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National Audit Office Press Notice

The Hospital Information Support Systems Initiative

Report by the Comptroller and Auditor General
HC 332 1995/96
11 April 1996
ISBN: 0102715963
Price: £8.95

Sir John Bourn, head of the National Audit Office, reported to Parliament today on the NHS Executive's Hospital Information Support Systems Initiative.

The NHS Executive launched the Initiative in 1988, since when they have spent some £56 million on the Initiative, including £48 million in financial support to 16 projects at 25 hospitals. Of this, some £32 million was spent on the three main pilot projects, at Nottingham, Darlington and Greenwich.

The main points in the Report are:

The aim of the Initiative

• the Initiative was intended to support the NHS reforms by exploring ways in which integrated computer systems (see Note 1) could provide the information needed by NHS acute hospitals.

On the progress of the projects

• when the initiative was launched, there was limited experience of integrated systems in the NHS, and the NHS Executive wished to explore the costs and issues involved in implementing such systems.
• the NHS Executive selected the three main pilot projects within two months, to make early progress in support of the NHS reforms. Judged by today's standards, most of the hospitals visited by the National Audit Office were not ideally geared up to undertake a complex computer project when their projects were selected. A number of the deficiencies were addressed during procurement or implementation.
• there have been significant delays in implementing key systems and in completing each of the six projects examined by the National Audit Office (see Note 2). Two of the projects had been reduced in scope, deferring the completion of the projects and delaying the achievement of cost savings and quality improvements.
• five of the six hospitals had kept within budget. However, slippage had delayed the achievement of cash savings for all of the projects: by March 1995, the projects had achieved cash savings of £3.3 million (eight per cent of lifetime savings) compared with the £10.4 million (25 per cent of lifetime savings) originally expected by that date.

  ° projects had been justified on the basis that quality improvements would outweigh the net cash cost. The hospitals examined considered that their systems had brought about improvements in the quality of service. The NHS Executive now need to complete their evaluation of the Initiative.

On the dissemination of lessons learned

• the NHS Executive have provided considerable advice and guidance to the NHS on the procurement and implementation of integrated computer systems based on their experience so far. The Executive plan to publish an evaluation report on the Initiative in October 1996.

On the impact on the market for integrated computer systems

• since 1988, there has been some growth in the number of integrated computer systems on offer to hospitals, and their average cost has fallen from £6 million in 1989 to under £2 million in 1994.
• most hospitals have yet to embark on implementing integrated systems. By October 1995, 13 of the 260 acute NHS hospitals in England had implemented complete integrated systems, and a further 35 had implemented partially integrated systems. Together with the 41 hospitals which have systems under development, these represent around one quarter of the 300 to 400 hospitals which the NHS Executive consider might in time purchase integrated systems.

The Report concludes that the NHS Executive might have achieved greater value from the Initiative had they been able to proceed at a slower pace at the outset. Although the projects have experienced problems along the way and had not delivered benefits as quickly as originally hoped, the Initiative had provided lessons from which the NHS could learn, and these early systems should not be seen as indicative of what might be expected by hospitals embarking on integrated systems today. But there is still much work to do to ensure that integrated computer systems play a full part in the development of the NHS reforms.

Notes for Editors

1. Integrated hospital computer systems cover all aspects of a hospital's functions and management, and are linked together so that information is entered only once and shared by authorised staff across the whole hospital. Such systems are commonly called Hospital Information Support Systems (HISS), and typically include links between hospitals' Patient Administration Systems, departmental systems such as Pathology and Maternity and administrative systems to facilitate clinical audit and research. Systems may also include electronic ordering of clinical tests and the transmission of the results of those tests.

2. The National Audit Office examined the progress of six projects funded under the Initiative:

   Hospitals with one project:

   • Darlington Memorial Hospital NHS Trust
     
   • Greenwich Healthcare NHS Trust
     
   • Nottingham City Hospital NHS Trust
     
   • Kidderminster Healthcare NHS Trust

   Hospitals participating in a consortium in East Anglia:

   • Addenbrooke's NHS Trust
     
   • James Paget Hospital NHS Trust, Great Yarmouth

   Hospital participating in a consortium in the West Midlands:

   • Birmingham Heartlands Hospital NHS Trust
3. The Committee of Public Accounts is expected to take evidence on this report on May 8 1996.
4. (4) The Comptroller and Auditor General, Sir John Bourn, is head of the National Audit Office, employing some 750 staff. He and the National Audit Office are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

Press Notice 36/96
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