The NHS Connecting for Health (CFH) agency was part of the UK Department of Health and was formed on 1 April 2005, having replaced the former NHS Information Authority. It was part of the Department of Health Informatics Directorate, with the role to maintain and develop the NHS national IT infrastructure. It adopted the responsibility of delivering the NHS National Programme for IT (NPfIT), an initiative by the Department of Health to move the National Health Service (NHS) in England towards a single, centrally-mandated electronic care record for patients and to connect 30,000 general practitioners to 300 hospitals, providing secure and audited access to these records by authorised health professionals.
On 31 March 2013, NHS Connecting for Health ceased to exist, and some projects and responsibilities were taken over by Health and Social Care Information Centre.
History Contracts for the NPfIT spine and five clusters were awarded in December 2003 and January 2004.
It was planned that patients would also have access to their records online through a service called HealthSpace. NPfIT was said by NHS CFH to be "the world's biggest civil information technology programme".
The cost of the programme, together with its ongoing problems of management and the withdrawal or sacking of two of the four IT providers, placed it at the centre of controversy, and the Commons Public Accounts Committee repeatedly expressed serious concerns over its scope, planning, budgeting, and practical value to patients. As of January 2009, while some systems were being deployed across the NHS, other key components of the system were estimated to be four years behind schedule, and others had yet to be deployed outside individual primary care trusts (PCTs).
The Guardian noted that the announcement from the Department of Health on 9 September, had been "part of a process towards localising NHS IT that has been under way for several years". In 2011 remaining aspects of the National Programme for IT were cancelled, and most of the spending would proceed with the Department of Health seeking for local software solutions rather than a single nationally imposed system. On 31 March 2013, NHS Connecting for Health ceased to exist, and some projects and responsibilities were taken over by Health and Social Care Information Centre.
In August 2018, NHS launched a healthcare finance innovation initiative to identify solutions which could streamline financial operations.
Structure and scope The programme was established in October 2002 following several Department of Health reports on IT Strategies for the NHS, and on 1 April 2005 a new agency called NHS Connecting for Health (CfH) was formed to deliver the programme. CfH absorbed both staff and workstreams from the abolished NHS Information Authority, the organisation it replaced. CfH was based in Leeds, West Yorkshire. By 2009, it was still managed nationally by CfH, with responsibility for delivery shared with the chief executives of the ten strategic health authorities. The programme represented a significant shift to national priorities over local priorities.
The Conservatives pledge £730 million to expand NHS mental health services in England, aiming to reduce welfare costs by helping more people return to work. Critics, including Labour and the Institute for Fiscal Studies, question the feasibility of the projected savings and effectiveness of the proposed reforms.
Reviews The refusal of the Department of Health to make "concrete, objective information about NPfIT's progress [...] available to external observers", nor even to MPs, attracted significant criticism, and was one of the issues which in April 2006 prompted 23 academicsSignatories 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 in computer-related fields to raise concerns about the programme in an open letter to the Health Select Committee. On 6 October 2006 the same signatories wrote a second open letter
A report by the King's Fund in 2007 also criticised the government's "apparent reluctance to audit and evaluate the programme", questioning their failure to develop an ICT strategy whose benefits are likely to outweigh costs and the poor evidence base for key technologies.
A report by the Public Accounts Committee in 2009 called the risks to the successful deployment of the system "as serious as ever", adding that key deliverables at the heart of the project were "way off the pace", noting that "even the revised completion date of 2014–2015 for these systems now looks doubtful in the light of the termination last year of Fujitsu's contract covering the South", and concluding "essential systems are late, or, when deployed, do not meet expectations of clinical staff".
The initial reports into the feasibility of the scheme, known to have been conducted by McKinsey, and subsequent reports by IT industry analyst Ovum among others have never been published nor made available to MPs.
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, and the NAO also noted that "...it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme". Similarly, the British Computer Society (2006) concluded that "...the central costs incurred by NHS are such that, so far, the value for money from services deployed is poor". Officials involved in the programme have been quoted in the media estimating the final cost to be as high as £20bn, indicating a cost overrun of 440% to 770%.
In April 2007, the Public Accounts Committee of the House of Commons issued a damning 175-page report on the programme. The Committee chairman, Edward Leigh, claimed "This is the biggest IT project in the world and it is turning into the biggest disaster." The report concluded that, despite a probable expenditure of 20 billion pounds "at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period."
In September 2013, the Public Accounts Committee said that although the National Programme for IT had been effectively disbanded in 2011, some large regional contracts and other costs remained outstanding and were still costing the public dearly. It described the former National Programme for IT as one of the "worst and most expensive contracting fiascos" ever.
The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.
Deliverables The programme was divided into a number of key deliverables.
DeliverableSinceName of softwareOriginal delivery dateProgress 2007Progress 2009Integrated care records service2002NHS Care Records Service (NCRS) / Lorenzo2004"Real progress only just beginning", no go-live date specified"Recent progress...very disappointing", completion date of 2014–2015 now looks unlikely following withdrawal of Fujitsu, arrangements for South region not resolved, Lorenzo still not live in a single acute TrustElectronic prescribing2002NHS Electronic Prescription Service2007Implementation began in early 2005, used for 8% of daily prescriptions70% of GPs and pharmacies had 1st release of software, but only 40% of prescriptions issued with readable barcodesElectronic appointments booking2002Choose and Book2005Take-up slow, system reliant on outdated technology, GPs dissatisfied, target of 90% of referrals on system by March 2007 missedMixed, around half of new appointments made using system, additional training and time requiredUnderpinning IT infrastructure2002New National Network (N3)March 2002On schedule, with 98% of GP practices connectedMedical imaging softwarePicture Archiving and Communication System (PACS)Performance management of primary careQuality Management and Analysis System (QMAS)Central e-mail and directory serviceNHSmail*
*NHSmail was renamed to Contact in late 2004, before being reverted to NHSmail in April 2006.
The Spine (including PDS and 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 demographic information about each patient and their NHS number. Patients cannot opt-out from this component of the spine, although they can mark their record as 'sensitive' to prevent their contact details being viewed by 831,000 staff. The Summary Care Record (SCR). The Summary Care Record 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. These security measures were queried during the early stages of Spine development, with leaked internal memos seen by the Sunday Times mentioning "fundamental" design flaws. In addition, government spokeswoman Caroline Flint failed to dispel concerns regarding access to patients' data by persons not involved in their care when she commented in March 2007 that "in general only those staff who are working as part of a team that is providing a patient with care, that is, those having a legitimate relationship with the patient, will be able to see a patient's health record."
The Spine was migrated to a new system in August 2014.
Exceptions