NHS IT four years late and over budget
Outlook uncertain but expensive
The NHS IT project, one of the world's largest public sector IT programmes, is already four years late.
Parts of the project are progressing well and some savings have already been seen but Summary Care Records, a key part of the project, are now unlikely to be widely rolled out until 2014 or 2015, rather than the original target of 2010.
Progress has been measured by the National Audit Office. It warned: "The scale of the challenge in developing and deploying these systems in the NHS has proved far greater than expected, and the timescales... originally agreed... proved unachievable."
The Report said: "For the Care Records Service, the original timescales proved to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk." It said the project still "appears feasible".
Two of the five early adopter Primary Care Trusts have begun uploading patient records, two years late. The other three are running publicity campaigns to inform patients, but have not yet started uploading data.
In the North, East and Midlands Summary Care Records will be run using iSOFT's Lorenzo software - which is not yet available.
Lorenzo should get its first release this summer before a full roll-out in autumn of this year. The NAO warned: "Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East."
The NAO also warned that these plans to roll out Lorenzo "may prove over-ambitious" and called for rigorous testing in pilot areas before wider deployment. The NAO also called on the Department for Health to develop better reporting on how the programme is progressing and how much it is costing.
There is uncertainty over the costs of the programme, although the NAO is pretty sure it's getting more expensive. In 2006, when the NAO last looked at the National Programme for IT (NPfIT), it was going to cost £12.4bn. But it is now likely to cost closer to £12.7bn.
The NAO said: "It remains difficult to produce a reliable estimate of local costs." Most of the increase is due to increased functionality. But actual expenditure as of 31 March was £1,933m - 44 per cent less than expected, because of delays in delivering Summary Care Records.
Contracts with BT and CSC have been "reset to reflect changing circumstances" and the contract with Fujitsu is still being renegotiated. The NAO again warned: "Until the process of contract resetting is complete, there remains a degree of uncertainty in relation to the South."
Other aspects of the NPfIT are doing better - Choose and Book is nearly fully deployed but takeup remains disappointing. It has been used to make 6.7m appointments versus the target of 39m. PCTs vary widely on its use - between 20 and 90 per cent, overall about half of appointments are now made using the system.
Even at this stage, not all NHS staff are convinced the programme will have a postitive impact on patients. Less than 30 per cent felt they have had a chance to shape the new systems. But 67 per cent of nurses and 62 per cent of doctors believe the system will improve patient care.
The full report is available as a pdf here. ®
Public sector rubbish (again)
Having just had the 'joy' of helping my in-laws apply for a UK visitor's visa via the government's new online visa4uk.fco.gov.uk site, I'm really not in the least bit surprised the NHS IT project is years late, way over budget, only works in IE6 and overall a bit of a dog's dinner that's past its sell-by date.
Over my (many) years I've seen some utter crap as far as UI goes, but Visa4UK is in a class all on its own. I dread to think what the NHS one is like (if that is it ever fully sees the light of day)...
Fit for purpose?
One of the criticisms in the NAO report was the lack of progress on the Detailed Care Record - but they seem unclear as to whether this is a SSEPR (single shared electronic patient record) - the Lorenzo level 4 model, being one record per patient across all areas - hospital, general practice, community, therapies etc - or a hospital record on the Cerner Millennium model.
All I can say is that with the SSEPR model, there are serious problems in clinical governance (including who can read, who can write, who can correct and how you manage prescribing when a whole host of people are prescribing for the same patient), privacy and confidentiality (how do you define it if all of the county is using the same record, and who is the Data Controller and Caldicott Guardian?) and whether it would be useful and fit for purpose. (I have this vision of an orthopaedic surgeon wading through a GP record.. ;->)
I find the potential for destruction of general practice records in Lorenzo disturbing - and contract driven reform of the NHS on a 3 single system (one per LSP) basis insane.
As the representative from Fujitsu said at HC2007 "interoperability is not included in the contract".
What was wrong with the evolving interoperability approach we had before NPfIT?
Billions of pounds
and the project is described as; "appears feasible"