Hubbry Logo
NHS Connecting for HealthNHS Connecting for HealthMain
Open search
NHS Connecting for Health
Community hub
NHS Connecting for Health
logo
7 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
NHS Connecting for Health
NHS Connecting for Health
NHS Connecting for Health
View on Wikipedia
from Wikipedia

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,[citation needed] and some projects and responsibilities were taken over by Health and Social Care Information Centre.

History

[edit]

Contracts for the NPfIT spine and five clusters were awarded in December 2003 and January 2004.[1][2][3][4]

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".[5]

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.[6][7][8] 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).[8]

The Guardian noted that the announcement from the Department of Health on 9 September,[9] had been "part of a process towards localising NHS IT that has been under way for several years".[10] 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.[11] On 31 March 2013, NHS Connecting for Health ceased to exist,[citation needed] and some projects and responsibilities were taken over by Health and Social Care Information Centre.[citation needed]

In August 2018, NHS launched a healthcare finance innovation initiative to identify solutions which could streamline financial operations.[12]

Structure and scope

[edit]

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.[13] 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.[8] The programme represented a significant shift to national priorities over local priorities.[14]

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.[15]

Reviews

[edit]

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 academics[16] in computer-related fields to raise concerns about the programme in an open letter to the Health Select Committee.[17][18] On 6 October 2006 the same signatories wrote a second open letter[19]

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.[20]

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".[21]

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[22] have never been published nor made available to MPs.[23]

Costs

[edit]

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".[24] 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".[25] 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%.[26]

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."[6]

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.[27]

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.[28] Granger's first job was with Andersen Consulting,[29] which later became Accenture.

Deliverables

[edit]

The programme was divided into a number of key deliverables.

Deliverable Since Name of software Original delivery date Progress 2007[20] Progress 2009[8]
Integrated care records service 2002 NHS Care Records Service (NCRS) / Lorenzo 2004 "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 Trust
Electronic prescribing 2002 NHS Electronic Prescription Service 2007 Implementation began in early 2005, used for 8% of daily prescriptions 70% of GPs and pharmacies had 1st release of software, but only 40% of prescriptions issued with readable barcodes
Electronic appointments booking 2002 Choose and Book 2005 Take-up slow, system reliant on outdated technology, GPs dissatisfied, target of 90% of referrals on system by March 2007 missed Mixed, around half of new appointments made using system, additional training and time required
Underpinning IT infrastructure 2002 New National Network (N3) March 2002 On schedule, with 98% of GP practices connected
Medical imaging software Picture Archiving and Communication System (PACS)
Performance management of primary care Quality Management and Analysis System (QMAS)
Central e-mail and directory service NHSmail*

*NHSmail was renamed to Contact in late 2004,[30] before being reverted to NHSmail in April 2006.[31]

The Spine (including PDS and PSIS)

[edit]

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.[32] 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."[23]

The Spine was migrated to a new system in August 2014.[33]

Exceptions

[edit]

The NHS in Wales was also running a national programme for service improvement and development via the use of information technology – this project was called Informing Healthcare. A challenge facing both NHS CFH and Informing Healthcare was that the use of national systems previously developed by the NHS Information Authority were shared by both of these organisations and the Isle of Man. Separate provision needed to be made for devolution, while maintaining links for patients travelling across national borders.[citation needed]

NPfIT was focussed on delivering the NHS Care Record Service to GPs, acute and primary hospitals, medical clinics and local hospitals and surgeries. While there were no immediate plans to include opticians or dentists in the electronic care record, services are delivered to these areas of the NHS.[citation needed]

Clusters and local service providers

[edit]

The programme originally divided England into five areas known as "clusters": Southern, London, East & East Midlands, North West & 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. Four clusters were awarded in two tranches on 8 and 23 December 2003,[1][3] with the fifth on 26 January 2004.[4] However, in July 2007 Accenture withdrew from their 2 clusters, and in May 2008 Fujitsu had their contract terminated, meaning that half the original contractors had dropped out of the project. As of May 2008, two IT providers were LSPs for the main body of the programme:

  • Computer Sciences Corporation (CSC) – North, Midlands & Eastern (NME) cluster
  • BT Health London (formerly BT Capital Care Alliance) – London cluster
  • Accenture had full responsibility for the North East and East/East Midlands clusters until January 2007, when it handed over the bulk of its responsibilities to the CSC, retaining responsibility for Picture archiving and communication system (PACS) rollout only.
  • Fujitsu – had responsibility for the Southern cluster until May 2008 when their contract was terminated.[34] Most of their responsibilities were subsequently transferred to BT Health except for PACS which was transferred to the CSC Alliance.

Local ownership

[edit]

In the first half of 2007, David Nicholson announced the "National Programme, Local Ownership programme" (known as "NLOP") which dissolved the 5 clusters and devolved responsibility for the delivery of the programme to the ten English strategic health authorities (SHAs).[35] Connecting for Health retains responsibility for the contracts with the LSPs.[36]

Under NLOP, staff employed by CfH in the clusters had their employment transferred to the SHAs, with some being recruited to revised national CfH posts.[citation needed]

National Application Service Providers

[edit]

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

Changes to service providers

[edit]

In March 2004, EDS had their 10-year contract to supply the NHSMail service terminated.[37][38] On 1 July 2004, Cable and Wireless were contracted to provide this service, which was initially renamed Contact.[39]

IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005 following repeated failure to meet deadlines.[34] They were replaced in September 2005 by Cerner Corporation.[citation needed]

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 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 Healthcare Systems, part of the CSE-Global group of companies, respectively.[40] 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. As part of the handover process, around 300 Accenture personnel transferred under a TUPE process to CSC, and CSC took over the leases for some of Accenture's premises in Leeds. Accenture now retains only a small presence in the city for the delivery of its PACS responsibilities.

In May 2008 it was announced that following the failure to conclude renegotiation of the contract for the Southern Cluster, CfH terminated the contract with Fujitsu.[41] The majority of the Southern Cluster care systems were subsequently transferred to BT Health except for PACS which was transferred to the CSC Alliance, aligning with the technology deployed by each company.

