According to the NAO’s report, total spending over the 10-year duration of the program will be 12.4m pounds ($23bn), compared to the initial value of 6.2m pounds ($11.5bn) announced at the time of the initial contract awards.
However, the revised figure is still significantly lower than some within the NHS feared. One UK government minister responsible for the project had estimated the full cost to be nearer to 20bn pounds ($37.1bn), but CfH has said this figure represents the total cost of IT spending throughout the NHS over 10 years.
The new systems and services are being delivered across five regional clusters by four principal suppliers: BT, Fujitsu, Accenture, and CSC, along with numerous subcontractors.
The NAO’s report was also critical of delays in the implementation of core sections of the project. Improvements to the functionality of the national data spine, the basis of the new NHS care records service, has been delayed for up to 10 months, while deployment of the care records service itself is now planned to start later this year, almost two years behind schedule.
The report said that while there is support amongst NHS staff for what the program is trying to achieve, there also remain significant concerns among some staff that the program is moving slower than expected, that clarity is lacking as to when systems will be delivered, and what they will do.
In order to deal with these misgivings, the NOA recommended that both the Department of Health and CfH should provide greater clarity to organizations and staff in the NHS as to when the different elements of the program will be delivered. The report also said staff should be warned of the challenges facing them so that the setbacks and changes of priority inevitable with a program of this size do not cause a loss of confidence.
The NAO urged the NHS to prepare an annual published statement setting out the quantifiable benefits delivered by the program, and pointed out that the main aim of the entire CfH project is to improve services rather than to reduce costs.
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Among the criticism of its shortcomings, there was much praise for a project that, as the NAO said, is wider and more extensive than any ongoing or planned healthcare IT program in the world. For example, the decision to procure contracts centrally is estimated to have saved 4.5bn pounds ($8.3bn).
CfH’s decision to dispense with the preferred-bidder stage of the contract award process and negotiate contracts with at least two final bidders is also credited with achieving significant price reductions from the eight prime contractors, the difference between their initial and final bids totaling 6.8bn pounds ($12.6bn).
Richard Granger, director of IT at the NHS, has been outspoken in his criticism of suppliers such as Accenture. However, the forthright approach he has brought to the program was lauded by the NAO. It was so impressed with CfH’s handling of its vendors that it insisted, other organizations could learn lessons from [CfH’s] experience so far, in particular the advantages that were gained through the swift procurement exercise, the incentives and penalties included in the contracts, and the robust management of the suppliers.
