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NPfIT to cost £10 billion

22 August 2013   Rebecca Todd

The final cost of the National Programme for IT in the NHS is expected to be more than £10 billion.

Around £2.6 billion of actual benefits had been identified as of March 2011, but the Department of Health is predicting a final benefit figure of £10.1 billion.

An NPfIT benefits statement, released to EHI under the Freedom of Information Act, reveals that as of 2012, the total cost of the programme in 2004-05 prices was forecast as £10 billion with around £7.3 billion spent already.

The programme was set up in 2002 and originally slated to cost £12.7 billion, however it was officially axed in September 2010 and again in 2011, without delivering its original vision of electronic patient records across the health service.

The benefits report was released by the National Audit Office, which used it for a recent note for the Commons’ Public Accounts Committee on the DH's analysis of the costs and benefits of the national programme, which has still to be published.

The NAO is sceptical of the DH’s benefits predictions, saying there is “very considerable uncertainty about whether the forecast benefits will be realised.”

Another report released by the NAO comparing the costs and benefits provided by the DH in previous years confirms that in 2008, the total forecast spend until the end of national contracts was £12.7 billion.

By 2011, this had reduced to £11.4 billion and by 2012 this had reduced again to £9.6 billion. The headline figure of £10 billion relates to the cost until the ‘end of life’ of the programme, although it does not specify when this is.

The NPfIT benefits statement says the forecast cost until the end of life of the London Programme for IT – where BT has rolled-out Cerner Millennium to acute trusts and CSE’s RiO to community and mental health trusts - is £1.25 billion.

The cost as of March 2012 was £764m, but a number of Cerner deployments are yet to go ahead including Croydon Health Services NHS Trust, which was due to go live this Sunday, but is now aiming for the end of September.

The actual benefits realised from the London programme were £18m by March 2011, but estimated at £784m by the programme’s end.

In the South, where Millennium has been deployed at 10 trusts and 19 trusts have 25 instances of RiO, the forecast is £960m in ‘core’ costs and another £300m in ‘local clinical systems’, however what comes under ‘local clinical systems’ is not explained.

While just £15m benefits had been realised by March 2011, more than £1.3 billion was forecast by the end of SPfIT.

The North Midlands and East forecast cost is £2.9 billion. Actual benefits as of March 2011 were £114m, but forecast benefits are nearly £3.3 billion.

These figures are excluding the costs and benefits of the Lorenzo elements of the CSC contract.

When questioned by the PAC, Tim Donohoe, the senior responsible owner for the local service provider programmes at the DH, said the government’s total predicted spend on the Lorenzo system is nearly £600m.

The National PACS Programme cost to install picture archiving and communications and radiology information systems at trusts that needed them is expected to be nearly £1.1 billion.

The documents identify £711m in actual savings by March 2011, with £1 billion in total savings forecast.

The combined cost of national applications such as Choose and Book, GP2GP, the Electronic Prescription Service and Summary Care Record programme is forecast as £950m.

The predicted benefit of these applications is nearly £2 billion by the end of the programme, but just £650m in benefits had been identified by March 2011.

National infrastructure including N3, NHSmail and the Spine is estimated to cost £2.4 billion and to reap £1.8 billion in benefits.

EHI has received detailed reports on the costs and benefits of NPfIT from the National Audit Office. We will be running a series analysing the released information called ‘The NAO Files’ over coming weeks.


Related Articles:

7 News: NPfIT puts reputations at risk | 9 July 2013
Last updated: 22 August 2013 15:56

© 2013 EHealth Media.


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Colin Cohen 68 weeks ago

This article, while interesting, begs a lot of questions about how the figures were arrived at, especially the measurement of benefits. Isn't it about time for some independent research to be commissioned, along the lines of the CfH Evaluation Programme, to evaluate the aftermath of the National Programme for IT. There ought to be a lot to be learned.


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Richard Fitton 68 weeks ago

As Paul Cundy pointed out, the GP record has been built around the business, clinical and administrative requirements of General Practice that has been providing emerging and evolving General Medical Services for over 95% o the UK population. The GP provides and oversees the commissioning of immediate, continuing, preventative and health promotional care for the majority of the English population and remains a trusted profession within the public's eyes.

One issue that the NHS has been struggling with, as it has looked to utilise ITC to enhance healthcare and health outcomes, has been to identify and support the legal data controller of NHS data.

General Practice accepted the role of maintaining the lifelong patient record in the early twentieth century when they adopted the Lloyd George Record. Since the early 1980's the electronic record has augmented and is gradually replacing the paper Lloyd George record. It has been standard practice to copy summaries of all NHS service to the lifelong GP record for over 70 years.

I believe that the GP should still be the data controller for the NHS lifelong patient record. " (data controller means, subject to subsection (4), a person who (either alone or jointly or in common with other persons) determines the purposes for which and the manner in which any personal data are, or are to be, processed;)

because the GP provides and oversees the commissioning of immediate, continuing, preventative and health promotional care for the majority of the English population and remains a trusted profession within the public's eyes. The population understand and know this and have easy recourse to visit and execute their right to negotiate for healthcare with their GP at a site fairly close to their residence or in their own homes. This relationship generally fulfils the requirement of the first Data Protection Act principle -

1 Personal data shall be processed fairly and lawfully

1 (1) In determining for the purposes of the first principle whether personal data are processed fairly, regard is to be had to the method by which they are obtained, including in particular whether any person from whom they are obtained is deceived or misled as to the purpose or purposes for which they are to be processed.

