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UK's healthcare programme passes its check-up

Tola Sargeant

UK's healthcare programme passes its check-up

The UK government-spending watchdog, the National Audit Office (NAO), published its long-awaited report into England's multi-billion pound National Programme for IT (NpfIT) in the NHS last Friday.

The NAO found that the UK Department of Health and NHS Connecting for Health (NHS CFH), the government agency in charge of NPfIT, have made substantial progress with the programme, which is overhauling the NHS's IT infrastructure. It singles out a number of areas for praise including the swift procurement process, the money saved by central procurement and the competitive tendering process used, the innovative terms and conditions in the supplier contracts, the intrusive management of the supply chain and the tight change-control mechanisms.

However, the report also concludes that the successful implementation of the programme continues to represent significant challenges for the DoH and NHS CFH. The NAO pinpoints three key areas where this is the case:

  • Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS, and to agreed timescales without further slippage
  • Ensuring that NHS organisations can and do fully play their part in implementing the Programme's systems
  • Winning the support of NHS staff and the public in making the best use of the systems to improve services.
The head of the NAO, Sir John Bourn, also noted that the main implementation phase of the Programme and the realisation of benefits are still in the future, and that it will therefore be some time before it is possible to fully assess the value for money of the Programme. We may well see the NAO return to carry out a further examination of NPfIT later. Comment: There is nothing particularly Earth-shattering in the NAO's 60-page report. Despite spelling out the progress and delays encountered by the programme to date, the report comes across as broadly positive and shouldn't make too uncomfortable reading for the programme management.

Nor should the report's key conclusions come as surprise to anyone who has been following the programme closely over the last few years. They hark back to common themes, particularly the need for continued engagement with NHS staff and the need to provide greater clarity to organisations and staff in the NHS as to when the different elements of the programme will be delivered. Not many people would argue with this. From the very beginning of the procurement process, we've stressed how important engagement with NHS staff would be to the project's long-term success and how the Programme needs to be seen as a business change programme rather than just an IT project.

Interestingly for suppliers, one of the report's recommendations is that NHS CFH should continue its strong management of supplier performance, including the imposition of contractual penalties where needed and if necessary the termination and replacement of contractors. No doubt this will make the likes of iSoft and GE Healthcare (which acquired London application provider IDX Systems last year) even more nervous.

Suppliers should also note the report's conclusions on the lessons that other departments can learn from NPfIT, particularly in the area of procurement. The NAO highlights the fact that suppliers - and not taxpayers - have borne the cost of overcoming difficulties in delivering software because of the way NHS CFH structured the contracts (payment is only received for systems that are delivered and working). What is more, the report concludes that "the speed of the negotiations and the inclusion of a sound balance of incentives and penalties within the contracts have put NHS CFH in a strong position in its relationships with suppliers, and one that is stronger than previous government procurement practice."

Does this mean similar-style procurements in the public sector from now on? Quite possibly, but we suspect that suppliers will be a bit more reticent about signing up to such Ts & Cs having watched the impact they've already had on some NPfIT suppliers.



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