Memorandum for Health Committee
From Nhs It Info
(Sent 14 May 2004)
The need for an Independent Review of NPfIT.
As experts in complex systems, we are concerned that the NHS National Program for IT (NPfIT) is starting to show many of the symptoms displayed by large IT and business change projects that have failed in the past. We have a wide range of IT backgrounds and experience, and have studied many failed projects, as well as many that succeeded. Our professional opinion is that a constructive, independent review is urgently needed, to ensure that the risks to NPfIT are fully recognised and that appropriate actions are taken.
Most IT project disasters stem from problems with requirements or specifications. Either the requirements keep changing, or they do not take sufficient account of the need for consultation to ensure that all the users of the system will be able to adopt the new work practices. Unexpected changes in requirements always emerge; but when a project's requirements keep on changing, the project will be delayed, costs will rise and the project may get out of control.
The attempt to contain costs and to keep to milestones often reduces flexibility, as suppliers interpret their contracts ever more strictly to avoid “unnecessary” work. When milestones slip, the slips typically get concealed by re-interpreting the specification or the milestones: people often prefer to postpone the day of judgment, hoping that it will be possible to catch up later, or that someone else will be forced to announce a slippage first.
Sometimes, real technical problems arise - such as a wrong data model or a network that is insufficiently reliable. It often turns out that the designers had simplistic fault assumptions: the dependability criteria turn out to be wrong, or missed, or both. Even when a working system is introduced, if the specification does not fit the real needs, the users may need so many work-arounds that the project's goals are undermined.
In the case of NPfIT, we have heard reports of changing specifications, delays, cost escalation, dependability problems, and significant technical issues.
The Department of Health has acknowledged that the published specifications (which date from 2002 and 2003) are now obsolete; as the NHS changes, and CfH has learned more about the real requirements of users, the specification has evolved significantly. It has become clear that the system will require the clinical professions to work differently; we have heard many clinicians criticise this, or complain of a lack of information about the system’s current goals.
Costs now appear much higher than anticipated; with suppliers issuing profit warnings, they will be tempted to focus on the cheapest possible reading of the specification. There is sharp technical debate about whether the proposed data standards (and a number of other aspects of the system architecture) are fit for purpose. Finally, early implementations (such as in Oxford) have been reported as insufficiently usable and dependable. We cannot be certain how serious the underlying problems in the project might be, but our experience suggests that the symptoms could be the early signs of a failing project.
Since publishing our open letter to you, we have been contacted by many people: from clinicians to health service managers to experts in computer companies. We also have met with the top NPfIT management team. The information we have gathered since our letter has reinforced and sharpened our concerns.
There are two possible ways of viewing NPfIT. The optimistic view is that the specification is now stabilising into something that can be built, and that will deliver benefits to the NHS. The pessimistic view is that things are running out of control.
We hope that the optimistic analysis is correct, in which case an independent review can help by improving communications and building stakeholder confidence. We fear that the pessimistic analysis may be correct, in which case an independent and constructive technical review can provide evidence and recommendations to help the project to recover.
Richard Granger and the NPfIT management team agree with us that a review at this time would be useful. We have also received many private communications that reinforce our belief that an independent review is essential. We attach outline proposed terms of reference to indicate the nature of the review that we recommend. We also attach a short annotated bibliography to illustrate some of the published concerns about the NPfIT.
