Conclusions and recommendations |
1 Recent progress in deploying the new care
records systems has been very disappointing, with just six deployments
in total during the first five months of 2008-09.
The completion date of 2014-15, four years later than originally
planned, was forecast before the termination of Fujitsu's contract
and must now be in doubt. The arrangements for the South have
still not been resolved. The Department and the NHS are working
with suppliers and should update the deployment timetables. Given
the level of interest in the Programme, the Department should
publish an annual report of progress against the timetables and
revised forecasts. The report should include updates on actions
to resolve the major technical problems with care records systems
that are causing serious operational difficulties for Trusts.
2 By the end of 2008 the Lorenzo care records
software had still not gone live throughout a single Acute Trust.
Given the continuing delays and history of missed deadlines, there
must be grounds for serious concern as to whether Lorenzo can
be deployed in a reasonable timescale and in a form that brings
demonstrable benefits to users and patients. Even so, pushing
ahead with the implementation of Lorenzo before Trusts or the
system are ready would only serve to damage the Programme. Future
plans for deployment across the North, Midlands and East should
therefore only follow successful deployment and testing in the
three early adopter Trusts. This will mean that lessons can be
learned before any decision is taken to begin a general roll-out.
3 The planned approach to deploy elements
of the clinical functionality of Lorenzo (release 1) ahead of
the patient administration system (release 2) is untested, and
therefore poses a higher risk than previous deployments under
the Programme. The Department and the
NHS should undertake a thorough assessment of whether this approach
to deployment will work in practice. No Trust other than the three
early adopters should be invited to take the first release of
Lorenzo until it is certain that release 1 and release 2 will
work effectively together.
4 Of the four original Local Service Providers,
two have left the Programme, and just two remain, both carrying
large commitments. CSC is responsible
for deploying care records systems to the whole of the North,
Midlands and East after taking over Accenture's contracts. As
well as deploying systems in London, BT is responsible for the
N3 broadband network and the Spine. In the light of the experience
of Accenture's and Fujitsu's departures from the Programme, it
is vitally important that the Department assesses BT's and CSC's
capacity and capability to continue to meet their substantial
commitments. The assessment should consider the impact on the
strength of the Department's position of having only two suppliers
responsible for the Programme's major components.
5 The termination of Fujitsu's contract has
caused uncertainty among Trusts in the South and new deployments
have stopped. One option being considered
for new deployments is for Trusts to have a choice of either Lorenzo
provided through CSC or the Millennium system provided through
BT. There are, however, considerable problems with existing deployments
of Millennium and serious concerns about the prospects for future
deployments of Lorenzo. Before the new arrangements for the South
are finalised, the Department should assess whether it would be
wise for Trusts in the South to adopt these systems. Should either
of the Local Service Providers take on additional commitments
relating to the South, the Department should take particular care
to assess the implications of the extra workload for the quality
of services to Trusts in the Local Service Providers' existing
areas of responsibility.
6 The Programme is not providing value for
money at present because there have been few successful deployments
of the Millennium system and none of Lorenzo in any Acute Trust.
Trusts cannot be expected to take on the burden of deploying care
records systems that do not work effectively. Unless the position
on care records system deployments improves appreciably in the
very near future (i.e. within the next six months), the Department
should assess the financial case for allowing Trusts to put forward
applications for central funding for alternative systems compatible
with the objectives of the Programme.
7 Despite our previous recommendation, the
estimate of £3.6 billion for the Programme's local costs
remains unreliable. The Department intends
to collect some better data as part of the process of producing
the next benefits statement for the Programme. In the light of
that exercise, the Department should publish a revised, more accurate
estimate for local costs and, thereby, for the cost of the Programme
as a whole.
8 The Department hopes that the Programme
will deliver benefits in the form of both financial savings and
improvements in patient care and safety.
In March 2008, the Department published the first benefits statement
for the Programme, for 2006-07, predicting total benefits over
10 years of over £1 billion. There is, however, a lot of
work to do within the NHS to realise and measure the benefits.
Convincing NHS staff of the benefits will be key to securing their
support for the Programme, and the credibility of the figures
in the benefits statement would be considerably enhanced if they
were audited. We consider future benefits statements should be
subject to audit by the Comptroller and Auditor General. The Department
should also review achievements under the Programme so that lessons
can be identified and shared where products and services are working
9 Little clinical functionality has been deployed
to date, with the result that the expectations of clinical staff
have not been met. Deploying systems that
offer good clinical functionality and clear benefits is essential
if the support of NHS staff is to be secured. For all care records
systems offered under the Programme, the Department and the NHS
should set out clearly to NHS staff which elements of clinical
functionality are included in existing releases of the software,
which ones will be incorporated in the next planned releases and
by what date, and which will be delivered over a longer timescale.
10 The Department has taken action to engage
clinicians and other NHS staff but there remains some way to go
in securing their support for the Programme.
To assess and demonstrate the impact of its efforts to secure
support for the Programme, the Department should repeat its surveys
of NHS staff at regular intervals (at least every year) and publish
11 Patients and doctors have understandable
concerns about data security. However
extensive the Care Record Guarantee and other security provisions
being put in place are, ultimately data security and confidentiality
rely on the actions of individual members of NHS staff in handling
care records and other patient data. To help provide assurance,
the Department and the NHS should set out clearly the disciplinary
sanctions that will apply in the event that staff breach security
procedures, and they should report on their enforcement of them.
12 The Department does not have a full picture
of data security across the NHS as Trusts and Strategic Health
Authorities are required to report only the most serious incidents
to the Department. The Department's view
is that it is not practical for it to collect details of all security
breaches but at present it can offer little reassurance about
the nature and extent of lower-level breaches that may be taking
place. Given the importance of data security to the success and
reputation of the Programme, the Department should consider how
greater assurance might be provided through regular reporting.
The Department should also report annually on the level of 'serious
untoward incidents', on any penalties that have been imposed on
suppliers for security breaches, and on the steps being taken
to keep patient data secure.
13 Confidentiality agreements that the Department
made with CSC in respect of two reviews of the delivery arrangements
for Lorenzo are unacceptable because they obstruct parliamentary
scrutiny of the Department's expenditure.
The Department made open-ended confidentiality agreements in respect
of these reviews, with the result that information will not be
disclosed even after commercial confidentiality has lapsed with
the passage of time. We believe this is improper. The Department
should desist from entering into agreements of this kind.