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 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: National Programme for IT A ten year £6.2bn programme to deliver four key 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 InformationTechnology/NationalITProgramme/fs/en

London cluster Capital Care Alliance, led by BT Eastern cluster Accenture North East cluster Accenture North West & West Midland cluster The CSC Alliance Southern cluster The Fujitsu Alliance National Application Service Providers National Infrastructure Service Provider Local Service Providers Suppliers

What the NHS will see Choose and Book (2004 on) PACs (phase 1) (phase 2) (phase 3) GP IT (QMAS) LSP bundles (NE and E) Electronic Transfer of Prescriptions GP to GP transfer LSP bundles (North West/West Mids) LSP bundles (London and Southern) NHS Care records Service (Security, messages, personal demographics) NHS Care Records Service - clinical records start NCRS - 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 : PACS Technology to capture, store, display and 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

 BMS  BMS 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  BMS  BMS  BMS  BMS  Internet  Internet Create referral letter Request advice & guidance Create referral request Book appointment Change appointment What are we building? Electronic Booking

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

E-Booking Sandpit 1Sandpit 2Sandpit 3 Front line systems and national applications LSP 1 GP system 1 PAS 1 GP system 2 NPfIT Testbeds Testing Standards - Compliance - Performance - Connectivity Today’s Challenge NCRS

Planning Summary of Planning information 16,000 Primary and Secondary Sites 12,000 dentistry sites Approximately 38,000 sites not including Pharmacy sites There 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. Choose & Book N3 ETP PACS CONTACT Spine Approximately 112,000 milestones and activities for National System Programmes

Our vision A digital health service that is fit for the future