back to article NHS IT dino-project NPfIT should be killed off - NAO

The National Programme for IT - the multi-billion pound contract to update NHS technology use - continues to show an absence of basic management, and even though the scope of the project is shrinking costs are not. Today's report from the National Audit Office is damning even for the NAO and questions whether there is any point …

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FAIL

privacy

If they had simply promised they would never ever provide access to care record data to third parties (i.e. sell off data to insurance companies etc) perhaps more people would have signed up. However I would not have believed any such promises.

I made sure all of my relatives knew about how to opt-out, printed out the opt-out forms for them and even tool them to the surgery. The three surgeries I had to go to were all really peed of with having to handle so many forms.

Also one receptionist suggested that the forms were "being binned anyway" so I suspect a lot of people who were opting out were opted in because their GP's had not come to an agreement to process the forms :-(

The NHS really know how to foobar big time.

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hope your relatives are happy to take the risks!

There was a man who had opted out of electronic records brought into a surgery after being hit by a bus outside. He was, unbeknown to even himself allergic to a rare ingredient of a drug he was given by the GP who was treated him, and he died... shame he wasn't on the database.. huh.

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Re: Privacy

When you say 'the NHS', which bit are you referring to?

GP practices are private firms set up much like solicitor practices. They are funded by NHS tariffs is all.

Hospitals are all either funded like universitys (again NHS tariffs) or on route to be funded in this way.

PCT's which commission the services and calculate the tariffs are being scrapped to be replaced by consortia of GPs.

SHA's which provide some sort of guidance and manage direction from DoH, also being scrapped.

The NHS as an entity you can blame doesnt really exist anymore.

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(Written by Reg staff)

Re: hope your relatives are happy to take the risks!

And the chances of that happening are?

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If he didn't know himself...

If nobody, including himself, knew he was allergic to a rare ingredient, what good would being on a database have been?

I guess it might have made it slightly easier to record the cause of death.

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Badgers

Your point being?

If it was "...unbeknown to even himself..." then it sure wouldn't have been in any electronic record now, would it?

Besides, the National Care Record doesn't record that kind of information yet. Just your name, current (and all previous known) addresses and your (current and all previously known) GPs. It's more of a stalkers database than a healthcare one.

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FAIL

Unbewknownest to even Himself eh?

If the patient didn't know about his allergy I'd say that in that case the infromation probably wouldn't have been on the SCR to begin with.

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FAIL

Huh?

"He was, unbeknown to even himself allergic to a rare ingredient of a drug he was given by the GP who was treated (sic) him, and he died.... shame he wasn't on the database.. huh"

Oh FFS - if this was unbeknown even to himself, how on earth would being on some leaky database have done one iota of wordly good? Perhaps they could have added a note after he died saying "the deceased turned out to be allergic to xxx"? Or do electronic patient records have some sort of time portal allowing GPs to future sniff for fatal anaphylaxis?

I call bollocks on that story.

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Re:- hope your relatives are happy to take the risks!

Surely when an allergy is detected it is routinely notified to the patient it affects, so in this case a lack of awareness would seem to indicate that the allergy was undiagnosed or unconfirmed so the database would be of little use in preventing this.

Medical records are OUR private and personal data, assembled by a service we pay for in our taxes. It is not NHS owned data to be sold off to whatever avaricious arm of private "enterprise" wants to turn a quick buck by looking into our lives. THAT is what keeps people off of such databases.

I guess most of those upset by this are NHS managers denied the income to fritter away or the advertisers/insurers/other miscellaneous carrion that exist trying to suck ever more money out of the citizens of this country.

Such information should be given an absolute protection against disclosure to any commercial enterprise - with huge fines and jail time for anyone who discloses it.

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Silver badge

@hope your relatives...

So, if this guy was allergic to an ingredient in a drug, but didn't know it, presumably his GP also didn't know it, so when he was hit by a bus, the hospital, even if it had been able to get hold of his medical record from his GP, also wouldn't have known it. Seems to me a bit of a nonsequitur.

