are yet to be developed the delivery of the Programme's aims is further at risk, the report argues. 

Scale and complexity underestimated

“The original vision for the National Programme for IT in the NHS will not be realised," confirmed NAO head Amyas Morse. "The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme," he said.

The Department of Health, however, has a slightly different take on the matter. While agreeing that the original vision is flawed, it points out that the programme has already moved away from a centralised, national approach to a more localised one. 

"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 said.

According to NHS Confederation policy manager Frances Blunden, "the key lesson from this project is that, no matter how exciting the vision is, such a complicated project needs buy-in across the NHS if it is to succeed".

While emphasising the need for an electronic record scheme for the safer and more effective delivery of patient care, Blunden conceded that "with NHS funding so tight and all the local and regional structures for implementing new IT being removed, some difficult decisions will need to be made".

The Department of Health will respond to the NAO’s report at the Committee for Public Accounts hearing on 23 May.