Sitting alongside Parkinson’s and Sod’s Law on project management is the definition of a successful Central Government project, namely one that lasts more than two years. As civil servants typically only stay in their positions for around two years, this ensures that the person that started the project doesn’t finish it, and the person that finishes it doesn’t start it. If the project is a success, both can claim the credit; whilst if it fails, both can blame each other.
And so the National Programme for IT in the NHS must be a successful project....
Unfortunately not. Yes – the person who started it has moved on – and it’s now being run by others – but it is years late, £billions over budget, several contractors (and subcontractors) have come and gone, and there are serious doubts that it will ever meet its objectives. I don’t intend to pick over the bones of this project (there are far too many articles on the topic – I recommend Private Eye and e-Health Insider for some of the best), but how should it have been procured and implemented?
Unfortunately, NPfIT was procured centrally, arguably by people who were out of touch with technology, the needs of the end users, and the basics of developing large computing projects successfully for multiple organisations. Major suppliers (and subcontractors) had no choice to become involved in the procurement if they wanted to remain in the NHS market, even though they saw the flaws in the way the programme was planned. As with many Central Government projects, they expected to be able to use the flaws to change the scope of the contracts once awarded, to both introduce delays and increase revenue.
In fairness to Granger, he setup the contracts in a very confrontational way (something that regular readers know I oppose), that has seen those delays and increases minimised (if one considers 100%+ over budget and years late as minimised) and two suppliers already withdrawing. Everyone in the IT industry knew that the plans for NPfIT were seriously flawed, many said so, but no-one in Government listened.
How should it have been done?
Rather than a number of centrally-procured, large contracts, the NHS should have seen its role as one of creating the framework under which individual Trusts, GP practices and other NHS organisations could have procured systems locally to meet their own specialised needs.
Initially, there should have been a major project for the collection of core requirements, involving end users from all levels, across most disciplines and geographic locations.
It’s been reported that NHS wished to use the introduction of the NPfIT systems as a way of imposing change of NHS working practices – something that IT professionals know is the way to guarantee end user resistance and a problem project – much better to develop systems that enable business process change rather than require it. Also, centralised requirement setting (with low levels of local and end user involvement) may be the quickest way to proceed initially, but as the current delays prove, it’s rarely the fastest way to implement new systems successfully.
In parallel with focussing on the core requirements, standards for interoperability and security, the NHS could have funded a number of demonstrator projects with smaller, specialised software houses to develop and trial the key applications. These would have allowed the developers to get closer to the eventual end-users, clarifying requirements and produce functionality that worked in practice before any attempt at large-scale roll-out.
Most importantly, the software houses should have been those companies that understand how to build packaged applications that can be easily tailored to meet the varying needs of multiple customers. Central Government typically procures large bespoke systems for individual departments from large IT service suppliers who are used to big one-off projects – i.e. not focussed on the production of easily customised, re-usable software modules. Using companies experienced in the development of application software packages would potentially avoid the current major excuse of "the customisation has been more extreme that we envisaged at the beginning of the programme."
The supply, installation and ongoing support of the core computing hardware (e.g. PC’s, network servers, etc ..) and network infrastructure could have been procured separately, leaving application servers and specialist hardware (e.g. handheld computers, scanners, etc ..) to individual local procurements - possibly against centrally procured call-off contracts.
Overall, such an approach would have delivered the new systems in a timetable far longer than the initial NPfIT schedule, but most probably earlier than the likely timetable for the current projects (which, already years behind schedule, will inevitably slip even further). Most importantly, such an approach is more likely to deliver systems that meet end user requirements and actually bring real benefits to the NHS.....
I think there is a serious risk that a change in Government will result in the abandonment of much of the current NHS NPfIT. In practice, this may be the cheapest option for the taxpayer, but if it happens, what a missed opportunity - £billions and years down the drain – money and time that could have been used, not only to have completed the groundwork for an integrated Health IT system, but also helped take UK software houses to the forefront of health applications software packages – and just think of the exports that might have brought.