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Better connected?

Sunday September 20th, 2009

by Louisa Boyle, GO Staff Writer

GO looks at the recent developments taking place within the Connecting for Health Programme and the responses it has generated.

Four years on from the launch of the Government’s ‘NHS Connecting for Health’ IT programme, there remains criticism and questions over its success. The Public Accounts Committee (PAC) recently released a report entitled The National Programme for IT in the NHS: Progress since 2006, discussing the progress which has been made so far.

The programme is intended to generate substantial benefits for patients and the NHS. The aim is for care records software to be delivered in a series of releases with increasing functionality. Delivering the clinical functionality will be key to convincing NHS staff, the public and sceptics of the benefits of the programme, because what has been provided to date has not met expectations.


NHS Connecting for Health is a major directorate of the Department of Health whose primary aim is delivering the National Programme for IT (NPflT) in order to modernise the NHS and ensure that patient care is the key priority. The multibillion-pound initiative was launched in April 2005 and is expected to take ten years to complete.

The programme has its origins in the 1998 Department of Health strategy ‘Information for Health’. This strategy committed the NHS to lifelong electronic health records for patients, round-the-clock online access to patient records for clinicians and information about best clinical practice for all. The programme was subsequently developed through a series of events, the most notable being publication of the Wanless Report.

In 2001, Derek Wanless, a commissioner with the Statistics Commission, was asked to examine future trends affecting the health service in the UK. The resulting 2002 Wanless Report contained several key recommendations for IT in the NHS. These recommendations led to a 2004 Department of Health announcement which saw the creation of a new organisation, combining delivery of the National Programme with management of NHS IT. The organisation was entitled NHS Connecting for Health.

Findings of the PAC report

The Public Accounts Committee’s National Programme for IT in the NHS: Progress since 2006 report has found that many of the key objectives of Connecting for Health are not being fulfilled and a number of the objectives have already failed.

The report states that although some systems are being deployed across the NHS, the Care Records Service is at least four years behind schedule, with the Department’s latest forecasts putting completion at 2014-15.

By August 2008, new care records systems had been deployed in 133 of the 380 NHS Trusts. Trusts in the North, Midlands and East have been receiving an interim system and will have to go through a further deployment in due course to implement Lorenzo, the care records software for these regions. By the end of 2008, Lorenzo had not been deployed throughout any Acute Trust and in only one Primary Care Trust.

Additionally, while the programme started with four Local Service Providers – the main suppliers responsible for implementing systems at local level across England – two have since left. The two remaining providers now carry the responsibility for all major components of the programme, and this has caused further problems. A prime example is the termination of Fujitsu’s contract in May 2008; this contract covered the South of England.

One of the most significant findings of the report concerns financial uncertainties. The estimated cost of the programme is £12.7 billion, including £3.6 billion of local costs. In the event that Trusts decide not to deploy the programme’s systems, the Department of Health is nonetheless obliged to make payments to the suppliers concerned. While the Department can direct NHS Trusts and PCTs to take the systems, it has no such power over Foundation Trusts.

Independent report from the Conservatives

The Conservative Party has criticised the National Programme for IT in the NHS and announced plans to overhaul the Government’s current system.

In their Independent Review of NHS and Social Care IT, the party proposes to deliver cost savings that will help ensure that NHS IT is geared towards the needs and wishes of patients. In addition, patients will be consulted on the use of their health care information.

Some of the key proposals include dismantling government’s central NHS IT infrastructure and delivering its benefits through local systems instead; and halting and renegotiating the contracts that have been signed for IT service providers, to prevent further inefficiencies. 

The party has also proposed plans to stop imposing central IT systems on the NHS, instead allowing health care providers to use and develop the IT they have already purchased.

The review argues that when health care IT is freed from its current constraints, both private sector and open source software will develop.

Conservative Party Leader David Cameron said: “There is huge potential for the NHS to harness the power of technology in bringing about change. As patients, we want to know we’re getting the best possible care; as taxpayers we want to know we’re getting value for money: technology, well applied, can create opportunities for both in a decentralised NHS.”

Shadow Health Minister Stephen O’Brien added: “Labour’s handling of NHS IT has been shambolic. Their top-down, bureaucratic plans have been hugely disruptive to the NHS and have been plagued with delays and cost overruns. The Conservatives will not let patients pay the price for the Government’s inaction.”

Response from the Department of Health

The Department of Health has been quick to respond to the Conservatives’ independent review, arguing that the original vision of the National Programme for IT in the NHS was to improve health care by making better information available to clinicians, and that nothing in the PAC report challenges that vision.

They have also pointed out that the programme has always had a mixed economy of suppliers, and that it long ago recognised the value of existing systems in supplementing Local Service Providers’ offerings.

A Department of Health spokesperson said: “The report highlights nothing new – we already know that quality health care can be delivered through the effective use of IT.

Patients are now directly benefiting from the modernisation of NHS IT – including being able to make their first outpatient appointment through Choose and Book, new digital images and a new electronic prescriptions service.

“The programme is already being delivered locally. For example, detailed records will continue to be held locally in an electronic form, enabling hospitals and GPs to easily access information in order to deliver the best service for patients.”

The Department of Health’s Director General of Informatics, Christine Connelly, has recently made it clear that if significant progress has not been achieved by the end of November 2009, a new approach to NHS IT may need to be adopted.

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