The National Programme for IT in the NHS: an update on the delivery of detailed care records systems

18 May 2011

Full report: The National Programme for IT in the NHS: an update on the delivery of detailed care records systems

The rate at which electronic care records systems are being put in place across the NHS under the National Programme for IT is falling far below expectations and the core aim that every patient should have an electronic care record under the Programme will not now be achieved. Even where systems have been delivered, they are not yet able to do everything that the Department intended, especially in acute trusts. Moreover, the number of systems to be delivered through the Programme has been significantly reduced, without a commensurate reduction in the cost.

Today’s NAO report concludes that the £2.7 billion spent so far on care records systems does not represent value for money. And, 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.

The original aim of the Programme was for every patient to have an electronic care record by 2010. The systems the Department contracted its suppliers, BT and CSC, to deliver are now not all expected to be in place until 2015-16. Even so, based on performance so far, it is unlikely that the remaining work in the North, Midlands and East, where just four of 97 systems have been delivered to acute hospital trusts in seven years, can be completed by 2016 when the contract with CSC expires. Indeed, in order to meet the revised deadline, over two systems a month would need to be delivered in this Programme area over the next five years.

Progress in delivering care records systems varies dramatically between regions. There has been more progress in London in some health settings, although no GP practices are now receiving a system through the Programme and the number of systems in acute hospital settings has halved.

Where care records systems are in place, they are not yet delivering what the Department had expected. In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals. The Department has now changed its approach and moved away from its intention to replace systems wholesale, instead, building on and using trusts’ existing systems. To do this the Department estimates it will cost at least £220 million to get the systems to work together.

"The original vision for the National Programme for IT in the NHS will not be realised. 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. "The Department of Health needs to admit that it is now in damage-limitation mode. I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help to prevent further loss of public value from future expenditure on the Programme."

Amyas Morse, head of the National Audit Office, 18 May 2011

Notes for Editors

  • The National Programme for IT began in 2002 and is set to cost around £11.4 billion. Total expenditure on the Programme was around £6.4 billion by March 2011. The Department of Health has spent £2 billion on the development and delivery of nine national systems, including a broadband network and a system to share X-rays electronically. Delivery of these systems is almost complete. A further £1.7 billion has been spent on central Programme management by the Department and on the maintenance of national systems by local NHS organisations.
  • The original central aim of the Programme was the creation of a fully integrated electronic care records system, designed to reduce reliance on paper files, make accurate patient records available at all times, and enable the rapid transmission of information between different parts of the NHS. The system was intended to comprise for each NHS patient:
    • a Detailed Care Record containing full details of the patient's medical history and treatment, that is accessible to a patient's GP and local community and hospital care settings, for example in the event that the patient is referred for hospital treatment; and
    • a Summary Care Record containing key medical information, such as allergies, available across England to NHS staff involved in treating the patient.The care records systems were due to be in place by 2007, with all functions to be delivered by 2010.
  • a Detailed Care Record containing full details of the patient's medical history and treatment, that is accessible to a patient's GP and local community and hospital care settings, for example in the event that the patient is referred for hospital treatment; and
  • a Summary Care Record containing key medical information, such as allergies, available across England to NHS staff involved in treating the patient.The care records systems were due to be in place by 2007, with all functions to be delivered by 2010.
  • Unless otherwise stated the cost information in this report is at 2004-05 prices to enable comparison with cost information in previous National Audit Office reports on the Programme. Our findings are presented in the context of a lack of clarity between the Department and its suppliers about basic management information. In some cases we have been unable to reconcile the discrepancies we have identified. For example, information we received from the suppliers on Friday 13 May does not reconcile with information provided by the Department the previous day. The Department was unable to provide clarification to reconcile the discrepancies by the time this report was submitted by the Comptroller and Auditor General for publication on Monday 16 May.
  • Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  • The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 900 staff. He and the NAO 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.
Contact: Hana Esselink
PN: 26/11
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