Criticisms

[edit]

Failure to deliver clinical benefits

[edit]

The 2009 Public Accounts Committee (PAC) report noted, that the NPfIT had provided "little clinical functionality... to-date".[citation needed] The PAC report of 18 July 2011 said it failed to deliver clinical benefits.[42]

Data security risks

[edit]

NPfIT has been criticised for inadequate attention to security and patient privacy, with the Public Accounts Committee noting "patients and doctors have understandable concerns about data security", and that the Department of Health did not have a full picture of data security across the NHS.[8] 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.[43] 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.[44]

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[citation needed].

A January 2005 survey among doctors indicated that support for the initiative as an 'important NHS priority' had dropped to 41%, from 70% the previous year.[45] 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.

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.[citation needed]

Reservations of medical staff

[edit]

As of 5 August 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 at risk of becoming a white elephant. The Public Accounts Committee observed in 2009 that "the current levels of support reflect the fact that for many staff the benefits of the Programme are still theoretical".[8]

Surveys in 2008 suggested that two-thirds of doctors would refuse to have their own medical records on the system.[citation needed]

Impact on IT providers

[edit]

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 contracts meant that withdrawing from the project would leave the providers liable for 50% of the value of the contract; however, as previously mentioned, when Accenture withdrew in September 2006, Granger chose not to use these clauses, saving Accenture more than £930m.[28]

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.[46] On 28 September 2006, the consultancy Accenture announced its intention to withdraw from £2bn of 10-year contracts with NPfIT, which were taken over in January 2007 by the CSC Alliance – both Accenture and CSC laid blame with iSOFT, although CSC has said it will be retaining iSOFT as its software provider for all its clusters.[47] Earlier in the year Accenture had written off $450m from its accounts because of 'significant delays' in the programme. iSOFT announced in March 2011 that trading in its shares would be suspended pending a corporate announcement. Subsequently, in April 2011, the company announced that it was recommending a cash offer from CSC. CSC acquired iSOFT in August 2011.

In September 2018 it was reported that Fujitsu was to be paid "hundreds of millions of pounds" in settlement of a legal dispute stretching back to the National Programme for IT when their £896 million contract was terminated. Substantial payments had also been made to CSC.[48]

Implementation

[edit]

The first trusts in the London and Southern clusters to implement the new Cerner system found it problematic, with hospital trust board minutes revealing a catalogue of errors. Difficulties with the system meant that:[49]

  • 2007: Enfield PCT were unable to obtain vital data on patients awaiting operations and were obliged to delay 63 patients of the Barnet and Chase Farm hospitals. Further, 20 patients were not readmitted for treatment within 28 days towards the end of the year because the surveillance system for tracking them "was not operational in the new ... system". Buckinghamshire Hospitals NHS Trust found that problems with the system had meant potentially infectious patients with MRSA were not isolated for up to 17 days, requiring six weeks work by staff to update them manually.
  • April 2008: Enfield PCT found that the system had failed to flag up possible child-abuse victims entering hospital to key staff, "leaving the responsibility to the receptionist"
  • May 2008: Enfield PCT found that 272 elective operations were cancelled at the last minute for "non-clinical reasons"
  • May 2008: Barts and The London NHS Trust blamed their failure over the preceding six months to meet targets for treating emergency patients within four hours on staff not being familiar with the new computer system. The same report cited "breaches of the two-week urgent cancer access guarantee" and delays in assessing 11 patients with possible cancer as being due to the computer system.
  • July 2008: the Royal Free Hampstead NHS Trust said 12,000 patient records had to be manually amended over a three-week period due to the system, and noted that "The outpatient appointment centre has experienced a significant increase in the time taken to process individual patient appointment bookings. This has had a consequent and negative effect on call-answer performance."

Management team

[edit]

The NHS appointed a management team, responsible for the delivery of the system:[50] In October 2002, Richard Granger the former Director General of IT for the NHS, took up his post 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 £280,000 per year, £100,000 per year more than then-Prime Minister Tony Blair.[51] Granger announced on 16 June 2007 that he would leave the agency "during the latter part" of 2007.[52] In February 2008 Granger left the programme .[53] His credentials were questioned by his own mother, a campaigner for the preservation of local health services in her area, who expressed her amazement at his appointment, criticising the whole scheme as "a gross waste of money".[29]

In 2009, overall leadership of CfH was described by the Public Accounts Committee as having been "uncertain" since the announcement that Richard Granger would be leaving the project.[8]

See also

[edit]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

NHS Connecting for Health

View on Grokipedia
from Grokipedia
NHS Connecting for Health was a specialist agency within the Department of Health, established in 2005 as the primary delivery body for the National Programme for IT (NPfIT), a centralized initiative launched in 2002 to digitize patient records, enable electronic data sharing, and modernize infrastructure across the () in . The program sought to connect over 30,000 general practitioners and hundreds of hospitals to integrated systems, including electronic health records and secure national networks, under contracts awarded to private sector local service providers in regional clusters. Budgeted at approximately £12.4 billion over a decade, NPfIT represented the largest civil IT project attempted in the UK, driven by political imperatives to overhaul outdated NHS systems and improve efficiency through top-down standardization. Despite partial successes, such as the deployment of the Spine national backbone (handling billions of secure messages annually), the Electronic Prescription Service, NHSmail for secure communications, and Picture Archiving and Communications Systems in radiology departments, the initiative fell short of its core goals. The program encountered profound challenges, including technical incompatibilities with legacy systems, insufficient clinician input leading to unfit-for-purpose software, protracted contract disputes with vendors like and (several of which withdrew), and costs that ballooned without commensurate benefits, prompting parliamentary scrutiny over value for money. By 2011, amid widespread resistance from NHS trusts and evidence of stalled implementations—particularly for comprehensive electronic patient records—NPfIT was effectively dismantled, with remaining elements devolved to local control. NHS Connecting for Health itself ceased operations in 2013, its functions transferred to successor bodies like the Information Centre, marking the end of a cautionary example of overambitious, centrally mandated IT in public healthcare.

