The National Programme for IT (NPfIT) which is being delivered by the new Department of Health agency NHS Connecting for Health (CfH), is an initiative by the National Health Service in England to move towards an electronic care record for patients and to connect 30,000 GPs to 300 hospitals, providing secure and audited access to these records by authorised health professionals. In due course it is planned that patients will also have access to their records online through a service called HealthSpace. NPfIT is said by the CfH agency to be "the world's biggest civil information technology programme" [1] The Department of Health headquarters in Whitehall The Department of Health is a department of the United Kingdom government. ... Connecting for Health is an agency of the UK Department of Health which was formed on the 1st April 2005. ... The logo of the NHS for England. ... This article or section does not cite its references or sources. ...

The cost and scope of the programme, together with its ongoing problems of management, have placed it at the centre of ongoing controversy.

Structure and Scope of the Programme

Following several Department of Health reports on IT Strategies for the NHS, the NPfIT was formally established in October 2002 [2]

On April 1 2005 a new agency called NHS Connecting for Health (NHS CFH) was formed to deliver the programme. (The NHS CFH absorbed both staff and workstreams from the abolished NHS Information Authority, the organisation it replaced.) April 1 is the 91st day of the year (92nd in leap years) in the Gregorian calendar, with 274 days remaining. ... The NHS Information Authority (NHSIA) was established by an an Act of Parliament in 1999. ...

The programme is divided into a number of key deliverables. These are:

• The NHS Care Records Service (NHS CRS)
• Choose and Book, an electronic booking service
• A system for the Electronic Transmission of Prescriptions (ETP)
• A new national broadband IT network for the NHS (N3) (see also external link to BT N3 website)
• Picture Archiving and Communications Systems (PACS)
• IT supporting GPs including the Quality Management and Analysis System (QMAS) and a system for GP to GP record transfer.
• NHSmail – a central email and directory service for the NHS. NHSmail was renamed to Contact in late 2004,^[1] before being reverted to NHSmail in April 2006.^[2]

The NHS Care Records Service (NHS CRS) is part of the National Programme for IT of the English National Health Service The CRS describes its objectives as follows: Patient-centred care requires information to follow the patient so that it is available wherever and whenever it is needed. ... Choose and Book (a. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... It has been suggested that NHSNet be merged into this article or section. ... It has been suggested that NHSNet be merged into this article or section. ... In medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. ... In medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. ... QMAS is an IT system supporting the quality and outcomes framework for paying GPs in Great Britains NHS. It determines remuneration according to a range of criteria, including the number of patients that have had consultations, how they were treated, and the overall level of health in that surgery... NHSmail is the name of the internal communications system being developed for the UK National Health Service (NHS) under the National Programme for IT by the Connecting for Health Agency. ...

The Spine (including PDS & PSIS)

The Spine is a set of national services used by the NHS Care Record Service. These include:

• The Personal Demographics Service (PDS), which stores basic demographic information about each patient and their NHS Number.
• The Personal Spine Information Service (PSIS). This is a summary of patient's clinical information, such as allergies and adverse reactions to medicine.
• The Secondary Uses Service (SUS), which uses data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery

The Spine also provides a set of security services, to ensure access to information stored on the Spine is appropriately controlled.

Further information is available from the NHS Connecting for Health website [3]

Exceptions

The NHS in Wales is also running a national programme for service improvement and development via the use of Information Technology - this project is called Informing Healthcare. Motto: (Welsh for Wales forever) Anthem: Hen Wlad Fy Nhadau Capital Cardiff (Caerdydd) Largest city Cardiff (Caerdydd) Official language(s) Welsh, English Government Constitutional monarchy  - Queen Queen Elizabeth II  - Prime Minister of the UK Tony Blair MP  - First Minister Rhodri Morgan AM Unification    - by Gruffudd ap Llywelyn 1056  Area    - Total... Informing Healthcare is a key part of the Welsh Assembly Government strategy to corporately and collectively modernise health services in Wales over the next ten years. ...

