The retirement of Sir John Pattison, the senior officer
responsible for the national plan for IT, goes against Cabinet
Office guidelines. Computer Weekly talked to him.
Sir John Pattison rarely gives interviews, and he was not
expecting to give one after he presented IT awards at a healthcare
conference at the Queen Elizabeth Centre in London last week.
He had just given a speech in praise of the work of
award-winning trusts such as North Bradford Primary Care,
Nottinghamshire Healthcare, Tees and North East Yorkshire, and
South Yorkshire Health Authority. But he said nothing at the event
about the largest civil IT programme in Europe, and for which he is
responsible until he retires next year.
The government has assigned Pattison the title of senior
responsible owner (SRO) of the £2.3bn national programme for IT in
the NHS. He is the most senior civil servant directly accountable
for the success of the national programme.
He is also chairman of the board of the national programme.
Rumours of his retirement have circulated for some time but he
confirmed it in his impromptu interview with Computer Weekly after
the awards presentation.
The importance of his role as SRO was made clear in a speech he
made in March 2002, when he said, "My most important task is to
make the case for IT in the NHS at board level, to ministers on the
fourth floor of Richmond House [the headquarters of the Department
of Health in Whitehall], across Whitehall to the Treasury and also,
importantly, to Number 10."
Pattison made those comments about six months before the
appointment of Richard Granger as director general of IT in the
NHS.
When the government announced Granger’s appointment from the
private sector to run the national programme on a day-to-day basis,
the official statement said that he would "report directly" to
Pattison. Since then, Granger has become the public face of the
initiative and Pattison has melted into the background.
Indeed, Pattison told Computer Weekly last week that he was not
directly involved in a recent briefing of prime minister Tony Blair
on the progress of the national programme.
Yet Pattison is a crucial figure when it comes to accountability
for the programme’s success. After a string of IT disasters,
including one at the Passport Office and a £1bn "Pathway" project
to reduce fraud over welfare benefits, the Cabinet office announced
a series of measures to head off failures.
One of these measures was the appointment on every major IT
project of an SRO. This was to ensure that one person would be held
accountable for a project almost from start to finish. That person
would provide support and continuity, while other officials on the
project moved from department to department, as is customary in the
civil service.
But Pattison will not be in post to see the delivery of the
national programme’s England-wide systems which will include online
booking of hospital appointments, an integrated care records
service with electronic patient records, e-prescriptions and a new
IT infrastructure.
"With the restructuring of the department, I am pulling away
from IT and becoming director of research and development again [at
the Department of Health]," said Pattison. He added that his
presentation of IT awards at the conference was his last formal
function as SRO of the national programme. So will his replacement
be the head of the national programme?
"That is a very interesting question. Strictly speaking, I am
still SRO of the national programme," he said. "I am also still
chairman of the national programme, but I will have to work out a
migration path [for a successor]."
According to a Cabinet Office document which set out the
government’s measures to avoid the mistakes that caused or
contributed to past IT disasters, an SRO was to be appointed to
every project to "ensure that a project or programme is focused
throughout its lifecycle on delivering its objectives and the
projected benefits".
The then Cabinet Office minister Ian McCartney introduced this
in his department’s document, "Successful IT" in 2000. In its
foreword he said that the government needed to "avoid the mistakes
of the past".
Citing the lessons from a range of IT successes and failures,
the document said the SRO should oversee the business case, the
project structure and close the project, ensuring that lessons are
documented - or refer problems upwards to top management or
ministers in a timely manner. "Crucially, an SRO should be ready to
recommend that a project be abandoned or changed fundamentally if
necessary."
Pattison’s early departure from his role goes against a Cabinet
Office recommendation that the SRO should not change during the
project inception and initial implementation, "The SRO should
remain in place throughout or change only when a distinct phase of
benefit delivery has been completed. Departments should take the
need for continuity and previous experience into account when jobs
are advertised and appointments made."
Similar advice is given on the website of the Treasury’s Office
of Government Commerce which provides independent oversight of
civil IT projects.
If the programme is a success, the government and Granger will
be entitled to take the credit, because patients will enjoy the
benefits of the national programme:, such as electronic records and
online booking of appointments. But there are doubts over who would
be held accountable if the programme proved a good but flawed
idea.