Establishment and Objectives

Formation and Political Context

NHS Connecting for Health emerged from the Labour government's ambitious push to digitize the (NHS) amid post-1997 reforms emphasizing centralized efficiency and expanded funding. Following Tony Blair's 1997 election victory, initiatives like the 2000 NHS Plan allocated record investments—rising from £33 billion in 1996-97 to over £49 billion by 2003-04—to reduce waiting times and modernize operations, but highlighted the NHS's fragmented IT systems, which trailed counterparts in electronic and data sharing. The National Programme for IT (NPfIT), announced in 2002, represented a top-down response to these deficiencies, with the Department of Health allocating an initial £2.3 billion over three years (2003-06) to fund national infrastructure upgrades. Politically, NPfIT served as a high-profile demonstration of Blair's vision for a "dependable" NHS through technology-driven transformation, influenced by global benchmarks and consultations such as Blair's meetings with industry leaders like . The programme's centralized mandate aimed to supplant prior decentralized efforts, like the 1998 Information for Health strategy, which had yielded uneven adoption due to local variations. By promising integrated national systems for patient data, prescribing, and imaging, NPfIT was positioned to yield efficiency gains, with early projections estimating benefits like £1.6 billion from infrastructure investments alone, offsetting costs through streamlined administration and reduced duplication. In 2005, responsibility for NPfIT delivery shifted to NHS Connecting for Health, created as an arm's-length special health authority under the Department of Health to manage procurement, rollout, and oversight across . This entity consolidated authority to enforce the programme's uniform standards, reflecting the government's preference for national coordination over regional autonomy in pursuit of systemic IT parity with advanced healthcare models.

Core Mandates of the National Programme for IT

The National Programme for IT (NPfIT) mandated the creation of a centralized electronic care record system for all NHS patients in , enabling rapid sharing of patient data across primary, secondary, and social care settings to replace fragmented paper-based records. This core objective targeted the delivery of summary care records—containing essential clinical information such as medications and allergies—and detailed care records with comprehensive histories, with an ambition for nationwide availability by approximately 2010. The programme's infrastructure relied on the National Spine, a national database backbone designed to support through services like the Personal Demographics Service (PDS), which maintains verified patient identifiers including NHS numbers, names, and addresses to prevent duplication and errors in . Additional mandates included the N3 network for secure broadband connectivity across over 18,000 NHS sites, facilitating encrypted data exchange, and NHSmail as a secure system for clinicians to communicate information compliantly. National applications such as Choose and Book for electronic appointment booking and referrals, and the Electronic Prescription Service for transmitting prescriptions digitally, were specified to streamline administrative processes, with rollout targets extending to 2014 in phased clusters. These elements presupposed that government-directed procurement of proprietary systems from select vendors would enforce uniform standards, bypassing incremental adoption in favor of rapid, top-down scalability. The programme's rationale emphasized empirical reductions in administrative burdens, citing paper ' vulnerability to errors—such as misfiling or illegibility contributing to up to 44% of reported clinical incidents—and delays in access that hindered . Proponents argued that digitized would enable real-time for evidence-based planning, drawing on showing prescribing errors alone at 21% in manual processes. However, this centralised model overlooked causal mechanisms evident in private sectors, where emerges from voluntary standards and competitive incentives rather than mandated infrastructures, potentially fostering greater adaptability without the risks of single-point dependencies.

Organizational Framework

Governance Structure

NHS Connecting for Health operated as a special health authority under the Department of Health, reporting directly to the Secretary of State for and functioning as the central delivery body for the National Programme for IT (NPfIT). Its governance framework followed the government's model for major projects, incorporating structured decision-making processes, risk management protocols, and escalation pathways to senior ministerial levels for critical issues. This setup emphasized accountability through a hierarchical chain linking program execution to departmental oversight, with internal directorates organized around key delivery areas such as regional clusters to coordinate implementation across . The board and senior management included civil servants from the Department of Health, executives from NHS trusts, and specialists in to balance policy direction, operational expertise, and technical delivery. Program directorates were aligned with NPfIT's regional clusters—covering areas like the North East, London, and the South—to facilitate localized rollout while maintaining national coherence, though ultimate authority resided centrally to enforce standardized systems. Procurement operated through a centralized model using framework agreements with prime contractors, which circumvented the autonomy of individual NHS trusts and enforced uniform national standards for . As a non-profit entity, the structure lacked market-driven incentives such as competitive bidding for core system design, resulting in reliance on a limited number of suppliers and reduced flexibility to pivot amid delivery challenges.

Leadership and Key Personnel

Richard Granger served as the inaugural of IT for the (NHS) from September 2002, transitioning to Chief Executive of Connecting for Health upon its establishment in April 2005, where he oversaw the negotiation and awarding of initial major contracts for the National Programme for IT (NPfIT). Prior to this, Granger's career centered on IT consulting at , including leading the implementation of London's congestion charging system, rather than direct experience in healthcare delivery or clinical informatics. His tenure, ending with announced in June 2007 and departure by year's end, emphasized a top-down approach to and standardization, which critics argued prioritized contractual rigidity over iterative feedback from NHS clinicians and trusts. Following Granger's exit, leadership instability persisted, with no immediate permanent successor appointed and interim arrangements such as Gordon Hextall assuming the role of Director of Programme and Systems Delivery in early 2008; this reflected broader rotation that contributed to discontinuities in project oversight amid mounting delivery delays post-2006. Efforts to stabilize included brief stints by figures like Matthew Swindells as interim , but high turnover in executive roles—exacerbated by political shifts and internal reviews—hindered sustained adaptation to emerging technical and user requirements. The Connecting for Health board comprised primarily Department of Health appointees with expertise in and IT procurement, featuring limited representation from frontline clinicians or technology leaders experienced in scalable healthcare systems. This composition reinforced a centralized model, where strategic directives from often overlooked granular input from regional NHS providers, fostering perceptions of detachment from practical clinical workflows and local implementation challenges.

Planned Scope and Technical Components

Major Deliverables Including the Spine

The Spine constituted the core national backbone of the National Programme for IT (NPfIT), functioning as a centralized repository and messaging hub for key data services. Launched following contracts awarded in December 2003 and January 2004, it integrated components including the Personal Demographics Service (PDS), which maintains a national database of identifiers and demographic details for over 60 million individuals, and the Summary Care Record (SCR), a selective electronic summary of critical clinical information such as medications, allergies, and adverse reactions. Additional Spine elements encompassed prescription-related services, facilitating secure data transmission for . By 2019, the Spine processed up to 47 million messages daily, held over 2 billion records, and supported SCR access viewed every four seconds, though early integration with local systems remained incomplete, limiting full in some deployments. Among other major deliverables, the Choose and Book system enabled electronic booking of outpatient appointments, with initial rollout in 2005 achieving over 100 million referrals by 2018, including up to 40,000 daily bookings at its peak. The N3 network provided secure, high-speed connectivity across NHS sites, deployed from 2004 under British Telecom operation to link over 15,000 locations with broadband infrastructure for protected data exchange. Electronic document management tools were intended to support digitized record handling, though realization focused more on underpinning infrastructure than comprehensive national rollout, with partial adoption tied to Spine access for secure . These components aimed to standardize data flows but encountered shortfalls in seamless integration with disparate legacy systems, resulting in uneven technical realization across intended scopes.

