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NHS told to prepare to ditch care records

Time to ditch scheme that's four years late

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The Public Accounts Committee says that if the NHS Care Records Service is not ready in six months, the government should consider funding alternatives

In a critical report on the progress of the NHS National Programme for IT (NPfIT) since 2006, the committee said that the Care Records Service, one of the programme's key projects, is four years behind schedule. The government's latest forecast is for completion between 2014 and 2015, but the committee says this is now in doubt.

By the end of August 2008 new care record systems were being used in 133 of the 380 NHS trusts in England. Trusts in the largest of the regions covered by the national programme, the North, Midlands and East, are using an interim system because of major delays to the Lorenzo system which should have been deployed there. At the end of last year Lorenzo was being used in only one primary care trust, and in no acute trusts.

The £12.7bn cost of the programme remains uncertain. If trusts decide not to implement care records and other systems, the government still has to make payments to the suppliers involved. Although the government can direct NHS and primary care trusts to take NPfIT systems, it has no power over foundation trusts.

Risks to the successful delivery of NPfIT remain serious, the committee warns. Essential systems are running late and, where deployed, are not meeting the expectations of clinical staff. Despite action to secure the commitment of NHS staff, many remain unenthusiastic.

Edward Leigh, chair of the committee, said: "The original aim was for the systems to be fully implemented by 2010. The truth is that, while some are complete or well advanced the major ones, such as the care records systems, are way off the pace."

NPfIT's vulnerability increased with the departure of two of its local services suppliers, Accenture and Fujitsu. The two remaining companies, BT and CSC, are now carrying the responsibility for the major components of the programme.

CSC is responsible for deploying care records systems to the whole of the North, Midlands and East after taking over Accenture's contracts. As well as deploying systems in London, BT is responsible for the N3 broadband network and the Spine.

"The programme's high dependence on just two major suppliers has implications for its capacity and capability, and for the department's leverage," says the committee. It is calling on the Department of Health to assess the capacity and capability of BT and CSC to continue to meet their commitments.

The termination of Fujitsu's contract, after negotiations to reset the arrangement failed, has caused uncertainty among trusts in the South and new deployments have stopped.

One option being considered for new deployments is for trusts to have a choice of either Lorenzo, provided through CSC, or the Millennium system provided through BT. However, the committee says there are "considerable problems" with existing deployments of Millennium and serious concerns about the prospects for future deployments of Lorenzo.

It recommends that before the new arrangements for the South are finalised, the Department of Health should assess whether it would be wise for trusts in the South to adopt these systems. In particular if either of the local service providers takes on additional work in the South, the department should assess the implications for the quality of services to trusts their existing areas of responsibility.

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association said: "We are particularly concerned about the demise of two of the local service providers responsible for implementing local IT systems. Trusts must have more freedom to implement IT systems that take into account their local needs. Important IT developments should not be jeopardised because of the reduction in the number of local service providers.

He added: "Despite the problems we must not lose sight of the potential benefits that could be delivered in terms of patient safety, by the National Programme for IT."

This article was originally published at Kablenet.

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