Tony Collins's IT Projects Blog

NHS Connecting for Health, which runs the NHS's National Programme for IT NPfIT], has withdrawn its speakers from Europe's biggest annual IT health conference at Harrogate.

The agency, which is part of the Department of Health, is under political pressure to improve its communications and engagement with the health service, which suggests its speakers would want to be at the HC2007 Healthcare computing conference in force.

But two weeks before the conference and exhibition, the three speakers from Connecting for Health have been withdrawn.

The most common factor in the failure of many large IT-based programmes is the lack of a clear objective, it was said at a recent roundtable meeting of the Association for Project Management.

So where does that leave two of government's biggest projects, ID cards and the NHS's National Programme for IT [NPfIT]?

An executive who has IT responsibilities for several large hospitals has phoned to enthuse over the Private Eye special report on the National Programme for IT [NPfiT]. He described it as very well informed.

Not everyone connected with the NPfIT who reads the report will be quite so enthusiastic. Whatever your reaction to the report there is one thing in particular that should be mentioned.

Connecting for Health, which runs the NHS's National Programme for IT [NPfIT] has suggested that it is withdrawing speakers from the HC2007 Healthcare IT conference because their time is limited and, if they can spare it to speak at conferences, it would be better spent talking directly to doctors and nurses.

Now an anonymous email to this blog makes the point that managers are important too; and without their analytic competencies and actions, the "smooth running and efficacy of the NHS would be at risk".

This is the article on NHS Connecting for Health's withdrawing speakers from the HC2007 conference - here

This is the anonymous email:

"Clinical professionals of all types will need to input and make decisions based on outputs from the new applications currently being implemented; but what of all the other areas of making the NHS an effective, efficient and efficacious entity?

This is from a brochure produced by the public relations company Bell Pottinger on its Issues and Crisis Management service. The contact name on the brochure is Claire Cater, a director of Bell Pottinger, who has been seconded from the company to work on the NHS's £12.4bn National Programme for IT [NPfIT].

Bell Pottinger Group
Issues and Crisis Management
24hr crisis line:

Helping organisations and individuals to prepare, build, manage, manage, recover and protect their reputation.

Contact Claire Cater: [phone number]
24hr contact number: [phone number]

A spokesman for NHS Connecting for Health, which runs the NPfIT, said "absolutely not" when asked if Bell Pottinger has been hired to work on the NPfIT because of its skills in crisis management.

But the fact remains that Cater is depicted in Bell Pottinger's literature as a specialist in crisis management, and she replaces James Herbert, former Shell International PR executive, who has ceased to be director of communications and stakeholder engagement at Connecting for Health.

Lord Hunt, the health minister responsible for the NHS's National Programme for IT [NPfIT] says the biggest challenge is getting "local ownership of the programme."

He was referring to an initiative of David Nicholson, the Chief Executive of the NHS, who has helped to put in place the National Programme for IT Local Ownership Programme. This aims to devolve responsibility for the NPfIT to the heads of strategic health authorities, and the chief executives of NHS trusts.

Speaking at the HC2007 Healthcare IT conference at Harrogate on 19 March 2007, Lord Hunt said: "The biggest challenge is this question of local ownership of the programme. I have no doubt about that whatsoever. I see that as a minister that is one of my major areas of work in engagement with local NHS organisations.

Comment:

In 2003 Computer Weekly interviewed Lord Hunt, after he had resigned from the government over the Iraq war, at which time he had an easy self confidence, and was always enthusiastic about the National Programme for IT [NPfIT] and its future.

At the HC2007 Healthcare IT conference conference at Harrogate on Monday 19 March 2007 he was not as relaxed.

A helpful (anonymous) request was sent to this blog today (21 March 2007) in response to our article about a not-so-relaxed health minister, Lord Hunt, who made a speech to the HC2007 Healthcare IT conference at Harrogate on Monday 19 March 2007:

"I'd like to see some articles about how you deal with a failed or part-failed project. What do you actually do when you've contracted to deliver things you didn't understand, the project has muddled along for a few years with everybody doing what they can, and the consequences are gradually getting clearer?"

We'll be seeking some expert help but meanwhile any suggestions welcome.

Anyone who wants to comment anonymously on this blog site should leave blank the field in the comment form which asks for the email address. If this is left blank not even we know who the emailer is - the email address of the sender is not seen by us.

Several years ago, executives at Accenture, who were working on a replacement National Insurance Recording System, NIRS2, joked privately that the system was so complicated nobody else could run it. They have been proved right.

Gordon Brown's HM Revenue and Customs is now locked into Accenture in what an internal government briefing paper says could be an indefinite period.

This explodes the myth that the government can replace any supplier in a competitive bid if it really wants to.

Comment

Some newspapers have followed up Computer Weekly's article on the escalating cost of the "Aspire" contract between HM Revenue and Customs and its main IT supplier Capgemini. The Daily Mail - "Computer firm in Labour's tax credit fiasco gets extra £3.5bn" - is here, The Independent - "Cost of Revenue computer system soars to £8bn" - here, and "IT Cost Soars" in The Times here.

