The £10bn NHS computer that never was: how NPfIT became Britain's biggest IT fiasco

In 2002 the Department of Health launched the National Programme for IT: one integrated records system for the whole English NHS, billed at £2.3bn and described as the largest civilian IT project ever attempted. Instead of letting trusts buy systems, Connecting for Health divided England into five regions and handed each to a single Local Service Provider — Accenture, BT, Fujitsu and CSC — with common software, central contracts and penalty clauses of up to 50% of contract value for walking away.

Delivery stalled almost immediately. In September 2006 Accenture quit its East and North-East clusters, blaming delays on sub-contractor iSoft. The withdrawal fee was supposed to start at 50% of the contract — roughly £1bn — but Connecting for Health charged just £63m, telling the industry that Accenture 'has been delivering'. CSC absorbed Accenture's regions and became the dominant supplier anyway; Fujitsu's southern contract was later terminated in 2008 with its exit bill still unresolved years afterward.

The 2011 National Audit Office review found the £2.7bn already spent on detailed care records 'does not represent value for money', with no grounds for confidence in the remaining £4.3bn; in CSC's North, Midlands and East cluster, just four of 97 planned Lorenzo hospital systems had been delivered. The programme's total budget had been revised up to £11.4bn.

In September 2011 the government dismantled the centralised care records programme, moving to locally chosen systems. Two years later the Public Accounts Committee put the bill at £9.8bn — excluding Fujitsu's termination costs — and called it 'one of the worst and most expensive contracting fiascos in the history of the public sector'. What survived was the modular N3 network, PACS imaging and NHSmail; what died was the single national database clinicians had never wanted.

Costed at £2.3bn in 2002; the 2013 PAC count was £9.8bn and still excluded Fujitsu termination costs; Accenture's exit cost £63m where the contract allowed up to £1bn

The programme imposed one central architecture on 300+ trusts and their clinicians, who had no ownership of the design and no patience for it.

Regional monopoly contracts removed competitive pressure: once signed, a failing Local Service Provider had to be renegotiated with rather than replaced, as the £3.1bn CSC renegotiation showed.

The buyer waived its own remedies — the up-to-£1bn Accenture fee settled for £63m — teaching every supplier that NPfIT deadlines carried no real cost.

There was no plan B: MPs found the Department negotiating with weak-performing suppliers 'from a weak position' and could not even price the Fujitsu exit when the programme ended.

The £2.3bn headline number drove approval; the true £11.4bn scale emerged in increments, too late for the decision to be revisited.

Monolithic national IT with monopoly suppliers fails on contact with reality. Buy modular, enforce penalties, keep a plan B — or renegotiate from weakness while the bill climbs.

Connecting for Health was wound down and its functions moved into what became NHS Digital. Lorenzo, CSC's long-delayed record system, was eventually deployed to most of its cluster's trusts by the mid-2010s, years late and stripped of its central design. BT continued serving London under modified terms. The 2013 PAC report warned the taxpayer was 'continuing to pay the price' through successor components, and the collapse cast a decade-long chill over NHS-wide IT procurement — later national record efforts were built as federated, local-first systems instead of a single database.