Concerns about escalating costs and project delays have been circulating for months, but came to a head last week when health minister Lord Warner, challenged by a Conservative call for an independent review of the programme, admitted that the project was experiencing difficulties. Crucially, he conceded that the electronic patient record, a core element of the system that was due for first deployment last year, would not now be rolled out until late 2007 or early 2008.
He also agreed that overall costs over the next 10 years are likely to be nearer £20 billion than the £6.2 billion spent on original spine and regional contracts with companies including BT, Accenture, Fujitsu Services and CSC.
Responding to critical media reports and clarifying Lord Warner's admissions, NHS Connecting for Health stated: "This programme is about patient and clinician benefit and improved safety. Some areas of the programme are going well and are ahead of target, but some areas are going more slowly than we would otherwise like. However, we should not be overly concerned about missed targets because we set ambitious targets to drive the programme."
Addressing the issue of cost, Connecting for Health agreed that total spend over 10 years would be close to £20 billion, but insisted that costs had not escalated. It said the core contract costs of £6.2 billion have not risen, but noted that the NHS already spends over £1 billion a year on IT, making the 10-year spend close to £20 billion.
It added: "This is an entirely reasonable spend on IT and is proportionately less than other industry norms. This does not mean the programme will cost more than expected, but reflects the full expense of switching existing IT spending from outdated systems to new ones."
While ministerial argument is likely to continue, the programme still faces immense internal problems as the medical profession fails to agree on whether patient information should be uploaded automatically to the patient record system or whether patient approval should be sought.
NHS Connecting for Health response to File on Four
The recent File on Four programme on BBC Radio 4 largely focused on a small number of negative issues in relation to the NHS National Programme for IT.
In a programme of the size, scale and complexity of the National Programme for IT, it is to be expected that there will be issues and difficulties and we have been open about that. This kind of activity can be disruptive. But we do not believe that there should be a poverty of ambition and the current situation - where hundreds of different, and often ageing computer systems, do not link up - is not right for a modern health service.
The issues that the BBC has reported must be seen in the wider context of a significant amount of progress that has been made to date. Up and down the country patients and clinicians are benefiting from new computer systems.
* 8,800 GP practices (28,000 GPs) are daily using the Quality Management Analysis System that pays GPs £600m pa based on quality outcomes.
* 227,239 users registered for access to the NHS Care Record Spine
* 1,246,528 prescriptions transmitted using Electronic Transmission of Prescriptions (ETP) system - live (on time) since February 2005
* 401,827 Choose and Book electronic bookings - live (on time) since July 2004. Now exceeding 7,000 bookings per day.
* 28,092,700 digital images are stored using Picture Archiving and Communications Systems (PACS) - live in 31 NHS sites
* 175,624 registered NHS secure E-Mail users, over 79,000 of whom use the system daily.
* 14,538 National Network (N3) secure broadband connections, including 9,912 GP locations (practices and branch surgeries).
Choose and Book, the national outpatient appointment booking system, often attracts interest. But we have listened to and responded to doctors' concerns about Choose and Book. We have made software upgrades to address concerns and we continue to undertake a national programme of engagement with key groups to ensure we address any remaining concerns. There are myths and misconceptions about Choose and Book but we find once people understand and are familiar with the service they are broadly supportive.
Feedback from patients is very positive - as they have much more certainty and control over the time and place of their appointment.
Reports about the London Child Health system have been unnecessarily alarmist. The first place a child's vaccinations are recorded is in the "red book" that parents hold, secondly a record exists at their GP surgery and then only thirdly, this data is held in the child health system.
The system was implemented at short notice because the previous supplier withdrew support for its ageing system from the market.
The size of the challenge to provide one child health system across 10 primary care trusts was underestimated and we acknowledge there have been difficulties.
Despite these difficulties, dedicated NHS and supplier staff have ensured that routine immunisation and vaccinations programmes have continued to run.
Meeting statutory reporting standards is currently reliant on two factors:
Clearing the paper backlog resulting from using "manual" processes, and delivery of the computer reporting capability.
These have been addressed since last autumn and a rigorous and steady programme of improvement put in place. A joint team including the Department of Health, Health Protection Agency and local health professionals are working together to solve current problems and to plan a sustainable way forward.
Turning to the cost of the programme, the cost of the core contracts of £6.2 bn for the National Programme for IT has not risen. There are some delays and those are to be expected in such a large and complex programme. But this does not lead to additional cost as the contracts we have in place mean that suppliers only get paid for what they deliver.
The National Programme for IT is a ten year programme and there has always been a requirement for the NHS to fund certain implementation activity like training and local hardware upgrades that will come from existing IT budgets.
Financial issues in the NHS are on many people's minds and will have had an impact on doctor's answers to the BBC's Medix survey. We know from our own research that the majority of all NHS staff support the objectives of the programme and most doctors agree that it will improve care. We have made real progress in our engagement with clinicians but we know that we need to continue to build on this.
We are learning and adapting all the time. We believe that we have the teams and approaches in place to successfully implement the programme which is much needed and will bring real benefit.