News: MPs fret over delays to electronic care records

Parliament’s watchdog, the Public Accounts Committee, has published a report on England’s National Programme for IT in the NHS. It says there has been progress in some areas, but little movement on the key objective of delivering electronic care record systems to trusts. Lyn Whitfield reports.

An influential committee of MPs has expressed concern about the continued delays to the project to deliver electronic care records to the NHS in England.

In a report on the National Programme for IT in the NHS, the House of Commons Public Accounts Committee (PAC) says that while some of its projects are going well, “recent progress on deploying the new care records systems has been very disappointing.”

It says that just six care record systems were deployed in acute trusts in the five months before it held hearings on the national programme in June, and that this part of the programme is now unlikely to be complete before 2014-15; four years later than originally planned.

The committee also argues that if deployments do not pick up within six months, the Department of Health should consider allowing trusts to choose their own IT systems and pay for them centrally. However, opposition MPs have seized on the report and used it to call for the national programme to be abandoned.

Conservative MP Richard Bacon said: “In its current form, the programme is in deep trouble from which it is unlikely to recover. Hospital trusts should now be free to buy the systems they want, subject to common standards, and they should be funded to do this through the national programme.”

Running late, running into problems

The ten-year National Programme for IT in the NHS was set up in 2002 and has been run by NHS Connecting for Health since 2005.

When it was created, it had three main aims: to deliver a new broadband network to the NHS, known as N3; to deliver national projects such as the Choose and Book electronic booking service; and to deliver electronic care records for use in hospitals, surgeries and other health services.

The latest report from the PAC acknowledges that “some aspects, such as the N3 broadband network and the Spine, are complete or well advanced” and that progress is being made on Choose and Book and other national projects, such as the Electronic Prescription Service.

However, it is critical about the lack of progress being made on electronic care records. The report notes that the introduction of the NHS Summary Care Record (SCR) has been “delayed”, partly because of concerns about confidentiality.

The SCR is supposed to provide medical staff with a small amount of critical information about every patient in the country, but so far just six primary care trusts are trialling it in out-of-hours services. Meanwhile, the systems that are supposed to deliver Detailed Care Records to hospitals and other healthcare providers have run into more serious problems.

The Lorenzo system, which is due to be delivered across the North, East and Midlands of England, is being trialled by just one PCT and one acute trust; while the Millennium system, which is due to be used in the South and London, has stalled because of contractual disputes and problems at the trusts that have deployed it.

The contracts that NHS CFH has signed with local service providers mean it does not have to pay them until they have delivered these systems. Even so, the PAC says “the programme is not providing value for money at the moment because there have been few successful deployments.”

The programme is due to cost around £12.7 billion; with between a third and a quarter of this having been spent to date. The report also says that NHS CFH still needs to do more to engage clinicians and that to do this it will need to deliver “clinical functionality and clear benefits.”

It says the benefits statement that NHS CFH has started to publish each year should be audited by the head of the PAC’s watchdog, the National Audit Office. On other topics, it also says the Department of Health should do more to monitor security breaches across the NHS and that it should set out clearly what penalties staff will face for breaching data protection policies.

Criticism and response

The NHS Confederation, which represents NHS organisations, responded to the report by saying the government should “call in” the national programme and find better and more cost effective ways to deliver it, while the British Medical Association, which represents doctors, said the report confirmed many of its concerns.

Dr Vivienne Nathanson, head of science and ethics at the BMA, said “trusts must have more freedom to implement IT systems that take into account their local needs” – although she also stressed that “despite the problems, we must not lose sight of the potential benefits that could be delivered in terms of patient safety by the national programme.”

Despite the criticism, the Department of Health said it “welcomed” the report. "New IT systems in the NHS are delivering better, safer and faster care,” it said.

“Current costs have declined because of the delays to implementation.  Costs are also controlled by the contracts which only pay to providers once the service has been successfully delivered." The government will give a formal response to the PAC report later this year.