Five years ago, in July 2002, Computer Weekly published
myfirst article about the National Programme for
IT(NPfIT).I’ll
ignore fifth anniversary “I told you so” temptations. Instead, the
editor has kindly agreed to publish the following open letter to
Gordon Brown:
Dear Prime Minister,
I don’t suppose that the
NHS National
Programme for IT (NPfIT) is high on your list of priorities. I
suggest it should be: you have an opportunity now to make some
simple changes that could transform the programme, benefit the NHS
and make a real difference to clinical care.
Most informed people welcomed NPfIT when it was launched in June
2000, recognising the need for a comprehensive update of NHS IT
systems. The project got fully started in April 2003 and, since
then, around £2bn has been spent and much more committed. A lot has
been achieved. Yet there are problems:
key elements of the programme are years late,
costs are escalating,
suppliers are in trouble,
users are disappointed and stakeholders feel neglected. The NHS
insists all is well:
a
recent report for your predecessor is reported to have said,
“Much of the programme is complete …” In contrast, an
April 2007 Public Accounts Committee report did not expect
significant clinical benefit before 2013/14 when current contracts
end.
My purpose is not to discuss which view is correct but to
recommend three actions that could transform NPfIT.
1. First, I propose that a full-time “senior responsible owner”
(SRO), as defined by the Office for Government Commerce, be
appointed with unambiguous responsibility for the entire project.
At present David Nicholson, NHS chief executive, is the official
NPfIT SRO and below him are other SROs responsible for various
aspects of the project. It is unsatisfactory that a project so
important to the future of the NHS should be managed in this way.
NPfIT is the biggest civil IT project in Europe and probably the
world. Expecting the person with overall responsibility for it to
have a range of other responsibilities is like expecting Churchill
to prosecute the Second World War while giving most of his
attention to painting, bricklaying and writing. A result is that
full-time responsibility is divided between various people who can
blame each other for any problems: thus we’re told by one faction
that all would be well if it were not for a failure of “attitudes
and behaviours” elsewhere.
In my view, the appointment of a full-time overall SRO would be
a huge step forward. And its implementation is probably easier now
in view of the recently announced
departure of Richard Granger, director general for NHS IT.
2. Secondly I propose that, as recommended in April by the
Public Accounts Committee, the business case for NPfIT be subject
to an independent review in the light of progress and experience so
far. Such a review is an essential element of any well-run project:
as time and circumstances change, so inevitably the original
business case can come to be seen in a new light. A project often
derives substantial benefit and fresh focus from such a review. The
results should be published, in particular as part of the
engagement exercise referred to below.
Independence is essential: evidence at a recent select committee
hearing regarding the farmers’ payments debacle showed how a
“conspiracy of optimism” had developed in the Rural Payments
Agency. Over time, people directly involved in a project can, quite
understandably, cease to be objective about it.
3. Finally, I propose that a major exercise be implemented to
engage NHS staff, especially clinicians, with the programme. No one
denies the need for such engagement yet, despite years of promises
and initiatives, the results have been dismal:
a
range of surveys has confirmed that most doctors and nurses,
whose support is vital if NPfIT is to be effective, feel that they
have not been adequately consulted. Consultation with and
engagement of end-users is a basic commonplace of project
management – yet this project has been running for over four years
and clinicians still feel neglected. Their initial enthusiasm is
evaporating. By any measure, it has been an irresponsible
failure.
It should be a long-term continuous programme comprising direct
individual contact, an interactive website, regular surveys of
opinion and a willingness to listen. Regaining enthusiasm at such a
late stage will be difficult. But it is essential: without user
enthusiasm the whole project is at risk. Properly done, it would
cost several hundred million pounds. But, if £1bn can be spent
engaging BT, surely a rather smaller sum can be made available for
the equally important priority of engaging clinicians?
I urge you to consider these recommendations. They need not mean
any serious delay in the continuing implementation of NPfIT.
Yours sincerely
Robin Guenier
Robin Guenier is an independent consultant and
chairman of the medical online research company, Medix UK. In 1996,
he was chief executive of the Central Computing and
Telecommunications Agency reporting to the Cabinet Office. He is a
liveryman of the Information Technologists Company (a City livery
company) and is chair of its medicine and health panel. He has
written this letter in his private capacity, in no way is it
intended to represent the views of Medix or of the
ITC.
More about Robin Guenier
>>
Further reading
Round-up
of news stories on the National Programme for IT in the NHS
>>
Tony Collins' IT projects blog >>
Public Accounts Committee report into the National Programme for IT
>>
Connecting for Health
website >>
NAO highlights perils facing key IT projects >>
Comment on Guenier's letter:
computer.weekly@rbi.co.uk