(2) Subject to paragraph 2, for the purposes of the first principle data are to be treated as obtained fairly if they consist of information obtained from a person who

(a) is authorised by or under any enactment to supply it, or

(b) is required to supply it by or under any enactment or by any convention or other instrument imposing an international obligation on the United Kingdom.

It was unfortunate that General Practice failed to make the record available out of hours when they opted out of hours - surely a dereliction of their duty to provide best care for their patients but that is being rectified now with summary care records and patient access to records.

I hope that General Practice, IT service providers, PPGs and patients will continue to work together to maintain and enhance the GP lifelong record and to learn how to share it more with the patients and carers and across health and social care services and with commissioning services within the spirit of Caldicott 2 data sharing review.


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Geepsi 68 weeks ago

You accuse general practice of failing to make our records available. However, the loss of OOH ( we were automatically opted out and it was made very difficult to opt back in) coincided with GP IT being taken over by PCTs.

My practice would have been delighted to make our records available but we were told that this was 'low priority' as it would entail new costs for the PCT. This, of course, changed when SCR became a national priority although my PCT also decided to abandon any enrichment of the basic SCR leaving the entirely inadequate original data set for OOH.


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just_instantiate 68 weeks ago

It's really about the opportunity cost. What if the £10bn had been spent differently? Just doled out to trusts like they did in the (newly returned) good old days. Or - deep breath - didn't spend it on IT at all, but on more hospitals and MRIs. Or high speed rail networks, or schools ... or just cut taxes? Where is Jeremy Bentham when you need him?


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DayJarView 68 weeks ago

Even if the numbers turn out to be right the fact that they exist does not mean that we got the best value for money.

The PACS procurement arguably cost no less, happened later and has higher replacement cost than local procurements would have had if the market momentum of 2001 been maintained.

C&B produced a poor response to the wrong question...

Now HSCIC seem to be proposing workarounds to ensure that some of the NPfIT infrastructure legacy actually turns out to be usable in the real word.

As to patient cost:benefit - how many patients have been diagnosed and treated sooner, to better effect?


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Merda_taurorum_animas_conturbit 68 weeks ago

On the C&B point, not a poor response where it was delivered and supported properly by people (not CfH) who fully understood the programme, the software and all the co-dependant processes and activities that needed to be considered for succesful change management, implementation and angagement

Linking this to your last point I can tell you that where C&B has been delivered properly and is used as BAU for referrals, benefits are being realised (although not necessarily obvious from a cursory view). As an example there have been substantial intangible patient benefits in areas such as 2WW suspected cancer referrals using C&B - When booked through C&B the patient has their actual appointment date before they leave the GP Practice instead of having the extra psychological burden of waiting for their appointment to come through the post, with an added benefit that they are not aware of, which is that their C&B referral can't be lost by the Cancer service at the provider as can happen with faxed 2WW referrals - whilst these examples are of no obvious immediate financial benefit (definite patient benefits I think you'll agree) there are long term cumulative savings associated - think reduction/removal of fax costs for referrers and providers, think reduction of time taken by admin staff to call for confirmation of receipt of the 2WW fax, think reduction of admin staff time dealing with calls from patients chasing up their appointment dates because they havent received a letter.

Whilst I share your sentiment that the figures quoted does not mean we got the best value for money, IMHO the blame has to be shared by everyone and if HSCIC were to completely dump the NPfIT infrastructure legacy without trying to get some VFM out of it would that not just be compounding things?


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Geepsi 68 weeks ago

The 'book' part of choose and book was the bit that had the potential to save money. Unfortunately the 'choose' bit was where the problem was. It put choice of provider over other aspects such as named clinicians.

In meant that GPs like me could sometimes spend more time trying to find the correct service and negotiating with the patient over clinic/appointment etc than we actually spent talking to the patient.

The saving on faxes was easily offset in general practice by the transfer of administration from hospitals to primary care.

As for chasing appointments, my staff do just as much as they ever did because the follow-ups are still messed up by trusts and there are still a significant number of C&B referrals that are moved onto paper by recipient organisations.

And I'm a C&B enthusiast who does 95% rferrals by this route and consider myself reasonably competent using the system.

What this does point out is how value is in the eye of the beholder. I'm sure the debates will go on and on as to the true VFM of the programme.


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cjervis 68 weeks ago

I find this article difficult to follow.

We need to know what 'costs' are included in this figure and how it relates to the value added. We also needs to account for the effort that the NHS put into the Programme as an opportunity cost.

Using a suggested denominator of 'patient' is only one way of looking at cost, and it assumes that the patient actually gets value from IT systems in a care setting - otherwise why use it as a factor?


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Paul Cundy 69 weeks ago

Could we have these costs broken down into numbers Joe Soap can understand please? say How much per workstation deployed, how much per person in the population, how much per user?

For instance all of the IT currently deployed in general practices costs approx £2 per patient per year which i think considering what you get is an absolute bargain, even if if i'm out by a factor of 2 or 3.

£10B for 40 million patients over 10 years is roughly £25 per person per year?

Have we had value for money?

Regards

Paul C


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