MPs have criticised “a worrying lack of progress” on implementing local systems to support the planned National Care Record Service.
The electronic patient record systems – with a summary care record (SCR) and, eventually, a detailed care record (DCR) for each-patient form the core of the NHS’s £12.4bn National Programme for IT (NPfIT).
But in a new report, the Commons health select committee warns that the huge computer project is being hampered by delays and lack of clarity about the scope of some systems.
“In particular, the introduction of new basic hospital Patient Administration Systems (PAS) has been seriously delayed,” the report says. One of the two main hospital PAS products - Lorenzo, to be supplied by troubled software firm iSoft - will not be trialled in these NHS until 2008. “As a result of these and other delays, it is not clear when joined-up DCR systems will be widely available.”
The MPs “found it difficult to ascertain either the level of information sharing that
will be possible when DCR systems are delivered, or how sophisticated local IT
applications will be”, the report adds.
It points to a shifting scope for the project. “In its original specification documents in 2003, NPfIT established a clear vision for local electronic records systems. Four years later, however, the descriptions of the scope and capability of planned DCR systems offered by officials and suppliers were vague and inconsistent,” the report says.
The MPs heard some witnesses suggest that “parts of the original vision have
been abandoned because of the difficulties of implementing new systems at a local level”.
The report says the centralised approach taken by Connecting for Health, which runs NPfIT, has “brought important benefits” but will “increasingly need to be modified” if the DCR system – described in the report as “the holy grail” of NPfIT - is to succeed.
It urges Connecting for Health to clearly restate the programme’s aims, “providing timetables and indicating how they will be met” as well as ensuring local organisations take charge of deployment. Plans for the DCR should outline how the scope of the project has changed since 2003, while completion timetables should be published by suppliers, the report says.
Connecting for Health’s “local ownership programme” – a decentralisation of control over systems deployment – does not go far enough, the MPs believe.
“We recommend that Connecting for Health switch as soon as possible to focus on setting and ensuring compliance with technical and clinical standards for NHS IT systems, rather than presiding over local implementation.”
Local users should have “the final say over which system is procured” for hospitals, as for family doctors, who can now choose alternatives to the software provided by NPfIT’s lead contractors under the GP Systems of Choice scheme.
The committee’s members did not unanimously agree the final report, however. In a relatively unusual move, the committee’s three Conservative members voted against its publication.
Earlier this week, Derek Wanless – whose 2002 report to the Treasury set out the need to invest in NHS IT – published a follow-up, in which he called for a “comprehensive audit” of NPfIT and detailed scrutiny of Connecting for Health.
The call for a review was rejected by the government, prompting the Conservatives to promise to carry out their own review.