NHS chief executive Sir Alan Langlands has blamed the internal market for being unable to say how much was spent on the NHS's first information management and technology strategy or exactly what it achieved.
Sir Alan appeared before the Commons public accounts committee on Monday to answer questions on a critical National Audit Office report into the 1992 and 1998 IM&T strategies, released earlier this year.
It says the 1992 strategy was hindered by the lack of an overall business case, which made it difficult to monitor progress and measure benefits and costs.
PAC member Alan Williams told Sir Alan: 'There was no monitoring, no overall expenditure plans. That does not seem to be in any way consistent with overall management and control.'
But Sir Alan said that at the time of the internal market 'monitoring was confined to a very few financial parameters that did not include IT'. He insisted that this did not mean there had been no oversight of local spending, as health bodies' accounts were audited.
Sir Alan told MP Maria Eagle that the 1992 strategy had been a success 'to the extent that it established some very important infrastructure that allowed us to move forward', although he accepted there had been 'shortcomings'.
But Ms Eagle wanted to know how he could be sure when the strategy had not been evaluated. Sir Alan said the NHS Executive knew 'what works in practice'.
He also said it intended to evaluate 'once things are working' - an argument Ms Eagle described as 'circular' and designed to 'ensure a positive outcome'.
In a bad-tempered exchange, Ms Eagle pressed Sir Alan on the use of the NHS number and NHSnet, to which only 10 per cent of GPs are connected.
Sir Alan insisted that the NHS number was being used by 74 per cent of acute hospitals, although he accepted that it was not being widely used by GPs. 'We are working at the moment at getting GPs into the system, ' he added.
The NAO report warns that key lessons from the 1992 strategy have not been learned as the government prepares to spend£1bn on the 1998 version.
PAC chair David Davies asked how Sir Alan could be sure the NHS was spending the money the right way when there was still no full business case for the strategy.
Sir Alan responded that£1bn was a 'broad-brush' figure and 'likely to be an underestimate.' He said no money would be released until full business cases were prepared for projects.