Nigel Hawkes, Health Editor of The Times, says today's National Audit Office report into the new NHS IT system lays to rest some fears about its cost, but leaves one question unanswered: will it work?

After all the doom and gloom, the National Audit Office report seems quite upbeat about the NHS IT programme. Is that fair?

The NAO report says that the new NHS computer system has been well procured, under tough contracts which saved more than £6 billion on the initial tenders the suppliers submitted. But implementation is only part-way through, so the NAO cannot assess whether it will work as intended, or achieve benefits that exceed its costs.

So far, so good, it is saying - but the project is unique in the world in scale and ambition, so there are still possible pitfalls ahead. This is a ten-year programme, with seven years still to go.

What is the system designed to do? What delays are users facing?

The programme actually consists of a dozen applications, all of which are being introduced at different times in different places. There are significant delays of two years on the most important element, the "central spine" that will store patient records.

Choose and Book, the direct booking of hospital appointments, has also made a slow start, but 65 per cent of GP practices have now installed it, it is claimed. The Picture Archiving and Communications Systems, which allow the electronic storage and display of X-rays and other scans, is now available in half of hospitals in the south of England.

So bits of the system are working and every week it spreads to new users.

The NAO said NHS staff are not yet convinced that it will make their work easier. Is that a serious problem?

Connecting for Health has put communicating with staff rather low on the agenda. One reason is that because of the way the system is being deployed, there is no point in telling doctors about a new system if it is still a year away from use in their area. Also, if there is nothing to show them, they are unlikely to be impressed.

The department acknowledges that too little has been done, and promises more. But greater problems could arise if many patients object to their health records being accessible on the system. Nobody has yet asked patients what they think, and some are sure to object.

What about the cost? Is this a white elephant that will cost billions or will it really be a 21st century system?

The cost is high, £12.4 billion, made up of £6.8 billion for procurement and the rest for implementation, training costs, and local costs. But this is a ten-year programme in an organisation that spends £70 billion a year, so it is not disproportionate - £1.2 billion a year.

A good part of this would have been spent anyway on local GP and hospital systems that cannot communicate with one another, if the programme had not been launched. It makes sense: the unanswered question is how well it will work.

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