An unachievable timetable for electronic patient records has damaged confidence in the National Programme for IT, according to the National Audit Office.
The National Audit Office (NAO) has published a report that includes some sharp criticisms of the programme's implementation and states that confidence in it has been undermined. However, the report acknowledges the programme has stayed within its budget and that its vision remains feasible.
"The original timescales for the electronic Care Records Service [CRS], one of the central elements of the programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the programme at risk," the NAO said in a statement released with the report on 16 May, 2008.
Full implementation of the electronic Summary Care Record (SCR) system for recording patients' medical history, a key part of the programme which is run by NHS Connecting for Health (CfH), is likely to take until 2014-15, four years later than planned, the report states. In the North, Midlands and East areas, the software to support SCR has taken much longer to develop than planned, forcing some NHS trusts to adopt interim systems.
"Completing the development of the system and introducing it in this area are significant challenges still to be addressed," the NAO stated in the report.
Victor Almeida, senior analyst at Kable, commented: "SCR is a scaled-down version of CRS which contains selected medical information instead of cradle-to-grave patient data. This does not mean, however, that SCR is uncomplicated. There are three layers of data confidentiality, and also some issues around user legitimacy."
"CfH still needs to conduct more conversations with patients and with the clinical community to order SCR parameters in more detail," Almeida added.
Dr Chaand Nagpaul, GP negotiator with responsibility for IT at the British Medical Association, said: "It is clear from the NAO report that the setting of unrealistic deadlines has been very damaging to the National Programme for IT [NPfIT]. Slipping deadlines for new IT systems and the premature release of systems that are not fit for purpose has been deeply frustrating for NHS staff, leaving many doctors thoroughly disillusioned with the programme."
The scale of the challenges involved in developing the detailed care record has also proved far greater than expected, according to the report. The timescales for the three local service providers — BT in London, Fujitsu in the South and CSC in the North, Midlands and East — agreed with CfH have proved unachievable.
The security and confidentiality of electronic patient records depend on the actions of the NHS and individual members of staff, the NAO said. However, it found that early experience of SCR indicates that patients have a high level of confidence that their personal data will be secure.
The health service has developed a Care Record Guarantee which sets out the principles that will be applied in handling electronic care records. Access is controlled through smartcards and pass codes.
However, the report warns that security lapses could easily undermine that confidence and reduce the benefits of the overall programme. "The Department [of Health] and the NHS should give priority to data protection, monitor levels of public confidence, and review how the levels are being influenced by its communications about the protections in place to secure and manage access to care records," the report states.
Although Choose and Book, the electronic hospital-appointment- booking system, is now nearly fully deployed, usage has been less than expected, with 6.7 million bookings made against an original forecast of 39 million by January 2008. Some GP practices are using the system to make 90 percent of their patients’ hospital appointments, but other practices are using it for less than 20 percent.
In terms of successes, NPfIT has delivered the N3 network, providing the NHS with an IT infrastructure and broadband, and released software to support care records on or ahead of schedule. For example, 18,000 NHS sites were connected to N3 by January 2007, two months ahead of target, the report states.
All acute trusts have installed the picture-archiving and communications systems, which the NAO said have yielded the most tangible benefits to date, including helping to reduce diagnostic waiting times.
Both the contractors and CfH have reported an increasingly collaborative relationship. Furthermore, the NHS trusts visited by the NAO commented positively on the working relations they had with staff from the contracting companies. However, feedback from the three main IT contractors shows they have found the scale and complexity of the programme "extremely challenging".
All the trusts visited by the NAO had experienced technical problems with the new care record systems, and there had been some dissatisfaction, especially in the period following deployment. A further problem was the poor performance of a helpdesk set up to deal with technical problems. The report states that Fujitsu and CfH are now working to improve this service.
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Although the main aim of NPfIT is to improve services, the Department of Health expects that the total savings delivered by the programme will be "considerably higher" than the current estimate of £1.1bn.
In its first report, the NAO estimated that the programme would cost £12.4bn, but this figure has now risen to £12.7bn. The new report points out that the figure is still an estimate, but that the increase is mainly due to the purchase of increased functionality.
Spending on the programme totalled £3.5bn in March. As originally planned by former programme director Richard Granger, suppliers are only paid when systems are proven to work.
The investigation found that, in some cases, suppliers had not been paid for more than 12 months after the deployment of systems. Also, if suppliers miss key deadlines, they incur "delay deductions". From the start of the programme until March 2008, deductions of more than £25m had been made.
The NAO said that its difficulty in producing this report reinforced its view that reporting and communications about the programme need to be improved, particularly in relation to the work of the three local service providers. Since November 2007, however, CfH has been developing an electronic tool which is intended to provide a roadmap of progress.
Tim Burr, head of the NAO, said: "The priority now is to finish developing and deploying care records systems that will help NHS trusts to achieve the programme's intended benefits of improved services and better patient care."
The British Medical Association said the report echoed some of its own criticisms of the programme. Dr Nagpaul said: "The NAO report highlights that the success of the NHS IT programme will depend on the commitment of NHS staff. The major challenge for local health organisations will be to create an environment that fosters the commitment and confidence of staff. This will only happen if the progress on the development of the programme becomes more transparent."
Dr Nagpaul added: "Staff must be kept abreast of how new technology is going to impact on their hospital or practice. More work needs to be done on achieving this at a local level."
