I did a short blog on the reporting on the National Audit Office (NAO) report on the National Program for Health IT a few days ago.
This is found here:
I have now had time to have a browse of the reports. They are pretty blunt and make riveting reading. This extended key quote gets the flavour.
The National Programme for IT in the NHS: an update on the delivery of detailed care records systems
The rate at which electronic care records systems are being put in place across the NHS under the National Programme for IT is falling far below expectations and the core aim that every patient should have an electronic care record under the Programme will not now be achieved.
"The original vision for the National Programme for IT in the NHS will not be realised. The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme.
"The Department of Health needs to admit that it is now in damage-limitation mode. I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help to prevent further loss of public value from future expenditure on the Programme."
Amyas Morse, head of the National Audit Office, 18 May 2011
The rate at which electronic care records systems are being put in place across the NHS under the National Programme for IT is falling far below expectations and the core aim that every patient should have an electronic care record under the Programme will not now be achieved. Even where systems have been delivered, they are not yet able to do everything that the Department intended, especially in acute trusts. Moreover, the number of systems to be delivered through the Programme has been significantly reduced, without a commensurate reduction in the cost.
Today's NAO report concludes that the £2.7 billion spent so far on care records systems does not represent value for money. And, based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different.
The original aim of the Programme was for every patient to have an electronic care record by 2010. The systems the Department contracted its suppliers, BT and CSC, to deliver are now not all expected to be in place until 2015-16. Even so, based on performance so far, it is unlikely that the remaining work in the North, Midlands and East, where just four of 97 systems have been delivered to acute hospital trusts in seven years, can be completed by 2016 when the contract with CSC expires. Indeed, in order to meet the revised deadline, over two systems a month would need to be delivered in this Programme area over the next five years.
Progress in delivering care records systems varies dramatically between regions. There has been more progress in London in some health settings, although no GP practices are now receiving a system through the Programme and the number of systems in acute hospital settings has halved.
Where care records systems are in place, they are not yet delivering what the Department had expected. In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals. The Department has now changed its approach and moved away from its intention to replace systems wholesale, instead, building on and using trusts' existing systems. To do this the Department estimates it will cost at least £220 million to get the systems to work together.
HC: 888, 2010-2012
----- End Quote
Reading through the documentation there are some vital points:
First this report is the third released on the program - with the first done in 2006 and the second in 2008. Each of the reports has become increasingly pessimistic yet the spending and effort has continued without any apparent checkpoint and re-assessment. Result has been what was an eight year program winding up being a 15 to 16 year program. Never the less our Government seems to imagine that kicking off a form of national program - with none of the levers and controls held by the NHS over all parts of the health system - is going to result in a working national PCEHR System in a couple of years - you can really only wonder what they are smoking. (I know Australians and good but are we really that good?)
My fear is that what will happen is that we will see the initial 2 years funding continued for the PCEHR - dig ourselves into a deeper and deeper ditch - and despite recognising it is not going well not do the fundamental reviews that will be (and already are) needed.
Second this report makes it clear that when Government crosses swords with smart corporates (like CSC and BT) that it is possible to contract for something, deliver less and still get paid. There is a red light flashing warning here for DoHA. May be they should hire a fox to manage their henhouse to save themselves from this outcome!
Third it is alarming that it seems the clinical systems have been the ones that have been the most under delivered. The same, to varying degrees is also seen here - reminding us again just how hard doing clinical systems on any scale seems to be.
Fourth the first bold paragraph above just re-enforces the point about how long this takes before results are really seen. Making continuing funding contingent on the results of the first 2 years is utterly absurd!
Fifth the progress that has been made with the N3 Network, PACS and other nonclinical systems reminds us all that building basic infrastructure is the easy bit - the clinical applications and use of those is very much the ‘hard bit’!
Last, the scale of the mess here means we really need to challenge the wisdom of large national programs of this sort and come up with a fundamentally different way to approach things, as this really does not appear to be a good way forward.
On balance I still think the National E-Health Strategy, with an emphasis on local provider systems and clinical information flows before moving to shared records was correct and this report and the earlier reviews by Prof Trisha Greenhalgh just confirm that view.
We really do need not only to read the report but also have some real conversations with those who wrote it!