Update: Please note the Department of Health comment at the end of this article
I understand that when auditors carried out a check at NHS Connecting for Health they found box-loads of invoices that had not been analysed.
Auditors found that the invoices were being paid as they came in, without a reconciliation of what was being charged against what was being delivered, and without a check on the extent to which payments related to sign-off of systems by local trusts.
I am also told that auditors had more confidence in the quality of information from NPfIT suppliers than from the civil service: the suppliers were able to say what they had been paid, and for what.
How can the Department of Health know if the NPfIT will be value for money?
If the DH doesn't know exactly what it is paying for, how can it say the NPfIT has been, or will be, value for money?
Yet the DH says the programme will be value for money. This is what the DH told the National Audit Office, as featured in the NAO's report last month on the NPfIT Detailed Care Records Systems:
"... Money spent to date has not been wasted and will potentially deliver value for money..."
CfH pays suppliers only on delivery - delivery of invoices?
Independent specialists who work in, and for, the NHS tell me there are talented and committed people in NHS Connecting for Health, which is no doubt true. But as an organisation it appears to be thin-skinned and, at times, less than organised.
CfH officials say they pay suppliers only on delivery. But is that delivery of invoices? If suppliers are paid on submission of invoices, how can CfH be certain they have delivered?
Last month's NAO report is infused with references to CfH's not being able to supply basic management information on its payments to suppliers. So can CfH be trusted to spend wisely the £4.5bn that has yet to be spent on the NPfIT? CfH is about to sign a new deal with CSC that is likely to be worth about £2.5n.
Connecting for Health was mentioned frequently in a debate in the House of Commons this week on the NPfIT. The debate was prompted by Richard Bacon, a campaigning Conservative member of the Public Accounts Committee.
NHS suppliers "running rings around Connecting for Health"
Bacon told MPs:
"The local service providers appear to be running rings around Connecting for Health commercially.
"... CSC is offering a one-third reduction in the cost of its contract in return for doing two-thirds less work. As the Cabinet Office observed, that would roughly double the cost compared with the original agreement...."
And referring to the danger to the NHS of future high costs, Bacon said: "When the [local service provider] contracts finish, there is inadequate provision to manage the systems in future.
"It takes a special skill to leave trusts stuck with systems that are functionally very poor and out-of-date, which were not deemed adequate nine years ago, and still manage to expose them to enormous future costs over which they will have very little control. That is precisely what Connecting for Health is managing to do.
"Finally, there is a serious danger that Connecting for Health will put CSC in particular in a monopoly position. The proposed revised agreement may be open to legal challenge from other suppliers who have not had the chance to bid.
What should happen now?
"... It is plain that the NHS IT programme has not worked and there is no evidence that it will work. Rather than squandering another £4bn to £5bn, which is still unspent, the NHS should recognise reality," said Bacon.
"Connecting for Health has failed to achieve its central purpose and should be closed down. I am afraid that it will not help and is now more interested in the preservation of its own position than in protecting the interests of taxpayers.
"NHS trusts must be set free to choose the systems that meet the needs of patients and medical professionals. They should have the power to source products locally that suit their needs, subject only to common standards."
Not for the first time
, I'd suggest that control of NPfIT contracts pass from the DH and CfH to the Cabinet Office which is independent. It's worrying that taxpayers are represented by the Cabinet Office and David Cameron in one corner who are facing the formidable DH, its allies BT and CSC as NPfIT local service providers, and the NPfIT chief press officer, NHS minister Simon Burns.
Is that a fair fight? I suspect the outcome for taxpayers and parts of the NHS is already decided.
Department of Health comment - 17 June 2011:
A Department of Health spokesperson said:
"There is absolutely no truth in the assertion that invoices are lying around in boxes or that they are paid without checking whether the goods or services have been received. A recent Department of Health audit has confirmed Connecting for Health has good governance for invoice processing and makes clear that any deployment invoices are checked both internally with service management and the relevant Trusts before any payment is authorised."
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