Personally, I'd be a lot more concerned about all and sundry being able to access my personal details in my GP record. At the moment, it's (officially) the GPs at my surgery and presumably, unofficially, receptionists, etc. if they still have paper records, being able to take a peek. If my medical records were to be made availabel to the whole NHS, this would open up that information to all 'authorised' personnel (i.e. doctors, nurses) throughout every hospital and surgery in the NHS, as well as any unauthorised access by admin staff, DB admins, hackers etc. that that entails.

When it comes to useful information not being available to hospitals when needed, this is an edge case for a number of reasons.

Firstly, anyone with a serious allergy or other condition should really either be wearing some sort of wrist-band or similar that medics can see to find that information, or carry that information about with them in their wallet, with their ID (which would be used to find the records in the first place). A friend of mine suffers from a rare metabolic condition. Rather than relying on his medical notes being found in an emergency, he has such information in his wallet. This has the added advantage that non medical people such as first-aiders can know about this, without his needing to be conscious at the time.

Secondly, in order to get a persons medical details, first they have to be reliably identified, and a search made for the correct medical details. At the scene of an accident, for example, even if a person can be identified at the scene, this presumably then entails the paramedic calling the hospital with teh person's details in order to get their medical details to knwo if they have any allergies before treating them at the scene. Not only does this add a possibly life-threatening delay, but also introduces the possibility of pulling up the wrong medical details. How many John Smiths will there be in a national database and how can you be sure you have got the right one? Most people don't carry their NHS number with them.

Thirdly, most hospital admissions whill be compis mentis enough to let the doctors know if they are allergic to penicillin. With those that aren't conscious, there is instead the problem with identification, so you are left with the edge case where those with mental impairment who know their own name but not whether they are allergic to anything are the only ones who this would help. Surely it would be a duty of care for their carers to ensure that such important medical information travelled with them as described above?

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L.B
FAIL

Not knowing your allergic...

It could be that youknow your allergic to one drug, but:

- Can you remember its name (there are lots of similar names)?

- Do you know that some drugs have multiple names and variants, do you know every one of them?

- In the case of a serious accident/incident, you may not be able to speak, let alone remember all your medical details.

As for the 1st poster:

I received documents through the post regarding this just last week, and i clearly states that the ONLY people who are permitted to see them are:

- Medical staff treating you.

- Said staff are only allowed to look at these records after getting your permission.

- The only exception to the above is if your are unable/incapable of giving that permission due to your current medical condition.

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Silver badge
WTF?

I'm allergic...

... to being hit by buses!

Perhaps I should have that included on my medical records...?

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Alert

Re: privacy: YOU CAN'T OPT OUT!!!

Jacqui wrote

"I made sure all of my relatives knew about how to opt-out, printed out the opt-out forms for them and even tool them to the surgery."

I bet you've only opted out of Summary Care Records (SCRs), not the rest of it.

Have a look at the following pages on the NHS Care Records site.

http://www.nhscarerecords.nhs.uk/

http://www.nhscarerecords.nhs.uk/about/

http://www.nhscarerecords.nhs.uk/detailed/

You haven't opted out of having Detailed Records, and you haven't opted out of the NHS Spine. But, like others, it appears you might have fallen for the ploy of providing you with information that tells you about Summary Care Records and Detailed Records together, while providing you with the option of opting out of SCRs.

This would mean you've only opted out of one, small part of it, the tip of the iceberg, lulled into a false sense of security, and in a way where the authorities can claim you were adequately informed and it's not their fault if you failed to read the information they provided you with properly.

You've been conned.

Now tell all your relatives this, so they know that they, with your unwitting help, have also been conned.

And then all go and kick up a stinking fuss about this with your local part of the NHS, demanding to know how you can trust them with your lives when they've conned you.

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Silver badge
Troll

@ David. So how does a SCR help him?

If he didn't know he was allergic to this ingredient, neither, presumably, did his own GP. Subsequently, no flag on his SCR.

And what was the drug he was given? I would imagine morphine to be one of the few necessary in a case like that.

Do you have a citation please? Or are you just trolling?

