Health minister Lord Warner is relaxed when answering
the toughest questions on the NHS’s National Programme for IT
[NPfIT].
Being a minister he can answer in any way he chooses, whether or
not his response has much bearing on the question.
Two weeks ago week at a press conference in Whitehall, a
respected BBC journalist asked Lord Warner whether a report on the
national programme by the National Audit Office, had been a “bit of
a whitewash”.
The journalist had observed that the report was “less barbed
than expected but was also a year late". He questioned whether
Connecting for Health, an agency of the Department of Health which
runs the NPfIT had played a part in the delay.
His question arose because of a Parliamentary convention which
ensures that reports of the National Audit Office are published
only after the department investigated has signed off the document
as factually accurate.
If officials raise many queries on draft reports, they can delay
the final publication date. In the 1990s, a Whitehall official
conceded at a hearing of the Public Accounts Committee that the
Department of Health had contributed to the delayed publication of
a report by the National Audit Office report on an IT-related
project Read Codes.
At last week’s press conference the BBC journalist said, “We
were advised at the National Audit Office that the reason [for the
delay in publishing the report on the NPfIT] was that the draft was
with Connecting for Health.”
He understood that there had been an “almighty tussle” over the
contents of the report, “with the obvious implication that what has
emerged is a bit of whitewash”. He added that Connecting for Health
appeared to have emerged victorious from the tussle.
Lord Warner did not seek to contradict the journalist’s claims
of arguments over the contents of the report, or that it was a bit
of a whitewash, and he deftly answered the question by promoting
the NPfIT.
He said, “It seems important in these projects – and the
National Audit Office recognises this - that there is both factual
accuracy and an uptodateness about the report in terms of the
information that is in it. This is a pretty fast changing project.
All sorts of things are now beginning to happen quite rapidly.”
He added that his department had a duty to ensure that the
National Audit Office understood the “complexity of some of the
figures and numbers in this area” and any delay was not about
ensuring that Connecting for Health emerged triumphant.
Some in the NHS disagree with the BBC journalist: they regard
the report as a comprehensive whitewash, not a bit of one. But the
apparent reluctance of the National Audit to criticise the
programme – in the face of deep concerns which are expressed by
directors of a number of boards of NHS trusts – is in some ways
understandable.
It is rare for the National Audit Office to investigate a live
project. Its auditors usually pore over the archived papers of
projects that ended, for good or ill, some time before.
By the time the audit office publishes a report on a dead
project, officials in Whitehall and ministers will be much less
sensitive to criticism than if the project were continuing.
Probably, the officials and ministers involved will have moved to
other posts.
In the case of the report on the NHS’s national programme, the
Prime Minister Tony Blair, who set the NPfIT in motion, is still in
office. He spoke with enthusiasm earlier this month (June) on the
NPfIT and the positive messages in the report of the audit
office.
So a critical report is likely to have angered the Prime
Minister who chaired a meeting at Downing Street in February 2002
when the NPfIT was given a provisional go-ahead.
Only five months after this meeting, in July 2002, the NPfIT had
successfully passed its initial “gateway review” by the Office of
Government Commerce. Gateway reviews are independent strategic
assessment of IT-related programmes at various stages in their
life.
Being a programme that is costing £12.4bn or more – the largest
IT programme undertaken by the UK government – political
sensitivities to criticism are particularly high.
And while a large project is continuing, auditors do not want to
be seen to be critical in a way which could affect morale. The
National Audit Office falls in firmly behind Connecting for Health
in criticising negative media of the NPfIT.
“There is a risk that negative reporting about the programme and
its progress will tend to increase the level of NHS staff
scepticism about the programme,” said last week’s report of the
National Audit Office.
So nobody should be surprised if the National Audit Office wants
to avoid being seen to add to negative perceptions of the
programme. However most major failures of IT-related projects
commissioned by various governments have at least one thing in
common: a hypersensitivity to criticism and a suppression of
dissent.
An independent report by consultants Arthur D Little on a
long-delayed project to build air traffic control systems for use
at Swanwick in Hampshire, for example, criticised the culture of
secrecy and management’s unwillingness to face up to bad news.
A further reason for a reluctance to criticise might have been
the difficulty of obtaining concrete facts.
Rather than dip hands into the scalding hot stew of commentary,
reports and papers of the many critics of the programme, it is
safer to go to a computer and read files from an unassailable
source: Connecting for Health. To obtain supplementary information,
the National Audit Office has sought the help of, for example,
those working on the programme in regions and clusters.
According to the “Methodology” section of the report, the
National Audit Office had little direct contact with the hundreds
of NHS trusts and GP practices.
The report said the audit office visited two of the early
roll-out sites to “identify examples of what the programme is
delivering in practice.” This is one of the only references in the
report to trusts having contributed directly to the report.
Yet it will be the widespread use of technology in trusts and GP
practices, and the changing of working practices to suit the new
systems, that will largely determine the success of the NPfIT.
The National Audit Office had received a plethora of
submissions, including papers from specialists, MPs, and
organisations such as the British Computer Society and the
Worshipful Company of Information Technologists.
Many of the submissions contained some cogent criticisms of
aspects of the programme. But the report of the National Audit
Office appears to attach little significance to the concerns.
In understanding what is and what is not important the National
Audit Office is likely to have been helped by having as an observer
one of its senior executives on the programme board of Connecting
for Health for two years.
This has its pros and cons. The placement gives auditors an
invaluable insight into the programme’s vicissitudes. It also helps
the audit office to give Connecting for Heath’s executives an
insight into the lessons from other government IT-related
projects.
But it leaves the National Audit Office vulnerable to a
perception of a potential conflict of interest. Could the National
Audit Office criticise a programme which has been advised by one
its senior executives, even if he did not take part in decision
making?
In the end, the audit office has published a report which
contains less criticism of the programme than a speech or media
interview by Richard Granger, Chief Executive of Connecting for
Health. Where the report does criticise, its comments are mild or
counterposed by a positive statement. In contrast, the praise is
effusive.
It appears, then, that the National Audit Office has faced one
of its toughest ever challenges in producing a report on the NPfIT.
If its draft report had been critical, this is likely to have
incited the anger of Connecting for Health, with the possible
result that the document might have gone unsigned by health
officials.
Had the report been published without any sign-off from the
department, this would have been a rare departure from convention,
and a potential cause of bitter exchanges over facts when auditors
and Whitehall executives came together at a subsequent hearing of
the Public Accounts Committee over the progress of the NPfIT.
The much safer alternative for the National Audit Office has
been to publish a largely uncritical report. It is replete with
praise for almost every aspect of the programme, and its findings
have been welcomed by the government as fully supportive of an
important and costly initiative, the largest IT programme
undertaken in the UK public sector.
The benignity of the report avoids any possible confrontation
with Connecting for Health over whether the facts in the report are
up to date and accurate.
The only disadvantage is that a BBC reporter asks the Health
minister an awkward question about a possible whitewash and one or
two MPs become suspicious that the National Audit Office has gone
native or become politicised in this instance.
In their formal responses, Connecting for Health and Lord Warner
took issue with not a single sentence in the report of the National
Audit Office. Lord Warner said, “This is a very positive report
which confirms that the programme to modernise the NHS’ computer
systems is much needed, well managed, based on excellent contracts,
delivering major savings, is on budget [and] has made substantial
progress.”
But if the National Audit Office has writes an unbalanced
report, which reflects the strengths of a programme and few of the
weaknesses, is it doing its job well?