Parliamentary IT adviser Tom Brooks argues that NAO
report overlooks crucial issues
Enough evidence now exists to make everyone aware that there are
serious doubts as to whether the National Programme for IT will
ever be able to provide the necessary IT capability to underpin the
modernisation of the NHS.
Everyone, that is, except for ministers, who seem in a state of
denial, and the National Audit Office, which appears overwhelmed by
the task of peering into the deepest recesses of NHS Connecting for
Health, examining the evidence and interpreting the facts.
The NAO's report on the National Programme for IT in the NHS,
said, "NHS Connecting for Health has taken positive action to
ensure the contractors are managing their tasks well."
How can that possibly be true when all the main contract
deliveries are running so late?
The NAO was taken in by the Department of Health's propaganda,
congratulating it for the procurement of contracts being "completed
commendably quickly". If that was so, how then does the NAO explain
why the deliverables are appearing so slowly?
The NAO report virtually salivated with excitement about the
speed of procurement, blithely recommending that other
organisations learn lessons from the experience of Connecting for
Health, in particular the advantages supposedly gained through the
swift procurement exercise.
Yet the same NAO report pointed out that the delivery details in
the national data spine contract had to be reorganised and replaced
the following year. The core care records element of the Accenture
contract had been revised into four releases, the last of which was
13 months later than the original target date. Customers of CSC
fared even worse, with the contract rescheduled into five releases,
the last of which is now due 22 months later than originally
planned.
Despite being the main contractor for the data spine, BT was 14
months later than contracted in deploying a London system to
operate with it. Fujitsu, having been pushed into a "common
solution project" with BT by Connecting for Health, faced the
embarrassment of having to change its principal subcontractor just
over a year into the contract.
The reality of Connecting for Health's "swift procurements" was
a record of delays and timescale renegotiation before the
programme really got started. It is hardly convincing evidence of
success.
So what confused the NAO into believing the procurement was
sound? Should it not have spent more time exploring the root cause
of these contractual failings? Did the NAO go back to the original
swiftly drawn-up contracts to examine their quality? If it had done
so, it might have noticed that the contracts postponed agreeing a
great deal of the detail until after the contracts were signed.
According to supplier sources, documents in various contracts
had to be produced after the contracts were signed. The missing
details included service level specifications, helpdesk
interworking procedures, annual implementation plans, component
system descriptions, quality plans, disaster recovery plans, module
testing plans and specifications - the list is interminable.
The NAO does not appear to have uncovered the extent of the
contractual holes that existed at contract signature time, nor
examined how much the absence in early 2004 of such important
detail from the contracts led to the subsequent rescheduling and
delays.
In May 2004, Computer Weekly revealed that only five months
after the deal had been signed it had run into contractual issues.
A leaked BT document revealed that the issues the supplier was
facing arose from "detailed definition of requirements and
practical deployment not envisaged at the effective date of the
agreement". Was it a case of sign in haste, correct at the
contractor's pleasure?
The NAO has not revealed how these differences were resolved,
nor at what price to the taxpayer. Subsequently, nearly all the
main contracts were redrawn to adopt a much slower product release
plan than the one originally envisaged. Whatever time was
supposedly gained in the procurement phase has certainly been lost
in the implementation. How on earth did the NAO miss this crucial
point?
The NAO claims that although there have been delays in
delivering the NHS care record service, suppliers - not the
taxpayer - have borne the cost of overcoming the difficulties in
delivering the software.
But elsewhere in its report the NAO recorded that the
dissolution of the contractual commitment for the common solution
project between BT and Fujitsu had added £62m to the original £934m
cost of the Fujitsu contract. Who is paying this £62m if not the
taxpayer?
Before Richard Granger's arrival as chief executive of
Connecting for Health and director general of NHS IT, a
well-constructed consultation exercise took place to define what
the NHS needed from the care records service. The NAO report said
that the final output-based specification had been issued to
prospective suppliers early in the contract negotiations.
But soon after contracts were awarded, the requirements were
redefined into "bundles". Connecting for Health broke the links
with the output-based specification requirements when it defined
different bundles for the northern iSoft and southern IDX
solutions. Bundles were then allocated to releases and phases,
which have been redefined several times.
Confused? So, apparently, was the NAO. It recommended, "While
some adjustment of suppliers' milestones for the delivery of
functionality may be a necessary pragmatic response to suppliers'
difficulties in delivering, it should not allow this to compromise
the eventual achievement of the vision of the fully integrated care
record service that was the objective of the programme at its
inception."
Does this mean that timescale slippages are OK as long as there
is no admission that the end date will be missed?
There is no longer a published specification of what suppliers
are contracted to deliver. Connecting for Health has never
published content specifications for each software release and
phase that is remotely equivalent in detail to that in the
output-based specification. Yet if, as the NAO report recorded,
"The plan remains for the entire implementation to be completed by
2010 in accordance with originally contracted timescales," a
detailed specification of each phase must surely exist.
How likely is it that this NHS IT implementation will succeed
and the 2010 target be met? The NAO seems too confused to express
an opinion. On the one hand, its report commended "the notable
progress and tight control of the central aspects of the
programme". On the other it nervously noted that "successful
implementation of the programme nevertheless continues to present
significant challenges".
There is no guidance in this report for MPs concerned that
billions of pounds of NHS money could be wasted. The need for
parliament, independent of the Department of Health, to commission
an open, transparent study into the state of the National Programme
for IT is greater than ever.
Whitehall remains firmly in denial that a problem exists.
Ministers are badly misguided. The NHS is an institution revered by
most of the population. It deserves all the support it can get to
deliver the 21st century healthcare that patients require. The NAO
report does not help it achieve that goal.
● Tom Brooks is a long-standing member of the Parliamentary
IT Committee, who has for several years helped MPs with their
scrutiny of NHS IT development
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