NPfIT has no links, planned or actual, to the equivalent system in Wales and there is no similar system yet proposed for Scotland. Scotland and Wales are responsible for their own systems complying with the continuing trend of devolution of government responsibilities.^[3]

NPfIT also currently only caters for GPs, Acute and Primary Hospitals, medical clinics and local hospitals and Surgeries. There are no immediate (certainly not before 2010) plans to include opticans or dentists (many of whom have opted out of the NHS), and some other medical areas are not included in the plans at all.

Clusters and Local Service Providers

The programme divides England into five areas known as "clusters": Southern, London, Eastern, North West and West Midlands, and North East. For each cluster, a different Local Service Provider (LSP) was contracted to be responsible for delivering services at a local level. This structure was intended to avoid the risk of committing to one supplier which might not then deliver; by having a number of different suppliers implementing similar systems in parallel, a degree of competition would be present which would not be if a single national contract had been tendered. As of October 2006, four different industry consortia were LSPs: Motto: (French for God and my right) Anthem: God Save the King/Queen Capital London Largest city London Official language(s) English (de facto) Unification    - by Athelstan AD 927  Area    - Total 130,395 km² (1st in UK)   50,346 sq mi  Population    - 2006 est. ...

• Accenture - North East cluster and Eastern cluster (due to depart programme January 2007 retaining responsibility for PACS rollout only)
• CSC Alliance - North West and West Midlands cluster
• The Fujitsu Alliance - Southern Cluster
• Capital Care Alliance - London

National Application Service Providers

In addition to these LSPs the programme has appointed National Service Providers (NASPs) who are responsible for services that are common to all users e.g. Choose and Book and the national elements of the NHS Care Records Service that support the summary patient record and ensure patient confidentiality and information security. As of October 2005, the NASPs are: Choose and Book (a. ...

• BT - NHS Care Records Service and N3
• Atos Origin and Cerner - Choose & Book
• Cable and Wireless - NHSmail

The NHS Care Records Service (NHS CRS) is part of the National Programme for IT of the English National Health Service The CRS describes its objectives as follows: Patient-centred care requires information to follow the patient so that it is available wherever and whenever it is needed. ... It has been suggested that NHSNet be merged into this article or section. ...

Changes to Service Providers

In March 2004, EDS had their 10-year contract to supply the NHSMail service terminated.^[4][5] On 1st July 2004, Cable and Wireless were contracted to provide this service, which was initially renamed Contact.^[6] Electronic Data Systems (EDS) (NYSE: EDS, LSE: EDC) is a global business and technology services company that defined the outsourcing business when it was established in 1962 by Ross Perot. ...

IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005. They were replaced in September 2005 by Cerner Corporation.

In early 2006, ComMedica's contract for supply of PACS to the North-West/West-Midlands cluster was terminated, and they were replaced by GE Healthcare. In medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. ...

In July 2006, the London region started the contractual replacement of IDX (which had been bought out by GE Healthcare in January 2006) as its supplier. Systems for secondary care, primary care and community and mental health services are proposed by BT to be provided by Cerner, INPS (formerly In Practice Systems) and CSE Servelecrespectively.^[7] In 2004 the NPfIT won the "Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards.^[8] 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... The Big Brother Awards recognize the government and private sector organizations. ...

Advocates of the NPfIT note that these concerns must be set alongside the necessity of care professionals having access to personal medical data if they are to deliver safe, high quality care. The balance between the right to privacy and the right to the best quality care is a sensitive one. Also there are sanctions against those who access data inappropriately, specifically instant dismissal and loss of professional registration. This means that not only will the perpetrator lose their job, but any chance of getting another.

More worryingly, a January 2005 survey among doctors indicates that support for the initiative as an 'important NHS priority' has dropped to 41%, from 70% the previous year.^[9] There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project. 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ...

