Tony Collins's IT Projects Blog

At a one-day event hosted by David Nicholson, Chief Executive of the NHS, "National Programme for Information Technology: Facing the issues, making progress" these were set out as eight challenges facing the programme:

A new era of official openness over on the NHS's National Programme for IT [NPfIT] began on 26 January 2007. On that date David Nicholson, Chief Executive of the NHS, spent a day listening to criticisms of the NPfIT and to proposals for putting the programme on the straight and narrow.

The event was called "The National Programme for Information Technology in the NHS: Facing the Issues, making progress." The audience of about 80 was individually invited. It included representatives from royal colleges, NHS trusts, the British Medical Association, the NHS Confederation, and suppliers to the NPfIT, BT, Fujitsu and CSC.

Some of the comments made by delegates that day were particularly important. One said safety lessons from implementations were "not being "systematically disseminated". Several delegates agreed that, for the programme to move forward, there needed to be an official admission of the strategic and local mistakes [not likely]. There was also agreement that the programme's objectives needed to be reprioritised.

And a white board was shown of eight challenges facing the NPfIT.

Comment

Kevin Barron, the chairman of the House of Commons' Health Committee, gave a sympathetic hearing last week to Richard Granger, head of the NHS's £12.4bn National Programme for IT [NPfIT].

Barron's fireside friendliness towards Granger was a contrast to a hearing on 26 June 2006 when the House of Commons' Public Accounts Committee investigated the NPfIT.

Loyalist Labour MP Kevin Barron, who is chairing an inquiry of the House of Commons' Health Committee into aspects of the NHS's National Programme for IT [NPfIT], has warned that too much questioning may harm scientific Progress.

Barron set out his views at the first of a series of hearings of the Health Committee into aspects of the NPfIT. MPs including Barron asked some witnesses whether they were in favour of an independent review of the NPfIT.

Barron's own comments suggested he was not in favour of too much questioning of the NPfIT.

He said: "If you go back in years in medical history, into some of the things that doctors were doing at the time, which made major breakthroughs, people were sceptical about [these]. People were questioning even what their peer groups were doing in terms of whether it was the right thing to do."

The NHS Confederation, which represents more than 90% of statutory health service organisations, has expressed concerns to the House of Commons' Health Committee about aspects of the National Programme for IT [NPfIT] in the NHS.

In a paper to the committee, which is investigating aspects of the NPfIT, the NHS Confederation said that organisations continue to be "fully committed to the overall vision" of a Care Records Service" which aims to give 50 million people in England an electronic health record.

But it said that "delays in the delivery of key operational systems which feed the NHS Care Records Service, such as patient administration systems, are "causing real problems and costs within the service".

Frank Burns, former head of NHS IT, has broken a long-standing silence over the health service's National Programme for Information Technology.

His unrestrained critique of the programme has been published by the House of Commons' Health Committee as part of its inquiry into aspects of the NPfIT.

His evidence adds further substance to calls by 23 academics for an independent review of the National Programme for IT [NPfIT] in the NHS.

He said there was, and is now, a "grotesquely over simplistic view of the transition from paper records to electronic records in the Health Sector".

And he observed that contracts on the scale of the NPfIT meant that "any major problem affects large swathes of the NHS simultaneously".

He added: "Worryingly this has also been found to be true for system failures where these have occurred." On 30 July 2006 the failure of a CSC data centre at Maidstone affected for several days 80 trusts across England - a IT problem of unprecedented scale in the NHS.

He also questioned whether the NPfIT will meet its main objectives. "Many in the NHS believe that by the time the systems procured are implemented and taking into account the need to standardise and simplify to allow simultaneous multiple site implementations--what they end up with will not be the sophisticated clinical management systems that they need for modern healthcare."

One highpoint of the first hearing of the Health Committee's inquiry into the National Programme for IT [NPfIT] on 26 April 2007 was an exchange between Martyn Thomas, who has called for an independent review of the scheme, and the committee chairman, Labour MP Kevin Barron.

Thomas made a good case for a review of the NPfIT and Barron appeared to remain sceptical throughout. Barron had not particularly welcomed his committee's deciding to hold an inquiry into the NPfIT.

Richard Granger, head of the NHS's National Programme for IT [NPfIT], when asked whether he supported the call for an independent review of the scheme, had made it clear that his door was open to critics whose comments were based on robust evidence.

But Martyn Thomas, visiting professor of software engineering at Oxford University's computing laboratory, emphasised the need for a review that was independent of the programme team

"Providence never intended to make the management of public affairs a mystery, to be comprehended only by a few persons of sublime genius, of which there seldom are three born in an age":

Gulliver's Travels - Chapter V1

Calls for an independent review of the NHS's £12.4bn National Programme for IT [NPfIT] were met with scepticism at a meeting of the Commons' Health Committee last week, despite increasing evidence of failings in the programme.

"It's the politicians and the media that are screwing up the system. Sure mistakes have been made - but it's the biggest non-military IT system implementation yet - so can we please allow the people a bit of leeway when they get things wrong."

