Spend and save card: the national programme’s annual benefits statement

NHS Connecting for Health recently published the first ever benefits statement for the National Programme for IT in the NHS, setting out what the programme has cost to date, what it has saved and what it will achieve in the future.

The National Programme for IT in the NHS is certain to generate savings of £1.4 billion over its ten year lifespan, according to its first annual benefits statement.

NHS Connecting for Health (NHS CFH), the agency that runs the programme, arrived at the figure by identifying the cash releasing savings made in its first three years and the recurring savings that can be expected over the remaining lifetime of its core contracts, which end in 2014.
“As more new frontline and clinical systems are deployed, NHS organisations will be able to seize the opportunity for more wide-ranging service transformation across healthcare communities.”
The report identifies £208 million of savings to the end of March last year, most of which came from decommissioning nhs.net and replacing it with the N3 broadband network, and from deploying digital imaging systems into NHS trusts that cut film, storage and administration costs.

It also estimates that £119 million of recurring savings will be generated over the next seven years, mostly from the same sources plus the replacement of the NHS wide clearing service with the secondary uses service (SUS).

However, the report predicts that the number of NPfIT deployments, savings and IT-led changes to NHS services are all set to increase rapidly. “To date, evidence of cash releasing benefits has been collated from approximately 20 per cent of NHS organisations with national programme systems,” it says.

“This will increase significantly over the coming months. As more new frontline and clinical systems are deployed, NHS organisations will be able to seize the opportunity for more wide-ranging service transformation across healthcare communities.”

Under-spending

The report says there are early opportunities for trusts to use N3 for internet telephony, cutting the cost of calls, and to use their picture archiving and communications (PACS) systems to speed up examinations and increase efficiency.

It also says some of the programme’s national projects will become more visible as the early adopter phase of the NHS summary care record is completed, the first stage of the electronic prescription service is completed, and the Choose and Book electronic booking system “become[s] more widespread.”

Conversely, the benefits statement shows that delays to other elements of the £12.4 billion programme mean that it has spent only half of what it was forecast to spend in its first three years.

The benefits statement shows that by March 2007, the programme had spent a total of £2.4 billion against a forecast of £4.5 billion. Most of the shortfall comes from delays in delivering local, detailed care records systems.

The local service providers and suppliers responsible for these systems – CSC, BT, Fujitsu, iSoft and Cerner – had been paid just £1.3 billion by the end of March last year, against a forecast of £2.8 billion.

“Health and IT experts [around the world] point to Britain as example of computer technology being used successfully to improve health services to the public."

Ministers flag benefits

At a press conference, healthcare IT minister Ben Bradshaw and Department of Health (DH) officials said the report proved that the programme was delivering benefits while contractors absorbed the cost of major delays.

Health minister Ben Bradshaw said: “"Our use of computer technology in the NHS is becoming the envy of the world. It is saving lives, saving time and saving money. If you talk to health and IT experts anywhere in the world they point to Britain as example of computer technology being used successfully to improve health services to the public."

At a recent conference in Berlin, NHS chief executive David Nicholson argued that a large amount of work had been put into the early years of the programme that was not always apparent to clinicians or commentators.

Despite that, he told the World Healthcare Congress that politicians had been remarkably constant in their support for the programme, that it was delivering “real benefits” and that it was a critical part of the wider reform of the health service. “It is a programme that gives us the potential to make that extra leap to have a world class healthcare service,” he said.

However, Mr Nicholson also acknowledged that the programme had become too centralised to support an increasingly decentralised and personalised NHS; which was why the NPfIT Local Ownership Programme (NLOP) had been introduced.

Benefits realisation goes local

Under NLOP, NHS CFH remains responsible for national IT projects and contracts, but local NHS organisations are responsible for deployment. The benefits statement recognises this shift.

It was published in response to a recommendation from the National Audit Office that the financial benefits of the national programme should be quantified and set against its costs. But DH officials told the press conference that researching and producing the statement had been “challenging.”

The report says there needs to be a clearer focus on benefit realisation and that NHS CFH is working with strategic health authorities (SHAs) to develop “an effective framework to ensure this is achieved.” In future, SHAs will be responsible for publishing an annual statement of benefits realised.

Opposition politicians were not impressed with what has been achieved to date. Shadow health minister Stephen O’Brien said the £208 million savings identified to March 2007 were “peanuts” when set against what the programme was costing and “nothing that the government should be crowing about.”

The national programme and primary care:

More than 600 GP systems had been installed under the National Programme for IT in the NHS by the end of March last year, generating £617,000 of savings in hardware maintenance and software licensing costs, and recurring savings of £1.6 million a year.

The benefits statement also says that more than 8,000 Choose and Book systems had been installed and that a number of organisations have reported reductions in the time that it takes to process a GP referral since they implemented electronic booking.

“In some locations, the reduction has been up to 88 per cent, with the time taken for a patient to receive an appointment falling by up to 93 per cent,” the report says. “The number of patients failing to attend a booked appointment has also reduced by 23 per cent and this continues to improve.”

As with acute systems, the Department of Health says work is underway to develop consistent benchmarks and ways of measuring these benefits.

Meanwhile, the report says there will be further improvement to the Quality Management and Analysis System (QMAS) and GP clinical systems to support the operation of the Quality and Outcomes Framework (QOF). Further implementation of the GP Systems of Choice initiative (GPSoC), the electronic prescription service and the GP2GP records transfer system are also promised.

Related links
A statement documenting the full benefits is available on the connecting for health website.