As of August 5 2005, research carried out across the NHS in England suggested that clinical staff felt that the programme was failing to engage the clinicians fully, and was in risk of becoming a white elephant. August 5 is the 217th day of the year in the Gregorian Calendar (218th in leap years), with 148 days remaining. ... A white elephant is a supposedly valuable possession whose upkeep costs exceed its usefulness, and it is therefore a liability. ...

In April 2006, 23 academics^[10] in computer-related fields raised concerns about the programme and wrote an open letter to the Health Select Committee.^[11][12] 2006-10-06 the same signatories wrote a second open letter^[13] and created a wiki^[14] documenting their concerns. The Health Select Committee is one of the Select Committees of the British House of Commons. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 6 is the 279th day of the year (280th in leap years). ...

However by July 2006, over 75 trusts were live in the NWWM cluster alone. Supporters of the scheme suggest the only other choice was to do nothing and this was unacceptable. Previously hospitals and GPs were expected to provide their own solutions and funding, with the end result that there was no standard interface or measurement of functionality.

Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition from civil liberties campaigners such as NO2ID the anti-database state pressure group and The Big Opt Out who provide patients with a letter to send to their doctor so that their records are withheld from the database. The NO2ID coalition was formed in 2004 to campaign against the United Kingdom governments plans to introduce UK ID Cards and the associated National Identity Register. ...

Costs

Originally expected to cost £2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the National Audit Office to be £12.4bn over 10 years [4]. However, reports in the media have claimed that unpublished internal Government documents estimate the likely final cost to be far higher [5]. ISO 4217 Code GBP User(s) United Kingdom Inflation 2. ... Categories: United Kingdom-related stubs ...

Calculating the true cost of any significant IT programme is notoriously difficult. The £2.3bn figure related to the obvious costs (procurement, development and deployment) and is only part of the equation . Additional costs are incurred through a number of other dependent activities ouitside of the core contracts, such as hardware upgrades (to accommodate new software), business and clinical process redesign, training, stakeholder engagement, marketing and evaluation. It is these areas that make it almost impossible to know the true, final cost.

Impact on IT providers

The size of the programme means that it has become a substantial element in the UK activities of many IT providers. The onerous contract terms which have been an element in the process have therefore placed significant organisational and financial strain on some providers. According to the Daily Telegraph, the head of NPfIT, Richard Granger, 'shifted a vast amount of the risk associated with the project to service providers, which have to demonstrate that their systems work before being paid.' The programme's largest software provider iSoft has been seriously affected by this process and is under investigation by the UK Financial Services Authority for irregular accounting.^[15] On 28th September 2006, the consultancy Accenture announced its intention to withdraw from £2bn of 10 year contracts with NPfIT, which will be taken over by CSC - both Accenture and CSC laid blame with iSoft, although CSC has said it will be retaining the company as software provider.^[16] Earlier in the year Accenture had written off $450m from its accounts because of 'significant delays' in the programme. iSOFT is an international supplier of software applications for the healthcare sector. ... The Financial Services Authority (FSA) is an independent non-departmental public body and quasi-judicial body that regulates the financial services industry in the United Kingdom. ... Accenture (NYSE: ACN) is a global management consulting, technology services and outsourcing company. ... Computer Sciences Corporation (CSC) NYSE: CSC is an information technology (IT) and business services company headquartered in El Segundo, California, USA. Its mission is to help clients achieve strategic goals and profit from the use of information technology. ...

Management team

The NHS has appointed a management team, responsible for the delivery of the system:^[17]

• Richard Granger - is the Director General of IT for the NHS. He took up his post in October 2002, before which he was a partner at Deloitte Consulting, responsible for procurement and delivery of a number of large scale IT programmes, including the Congestion Charging Scheme for London. In October 2006, he was suggested by The Sunday Times to be the highest paid Civil Servant, on a basic of £280,000pa - £100,000pa more than Prime Minister Tony Blair^[18]
• Gordon Hextall - Chief operating officer for NHS Connecting for Health. A career civil servant
• Richard Jeavons - Senior responsible owner for service implementation. Previous posts include being CEO of the West Yorkshire Strategic Health Authority.
• Harry Cayton - Chair of the Care Record Development Board.

