As ministers were publicly praising early progress on the NHS
IT programme, confidential initial Gateway reviews on the scheme
were scathing about poor planning, the approach, specifications and
lack of engagement with clinicians.
The first review of the National Programme for IT (NPfIT) in
June 2002 - a Gateway Zero strategic assessment of the scheme -
also confirms that the government planned for the "whole programme
cost" to be around £5bn. The cost is now put at nearly £13bn.
A separate Gateway review in October 2002 - about four months
after the National Programme for IT was announced - questioned the
plan to appoint five main suppliers.
The review report said that the plan in the outline business
case to use five service providers "seems to be an assumption
without justification". Just over a year later a small number of
large suppliers were given contracts worth £6.2bn.
Last week the Department of Health
disclosed
for the first time 31 Gateway reviews on the NPfIT - a week
after the information commissioner made an
unprecedented ruling that a slew of Gateway reviews be
published, including some on the NHS IT scheme.
Information is missing from some of the published reports. The
traffic-light red, amber or green status of the first Gateway
review on the NPfIT in June 2002 is not in the published text, and
some paragraphs in other reports end abruptly in mid-sentence. Most
of the text has been published with minor redactions, though.
The review reports show that ministers were, in the launch year
of 2002,making statements on the NPfIT, and answering parliamentary
questions on it, without giving any hint that then-confidential
Gateway reviews were raising doubts about the feasibility of the
plans and the approach.
Ministers carried out regardless of points raised in the initial
two reviews about whether a central approach was a good idea, and
whether the programme was being designed "in a vacuum" without
engagement of the medial professions.
These criticisms have been at the heart of disenchantment with
the programme in every year since 2002.
The initial Gateway review on the NPfIT in June 2002 said the
programme's timetable had been referred to as not merely extremely
ambitious but "hyper-ambitious". The review report added: "It is
that and more."
The government's health spokeswoman at the time, Hazel Blears,
told the House of Commons on 15 October 2002 that the NPfIT had
"successfully completed" a Gateway Zero review - strategic
assessment. But she didn't say that the review had been
scathing.
By the time of the first Gateway Zero review a specification for
electronic medical records - the Care Records Service - ran to 187
pages. But this first review found that "design work to date has
been conducted largely in a vacuum". There has been "little
injection of implementation reality and technology viability".
The prevailing sense was one of the programme being in an "ivory
tower". The review report said: "There seems to be a lack of
awareness of the need to engage at a detailed level with
stakeholders and indeed how to do so. In general terms this lack of
widespread engagement has led to there being no real perception in
the operational areas of what the programme is actually doing."
In October 2002, the Gateway One review for NPfIT e-records said
a small number of decided and professional people had worked hard
in a short time to produce documents to allow a procurement to
begin. "Unfortunately much of this work has not been conducted
within a rigorous project management framework".
Some Gateway reports also show that important risks were omitted
from NPfIT risk registers.
All Gateway reviews include criticisms - they exist for the OGC
to assess independently high-risk projects and programmes. But the
criticisms of the NPfIT in the first two main Gateway reviews go
beyond pointing to defects: they question the approach and
feasibility.
Taken together the reviews point to a flaw in the way the
government approves large IT programmes: without
parliamentary scrutiny of the cost, plans to cope with
excessive complexity and how to bring about change within the NHS
rather than just introduce IT.
Another flaw is that ministers can ignore recommendations in
Gateway reviews without the public, stakeholders or parliament
knowing what the reviews have said until years later, if at
all.
The Tories if they win the election are unlikely to solve this
problem, as they have announced no major changes to the way
projects and programmes are scrutinized or approved.
Was the NPfIT flawed before its launch?
A Gateway One review in October 2002, about four months after
the NPfIT was launched, showed a disconnect between the political
decision to launch the scheme and the ability of people to manage
and implement it.
The review report on e-records said there had been a "grand
vision" which was "conceptual" and then a "number of enthusiastic
people" had immediately set to work to turn the vision into reality
"without the requirement being fully defined and agreed".
The Gateway reviewers compared the approach of the programme to
building a car without designing it first.
"The analogy to a group of specialist car builders who are
separately providing the wheels, the body, the engine and the
transmission for a car that does not have an agreed design is
probably relevant."
Prophetically, the same report said: "There is much talk of what
the IT programme will achieve but little recognition of the
potential impact of this on current practices, procedures and
systems, both technical and organisational."
The flaws in the programme at these early stages - which appear
to have been ignored by ministers - could help to explain why the
main intended result of the NPfIT, a useful e-record for 50 million
people in England, is still years away.
NPfIT
failed nine Gateway reviews >>