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Silver badge

Can someone please explain

Serious question....

How what appears on the surface to be a relatively simple database has managed to cost so much for so little? Is it security? Or is there something about this database that makes it so much more different than, for example, any banking database?

TIA

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Realtively Simple

Heath records in a meaningful comprehensible form could get mighty complicated

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Anonymous Coward

@James Hughes 1

IT contractors realise that MPs are stupid, have no idea about IT and have huge amounts of money burning a hole in their pockets, so they bamboozle the idiotic MPs with science and completely exaggerate the difficulty in order to vastly inflate the prices. Then they get clauses in the contracts that if costs spiral the government will just keep paying.

IT contracts with UK governments are like having your own key to the treasury.

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the health records database is a tiny part of the project...

the npfit is not a huge database it is the total delivery of all of the IT services to the entire NHS, this includes GP's (who have fragmented software with huge differences in the quality and type of data held), hospitals with different systems again, etc etc. Many of the properties are old and remote and therefore need extensive work to bring them to any sort of basic IT standard.

It is a HUGE project, I am sure it has been badly managed and should probably have been split up into deliverable pieces and done one part at a time, i.e. infrastructure first, implementation of central databases, creation of "standard" client interface etc etc..

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Silver badge
Big Brother

Pretty much that...

But I have also personally noticed:

- Out-of-this world requirements from functionairies on the other side of the table who assume that implementation of magic functionality is either "already covered" or can be done "on the side". Consequence: pad the price beforehand because you know it's coming.

- Constantly changing requirements from functionairies on the other side of the table who assume that basically changing the system on political whim is either "already covered" or is just "a minor change". Consequence: pad the price beforehand because you know it's coming.

- Excessive bureaucratisation of the development and implementation process because functionairies on the other side of the table assume that delivering a whole truck of "documentation" that no-one can read is going to bring "clarity" or "transparency". Consequence: pad the price beforehand because you know it's coming.

- Red tape, arbitrary onerous requirements regarding "compliance" to ISO whatever as well as the minister's preferred management scheme as well as "working together" with politically favoured, already established players will make your life hell, kill your dog and make your spouse flee to Havana. Consequence: pad the price beforehand because you know it's coming.

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Anonymous Coward

They would be complex

if you tried modelling them in database - but if you want a way of retrieving and appending to a document for a human to read then it shouldn't be that complex (other than scale)

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Not...

A PAS database is very far from being simple!

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Anonymous Coward

WTF?

What the hell do "old and remote" properties have to do with it? Jeez, I've heard some lame excuses over the years, but...

And what effing infrastructure is required? This is only a SMALL country. And accessing health records does not demand millisecond response times. Even a minute would be fine while the patient is unpacking his/her dodgy body part(s).

Standardisation of local IT would have been a sensible first step to a national database. Trust our idiot politicians to have fragmented the NHS and allowed wasteful incompatibility and duplication to proliferate!

Didn't they know people sometimes move around the country?

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Anonymous Coward

So what?

The core of the system is about uniquely identifying and re-identifying patients and finding their records. I doubt Amazon spent billions on their (much larger) customer database. All the rest is just stuff that can be tacked onto that central core quite economically (unless you are being robbed.) Estonia got a functioning health records system for a few hundred million, but then, they probably had some competent people dealing with their suppliers!

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Terminator

The process is slightly different, as Sir Humphrey might explain.

The Civil Servants, either on their own or under guidance from Industry, come/came up with a Policy that satisfies the mutual objectives of the Minister and the Civil Servant.

The policy is/was approved, more often in the form of an act or Parliament, by a majority of MPs who try/have tried to introduce some of their own Ideas or those proposed by their special interest groups.

It is/was unimplementable as it stands so is/was handed back to the Civil Servants who lost control of it. The Civil Servants do, at best, a half-assed job of converting it into specifications and contracts with the help of the Industry and assorted consulting thieves and the money river flows.

Lo and behold we have a complete & total clusterf**k.