Regional Implementation via Clusters

The National Programme for IT (NPfIT) divided into five geographic clusters to support regionally tailored deployment of electronic health systems, aiming to reconcile national standardization with local healthcare variations. These clusters were , Southern, Eastern, North West and West Midlands, and . Each cluster engaged a Local Service Provider (LSP) consortium to deliver customized electronic patient record systems, including integrated applications for acute and settings, while ensuring connectivity to the central Spine for demographic and summary care data exchange. Contracts for the LSPs were awarded in December 2003 and January 2004, totaling approximately £5 billion over ten years, with BT leading the London cluster, CSC the Southern cluster, and the Eastern, North West/West Midlands, and North East/Yorkshire/Humber clusters. This framework sought scalability through LSP-led local adaptations, such as phased installations aligned with regional trust capacities and vendor-specific software selections like iSoft's Lorenzo in multiple clusters. Yet, the model inherently tensioned national mandates—enforced via common messaging standards and Spine protocols—against cluster-level customizations, as LSPs prioritized regionally optimized solutions over uniform architectures. Early implementation data underscored interoperability frictions from vendor-diverse s, with mismatched data formats complicating cross-cluster exchanges despite Spine mediation; for instance, Accenture's clusters employed distinct configurations that deviated from BT's setup, hindering seamless record portability. The cluster approach thus exposed causal disconnects between localized scalability intents and the empirical demands for rigorous national cohesion, as regional providers navigated flexibilities that amplified heterogeneity.

Execution and Timeline

Phased Rollout Attempts

The initial phase of the National Programme for IT (NPfIT) rollout, spanning 2004 to 2006, concentrated on piloting core infrastructure components to establish a national backbone for data exchange. The Spine, a central database for services including personal demographics service (PDS) handling 72 million records, went live in June 2004 as planned, enabling initial functionalities such as searches with 375,000 daily queries by mid-2006. Parallel efforts deployed the N3 broadband network starting in 2004, which connected over 18,000 NHS sites by January 2007—two months ahead of the March 2007 target—and supported data transfer volumes exceeding 96 terabytes monthly. Subsequent phases shifted toward comprehensive electronic health records, with Phase 2 targeting full deployment of detailed care records systems by 2008 to enable shared across providers. However, early implementation revealed slippage, as only 13 acute trusts had received new patient administration systems by June 2006, far short of broader expectations for hospital-wide adoption. The National Audit Office's June 2006 assessment documented these delays, noting that shared electronic patient clinical records were postponed by at least two years, with pilots rescheduled for late 2006 and wider rollout projected for 2007, extending overall completion toward 2010 rather than the initial 2008 horizon for key systems. Further extensions emerged in response, pushing ambitious targets for nationwide detailed care records to 2014–2015 amid persistent challenges in and local readiness. To mitigate resistance, rollout strategies incorporated incremental measures, such as voluntary participation in summary care record pilots from onward, allowing select regions to test opt-in models for basic patient summaries before mandatory scaling. These adaptations aimed to build buy-in but underscored the gap between original timelines and practical deployment, with core clinical benefits remaining limited by mid-decade.

Contract Management and Vendor Dynamics

The procurement strategy for the National Programme for IT (NPfIT) under NHS Connecting for Health emphasized fixed-price contracts awarded to prime contractors, designated as Local Service Providers (LSPs), to deliver integrated systems across regional clusters, with the intent of shifting financial and delivery risks away from the government. These contracts incorporated detailed specifications for electronic patient records and other components, often subcontracted to specialist firms such as iSoft for in certain clusters and Cerner for systems in others. The rigid structure, which precluded extensive and imposed strict timelines, aimed to enforce but inadvertently constrained adaptability to emerging technical challenges and user feedback. Significant vendor disruptions highlighted the limitations of this model. In March 2006, announced a £250 million loss provision on its NPfIT contracts for the North East and East clusters, attributing delays to performance issues, culminating in its full withdrawal in September 2006 under a settlement that allowed retention of £110 million from £173 million already paid while terminating further obligations. Similarly, (CSC), which assumed some responsibilities via a 2007 tripartite agreement, faced ongoing strains leading to a contract amendment in April 2009 and subsequent renegotiations amid delays in deploying its Lorenzo system. The over-specified contracts, prioritizing comprehensive upfront definitions over iterative refinement, diverged from private-sector practices that favored phased development to manage complexity and incorporate progressively. This approach exacerbated , as initial fixed commitments proved insufficient for the program's evolving demands, prompting ad-hoc adjustments that strained vendor resources without contractual mechanisms for flexible scaling. Parliamentary scrutiny later noted that such rigidity, while seeking cost control, undermined vendor incentives for and collaboration, contributing to persistent delivery shortfalls.

Financial Dimensions

Budget Projections and Allocations

The National Programme for IT (NPfIT), delivered through NHS Connecting for Health, was launched in 2002 with an initial budget allocation of £2.3 billion over three years, as announced by the Department of Health in response to recommendations for enhanced IT investment in the NHS. By 2004, following the awarding of eight major contracts to local service providers, the Department of Health revised the projected total to £6.2 billion, encompassing the full scope of regional and national systems over the programme's planned timeline. Funding for these projections derived primarily from the NHS capital budget, ring-fenced to support centralized procurement and deployment of aimed at modernizing healthcare delivery. Allocations prioritized external suppliers for core deliverables, with approximately 79% of the £6.2 billion earmarked for regional clinical information systems, including detailed care records. Specific contracts, such as those with for the Lorenzo care records system in northern and midland regions, totaled £3.1 billion. The Spine, comprising national applications for secure data exchange and underpinning the care records service, received dedicated funding within the central infrastructure category, though exact figures were integrated into broader national systems projections. Overall, the budget framework anticipated a positive return on investment through efficiency gains, such as reduced administrative duplication and faster data access, with Department of Health projections emphasizing financial savings from streamlined operations across trusts and primary care.

