We blogged the NAO Report on the NHS Supercomputer here. Given the disastrous nature of the whole enterprise, it was surprising the report was not more critical, and at yesterday’s packed Public Accounts Committee meeting, MPs quizzed the NAO’s head, the splendidly titled Comptroller and Auditor General Sir John Bourn, on why that might be.
Bluntly, had the NAO been nobbled by the Department of Health? All NAO reports have to be agreed with the department concerned, and the PAC Chairman said he’d heard this one had been fought over “street by street, block by block”. Another highlighted Nicholas Timmin’s assessment in the FT that it had been “the fiercest Whitehall battle for years". And listening to Richard Granger, the pugnacious husky killer who runs the project, you could easily see how that might happen.
Sir John, a dry old stick in the finest auditing traditions, played a very straight bat. He’d done his duty, and he wasn’t responsible for what journos might say. And actually, after two and a half hours of questions, denobbling as required, it became clear his report is deeply critical:
- The whole project has been imposed from the top, starting with that notorious Blair "summit" in 2002. NHS clinicians were never consulted, and their principal champions at the DH (Professor Peter Hutton and Dr Anthony Nowlan) were dismissed after they'd refused to play ball with an outrageous post-hoc spin exercise
- Support among GPs especially is still very low, despite furious DH backpedalling on their "one-size" plan, and some hastily cobbled measures supposedly going to safeguard patient confidentiality; as Doc Crippen keeps saying, GPs are quite happy with their existing computerised systems
- Although this is the biggest civilian IT project ever, there was no serious cost-benefit analysis to support it. The government committed to a massive expenditure without quantifying the supposed benefits. And they still can't show the benefits will exceed the costs
- The costs are way higher than originally advertised. That's because the now estimated £6.2bn spend on the central core project takes no account of the massive local spending on implementation. If all goes to plan, the NAO puts the total at £12.4bn. But Lord Warner puts it at £20bn, and others have put it as high as £50 bn. The bottom line is that nobody knows, and the financial burden on local health authorities is open-ended
- The guts of the system-the National Care Records System- is two years behind schedule and is not working; boasting about all the peripheral gimmicks they have put in is so much flim-flam: email is hardly new technology
- Although the DH has managed to procurement process well, inasmuch as it had properly competitive tendering and fixed price contracts, because of all the usual problems between IT customers and suppliers, as the problems have mounted, the hard-pressed suppliers are biting back: Fujitsu have already fined the NHS £19m for failing to provide sufficient support, and Accenture's lawyers are doubtless hard at work on recouping their $450m hit.
Overall, we were left with the same picture: this massive programme has been imposed on our battered NHS by pig-headed commissars and husky killers who are convinced they have "The Answer", and will use all means at their disposal- including our money- to drive it through. Cowards and rumour mongers will be shot!
Our advice remains the same: keep up those BUPA payments and be sure to ask your GP for a hard-copy print out of your medical record.