For album titles with the same name, see 2002 (album). ... This article is being considered for deletion in accordance with Wikipedias deletion policy. ... The white-on-red C marks all entrances to the congestion charge zone although in some areas the charge zone is poorly signed, and accidental journeys into the zone can occur For more coverage on London, visit the London Portal. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Sunday Times is a Sunday broadsheet newspaper distributed in the United Kingdom and Republic of Ireland, published by Times Newspapers Ltd, a subsidiary of News International which is in turn owned by News Corporation. ... Wikipedia does not yet have an article with this exact name. ... A prime minister (aka Gavinder Johal) is the most senior minister of a cabinet in the executive branch of government in a parliamentary system. ... West Yorkshire is a metropolitan county in the Yorkshire and the Humber region of England. ... A Strategic Health Authorities or SHA is part of the structure of the NHS. England is split into 28 Strategic Health Authorities, set up in 2002. ...

References

1. ^ http://www.e-health-insider.com/news/item.cfm?ID=889
2. ^ http://www.e-health-insider.com/news/item.cfm?ID=1849
3. ^ http://www.connectingforhealth.nhs.uk/faq/hottopic/hottopic_05-002
4. ^ http://www.e-health-insider.com/news/item.cfm?ID=676
5. ^ http://www.e-health-insider.com/news/item.cfm?ID=677
6. ^ http://www.cw.com/uk/public_sector/nhs_solution_centre/secure_email.html
7. ^ [http://www.e-health-insider.com/news/item.cfm?ID=2037 http://www.e-health-insider.com/news/This is subject to contractual negotiation known as 'CCN2'. In September 2006, the CSC Alliance, Accenture and Connecting for Health signed a tripartite agreement that as of January 2007, the CSC Alliance would take over the responsibility for the majority of care systems the North East and Eastern clusters from Accenture, with the exception of PACS.

   Criticisms of the Programme

   NPfIT has been criticised for inadequate attention to security and patient privacy. In 2000, the NHS Executive won the "Most Heinous Government Organisation" Big Brother Award from Privacy International for its plans to implement what would become the NPfIT.<ref> [http://www.privacyinternational.org/bigbrother/uk2000/ http://www.privacyinternational.org/bigbrother/uk2000/]</li> <li id="_note-7">'''[[#_ref-7|^]]''' [http://news.bbc.co.uk/1/hi/technology/3933679.stm http://news.bbc.co.uk/1/hi/technology/3933679.stm]</li> <li id="_note-8">'''[[#_ref-8|^]]''' [http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=2414 http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=2414]</li> <li id="_note-Signatories">'''[[#_ref-Signatories_0|^]]''' Signatories of the open letter to the Health Select Committee: [[Ross Anderson]], Professor of Security Engineering, Cambridge University ; James Backhouse, Director, Information System Integrity Group, London School of Economics ; David Bustard, Professor and Head of Computing and Information Engineering, University of Ulster ; Ewart Carson, Professor of Systems Science, Centre for Health Informatics, City University; Patrik O’Brian Holt, Professor, School of Computing, The Robert Gordon University ; Roland Ibbett, Professor, School of Informatics, University of Edinburgh ; Ray Ison, Professor of Systems, The Open University ; Achim Jung, Professor, School of Computer Science, University of Birmingham ; Frank Land, Emeritus Professor, Information Systems Department, London School of Economics ; Bev Littlewood, Professor of Software Engineering, City University ; John A McDermid, Professor of Software Engineering, University of York ; Julian Newman, Professor of Computing, Glasgow Caledonian University ; [[Brian Randell]], Professor, School of Computing Science, University of Newcastle ; Uday Reddy, Professor, School of Computer Science, University of Birmingham ; Peter Ryan, Professor of Computing Science, University of Newcastle ; Geoffrey Sampson, Professor, Department of Informatics, University of Sussex ; Martin Shepperd, Professor of Software Technologies, Brunel University ; Michael Smith, Visiting Professor, Department of Computer Science, University College London ; Tony Solomonides, Reader in Computer Science and Medical Informatics, University of the West of England ; [[Ian Sommerville]], Professor, Computing Department, Lancaster University ; [[Harold Thimbleby]], Professor of Computer Science, Swansea University ; Martyn Thomas, Visiting Professor of Software Engineering, Computing Laboratory, Oxford University ; Colin Tully, Professor of Software Practice, School of Computing Science, Middlesex University </li> <li id="_note-CW20060412a">'''[[#_ref-CW20060412a_0|^]]''' {{cite news | first = Tony | last = Collins This article is about the year 2000. ... The Big Brother Awards recognize the government and private sector organizations. ... Privacy International (PI) has been instrumental in establishing the modern international privacy movement. ...