In a defensive response to The Independent, HM Revenue and Customs said that the cost of running the enlarged department's IT systems over the next three years is about £100m lower than if the systems had been run separately, that is if the IT contracts at Customs and Excise and Inland Revenue had not been amalgamated after the departments merged in 2005.

This departmental response is odd.

Below is a memorable quote from Dr Phil Candy, National Education, Training and Development Director at NHS Connecting for Health, an agency of the Department of Health that is managing the IT element of the National Programme for IT [NPfIT].

The quote is a self-evident truth but is pertinent in the context of the NPfIT because centralised IT initiatives have been prone to failure (Hospital information Support Systems for example). These failures have occured in part because NHS trusts did not want the centrally-promoted systems - at Wessex Regional Health Authority for example.

"You can have the best technology, the most advanced functionality possible, but if people don't want it - perhaps because they aren't equipped to use it - then it's in danger of falling flat."

Below is the full text of a speech by the Health Minister, Lord Hunt, on the NHS's £12.4bn National Programme for IT [NPfIT].

The speech on Monday 19 March 2007 was at HC2007, the annual healthcare IT conference at Harrogate HC2007. The conference was organised by the British Computer Society Health Informatics Forum and the British Journal of Healthcare Computing and Information Management.

The text does not include Lord Hunt's replies to audience questions. Being unscripted these were more interesting. A blog article on Lord Hunt's speech, including the questions and answers session is here. Lord Hunt's biography is here.

**

Lord Hunt's speech to HC2007 at Harrogate on 19 March 2007:

"Thank you. I am delighted to be here and to be back as Minister for the Department of Health. I am also delighted to have been given responsibility for IT. My title is Minister for Quality, and I am also responsible for patient safety and I see IT as playing an integral role in this. I was responsible for NPfIT when it was established and, having been away for 4 years as Minister in DWP, it is good to come back and see how it has progressed.

Comment

On 19 March 2007 Lord Hunt, the Health Minister in charge of the NHS's National Programme for IT [NPfIT] showed a slide at HC2007, the annual healthcare IT conference at Harrogate, which suggested he did not see the technology for the world's biggest non-military programme as a principal challenge.

The slide outlined "challenges to future delivery" and said:

- "The technology has already been delivered - the remaining hurdle is to utilise these systems fully at local level.

- "The key challenges and risks to delivery are now not about the technology to support NPfIT but about attitudes and behaviours which need to be the focus of attention as we move forward."

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An anonymous emailer claims that crisis management experts employed by NHS Connecting for Health, which runs the NHS's National Programme for IT [NPfIT], were seen at one of the more controversial sessions at HC2007, the annual Healthcare IT conference at Harrogate.

The session dissected the NPfIT to discover its strengths and weaknesses. The crisis management experts are said by the emailer to have registered as press delegates. Connecting for Health is employing crisis management experts to work on the NPfIT but it denies they are being hired to do any crisis management on the programe.

If the anonymous emailer is correct, it suggests that NHS Connecting for Health will have discovered some of what was said about the NPfIT at the conference, even though its three speakers - who were each due to give key addresses - were withdrawn at short notice from the event.

The emailer's comment:

"Perhaps you could frame your questions to the newly appointed crisis management experts (sorry, delete, that is not what they are doing in Leeds); rebuttal team (sorry, not that function now either) - Communications team at NHSCFH - who were seen at Harrogate on Monday gathering views (pity they missed the other good stuff on the other two days) - after all they were badged as fellow 'Press' people there."

CSC is the most open of the Local Service Providers appointed under the NHS's National Programme for IT [NPfIT]. It has, for example, put documents on the web that explain some of its plans for transforming the NHS - here.

But at a time when the NPfIT local service providers are facing criticism that they are installing old patient administration systems, it's a little unfortunate that the key CSC document on how it plans to transform the NHS has the pdf title of "1982_1".

Experience of failure can be an important virtue in a senior manager of a large IT-related project or programme, but employers usually seem to want people who've had an unbroken chain of success.

Someone who has had an overview of a major failed project from conception to cancellation and who can identify the lessons may be as useful, and perhaps more so depending on the individual, than a person who knows only of success.

Whereas the manager who knows only of success may dismiss showstopping problems as minor and transitory, the manager who has experienced failure may be more finely-tuned to recognising the early warning signs of a potential calamity.

That is why a job advert for a pan-Strategic Health Authority Programme Director for the NHS's £12.4bn National Programme for IT [NPfIT] , is a little worrying. The advert, which is marked "management in confidence", seems to seek someone who will countenance only success, whose senses, perhaps, should be dulled to any possibility of failure.

An inquiry by the House of Commons' Health Committee into aspects of the NHS's National Programme for IT [NPfIT] will begin with a hearing on 26 April at which Richard Granger, Director General of NHS IT, will answer questions from MPs.

