A former Whitehall official has revealed that he and his colleagues were given 10 minutes to make the case to the Prime Minister over what became the world’s biggest civil IT-based modernisation programme.
The disclosure was made by Sir John Pattison who was headquarters director of research and e-champion at the Department of Health. He was speaking on BBC Radio 4’s “Wiring the NHS” documentary on the £12.4bn National Programme for IT [NPfIT], to which Computer Weekly contributed.
Sir John told the BBC that he was invited to Number 10 in February 2002 to a seminar on IT where he and his colleagues were “given 10 minutes to make the case” for a national programme.
Some in the IT industry may be surprised that the government made a provisional decision to invest billions of pounds in a technology-based programme on an apparently whimsical basis.
The lack of formality in the provisional investment decision meant that the government’s decision to announce the National Programme for IT [NPfIT] was made without:
- discussions with doctors and nurses on what they most needed from a major IT-based investment
- a debate in Parliament or an inquiry by a Parliamentary committee
- consultations with NHS IT directors and patient groups
- trials to assess potential loads on new networks of national systems that could be used by hundreds of thousands of NHS staff and clinicians
- studies into the required changes in working practices among doctors, nurses and other NHS staff
- independent assessments of the feasibility of plans
- an independent safety report on whether migrating data from old to new databases could be achieved without disrupting the care and treatment of patients
After the 10-minute presentation to Tony Blair, Sir John Pattison was asked to produce an outline implementation plan. And he was given three months to produce a document that laid down the standards, "or such standards and specifications and governance issues" as was possible at that time.
In March 2002, Sir John Pattison, who was by then senior responsible owner of the National Programme for IT [NPfIT], announced details of the scheme at the annual IT healthcare conference at Harrogate.
He revealed at that time that it was not thought through fully. He said: “I don't want to pretend that we've thought through all the consequences of this.”
Three months later, in June 2002, the NPfIT was announced formally and an advertisement placed for a new director-general of NHS IT who would receive a six-figure sum to manage "the IT challenge of the decade" - a "Herculean task" - which will require "extraordinary talent and experience".
Also in June 2002 - only four months after the meeting at Downing Street - the Department of Health published a document that set out the plans for the NPfIT. It was called “Delivering 21st century IT support for the NHS: National Strategic Programme".
It was only at this stage, when the shape of the NPfIT had been agreed documented and announced, that a "consultation" began.
Sir John Pattison told the BBC:
“They invited us to a seminar on it in number 10 and we were given 10 minutes to make the case … We quickly came down to suggestions for the four elements that should be developed in the first phase: first of all a platform, a solid dependable network, connecting up all parts of the NHS and top of that platform three specifics:
- one, an electronic patient record
- two, electronic booking of appointments
- and the third was electronic prescribing.”
Dr Paul Cundy, co-chair of the joint General Practitioners Committee and Royal College of General Practitioners IT Group, said of the meeting at Downing Street:
“The programme was very ambitious. That’s because of the level at which it was pitched - the famous Tony Blair sofa meeting.
“It was given a ludicrously tight timescale. The initial timescale I think was to deliver this electronic record for everyone within 29 months. That was impossible. If you’d asked anyone with their feet on the ground anywhere near any sort of IT project they would have said 'no', it’s not possible.”
Sir John Pattison told the BBC: “That was one of the two questions the Prime Minister asked: how long would it [the NPfIT] take?
“I suggested it would take three years. I think what we didn’t emphasise at that meeting or subsequently, we believed that people understood that this was simply the first phase; and if it was relatively straightforward, other than the infrastructure which you would put in place anyway, then that would take three years.
“The more elaborate you made each of those elements [e-bookings, electronic patient and e-prescriptions], then the longer it would take.
“So I think we didn’t really ever get that point across in the two or three years I was associated with the programme. That is possibly where some of the concern about delayed implementation has come from.
“Another thing we didn’t ever adequately get across was that the £2.4bn that was pledged was actually only the first three years of the programme.
“So the cost is staggering but the benefits are huge.”
The National Programme for IT in the NHS has been running about five years with some success. And some serious problems: there has been disruption to patient care at some “early adopter” hospitals and long delays in the introduction of a national service to make useful electronic medical records on everyone in England accessible to doctors and nurses.
Some of these difficulties may be traced back to early 2002: to the "Dragons' Den"-style of investment decision-making, to the lack of realistic risk analyses, to outline specifications that some suppliers thought vague and ambiguous, to a dutiful consultation that was not announced until the principal ideas had been formed, and to a lack of understanding of the scheme’s potential costs and complexities, especially the changes needed in the working practices of clinicians and the challenges of migrating data from existing hospital technology to new patient administration systems .
Indeed Sir John Pattison's commendable disclosures about the IT seminar at Downing Street in February 2002 show that, unfortunately, the informal style of decision-making of the government is not a myth.
Good intentions, encouragement from potential suppliers, a 10-minute presentation to the Prime Minister, a couple of questions from him and a response that it could take about three years if plans are not too complicated and the world’s civil largest IT programme was born.
The government's investment decision in the NPfIT did not go beyond a coterie of those in the know whose thinking was not sufficiently tested. And some in that coterie had 10 minutes to make their case to the PM.
Perhaps that explains why the Cabinet Office has refused our request under the Freedom of Information Act for minutes of the meeting at Number 10 where Sir John Pattison made his presentation.
The Information Commissioner has ruled that the Cabinet Office should publish most of the information requested by Computer Weekly. The Cabinet Office still says no. So much for open government.
If news leaked out that a fledging democracy had launched a technology project of enormous cost, size and importance on the basis of the informal style of decision-making that is parodied by the 10-minute presentation to the Prime Minister, its ruling party would, perhaps, be deeply embarrassed. Not the British government.
Its officials merely shrug and say in effect: ‘That’s the way it is and always has been. We don’t have to go to Parliament to ratify our investment decisions however large they are. Whatever we do, we do with the best of intentions. On this basis you must trust us. If we want to spend billions on an IT project that, it turns out, we haven’t thought through we can; and the Freedom of Information Act cannot be used to discover how we make our IT-related decisions; indeed we cannot be compelled to tell Parliament, or anyone else, how things are really going on any large government IT project. It’s our right to give you our interpretation of how things are going.’
Inefficient government is not the fault of Labour. But its unwillingness to change the bad habits of decades is blameworthy.
We believe the NPfIT was launched in good faith. And we support its objectives. But the government may rue the dangerously complacent and unaccountable way it set about approving the scheme in early 2002. The potential benefits are great. But so are the risks to hospitals and patients of poor implementations.
It’s too late for the NPfIT. But it’s not too late for the government to put new proposals on large mission-critical IT projects to Parliament before a final decision is taken.