Cost Escalations and Accountability Measures

The National Programme for IT (NPfIT), managed by , experienced substantial cost escalations, with £2.7 billion spent on detailed care records systems by 2011 yielding no commensurate value for money according to the National Audit Office (NAO). The programme's overall forecast total cost reached £9.8 billion by 2013, including £7.3 billion expended up to March 2012, far exceeding early projections and reflecting delays in software delivery and regional implementations. These overruns stemmed from underestimation of technical complexity and failure to achieve core objectives, such as electronic records for all patients, with only a fraction of planned systems deployed. Significant financial waste materialized through undelivered systems and contract terminations, including approximately £4.3 billion in remaining planned expenditures deemed inefficient or at high risk by 2011. Upon dismantling in 2011-2013, the documented net losses, with £3.7 billion in realized benefits against £7.3 billion in costs to date, alongside termination-related payments such as £100 million compensated to to lift exclusivity clauses. Legal expenses for disputes, including £31.5 million for the termination, further quantified inefficiencies in exiting supplier agreements originally valued at hundreds of millions. Accountability mechanisms proved largely ineffective, with contract clauses permitting penalties up to substantial sums—such as the potential £1 billion facing upon its 2006 withdrawal—rarely enforced due to evidentiary challenges and the Department of Health's weakened negotiating leverage. The PAC highlighted the absence of penalties against major suppliers like CSC despite documented performance shortfalls, attributing this to insufficient proof of default and a reluctance to pursue litigation amid ongoing dependencies. NAO assessments from 2006 onward repeatedly flagged poor value for money without triggering robust supplier repercussions, underscoring systemic weaknesses in oversight and of performance-based clauses.

Criticisms and Shortcomings

Delivery Deficiencies and Unrealized Benefits

The National Programme for IT (NPfIT), managed by NHS Connecting for Health, promised integrated electronic patient records across NHS trusts to enable seamless and clinical , but delivery fell short, with detailed care records systems experiencing significant and limited deployment by the program's later stages. For instance, systems like Lorenzo for the North, Midlands, and East clusters saw protracted implementation issues, leaving most trusts without fully functional integrated records despite initial targets for nationwide rollout by 2010. Similarly, the London Programme for IT and Southern Programme for IT, intended to provide comprehensive electronic records, achieved only partial uptake, contributing to a broader failure to digitize secondary care sectors as envisioned. Empirical assessments revealed stark unrealized benefits, with 98% of estimated gains from key components such as the Summary Care Record and electronic prescription services remaining unachieved by March 2012. Overall, realized benefits totaled £3.7 billion against £7.3 billion in costs incurred by that date, yielding a benefit-to-cost ratio of just 0.5:1, far below projections of efficiency improvements and patient care enhancements. No attributable reductions in clinical errors or patient wait times materialized, despite early claims of substantial operational efficiencies; post-implementation evaluations found promised gains in safety and productivity absent, with some sites reporting prolonged waits due to hurdles. These shortfalls stemmed from a centralized, top-down approach prioritizing over iterative, clinician-driven , which neglected varying local needs and fostered deployment resistance without yielding measurable clinical outcomes.

Security Vulnerabilities and Risk Exposure

The centralized Spine database, integral to the National Programme for IT (NPfIT) managed by NHS Connecting for Health, aggregated sensitive patient data including demographics, medical histories, and identifiers across a national repository, amplifying risks of systemic compromise compared to localized systems where breaches affect fewer records. This architecture created a , vulnerable to large-scale exploitation if breached, as critiqued in analyses highlighting inadequate safeguards against comprehensive scenarios. Official reviews noted that while audit trails and role-based access aimed to mitigate unauthorized viewing, incomplete implementation—such as reliance on passwords rather than mandatory Smartcards in certain trusts—exposed potential insider access gaps until targeted compliance by 2014. Reported incidents underscored these flaws; during the NPfIT rollout, the NHS notified the Information Commissioner of over 10 data security breaches in the six months post-2007 child benefit scandal, reflecting broader vulnerabilities in transitioning to electronic systems amid centralized data flows. Connecting for Health lacked a mandate for centralized breach notifications, with most handled locally by trusts, hindering oversight of Spine-related exposures and contributing to persistent doubts among clinicians and patients. Privacy advocates, including an early group, warned as far back as 2003 that NHS data protection failures precluded safe centralization, a concern validated by subsequent provisions allowing patients to block Spine uploads due to fears of unauthorized access. Audits and strategies revealed ongoing control deficiencies; the NPfIT information security framework emphasized Smartcard and annual reviews, yet parliamentary in 2009 highlighted uneven enforcement and no comprehensive breach aggregation, elevating risks through lax local protocols. Empirical contrasts with decentralized models, such as those in fragmented trust-level systems pre-NP fIT, showed lower per-incident impact scales, as centralized hoarding inherently magnifies breach consequences via aggregated attack surfaces—a causal dynamic evidenced by losses like the 2007 Revenue & Customs incident, which paralleled NHS concerns despite security assurances exceeding banking standards. These exposures prompted recommendations for mandatory incident reporting and penalties, underscoring the program's failure to fully operationalize robust and granular controls against both external and internal threats.