Other witnesses on that day will be:

• Harry Cayton, National Director for the Patients and the Public,Department of Health
• Dr Gillian Braunold, National Clinical Lead for GPs, Connecting for Health
• Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
• Dr Martyn Thomas, visiting Professor of Software Engineering, University of Oxford
• Andrew Hawker, NHS patient

On Thursday 10 May, the following will give evidence:

• Douwe Korff, Professor of International Law, London Metropolitan University
• Joyce Robbins, Co-Director, Patient Concern
• Jonathan Bamford, Assistant Information Commissioner
• Andrew Spence, Solution Director, NHS Account, Computer Sciences Corporation
• Brian Randell, Professor of Computing Science, Newcastle University

There will be further hearings on Thursday 7 and Thursday 14 June. We don't know yet who the witnesses will be.

Of the witnesses named so far, four are known to be enthusiastic supporters of almost every aspect of the programme. A smaller number - three - are known to be enthusiastic supporters of the objectives of the programme but have independent views on how things are going.

On 6 March 2007 we asked Connecting for Health, which runs the NHS's National Programme for IT [NPfIT], about a paper published by the British Computer Society - "The Way Forward for NHS Health Informatics".

The paper contained much praise for the NPfIT and the work of Connecting for Health. It made it clear that the British Computer Society wants the NPfIT to succeed. The Society has thousands of members working in support of front-line NHS services.

The paper also made some far-reaching criticisms of the NPfIT, for example that political pressure has caused health officials to "deny problems and to defend the indefensible".

Some other points in the British Computer Society's report:

- Put implementation of the Personal Spine Information System [personal health record] on hold

- While the NPfIT has delivered a number of local operational systems including PACS [x-ray systems called Picture Archiving and Communications Systems] PAS [patient administration systems], and some Community Health and departmental systems, it is possible that at least similar levels of delivery could have been achieved by the processes that were in place prior to the NPfIT...

- In the area of acute electronic patient record, NPfIT has majored on patient administration replacement and this has reduced the number of acute electronic patient record systems that would have been implemented had the NPfIT not existed.

- Viewing NPfIT as just an IT project as its name implies has led to implementation plans that have all too frequently ranged from the optimistic to the unreal.

- Overall, the net deliverables of the NPfIT have been limited considering the scale of what was planned. The NPfIT has been successful in limiting payment for non-delivery, but having under spent because of not delivering is hardly a success and the central costs incurred by NHS CFH are such that, so far, the value for money from services deployed is poor."

We asked Connecting for Health: Do you accept any of the above points, in particular the comment the one about political pressure to "deny problems and to defend the indefensible"?

Three weeks later we're still awaiting a response from Connecting for Health or the Department of Health.

GP Mary Hawking, a knowledgeable critic of aspects of the NHS's National Programme for IT, has pointed out that, in this blog's coverage of a speech by Health Minister Lord Hunt to the Harrogate healthcare IT conference, we failed to mention her questions to the minister.

She asks a good question about the NPfIT Local Ownership Programme. The scheme makes chief executives of strategic health authorities, primary care trusts and hospital trusts responsible for the success or failure locally of the NHS's £12.4bn National Programme for IT [NPfIT].

Mary Hawking asks what Whitehall is devolving to the NHS under the Local Ownership Programme. She then asks whether what is being devolved is "ownership of IT or only the responsibility for enforcing CfH diktats?" CFH is NHS Connecting for Health, an agency that is in charge of the NPfIT.

A slide shown at the HC2007 Healthcare IT conference at Harrogate suggests that NHS IT has travelled a circular route in seven years.

This list is part of the evidence from Computer Weekly which was published by the Work and Pensions Sub-Committee of the House of Commons, as part of its report on the management of IT projects. Although our paper was written with Whitehall departments in mind, several of the points may be relevant to private sector projects.

1) Better guidelines and advice will not prevent IT disasters. What are needed: tough decisions, direct language, and the ability to listen to warnings that are "off message".

2) Departments will sometimes not take tough decisions when serious problems emerge because they fear bad publicity. This provides the perfect breeding ground for IT disasters.

3) Openness is the first casualty of a project that is in serious trouble. Sometimes, it seems, ministers are not always aware of the seriousness of IT problems within their departments. But if ministers cannot always discover the breadth and depth of problems on major projects within their departments, who can?

4) Serious problems are sometimes categorised as teething troubles. Yet computer projects are largely about solving problems, sometimes serious ones. If problems cannot be faced up to unless circumstances force recognition of them, options for resolution may be limited to disaster avoidance.

5)Do not expect suppliers to always tell the whole truth. Those suppliers that do suspect they will not win the contract. In the UK civil service, and particularly among IT suppliers, criticism is associated wrongly with disaffection. Until optimism is checked by realism and scepticism, and constructive criticism is encouraged, we should expect project failures to continue.