The problem arose, not because MPs were baffled by science, because communication assumptions were made by them but nobody spoke to the end user or patient in any meaningful way to either find out what they wanted or, more precisely, needed. Furthermore, no accountable person did a realistic assessment on whether or not what was specified might be deliverable for the budget with the people. Whether they were capable of it is a different matter.

Nobody can, or feels obliged, to take responsibility because they are 'Professionals'. (and have had their money!)

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Anonymous Coward

Easy answer

graft and corruption. Hugely inflated price for software than may never work or even be delivered, but it provides lots of benefits to politicians and bureaucrats in jobs with these software providers or satellites thereof upon retirement, or sometimes it's just an envelop full of cash.

Otherwise, many/most of these systems could be implemented with open source software and actually be made functional.

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FAIL

Interesting comparison

Estonia popn. 1.3m, UK popn. 62.6m

Or by way of an analogy:

My corner shop manages to function perfectly well without ANY form of computerisation, so why does Tesco need so much IT infrastructure?

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FAIL

Big Government IT Project in Massive Failure Shocker

Colour me surprised.

They never learn.....

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LPF
Thumb Up

@Norfolk 'n' Goode

As someone who worked on that project , I could not have come up with a better summation if I tried , take a bow son, take a bow!!!

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Dinoincompetence

Man i was involved in this about 6 years ago and it's still going, shocking.

And it was so well managed as well /sarc.

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Gold badge

Watch this space

So if the NAO think it is a waste of money, and the present government are determined to slash costs wherever they can, how long do we have to wait before they scrap it?

This looks like a diagnostic test for the coalition's true motives in making all those cuts.

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Anonymous Coward

News from 2007

"More recently, the Estonian health service started the development of a new national E-Health system which will see the digitalisation of the medical records of every person in the country including integration across all hospitals and GPs by 2009.

Being developed by Hewlett Packard, the system will cost 2.2 million euros largely funded by the EU Structural Fund – a small sum in comparison to the estimated £12.4 billion (€18.4 billion) to implement a similar digital patient record system in the UK."

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Silver badge

1.60 euros per person?

yeah ... right.

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Grenade

Electronic care records allow better patient care

End of story. I am refering to the observations made in superfreakonomics that when doctors in ER didn't have access to a patients data in 1 place they spent 95% of their time managing information, i.e. finding test results, phoning other departments/GP practices etc. and only 5% of their time treating patients

When an IT system (now called amalgum) was installed they spent 40% of their time actually treating patients. The savings on costs and lives was massive.

So this project is expensive. I know I would like my doctor treating my ills in an emergency than on the phone checking if I am allergic to anything etc. (I am not, so just give me the F*cking DRUGS etc. etc.) Especially so when I am KO'd and about to die.

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Silver badge

What you describe

Sounds to me like an individual hospital management system, not the sprawling cash gobbling monster that is NPfIT. Believe it or not, many hospitals already have clinical management systems in place. They also don't use gas lighting or let blood to cure syphilis, since we are now in the 21st century and have been for several years now.

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Flame

I second that...

...it does sound just like an individual hospital management system and most hospitals do indeed have them and, while no system is perfect, they do by and large work and work reasonably well.

@Brian Miller 1 - the NHS NPfIT was and is a colossal and stupid waste of vast amounts of taxpayers money. Like most Government projects, its requirements were poorly thought out and inadequately specified, largely being driven by political motives rather than any realistic assessment of what was needed or could (or should) be achieved. Its senior management, on both the customer side and the contractor/provider side was generally breathtakingly poor, ill-advised and technically incompetent. Make no mistake, the previous Government ministers and other officials who were involved in coming up with this hideous white elephant should all be taken out and roasted over a slow fire. And the current lot should be treated in a similar way if they don't immediately call a complete halt to this ridiculous farce.

During the first two or three years of the NPfIT (or Connecting for Health or whatever you want to call it) most of the technical staff that I worked with knew that the whole thing was hopelessly ill-specified, monumentally poorly-understood and most parts were extremely unlikely ever to work properly, if at all. The fact that one or two parts of it are now sort of working in a roundabout and slightly crippled fashion is just testament to the ability of some of the people who have served time on this almighty sow's ear. It doesn't stop the whole thing overall being a scandalous waste of time, money and resources.

