The success of the NHS National Programme for IT is precarious, with key projects running late and suppliers struggling to deliver, according to a long-awaited report from Parliament's influential Public Accounts Committee.
"There is a question mark hanging over the National Programme for IT (NPfIT), the most far-reaching and expensive health information technology project in history," said committee chair Edward Leigh on 17 April.
"Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected."
Leigh called for urgent action by the programme's leaders to reduce the risks. He said they need to agree with suppliers on a robust delivery timetable in which everyone, including local NHS trusts, can have confidence.
Delivery of the electronic patient record is already two years behind schedule and no firm implementation date has been set. By now most acute NHS trusts should have new NPfIT patient administration systems (PAS), but at the end of February only 27 had introduced PAS.
Choose and Book, the electronic system to enable patients to book a first outpatient appointment, was deployed to more than 7,600 locations by April last year. But it still only accounts for 20 percent of referrals from GPs to first consultant outpatient appointments.
The report says the Department of Health (DoH) has failed to carry clinical opinion with it and still has to "win the hearts and minds in the NHS". It calls on the heads of clinical professions, such as the chief medical officer, to review clinical involvement.
The committee also highlights the procurement structure of the programme, saying there is a continuing risk if it remains overly dependent on a small number of suppliers. Accenture, Commedica and IDX, three key suppliers, have left the programme and use of only two major software suppliers may inhibit innovation, progress and competition.
Other key suppliers, including iSoft, have been affected by ongoing financial problems. iSoft shares have lost more than 90 percent of their value after profit warnings and allegations of accounting irregularities.
Delivery has been made more complex by the scale and fragmentation of existing IT systems. Furthermore, the programme is being delivered against a background of change in the NHS.
The DoH told the committee that, although procurement had been carried out centrally, implementation was local through individual NHS organisations. Chief executives of the new strategic health authorities, which came into operation last July, are now responsible for overseeing implementation of NPfIT in their local NHS. But the findings were unclear about how much the localising of responsibility will help unless local trusts have flexibility in the choice of systems.
On costs, the DoH has failed to maintain a detailed record of overall expenditure and its estimates of the total cost of NPfIT ranges from £6.2bn to £20bn. By the end of March 2006 total expenditure was £1.5bn. The figure is lower than predicted because of slower than planned delivery and contractual terms that suppliers are only paid when services are fully operational.
"The stakes are high," says the report. "If NPfIT is successful, it could revolutionise the way the NHS in England uses information and make significant improvements to patient care.
"But if it fails, it could set back IT developments in the NHS for years, as well as diverting money away from patient services."
The report calls for a number of urgent reviews. In particular, it says the DoH should review the capacity of local service providers to deliver. It should also regularly review suppliers' performance for any signs of financial difficulties which could affect their ability to fulfil their contracts.
NHS Connecting for Health, the agency overseeing the programme, should commission and publish an independent assessment of the business case, in the light of the progress and experience to date.
The MPs also recommend the publication of an annual statement outlining the costs and benefits of the programme.
Talkback
How is it possible that a major critical project within the government is so badly managed that the government don't know how much has been spent so far, how much it will cost and when it will be delivered? This is basic project management, and on a project of this size there is simply no excuse for not keeping proper track of it. In the private sector senior managers would be sacked for this level of mismanagement - if they had even risen to senior manager level given their clear inability to perform their job. Isn't it time the public and the media started calling the governement to task on this?