The Department of Health and its key IT supplier CSC have been slammed by MPs for a confidentiality agreement surrounding the £12.7 billion National Programme for IT, the world’s largest civilian IT programme.
The powerful House of Commons Public Accounts Committee also told the NHS to “get its head out of the sand” as it flagship IT project remains far off schedule.
The PAC hit out at civil servants and CSC for agreeing a gagging order over negotiations that took place about care records deployment in the northern, central and eastern parts of the country. CSC is the exclusive lead supplier to those regions.
Responding to the report, the Department of Health said, "New IT systems in the NHS are delivering better, safer and faster care. Current costs have declined because of the delays to implementation due mainly to adding extra functions to the system. Costs are also controlled by the contracts which only pay to providers once the service has been successfully delivered."
However, the PAC said, the care records service, which will provide digital health files for every patient in the country, remains “way off the pace”, and is due to be completed at least four years behind schedule in 2014 to 2015.
Only 133 of the 380 NHS trusts are running the care records systems, as of August last year. The committee demanded an improvement in the rollout and the working of the systems within six months, or, it said, “the department [of health] should consider allowing trusts to apply for funding for alternative systems”.
Under NHS funding regulations, the Department of Health can oblige NHS trusts and primary care trusts to take NPfIT systems, but it does not have the same power to make NHS foundation trusts take systems they don not want.
The NHS is becoming “increasingly devolved,” the PAC noted, which make the necessary organisational and cultural changes for the system difficult to effect.
NHS staff were disillusioned with the systems “because what has been provided to date has not met their expectations”, the PAC said. Health workers would only be reassured when real clinical benefits were delivered by the IT systems.
Trusts in the north, the Midlands and the east are receiving an interim system until their service provider, CSC, implements the iSoft Lorenzo system. But the PAC warned that Lorenzo had not been deployed in any acute trusts, and was only in one primary health trust.
In the south of England, where trusts are in transition following the departure of Fujitsu from the programme, many are awaiting a service provider to install the Cerner Millennium care records system, a competitive product to Lorenzo. They will choose between BT and CSC, under NHS plans.
In London, service provider BT last week warned of substantial writedowns in its large contracts. Its care records contract for the region was originally valued at £1.08 billion.
The rollout of Cerner Millennium software hit major hurdles in London, with the Royal Free Hospital losing £7.2 million in six months attempting to roll out the system.
The PAC said that the departure of Fujitsu and Accenture from the programme, leaving CSC and BT was a cause for concern. “The programme’s high dependence on just two major suppliers has implications for the Programme’s capacity and capability, and for the department [of health]’s leverage,” it said.
The committee also said that the Department of Health and CSC had acted in an “unacceptable” manner, obstructing public sector transparency, by signing a confidentiality agreement over to renegotiation over the delivery of Lorenzo. CSC had insisted on a confidentiality agreement as the basis for any Lorenzo renegotiation.
Cost estimates for the programme remain at £12.7 billion, of which £3.6 billion are local trust costs. But the PAC said the local cost estimate remained “very unreliable” because if trusts refused to deploy the systems, the Department of Health would still have to pay the suppliers.
Richard Bacon, an MP on the PAC, said the programme was “unlikely to recover” as it was so delayed, and trusts were already seeking alternative systems as the main systems were “not fit for purpose”.
“Hospital trusts should now be free to buy the systems they want, subject to common standards, and they should be funded to do this through the national Programme, which has failed to supply what hospitals want,” he said.
The NHS N3 broadband network scheme was given an award for excellence in innovation at the e-government awards last week, but Bacon retorted: “No one is going to be impressed that the NHS has discovered broadband.”
In December, NHS chief executive David Nicholson said the NHS "can't go on and on" with IT rollout problems.
Controversially, the NHS still automatically opts in patients to the care records programme, even after a review of the legality of the system. But in a major concession last September, the NHS said doctors would be obliged to ask patient consent to view care records.