And, like some of the other commenters here, I happen to know something about it 'cos I used to work on part of it. In fact, it was this project that led to me leaving the IT contract/consultancy industry altogether - the massive waste of public funds that it represented just conflicted too much with my professional ethics. Yes, I could have been on the gravy train for years with this one - in fact, I was for two or three - but in the end I got sick of not being able to face myself in the mirror knowing that I was involved in pissing huge amounts of everyone's money up the wall.

So kill it now. Kill it with fire.

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Thumb Down

Let me try to understand this

The project is being labelled as a failure by the "client" because they couldn't make their own people adopt the expensive product selected by "the management" and somehow this is somebody outside of the civil service's fault?

If you can stick any blame on the IT companies, it sounds like its not asking the question "just how f*king serious are you about all of this so we don't waste our time and reputation"

Still, I am sure that like any half well written contract it has scope for financial penalties if the client decides to pull the plug. It will probably be another few weeks/months before we hear that its more expensive to cancel than it is to finish the job off. Termination clauses are a bitch.

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Happy

>"NPfIT should be killed off - NAO"!

I thought you were headlining in lolspeak for a minute there!

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civil service

Typical civil service, f***ng useless management. Anyone who's been in the civil service or worked for them knows this.

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Gold badge
Flame

*Possible* 4 *billion* £ saving if this thing is killed now.

Unless of course we're looking at the old "Cancellation fee = remaining implementation fee + estimated running fees for 25 years" b****cks.

There is actually a law in the UK called The Unfair Contract Clauses Act (IIRC).

From the number of contracts that previous administrations have signed (and for all I know the current one *is* signing) you'd *never* believe that *any* civil servant had even *heard* of it.

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Re: *Possible* 4 *billion* £ saving if this thing is killed now

@John Smith 19

Of course the contract will contain penalties of that magnitude!

The suppliers would be stupid to have agreed to anything else - with the infrastructure, extra personnel the price will have been built around the ROI over the full term of the contract but the up front costs are absolutely massive to get it off the ground.

There's a damned good reason why "the usual three letter named suspects" are the only ones to bid for these deals, its because nobody else can afford the HUGE outlay that has to take place before a single penny gets paid by the customer....

Its not like agreeing to sell someone an Xbox game or a hundred copies of Windows.

So yes, as someone mentioned above, wait for the subsequent statement thats its too expensive NOT to finish the job now...

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Stop

Actually...

...while there may indeed be termination clauses, the one thing that the people who set this thing up on the Government side did right (to some extent) was ensure that there were also lots of penalty clauses for non-delivery. So much so that a number of the larger companies and consortia who worked on NPfIT in the early days almost ended up owing the Department of Health more money that the Department owed them. The delicious irony was that failures to deliver were often as much the fault of the customer as they were of the clueless senior managers and incompetent project management on the delivery side - but the penalty clauses still applied and there ended up being huge bun fights between accountants on both sides to work out who owed what to whom.

At least one major IT consultancy outfit ended up walking away from their nice juicy NPfIT contract even though it was rumoured to have cost them over £150 million quid to do so. And that was in actual losses that they made during the couple of years that they worked on this thing - not a loss of projected future revenues.

So while there will almost certainly be costs involved with shutting this thing down, I suspect (and fervently hope) that it would still work out much cheaper than keeping the damned thing going. Particularly since you're highly unlikely to get any kind of decent working system out of it at the end, whatever you do.

Of course, the ideal solution would be to pull the plug on the thing anyway and, if any suppliers come along whinging about it and invoking termination clauses, just tell them to jog on. I'm sure that most of the companies know that the project is just an albatross around their neck anyway...

Stop. 'Cos they should.

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RW
Megaphone

"World class"

The presence of that phrase in the bumf emitted by some faceless bureaucrat marks it indelibly as nothing more than gaseous PR-speak, meaning nothing at all.

Anything that bills itself as "world class" is de facto not world class. That is a well-known fact.

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