On Wednesday this week the National Audit Office will publish its third report on the NPfIT. The report's title: The National Programme for IT in the NHS: an update on the delivery of care records systems.
The NAO says the report will provide an update on the delivery of a central element of the Programme: a fully-integrated electronic care records system, making accurate patient records available at all times.
Nobody will be surprised if the DH and NHS Connecting for Health have reacted to NAO inquiries by providing a wealth of literature to support their case that the Care Records Service and the NPfIT have been a success.
The DH did this when the NAO first investigated the NPfIT. At that time the DH was so successful that when, in 2006, the NAO reported on the NPfIT, Greg Clarke, who was then an MP on the Public Accounts Committee, said:
"In a year on the committee I have read 62 NAO reports. This is easily the most gushing."
Now under the leadership of Amyas Morse, the NAO has impressed MPs on the Public Accounts Committee with the independence and clarity of its reports. The reports tend to be more up-to-date and punchy than sometimes in the past; and when the NAO's questions are not answered they usually say so in their reports - and this may be the case in the latest NPfIT report.
That said I haven't seen the report, though I would expect it to be highly critical in the face of strong contrary arguments from the DH and CfH.
I understand that the DH has asked managers at strategic health authorities to be on the lookout for anything said or written in praise of any aspect of the NPfIT, so some of this material is likely to have been passed to the NAO.
This is what DH and CfH marketing literature on the NPfIT tends to include:
- Quotes from happy NPfIT users. These quotes may reflect genuine enthusiasm from disinterested GPs, hospital doctors and administrators. Or they may be quotes from GPs, hospital doctors and administrators who have a financial or professional interest in the NHS IT programme, and may work for the DH or CfH.
- Statements that show the intention of the NPfIT is noble even if the IT is yet to work. Example: "I support the NPfIT because it's important for me to be able to access my patient's record wherever I am ...
- Statements in the future tense. Examples: " Patients will see that their health records are always readily available to staff Patients will be reassured to see that staff have the high quality IT systems in place Patients can expect up-to-date information about their symptoms to be on line ” [Source: 21st Century IT documents that launched the NPfIT in 2002.] This is on CfH’s website today “ Healthcare staff in prisons will be better placed to tackle the challenging health needs of prisoners as a result of a national prison healthcare IT system ”
Does any of this show that the £6.5bn or so spent so far on the NPfIT has been value for money? It has been the contention of some DH officials that the NPfIT does not need to prove itself as value for money, that its benefits are more important than money.
When the NAO gives its verdict on value for money this week, I doubt it will be as kind to the DH as it was in 2006. But will the NAO's report make any difference? In the end we will have to trust that the DH will spend its NPfIT funds wisely.
The brilliant wit Jonathan Swift attacked some scientific experiments of his age, one of which was to provide low-cost energy by extracting sunbeams from cucumbers. Thank goodness the DH, when conducting its informatics experiments, on NPfIT projects such as Healthspace and the Summary Care Records, adopts a far more practical approach.