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MPs have called for an urgent review of the programme to computerise the NHS in England, which they criticise for unprecedented delays and costs and whose benefits, they say, are uncertain.
In its report the House of Commons Committee of Public Accounts cites two former aides who attack the national programme for information technology (IT) in the NHS for the poor consultation with clinicians on how the new system should be designed and the use of “bullying tactics” with NHS trusts and suppliers.
Edward Leigh, chairman of the committee, said: “The programme is not looking good. The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear.”
The cost of the programme, which Mr Leigh describes as “the most expensive health information technology project in history,” is expected to exceed £12bn (€18bn; $24bn).
He said, “The [health] department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including local NHS organisations, can have more confidence. It must also launch reviews of the ability of the suppliers and local service providers to deliver against their contracts.”
Although MPs acknowledge that the programme's central ambition to create electronic health records accessible across the NHS is laudable, they say that failure of the system “could set back IT developments in the NHS for many years and divert money and time from frontline patient services.”
The committee's assessment of progress is harsher than that of the National Audit Office, published in a report last June (BMJ 2006;332:1467, doi: 10.1136/bmj.332.7556.1467). “At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period,” the new report says.
Although plans published by the NHS's IT agency Connecting for Health in January 2005 indicated that 151 acute hospital trusts would have installed new patient administration systems by April 2007, “as of February 2007 only 18 had been deployed.”
A recurring theme is the IT programme's alleged failure to engage with clinicians, especially during the initial design of new systems. The report highlights evidence given by two former senior figures in the programme, Peter Hutton and Anthony Nowlan, casting doubt on the programme's claim to have consulted widely on the system's core specification.
“Professor Hutton . . . told us that there was no good audit trail for clinical input into the production of the specification and that key decisions were taken in the early period of the programme without proper clinical input,” says the report.
Among the report's appendices is a memorandum by senior healthcare IT figures, including David Kwo, former regional implementation director for London, who questions the overall architecture of the programme and accuses the National Audit Office of failing to spot problems. Connecting for Health “is driven by no vision at all except the desire to retain central authority using bullying tactics on both suppliers and NHS trusts,” he claims.
The health minister responsible for IT, Lord Hunt, attacked the committee's report as being based on an audit office report “that is now a year out of date.” Since then, “substantial progress has been made” and the programme is “on track to meet our broad targets,” he said. The health department is already reforming the programme's management to put it under local ownership.
Gill Morgan, chief executive of the NHS Confederation, said: “The national programme for IT simply must be made to work. The key issue is to make sure that all NHS staff at a local level, especially the clinicians who will be using the new IT system, are fully engaged with the project as it moves forward.”
Department of Health: The National Programme for IT in the NHS can be seen at www.parliament.uk.