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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.

"The fundamental error made when setting up the programme was to assume that centralised procurement of single systems across the NHS would be more efficient than local decision-making guided by national standards," they said.

They were scathing of the government's attempt to micromanage an IT strategy for the whole NHS from the centre: "In this sense, the programme illustrates perfectly the limitations of a centralising mentality and an addiction to 'quick fix' political solutions."

They also criticised the programme's lack of transparency. There should be open reviews of NHS procurement so that trusts could learn from one another's achievements and mistakes.

"Hiding problems, as has happened too often in the current programme, helps no-one other than poorly performing suppliers and the decision makers in Connecting for Health,[the government agency managing the programme]" said the paper.

Bacon and Pugh were both members of the committee that commissioned the National Audit Office's review of the National Programme for IT, which was subsequently criticised for obscuring its own criticisms of the programme.

They pulled no punches in their own critique and took the programme's central tenets to pieces.

Contrary to received wisdom at Connecting for Health patient data should not be centralised to make it accessible all over the country, they said. Doing so would threaten the privacy of information patients give to their doctors.

"Making this information potentially available to 600,000 to 800,000 NHS staff...threatens to undermine the entire doctor patient relationship," they said.

Further, most patient information is used by local NHS services and can be forwarded easily when it is needed. And there is already a problem with the quality of patient data held by the NHS - adding more data would make matters worse.

"It is inconceivable that clinicians will ever be persuaded to make important treatment decisions based on large amounts of data entered by dozens of unknown clinicians."

The other main tenet of the programme was that "local trusts cannot procure systems properly so the centre has to do it for them".

But local NHS trusts have long been procuring their own computer systems. Such "successful" procurements, which would have delivered by now, were brought to an "abrupt end" with the National Programme in 2002 and 2003.

"Since then, the National Programme has failed to install a single working clinical IT system," said Bacon and Pugh.

But they did not call for it to be scrapped. They recommend that the programme should be reformed to "save billions...reduce its risks...[and] re-establish an open market place with competition on cost and technical advancement".

"We recommend that the deployment of the central infrastructure should continue in a modified form, but the complex, extremely expensive and high risk local systems replacement project should be reformed so that local hospital trusts can purchase locally systems which link into the national framework."

Doing so, they said: "Would engage the NHS in decision making at a local level, helping to ensure true local ownership of local systems."

Further, they said, CfH had been wrong to think that putting the disparate elements of the NHS on a single massive system would save money, or even that it would work.

The plan was complex, expensive, high risk, and "requires lots of compromises", they said, adding that hospitals were finding that it didn't work in practice anyway.

"Finally, the use of one or two major software suppliers kills innovation, progress and competition."

These suppliers, such as the troubled iSoft and Accenture, which is rumoured to be trying to find a way out of its crippling NPfIT contracts, simply can't cope, said the paper. All they can manage to produce for the programme is the most basic of systems.

"The type of advanced clinical systems that were beginning to be deployed before the National Programme began have simply been lost," they said. ®

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