The national service framework (NSF) for older people published in March 2001 recommended implementation of a single assessment process by the health and social care professionals involved in the care of each individual. The national programme for information technology included IT support as an additional service for a single assessment process within the contracts let to local service providers. A variety of information systems and tools are available to support this process. Successful local deployments of such systems by national programme suppliers, notably in the programme's north east and eastern clusters, have demonstrated the value of the technology and its potential to support the rapid development of integrated multi-agency working across all client groups.
In addition, the £25 million capital expenditure grant recently paid to local authorities (LAs) by the Department for improving information management made specific reference to the single assessment process. The circular issued to LAs contained the following reference:
'The integration of social care information is a key requirement in the final phase of NCRS implementation. This will include:
Electronic implementation of the Single Assessment Process...
It follows, therefore, that significant benefits will be gained by using the grant to facilitate that integration, in particular preparation for the NCRS implementation ... each local authority would be asked to summarise its spending proposals for 2006-07 and 2007-08, as covered by the extension of the grant. The Department is therefore asking each local authority to submit these proposals..."
A study has also been commissioned into options for national implementation of the electronic single assessment process (e-SAP), including linkage between health and social care systems. Consultation has been undertaken with health, social care and supplier representatives, and a report is due later in 2006.
Many of the components of the national programme for information technology have been delivered to time. There have been some delays to local systems but local plans for deployment of systems and services are subject to regular update and revision by the national health service as well as suppliers depending, for example, on the readiness of NHS bodies to receive them. In general, payment is not made to suppliers until systems have been satisfactorily delivered and have been demonstrated to be safe to use and fit for purpose, and, where appropriate, been the subject of consultation with representatives of end-user groups. In some areas of the programme this process is determining the pace at which development and deployment takes place.
In some instances savings have been achieved by NHS organisations where national programme systems and services have been delivered ahead of time, or additional to those originally planned. Examples include email and new national network connections in many areas, and the benefits of national software licensing arrangements with Microsoft and Novell. There has been no clawback of the savings in these instances. The question of compensation for non-delivery, either to or from the NHS, therefore does not arise in either case.
There was a situation in the early days of the new national network (N3) contract when early milestones were missed and compensation of £4.5 million was agreed with BT. The N3 performance has since recovered and is now ahead of schedule.
Delivery of systems and services to the NHS is generally ahead of schedule in some areas, and, in the context of a 10-year programme, broadly on track in others. Such delays that have occurred have been more than made up for by delivery of projects additional to the original contracted components such as the quality management and analysis system (QMAS), the secure NHSmail email service and payment by results, which are in addition to the original scope of the programme.
Two years since contracts were first awarded, over 10,000 instances of new deployments of all types are currently live in NHS locations in England. 8,800 general practices (28,000 general practitioners (GPs)) are daily using QMAS that pays GPs £600 million a year based on quality outcomes. There are almost 230,000 users registered for access to the NHS care record spine with over 45,000 users accessing every day and around one and a quarter million prescriptions have been transmitted using the electronic transmission of prescriptions system. Over 14,500 secure broadband connections have been delivered, including to almost 10,000 general practice locations, and there are over 175,000 registered NHSmail users, over 79,000 of whom use the system daily.
The new national network (N3) provides connections of 0.5 up to 2 megabits per second (Mbps) of dedicated bandwidth for general practitioner (GP) sites, and of 2Mbps up to l00Mbps for national health service trusts. This can be topped up by local organisations to accommodate local business requirements.
Bandwidth deployed in any particular site depends on the size of the site, and the type of application usage predicted. More than 85 per cent. of GP sites have or are planned to have 1Mbps bandwidth or higher. Around 60 per cent. of NHS trusts have or are planned to have l00Mbps bandwidth.
Research on bandwidth requirements was undertaken with the NHS user community and prospective local service providers as part of the N3 procurement exercise. Results of the research were used as the basis for developing N3 products and services.
N3 deployment is one of the national programme's major success stories. In the two years since it began, over 14,500 installations have been completed at a rate significantly in advance of the original deployment plan. Before N3, only main GP practice sites were connected, the majority at 64kbps and some at 256kbps. None of these had any backup service provided and no branch practices were funded centrally. Trusts were provisioned at one 2mbps connection per trust. Under N3 all GP practice sites are eligible for centrally funded connections, and trusts are provided with a connection per site and receive bandwidth commensurate with their size. In order to provide a standard level of service, the provision of broadband services in some rural communities was accelerated under N3 in order that GPs could benefit from consistent services, regardless of location. The NHS was the first public service organisation to achieve this ambition for equitability of services in rural areas.
All N3 services receive significant backup connectivity, and average service availability across both primary and secondary care sites routinely exceeds 99.9 per cent. It is estimated that the total cost of N3 connections will be at least £800 million less than the provision of the same amount of N3 bandwidth under the old NHSnet contract.