This comment on the website of The Register - Give the Guys a Break - will be welcomed by many supporters of the NHS's National Programme for IT [NPfIT]. It sums up the view that those running the NPfIT should be left alone to get on with it, without criticism in the press and without concern about data confidentiality being expressed by some MPs and groups such as The Big Opt Out and the Foundation for Information Policy Research.

The comment on The Register said also: "If you watched just the first ten minutes of the Health Select Committee meeting yesterday [26 April 2007], you would realise that whilst there have been major errors in implementation - the system is getting there.

"If it wasn't for silly politicians arguing about how the e-care records are stored, and they let the people with the expertise get on with it, then I'm sure the system would be implemented faster."

As a regular slot this blog will cast a spotlight on organisations that publish up to date and comprehensive papers on their discussions on IT-based projects and programmes.

We will also name organisations whose minutes are strikingly uninformative, or out of date. Some departments and agencies don't publish any minutes at all, which is inexcusable for government organisations that should account to taxpayers on their discussions about how they spend public money.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing, Independent MP, Dr Richard Taylor, summed up the spoken evidence of the first group of witnesses, Richard Granger, Harry Cayton and Dr Gillian Braunold, as "bland platitudes".

These three witnesses had left the committee room after giving their evidence, without waiting to hear what the second group of witnesses - Martyn Thomas, Dr Paul Cundy and Andrew Hawker - had to say.

Speaking to Thomas, Cundy and Hawker, Dr Taylor, MP, said: "I am echoing David [David Amess, Tory MP on the committee]. It is so good to have you three after the bland platitudes we had from the first lot - absolutely refreshing. We were told user involvement was there from the beginning, and you said obviously it was not..."

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of the things that concerns me about the programme is that there is no definition of what is an acceptable level of security breach.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy was asked by David Amess MP: "Dr Cundy, is it a good thing that general practitioners will be offered a choice of suppliers for their electronic record system and does the decision to offer choice represent a change of direction by Connecting for Health and will it mean a less centralising approach to these issues?

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy said: "I know from my system in my practice is that there are times when I, quite frankly, do not have an immediate clue as to what is going on with a patient, and we have 20 years' worth of patient electronic records.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Richard Granger said: "...I would say with the time overruns that one of the problems with this programme is there was no financial contingency.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of my concerns about the way the programme is going is that it is in danger of locking itself out of the advances that will be made in the availability of healthcare systems around the world.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said:

"It seems to me that there are two issues that are being run together here. The overall objectives of the system seem to be trying to tackle two problems in parallel and those two issues are perhaps in conflict.

"On the one hand, there is the question of putting in good IT to support the clinicians supporting the patients, and I think everybody in the NHS is entirely behind that. Where IT can improve healthcare, it is sensible to deploy it once you are in a position to be able to be able to roll it out without disturbing things too much.

There is also the issue of transforming the way that the Health Service operates and the way that the Health Service is managed and the need for information to be available in order to be able to change the management structures.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the first Health Committee hearing MP Jim Dowd asked Richard Granger: "When you say it [the NPfIT] has got more functionality than originally envisaged, is that because the original estimates were just wrong?"

Richard Granger replied: "I do not know of a large-scale IT enabled transformation programme in a complex organisation that from its starting point to its mid point has a direct correlation.

"I think it would be a fantasy to imagine. I know people write fantasies, but in the real world it would be ridiculous to imagine that halfway through a ten-year programme you would only be doing the same things as you set out five years ago.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing the chairman Kevin Barron asked Martyn Thomas why he was calling for an independent review of the NPfIT. Barron's view appeared to be that the facts independent reviewers would discover would already be known to the project team. So why have an independent review? In reply Thomas gave a sound summary of the benefits of an independent review over one commissioned internally.

Barron asked: "Do you think that people who are involved in the National IT Programme at the moment are aware and conscious of those facts, whether reviews have been published or not in terms of that? Do you think they are not capable of knowing that as something in their daily business, as it were? The programme is not without its problems. Are these people who are developing it not capable of being able to do that?"

Thomas replied: "I have reviewed a lot of large technical programmes over the years, and I want to stress, I am not asking to review this one personally, I am not for a second bidding for that job, but my experience of carrying out those reviews is that people get blinded by the fact that they are too close to the project and they get compromised by the fact that they cannot stand back and admit errors.

Transformation - Do we know what we're doing?

In an excellent piece on Transformational Government Glyn Evans, Assistant to the Chief Executive (transformation) Birmingham City Council, rightly questions the phrase "Transformational Government".

He points out that it may mean in practice the sort of incremental change that happens anyway, which few outside government will notice - and if they do it's probably because something has gone wrong.

Statement from Connecting for Health, which runs the NHS's National Programme for IT, on Computer Weekly's article on duplicate patient records in Greater Manchester.

Download file

Connecting for Health, which runs the NHS's £12.4bn National Programme for IT, has responded to some our questions. These are its replies.