Submission to the PAC by Robin Guenier (3 Nov 2006)

From Nhs It Info

A note on the NHS National Programme for IT for the Committee of Public Accounts

It is impossible to exaggerate the importance of the NHS National Programme for IT (NPfIT). It is my view, shared by others including many clinicians, that if the NHS is to be properly effective in the 21st Century its information systems must be transformed. So it was excellent news when the Government announced in early 2002 that it was to take the advice of the review it had asked Derek Wanless to undertake and had decided to invest a huge amount of time and effort in an ambitious programme of NHS IT reform. This project must succeed – its failure would mean a substantially ineffective health service and it is inconceivable that the Treasury would release so much money again (now estimated at over £12 billion) if it fails. In any case, the failure of such a massive and important project would probably create major disenchantment about public sector IT projects with both the public and politicians. There would be no winners.

Yet, after four years, it begins to look as if NPfIT may well be heading for failure. There are many signs of this – late deliveries, disappointed users, cost growth, loss of key suppliers, etc. The extraordinary thing is that this is happening largely because the Department of Health has chosen to disregard the clear lessons of earlier project failures and, in particular, the advice of Government and Parliamentary experts.

There are many reasons why projects fail. But I believe that nearly all successful projects share three essential characteristics: first, a recognised leader with full understanding of the project’s objectives, full authority for its success or failure and hands-on responsibility for the entire project; second, detailed, widespread and regular engagement with key staff and end users; and third, arising from these, an understanding of current processes and of how they must be aligned with the new processes plus a willingness to be brutally realistic about the project – is it likely to meet its objectives and, if not, what action is necessary?

Not one of these applies to the Department of Health’s management of NPfIT:

  1. The concept of a “Senior Responsible Owner” with overall authority, an understanding of the organisation’s key strategic priorities and detailed hands-on responsibility was originally defined and is commonly referred to by the Office of Government Commerce in the Treasury. Its importance has been emphasised by the Cabinet Office and I understand it to be endorsed by the National Audit Office.
    Yet NPfIT has not had a true overall SRO since Sir John Pattison retired soon after the project was started. One consequence has been that wholly inadequate priority has been given to the project’s implementation – e.g. local funding, user engagement, process change and staff training.
  2. Government and parliamentary reports on project management are full of references to the critical importance of user engagement. For example, giving evidence to the House of Commons DWP Select Committee in February 2004, Sir Peter Gershon, then CEO of the Office of Government Commerce, said, “If the staff are not brought into new ways of working, new processes, new ways of delivering benefits to the population, however successful the technology is, the systems will not be successful.” Even the document that launched NPfIT in 2002 stressed the need for “full involvement of interested parties” to overcome the risk of “lack of co-operation and buy-in by NHS stakeholders to investment objectives”.
    Yet clinician engagement in NPfIT has been poor from the outset. Six surveys of doctors’ opinions carried out by Medix UK plc and two by Ipsos MORI have established a clear pattern: most doctors are positive about what the programme could do for clinical care but are increasingly negative about whether it is worth the cost and, most worrying, continue to know little about it. An Ipsos MORI survey this year for the Department of Health, for example, found that 68% of doctors had little or no information about NPfIT, including an extraordinary 11% who said they had none. A recent survey of nurses’ views, conducted for the Royal College of Nursing, had very similar results.
  3. It is a commonplace of project management that current business processes should be brought into line with the proposed new systems (or vice versa) and that the identification of what is needed is usually a direct consequence of user engagement. It is a concept that has been strongly endorsed by the National Audit Office – e.g. in relation to the Libra project for the magistrates’ courts: see NAO report dated February 2002. Likewise, in its report “Releasing resources to the front line” in July 2004, the Office of Government Commerce said that it was “critical that new technology investments were effectively rolled out with the full involvement of front line staff and appropriate process redesign”.
    Yet, because of poor staff engagement (see above), process alignment inevitably has been a very limited part of NPfIT. Moreover, there are no signs – at least in the public domain – that the project has been subject to a hard review of whether it is likely to meet its objectives and, if not, of what must be done to ensure that it does.

All this is most disappointing – made worse by the failure of the National Audit Office’s recent report on NPfIT to do more than refer in passing to these matters. However, I am sure that it is still possible to get the programme back on track (1) by appointing a respected and senior person, preferably from within the NHS, as its Senior Responsible Owner, (2) by carrying out a massive and urgent programme of clinical engagement and (3), when the first phase of engagement is complete and clinicians’ views are known, by carrying out a thorough programme to ensure that all current and new processes are understood and fully aligned and that Trusts have sufficient funds to ensure that the programme can be fully implemented. One result might well be a major rethink and recasting of some elements, including technical elements, of the programme. These actions would inevitably take time and cost money – proper clinical engagement alone would probably cost several hundred million pounds. But they must be worth it: a radical improvement in NHS IT systems is essential if we are to avoid a diminished and substantially ineffective health service.

I would urge that the Department of Health be advised to give the most serious consideration to taking these actions now.

Robin Guenier – November 2006.

Guenier is an independent consultant and chairman of the medical online research company
Medix UK plc. In 1996 he was Chief Executive of the Central Computing and
Telecommunications Agency reporting to the Cabinet Office. He is a Liveryman of the
Worshipful Company of Information Technologists and is chairman of its medicine and health
panel. He has written this note in his private capacity: in no way is it intended to
represent the views of Medix or of the WCIT.

Return to Unpublished Concerns Regarding NPfIT

Your Ad Here
Personal tools