The National Programme for IT in the NHS in England

(NPfIT)

Richard Granger

Director General

September 2004

Context

The NHS serves 52m people in England. In 2002-2003 it dealt with:

– 325m consultations in primary care (each person visits their GP an average of 6 times a year)

– 13m outpatient consultations– Almost 5.6m people admitted to hospital for

planned treatment– Nearly 13m people attended A&E– 4m emergency admissions– 617m prescription items issued

Digital Information leads to Health

• 10.8% of patients on medical wards experience an adverse event, 46% of which were judged to be preventable

• One third led to greater morbidity or death, this means almost 1,300 hospital deaths each year could be prevented

• An average of 8.5 additional days unnecessarily spent in hospital

• If the data from a sample of trusts are extrapolated across the NHS, this costs almost £2 billion each year

• 12% of adverse events were related to medicines use

In the NHS in England:

Our aim

• To deliver a 21st Century health service that is better for patients, citizens, clinicians and people working in the NHS through the efficient use of Information and Communication Technology

• To improve the convenience, quality and safety of patient-centred care by ensuring that those who give and receive care have the right information, at the right time

The IT ‘No Needless ….’ List

• No needless harm

• No needless inaccuracy

• No needless clinical tests

• No needless approximation

• No needless inefficiency

• No needless bureaucracy

SMain:SMain:

National Programme for IT

A ten year £6.2bn programme to deliver fourkey elements:

– NHS Care Records Service• National Patient Record Spine• Local Service Providers

– Electronic appointment booking– Electronic Transmission of Prescriptions– Underpinning IT Infrastructure and

network

Shopping...• rapidity• creation of a multi-supplier contestable post award

framework• appropriate risk transfer• completion/service risk remains with the contractor• additional capacity• clear understanding of what we want to buy• ensure applications and systems perform before we buy

them• buy things that work together• cope effectively with change• equitable approach to intellectual property rights

www.dh.gov.uk/PolicyAndGuidance/InformationTechnology/NationalITProgramme/fs/en

London clusterCapital Care Alliance, led by BT

Eastern clusterAccenture

North East clusterAccenture

North West & West Midland clusterThe CSC Alliance

Southern clusterThe Fujitsu Alliance

National Application Service Providers

National Infrastructure Service Provider

Local Service Providers

Suppliers

What the NHS will see

Choose and Book (2004 on)Choose and Book (2004 on)

PACs (phase 1) (phase 2) (phase 3)PACs (phase 1) (phase 2) (phase 3)

GP IT (QMAS)GP IT (QMAS)

LSP bundles (NE and E)LSP bundles (NE and E)

Electronic Transfer of PrescriptionsElectronic Transfer of Prescriptions

GP to GP transferGP to GP transfer

LSP bundles (North West/West Mids)LSP bundles (North West/West Mids)

LSP bundles (London and Southern)LSP bundles (London and Southern)

NHS Care records Service (Security, messages, personal demographics)

NHS Care Records Service - clinical records startNHS Care Records Service - clinical records start

NCRS - future releasesNCRS - future releases

July 2004 Jan 2005 Jan 2006 Jan 2007 Jan 2008

LSP bundles - examples

• Maternity bundle

• Theatre management bundle

• Patient Administration System bundle: - Master Patient index - Clinical data repository - A & E tracking - Registration, admissions, discharges & transfers - Bed management etc

• Clinical support bundle - Results reporting - Order communications - Clinical noting and correspondence - Discharge summary

IT package solutions to support:

Value

This will be achieved by:

• Avoiding multiple procurements

• Significant reduction in time taken on procurement and acquisition costs

• Reduced unit costs for applications and systems e.g. PACS

• Ensuring that multiple national suppliers maintain on-going post award competitive pressures at the time of any change, extension or renewal

Value, an example : PACSTechnology to capture, store, displayand distribute medical images

• far less waiting for X-rays and scans to be processed and checked

• reduced costs as there will be no films and less storage space and resource

• taken over 5 years to get PACS in 25 trusts. Roll out to 142 trusts by March 2006 and all 178 by March 2007

• average price of total PACS system reduced by 50% with 71% pricing reduction on disc storage and 82% on PACS servers

Authentication

Nationwide Security

BMSBMS

Book appointment

Change appointment

Book appointment

Referrer or Booker

(via Primary

Care System)

Patient via Internet

& Unique Booking Ref No

Booker (via New NHS Network: N3)

View booking details

EBS

EBS

Create referral request

Create referral letter

View booking status

Book appointment

EBS

EBS

BMSBMS

BMSBMS

Internet

Internet

Create referral letter

Request advice & guidance

Create referral request

Book appointment

Changeappointment

What are we building? Electronic Booking www.chooseandbook.nhs.uk

What may come next?• Patients booking via the internet into primary care• Services delivered via Digital TV• Linked appointments• Transport requirements• Primary-to-primary booking• Tertiary booking and referral• Follow-up appointments• Clinical assessment services• Onward referrals

Electronic Booking

What are we building?NHS Care Records Service

• A single electronic health care record for every individual in England:– a comprehensive life-long history of patients’ health

and care information, regardless of where and when any by whom they were treated

– providing healthcare professionals with immediate access to summary of care encounters and clinical events held on a national data repository. 52m patient records

– supporting the NHS to collect and analyse information, monitor health trends and to make the best use of clinical and other resources

– essential information held at local level where most care is delivered.

What are we building?

New National Network (N3)• A combination of Broadband connections and network

services to link all NHS organisations in England with specialist applications and wider Internet applications

• Orders already placed for the first 3,300 Broadband connections for the NHS

• NHS will represent 10% of all Broadband usage in Britain

• In longer term data circuits will provide voice services to make phone lines redundant and increase savings

• Over the next 7 years new contract will save an estimated £900m compared to existing NHSnet contract

n3@nhsia.nhs.uk

E-Booking

Sandpit 1 Sandpit 2 Sandpit 3

Front line systems and national applications

LSP1

GP system1

PAS1

GP system2

NPfIT Testbeds

Testing Standards - Compliance - Performance - Connectivity

Today’s Challenge

NCRS

PlanningSummary of Planning information

16,000 Primary and Secondary Sites12,000 dentistry sites

Approximately 38,000 sites not including Pharmacy sitesThere are 10 significant milestones per site, which represents in excess of 380,000 milestone. Each site will have in excess of 100 implementation activities which will generate 380 million activities.

North West

North East

Yorkshire & The Humber

East Midlands

West Midlands

South WestSouth East

East of England

1 1

2

2

34

4

2

3

1

7

56

12

3

32

1

4

2

34

6

1

5

1

12

3

2

456

34

5South West1. Swindon

2. Bristol

3. Bournemouth

4. Exeter

5. Plymouth

South East1. Oxford

2. Reading

3. Guildford

4. Brighton

5. Portsmouth

6. Southampton

West Midlands1. Wolverhampton

2. Birmingham

3. Coventry

East Midlands1. Nottingham

2. Derby

3. Leicester

4. Northampton

East of England1. Norwich

2. Peterborough

3. Cambridge

4. Bedford

5. Ipswich

6. Luton

North West1. Carlisle

2. Blackpool

3. Liverpool

4. Manchester

North East1. Newcastle-upon-Tyne

2. Middlesbrough

Yorkshire & The Humber1. York

2. Leeds

3. Wakefield

4. Barnsley

5. Sheffield

6. Rotherham

7. Hull

LONDON

Choose & Book

N3 ETP PACSCONTACTSpine

Approximately 112,000 milestones and activities for National System

Programmes

Our vision

A digital health service that is

fit for the future