Clinician Resistance and Operational Disruptions

In 2005, the (BMA) expressed significant concerns regarding the National Programme for IT (NPfIT), managed by NHS Connecting for Health, particularly around patient confidentiality and the potential for inadequate safeguards in centralized data systems. Clinical staff, including representatives from royal colleges, highlighted flaws in proposed systems, such as inflexible interfaces that failed to align with existing workflows, and anticipated increased administrative time burdens that could divert resources from patient care. A qualitative study published in identified sociocultural barriers, with senior NHS staff reporting that the program's top-down imposition neglected frontline input, fostering skepticism about its practical value for empirical improvements in care delivery. Junior doctors and other clinicians voiced opposition to NPfIT components, emphasizing risks of disrupted training and service provision due to unreliable early implementations. Research from and the in August 2005 revealed widespread low morale among implementing staff, who felt excluded from design processes, leading to perceptions that the program prioritized bureaucratic standardization over clinician needs. This resistance manifested in limited adoption and feedback loops, with surveys indicating waning support; for instance, a 2006 poll of over 1,000 medical professionals found only 58% of general practitioners (GPs) anticipating long-term benefits, reflecting doubts about tangible clinical gains. Operational disruptions arose from delayed rollouts and frequent system unreliability, causing workflow chaos in affected trusts. Patient administration systems under NPfIT often experienced repeated failures, rendering them unavailable and forcing clinicians to revert to manual processes, which exacerbated delays in appointments and record access. By , implementation setbacks in secondary care sites contributed to fragmented , with healthcare professionals reporting no discernible benefits in care coordination or efficiency, as systems failed to deliver promised amid rushed deployments lacking user testing. These issues stemmed from insufficient consultation with end-users, resulting in configurations mismatched to local practices and a focus on top-level metrics rather than validated enhancements to outcomes.

Adverse Effects on IT Suppliers

The National Programme for IT (NPfIT), managed by NHS Connecting for Health, imposed rigid, fixed-price contracts with stringent specifications and timelines that exposed suppliers to significant financial risks, often without adequate negotiation or flexibility. Key supplier iSoft, responsible for clinical software in multiple regions, encountered severe financial distress, issuing repeated profit warnings in 2006 and 2007 directly linked to delays in NPfIT contract awards and payments, which strained cash flow and contributed to its near-collapse by 2008, culminating in acquisition by IBA Health. Similarly, Accenture, tasked with implementation in the North and East regions, withdrew from contracts valued at over £2 billion in September 2006 after sustaining losses exceeding £60 million, retaining only £110 million of the £173 million paid to date while handing responsibilities to CSC. These cases illustrated broader profitability erosion for participants, as the program's "take-it-or-leave-it" model prioritized low bids and national over supplier margins, enforcing penalties for without reciprocal incentives for government-induced setbacks. A 2010 review documented profit warnings from multiple major suppliers tied to NPfIT work, alongside fines for performance shortfalls, highlighting how high-spec, low-risk demands diverged from commercial norms and undermined viability. In contrast to market-driven IT projects, where iterative development allows cost recovery through adjustments, NPfIT's top-down structure locked firms into unprofitable terms, deterring and fostering adversarial dynamics. The fallout extended to a disincentive for public-sector engagement, with 2010 analyses noting that supplier experiences under NPfIT reduced appetite for domestic large-scale bids, as firms redirected resources toward more predictable overseas opportunities amid eroded trust in government contracting. This manifested in warnings of diminished investment in health IT capabilities, as the program's demands for upfront commitments without balanced risk-sharing prioritized short-term savings over long-term sector .

Assessments and Oversight

Official Reviews and Parliamentary Inquiries

The (PAC) in its July 2006 report identified substantial risks in the National Programme for IT (NPfIT), including deployment delays of patient clinical records by two years, supplier struggles such as Accenture's withdrawal, and insufficient early consultation during system specification and contracting. The report conceded flaws like an output-based specification lacking robust input and audit trails, alongside operational disruptions from inadequate testing and issues in early implementations. It recommended greater involvement in specifications and decentralization of to enable NHS trusts to select from a wider range of systems, warning that without enhanced local engagement, the programme risked failing to deliver benefits. In January 2009, the PAC's follow-up report on progress since 2006 acknowledged ongoing delays, with only 133 of 380 acute trusts equipped with care records systems by August 2008—four years behind the original timeline—and high dependency on limited suppliers like BT and CSC, increasing capacity risks. It highlighted local variability in adoption and contract creep from trusts' change requests, urging evaluation of alternatives allowing trusts to of failing systems and emphasizing local ownership through strategic health authorities to mitigate central control limitations. The National Audit Office (NAO) in its May 2011 assessment of care records systems concluded that the £2.7 billion expended by March 2011 did not represent value for money, citing significant delays, reduced scope, and incomplete functionality such as missing capabilities, which limited clinical benefits like improved . The report noted minimal realization of promised advantages despite costs, recommending a shift from top-down delivery to a locally led model where NHS organizations build on existing systems tailored to local needs. Subsequent NAO and PAC scrutiny in 2013 further conceded programme flaws, with the NAO reviewing the final benefits statement revealing £7.3 billion in costs against £3.7 billion in benefits by March 2012—a of 1:0.5—and high over £7 billion in projected future gains, excluding unresolved elements like the Lorenzo system. The PAC's June 2013 report on the dismantled programme admitted mismanagement, including weak contract negotiations leading to £100 million compensation for CSC's underperformance and legal costs exceeding £31 million from disputes like Fujitsu's, attributing unrealistic standardization goals and poor oversight to the preceding Labour administration. It highlighted that 98% of care record benefits remained unrealized, with insufficient monitoring exacerbating the failure to achieve clinical efficiencies proportional to expenditure.

External Critiques and Empirical Evaluations

External analyses have highlighted the over-ambitious scope of the National Programme for IT (NPfIT), managed by Connecting for Health, as a core flaw in its centralized design, arguing that the program's attempt to impose uniform electronic records and systems across the entire disregarded the heterogeneous needs of diverse healthcare providers. A assessment attributed this overreach to a lack of incremental testing and , drawing parallels to prior government IT failures where grand-scale ambitions outpaced practical feasibility. Independent IT journalism exposés documented how the program's strategy fostered by awarding massive, inflexible contracts to prime suppliers like and , with "take-it-or-leave-it" terms that stifled competition and innovation while imposing multimillion-pound penalties on NHS trusts for delays outside their control. Quantitative post-mortems estimated the program's expenditures at over £10 billion by 2011, yet delivered negligible , with core components like the integrated care records service largely abandoned and only partial functionalities realized in select regions, yielding an effective ROI approaching zero when benchmarked against promised efficiencies in and administrative savings. Comparisons to private sector implementations revealed that decentralized, market-driven approaches—such as those adopted by healthcare providers like —achieved comparable adoption at lower costs and faster timelines, often through modular, vendor-agnostic systems that avoided the NPfIT's . Critiques rejected common rationalizations attributing failure to inherent NHS complexity, instead pinpointing causal roots in the program's anti-market orientation, including top-down mandates that bypassed input and competitive , which suppressed bottom-up and mechanisms prevalent in private IT deployments. This centralized bias, per data-driven deconstructions, amplified risks by concentrating decision-making in unelected bureaucracies, contrasting with from agile private projects where iterative feedback loops and supplier diversity mitigate overruns. Such evaluations underscore how eschewing market signals for command-style planning inherently undermines IT efficacy in distributed systems like healthcare.