    | title = NHS Focus: Open Letter: Questions that need to be answered|url = http://www.computerweekly.com/Articles/2006/04/12/215323/NHS+Focus+Open+Letter+Questions+that+need+to+be+answered.htm 

   | work = ComputerWeekly.com|publisher = Reed Business Information Limited

    | date = [[2006-04-12]] | accessdate = 2006-11-01 

   }} </li> <li id="_note-CW20060411b">'''[[#_ref-CW20060411b_0|^]]''' {{cite news | first = Tony | last = Collins

    | title = Signatories to health committee letter |url= 

   http://www.computerweekly.com/Articles/2006/03/14/215264/Theexpertscallingforareview.htm | work = ComputerWeekly.com|publisher = Reed Business Information Limited

    | date = [[2006-04-11]] | accessdate = 2006-11-01 

   }} </li> <li id="_note-CW20061010a">'''[[#_ref-CW20061010a_0|^]]''' {{cite news | first = Tony | last = Collins

    | title = Experts strike new NHS warning note | url= 

   http://www.computerweekly.com/Articles/2006/10/10/218985/Experts+strike+new+NHS+warning+note.htm | work = ComputerWeekly.com|publisher = Reed Business Information Limited

    | date = [[2006-10-10]] | accessdate = 2006-11-01 

   }} </li> <li id="_note-Wiki23">'''[[#_ref-Wiki23_0|^]]''' [http://editthis.info/nhs_it_info/Main_Page Wiki Documentation of academics' concerns] </li> <li id="_note-9">'''[[#_ref-9|^]]''' Daily Telegraph, 28 September 2006, 'IT providers left in the debris of NHS's 'Big Bang'</li> <li id="_note-10">'''[[#_ref-10|^]]''' Daily Telegraph, 29 September 2006, 'Accenture pulls out of NHS deal'</li> <li id="_note-11">'''[[#_ref-11|^]]''' http://www.connectingforhealth.nhs.uk/about/whoswho/topteam</li> <li id="_note-12">'''[[#_ref-12|^]]''' http://www.timesonline.co.uk/newspaper/0,,176-2394025,00.html</li></ol></ref>

   See also

   • Choose and Book
   • National Identity Register
   • Citizen Information Project
   • Universal Child Database
   • UK topics
   • Medical privacy
   • Informing Healthcare
   • NHSmail

   External links

   • The Big Opt Out, Advice to patients - How to opt out
   • "A guide to the National Programme for Information Technology" (PDF), NHS Connecting for Health, April 2005
   • Programmes and Systems Delivery, NHS Connecting for Health, retrieved October 30 2005
   • NHS Connecting for Health NPfIT site
   • NHS Connecting for Health History Page
   • June 2006: NHS risks £20bn white elephant, say auditors
   • Times Online: Patient records go on database
   • Computer loophole hits hi-tech NHS trial
   • NHS IT upgrade success 'at risk'