Documents released last week show how key passages in the NAO report were changed after interventions by Department of Health officials. These included removing warnings about the difficulties of creating computerised records for every patient in the country.

The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients. Critics fear it could threaten patient confidentiality and make the NHS more vulnerable to damage from computer failures.

The NAO report on the scheme, published in June, was welcomed by NHS officials for its broad support of the programme. However, a draft of the report, dated January 26, 2006 and obtained by The Sunday Times under the Freedom of Information Act, warned of potential problems. It said:

• The Department of Health had failed to demonstrate “clear and effective leadership” to staff implementing the programme.
  
• NHS workers were worried “the confidentiality of patient information may be at risk”.
  
• The NHS lacked sufficient skills to support the delivery of the programme.
  
• Although there had been “substantial progress”, the programme faced “significant challenges”.

  When the report was published six month later, the warning over departmental leadership had been removed; the paragraph highlighting doctors’ worries over confidentiality was also missing and the claim that the NHS did not have the required skills to deliver the programme had been dropped.

  Instead, headings of the report were changed which gave more emphasis to what the project “has achieved”. Even the projected costs of the programme were cut from £13.4 billion in the draft report to £12.4 billion in the final version. The key conclusion on the challenges was unchanged.

  One source who has worked closely with the NAO said: “It’s pretty clear the NAO were bullied into changing this report.”

  An NAO spokesman said: “Like any report it went through a process to ensure the presentation was fair and the facts were accurate. The overall conclusions are the same in the final report as in the provisional report. The £1 billion fall in cost followed new information.”

  The health department said: “We co-operated fully with the NAO to ensure the publication of a balanced and accurate report.”

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