Termination and Consequences

Dissolution Process in 2013

The dissolution of NHS Connecting for Health was precipitated by the coalition government's recognition of the National Programme for IT's (NPfIT) fundamental unviability, culminating in the decision to scrap its core contracts in September 2011. This action dismantled the centralized procurement model for electronic patient records and related systems, shifting toward localized IT solutions amid escalating costs and delivery failures. The process reflected broader policy reforms under Health Secretary , prioritizing of commissioning powers to clinical groups over top-down national mandates. A phased wind-down commenced following the May 2010 , with initial reviews identifying salvageable infrastructure such as the N3 broadband network, which supported secure data connectivity across NHS sites and was preserved for ongoing use. By 2011, remaining NPfIT elements, including major supplier agreements with BT and (CSC) for local service provision, were terminated or renegotiated, though some legacy contracts persisted to avoid abrupt service disruptions. NHS Connecting for Health formally ceased operations on 31 March 2013, as mandated by the Health and Social Care Act 2012, which abolished special health authorities like CfH and restructured NHS functions. Assets, including and data assets, along with approximately 2,000 staff, were transferred to successor bodies to ensure continuity of essential services during the transition. The closure incurred substantial final expenditures, with payments to suppliers such as CSC totaling over £1 billion up to the cessation date, underscoring the program's entrenched financial commitments.

Transition to Successor Entities

Upon the dissolution of NHS Connecting for Health on 31 March 2013, key responsibilities for ongoing national IT infrastructure, including the maintenance and operation of the Spine system, were transferred to the newly established Health and Social Care Information Centre (HSCIC). This handover ensured continuity for critical shared services, such as the Spine's role in secure data exchange, while devolving other IT development and procurement decisions to local NHS trusts and clinical commissioning groups. The transition aligned with a broader shift in toward decentralized IT , emphasizing trust-level of systems tailored to local needs rather than centrally mandated solutions. This reduced the scope of national oversight, allowing individual organizations greater autonomy in selecting and implementing electronic patient record systems and other technologies, in contrast to the top-down approach of the preceding National Programme for IT. The Spine infrastructure underwent further technical transition under HSCIC, completing migration to in-house management and open-source elements by 2016, with HSCIC later rebranded as NHS Digital. As of 2025, the Spine remains operational for core functions, including demographic via the Personal Demographics Service, processing thousands of electronic messages daily to support patient identification and basic across the NHS. However, it operates without the comprehensive system-wide integration originally planned, serving primarily as a foundational messaging backbone rather than a fully unified platform.

Enduring Legacy and Systemic Lessons

The termination of the National Programme for IT (NPfIT), overseen by Connecting for Health, resulted in sunk costs exceeding £10 billion by 2013, with only £2.6 billion in identifiable benefits, primarily from partial deployments of basic infrastructure such as the N3 network and Spine directory services. This disparity underscored the program's negligible net value, as core objectives like nationwide electronic patient records and integrated care systems remained unrealized due to systemic implementation failures. The episode has served as a cautionary exemplar in analyses of public-sector IT initiatives, highlighting the perils of top-down mandates in complex, decentralized systems like healthcare, where empirical outcomes demonstrated superior efficacy of clinician-driven, incremental approaches over centralized . Post-mortem reviews emphasized that competitive, localized models—allowing trusts to select vendors and adapt solutions—yielded better adoption rates and adaptability, contrasting with NPfIT's rigid contracts that stifled innovation and ignored frontline needs. By the , this reinforced directives in NHS digital to eschew monolithic national rollouts, favoring federated systems with user to mitigate risks of overreach and . Broader systemic lessons pertain to public-sector dynamics, where state-led monopolies on large-scale IT exhibited recurrent inefficiencies, including poor allocation to suppliers and inadequate , as evidenced by parliamentary findings of contractual systemic failures. Successes were confined to commoditized elements like secure networking, which private-sector analogs in other jurisdictions delivered more cost-effectively without equivalent overruns. These outcomes have bolstered arguments for hybrid models integrating private competition, underscoring causal factors such as bureaucratic inertia and misaligned incentives in government-led endeavors versus market-driven alternatives.