Some IT managers have questioned in e-mails to Computer Weekly
the fundamental principles that underpin the national programme,
for example the decision by Downing Street, suppliers and the
Department of Health to impose on clinicians and IT specialists in
the health service a centrally controlled national IT programme
which covers the entire population of England.
Concern has also been expressed in board papers of trusts around
the UK, questioning whether the timetable was too tight, the scale
too enormous, the objectives too diverse, the money too limited or
the plans not adequately thought through.
If the programme does not live up to expectations, a new SRO
could legitimately argue that it was not his or her programme, that
the foundations were laid a long time before they arrived, and that
he or she was presented with a fait accompli over the tight
timetable for choosing suppliers and delivering systems, the scale
of the programme and the diversity of its objectives.
Granger, for example, would be entitled to argue that the main
principles behind the national programme pre-existed his
appointment by about six months, although he has firmly supported
them. Other civil servants or ministers could blame clinicians for
not using systems; clinicians could argue that officials had
designed systems without sufficient consultation and without taking
into account the idiosyncrasies in the way they worked.
And if the programme dies a slow death, a new government after
the general election of 2005 or 2006 could declare that the work on
the national programme was not wasted: it was being dovetailed into
a new initiative, as was the national programme, which evolved from
a strategy in 2002, 21st Century IT, which evolved from strategies
in 1992 and 1998.
In his interview with Computer Weekly, Pattison had not intended
to announce his retirement as a revelation, but rather as a defence
against the possibility of our questioning him about the national
programme when he was in the throes of retiring.
He smiled when asked if Granger had reported directly to him.
"That is what everybody said. I never believed that. I reckon that
Richard Granger and I worked side by side. He had lots of skills
and I had some skills. I knew the NHS well. I knew the clinicians
well."
He said that chief executive of the NHS Nigel Crisp and
ministers were last week in the process of making the decision
about who would take over when he retired. He added, "Probably what
I will do is run in parallel with my replacement for a few months
because there is quite a lot of learning involved."
It was hardly the natural setting for an interview. He was
surrounded by award winners; delegates were waiting to talk to him
and workers were crashing equipment, but he smiled a great deal,
was composed, and answered questions with a grace and an openness
that was incongruous considering the secrecy over the programme.
The Department of Health has warned suppliers against talking to
the media about the national programme, and few IT staff in the NHS
believe they can discuss the initiative candidly without damaging
their careers.
So it was important for Computer Weekly to discuss the national
programme with Pattison, if only because IT managers have raised
many questions about it which they feel have been ignored, such as
how much will it cost our trust to implement new national IT
systems? And where will we get the money?
The Department of Health was unavailable for comment on
Pattison’s retirement.
The full interview with Pattison will be printed next
week
Why the SRO role is so important
Richard Granger, as director general of IT in the NHS, has been
the individual most closely identified in the media and IT industry
as being responsible for the NHS national programme.
But he has never been the government-nominated senior
responsible owner (SRO) for the project, as Sir John Pattison
is.
Granger is responsible for the national programme systems and,
to a lesser extent, for delivering the business change that will be
concomitant with the introduction of new IT. That is one of the
tasks of the SRO and emphasises the supervisory importance of the
role.
According to the Cabinet Office’s "Successful IT" document, the
SRO in all cases "must be the business sponsor of the change that
is driving the IT development. This applies to individual projects
and also groups of projects making up a programme."
The Department of Health’s Modernisation Agency is responsible
for delivering the changes in working practices, although it also
has people working on the national programme.
NHS IT plan loses another minister
Pattison was not the only person who was most closely associated
with the launch of the national programme. The minister who
launched the national programme and chaired a ministerial taskforce
to improve the leadership and direction of the programme was Lord
Hunt.
He and Pattison attended a meeting at Downing Street in February
2002 where the terms of the national programme were agreed.
But Hunt quit the government’s front bench earlier this year in
a protest over the Gulf War. So the two people most closely
associated with launching the national programme will not be in
post when implementation begins in earnest.
Health service's £2.3bn programme loses its head >>