References

  1. https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs/making-it-work-harnessing-the-power-of-health-information-technology-to-improve-care-in-england
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC3206716/
  3. https://publications.parliament.uk/pa/cm201012/cmselect/cmpubacc/1070/1070.pdf
  4. https://assets.publishing.service.gov.uk/media/5a7c853740f0b62aff6c2405/newnhs.pdf
  5. https://publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf
  6. https://hansard.parliament.uk/commons/2004-04-19/debates/afe23890-1561-4e15-adac-3d2d9413ceff/NationalProgrammeForInformationTechnology
  7. https://hansard.parliament.uk/Commons/2011-06-14/debates/11061446000002/InformationTechnology%28NHS%29
  8. https://www.cl.cam.ac.uk/archive/rja14/Papers/npfit-mpp-2014-case-history.pdf
  9. https://publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/42205.htm
  10. https://publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/153.pdf
  11. https://digital.nhs.uk/services/personal-demographics-service
  12. https://assets.publishing.service.gov.uk/media/5a79dfd440f0b66d161aec5c/mpa-review-nhs-it.pdf
  13. https://pmc.ncbi.nlm.nih.gov/articles/PMC3118108/
  14. https://qualitysafety.bmj.com/content/30/2/96
  15. https://www.nao.org.uk/reports/department-of-health-the-national-programme-for-it-in-the-nhs/
  16. https://www.nao.org.uk/wp-content/uploads/2006/06/05061173_Qinetiq.pdf
  17. https://www.nao.org.uk/wp-content/uploads/2011/05/1012888.pdf
  18. https://www.digitalhealth.net/2008/09/ex-nhs-it-boss-richard-granger-joins-kpmg/
  19. https://www.theguardian.com/society/2006/nov/12/epublic.technology
  20. https://www.zdnet.com/article/richard-grangers-nhs-it-legacy-3039287612/
  21. https://www.theguardian.com/business/2007/jun/18/health.politics
  22. https://www.hsj.co.uk/home/dh-seeks-granger-replacement/752586.article
  23. https://www.digitalhealth.net/2007/09/grangers-successor-remains-a-mystery/
  24. https://www.zdnet.com/article/nhs-it-chief-resigns-after-brief-tenure/
  25. https://pmc.ncbi.nlm.nih.gov/articles/PMC411111/
  26. https://digital.nhs.uk/services/spine
  27. https://www.computerweekly.com/blog/The-Full-Spectrum/Heres-to-five-years-of-the-new-NHS-Spine
  28. https://www.digitalhealth.net/2018/12/nhs-e-referral-service-hits-100m-bookings/
  29. https://www.england.nhs.uk/2014/05/choose-and-book/
  30. https://www.cloudgateway.co.uk/knowledge-centre/articles/n3-to-hscn/
  31. https://www.nao.org.uk/reports/the-national-programme-for-it-in-the-nhs-progress-since-2006/
  32. https://www.parliament.uk/globalassets/documents/post/postpn214.pdf
  33. https://www.theguardian.com/business/2007/jun/19/politics.epublic
  34. https://www.computerweekly.com/opinion/Six-reasons-why-the-NHS-National-Programme-for-IT-failed
  35. https://www.digitalhealth.net/2006/09/accenture-pulls-out-of-national-programme/
  36. https://pmc.ncbi.nlm.nih.gov/articles/PMC1592380/
  37. https://www.theguardian.com/technology/2006/sep/28/news.business
  38. https://www.sec.gov/files/litigation/admin/2015/33-9804.pdf
  39. https://www.henricodolfing.com/2019/01/case-study-10-billion-it-disaster.html
  40. https://pmc.ncbi.nlm.nih.gov/articles/PMC1183135/
  41. https://healthmanagement.org/c/it/issuearticle/healthcare-it-in-britain-nhs-national-programme-for-it-npfit
  42. https://janelicc.files.wordpress.com/2017/07/paper-global-it-case-study-britain_s-national-health-service_s-nhs-4.pdf
  43. https://committees.parliament.uk/committee/127/public-accounts-committee/news/181704/dismantled-national-programme-for-it-in-nhs-report-published/
  44. https://data.parliament.uk/DepositedPapers/Files/DEP2010-0031/DEP2010-0031.pdf
  45. https://www.nao.org.uk/reports/the-national-programme-for-it-in-the-nhs-an-update-on-the-delivery-of-detailed-care-records-systems/
  46. https://publications.parliament.uk/pa/cm201314/cmselect/cmpubacc/294/294.pdf
  47. https://www.theregister.com/2006/09/29/accenture_nhs_penalty/
  48. https://www.nao.org.uk/wp-content/uploads/2013/06/10171-001_NPfiT_Review.pdf
  49. https://www.digitalhealth.net/2013/06/98-per-cent-of-npfit-benefits-unrealised/
  50. https://pubmed.ncbi.nlm.nih.gov/28166675/
  51. https://pmc.ncbi.nlm.nih.gov/articles/PMC10958994/
  52. https://www.digitalhealth.net/2008/04/over-10-nhs-security-breaches-in-last-6-months/
  53. https://www.pinsentmasons.com/out-law/news/nhs-fails-to-protect-patient-data-says-group
  54. https://www.theguardian.com/society/2008/sep/18/health.nhs
  55. https://www.digitalhealth.net/2005/06/bma-chair-to-lead-top-level-it-working-party/
  56. https://www.theguardian.com/society/2005/aug/05/health.politics
  57. https://www.digitalhealth.net/2006/11/survey-shows-waning-medical-support-for-npfit/
  58. https://www.digitalhealth.net/2006/09/npfit-systems-failing-repeatedly/
  59. https://www.digitalhealth.net/2006/07/isofts-financial-troubles-mount/
  60. https://www.theguardian.com/technology/2006/sep/28/news.business1
  61. https://www.zdnet.com/article/accenture-pulls-out-of-12-4bn-nhs-it-project/
  62. https://www.bestpracticegroup.com/nhs-national-programme-npfit/
  63. http://homepages.cs.ncl.ac.uk/brian.randell/Concerns.pdf
  64. https://editthis.info/nhs_it_info/Supplier_Problems_-_Others
  65. https://www.researchgate.net/publication/243967101_England%27s_national_programme_for_IT
  66. https://www.theguardian.com/healthcare-network/2011/sep/22/npfit-ends-cfh-andrew-lansley-bt-csc
  67. https://www.gov.uk/government/publications/department-of-health-corporate-plan-2013-14/department-of-health-2013-14-corporate-plan
  68. https://assets.publishing.service.gov.uk/media/5a81542d40f0b62305b8e5cf/HSCIC-Strategy-2015-2020-FINAL-310315.pdf
  69. https://www.gov.uk/government/publications/2010-to-2015-government-policy-nhs-efficiency/2010-to-2015-government-policy-nhs-efficiency
  70. https://www.ukauthority.com/articles/hscic-wraps-up-nhs-spine-transition/
  71. https://digital.nhs.uk/services/personal-demographics-service/personal-demographics-service-fair-processing
  72. https://6b.health/insight/the-backbone-of-the-nhs-understanding-the-nhs-spine-and-its-future/
  73. https://digital.nhs.uk/services/spine?preview-token=c304777e-7baf-463a-b1c8-7c47d6faf700
  74. https://www.digitalhealth.net/2013/08/npfit-to-cost-10-billion/
  75. https://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn
  76. https://www.panorama-consulting.com/nhs-it-system-failure/
  77. https://www.theregister.com/2020/05/18/latest_nhs_it_revolution_is/
  78. https://eprints.lse.ac.uk/39719/1/blogs.lse.ac.uk-Farewell_then_NPfIT_across_the_health_service_But_without_learning_longerterm_lessons_will_locallyori.pdf
  79. https://www.mja.com.au/system/files/issues/186_01_010107/coi11007_fm.pdf
Add your contribution
Related Hubs
User Avatar
No comments yet.