Tony Collins's IT Projects Blog

NHS Chief Executive David Nicholson: not focusing on successes and glossing over challenges.

Comment

The Annual Report of the NHS Chief Executive David Nicholson, which was published on 27 June 2007, has barely a mention of the NHS’s £12.4bn National Programme for IT [NPfIT].

For years the NHS, the IT industry, Parliament and the media has been groomed to believe that the NPfIT is not merely an IT strategy but a programme that would transform the health service, as Bazalgette’s sewers put an end to cholera epidemics.

Lord Hunt, the health minister most closely associated with the launch of the NHS's National Programme for IT, has left the Department of Health in Gordon Brown's shuffling of ministerial posts.

Less than four months ago, in March 2007, Lord Hunt told the HC2007 healthcare conference at Harrogate that he was pleased to be back as health minister.

Caroline Flint, a Health minister and government spokeswoman on the NHS’s National Programme for IT, has been moved out of the Department of Health as part of Gordon Brown’s ministerial changes.

Comment

In a speech in May 2007, accepting his nomination as leader of the Labour Party, Gordon Brown promised a “different type of politics – a more open and honest dialogue: frank about problems, candid about dilemmas, never losing touch with the concerns of people”.

Gordon Brown has also said that "Government must be more open and accountable to Parliament”.

We agree. As Lord Falconer, the Lord Chancellor, said in a speech in Newcastle on 18 October 2004: “The more there is a culture of openness, the better decision-making will be. If decisions have to be publicly explained, they will be better taken. Real informed accountability improves standards.”

All this is inconsistent, however, with a decision by the Treasury, when under Gordon Brown’s stewardship, to fund an expensive legal action in the High Court to protect government IT secrets from Parliament and the rest of us.

Alan Johnson has today (4 July 2007) announced an independent review of the NHS which will help inform the Treasury when it sets the funding for the health service as part of the 2007 Comprehensive Spending Review.

The review will be led by a practicising surgeon Sir Ara Darzi - and it will not be "controlled from above", said Johnson. He added that one aim of the review is ensure the NHS is "clinically led, patient centred and locally accountable". It will draw on the views of NHS staff, patients and the public.

It will look among other things at ensuring that "clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery". Johnson also emphasised that money spent on the health service needed to be invested wisely.

This review could be an opportunity for the government to revisit the £12.4bn National Programme for IT [NPfIT].

Many in the NHS want NHS trusts to have more discretion over what they buy, provided it meets national standards. If this happens as a result of the review, it is unclear how the programme's main suppliers, the so-called Local Service Providers, would make enough money from their NPfIT contracts to justify the investments they have made in national systems.

The Prime Minister Gordon Brown was told today (4 July 2007) that it could take up to 106 years for IT supplier EDS to pay all the money due as part of a legal settlement over problems with tax credit systems.

The settlement was raised at Gordon Brown’s first Prime Minister’s Questions by Tory MP Richard Bacon, a member of the Public Accounts Committee.

(based on years of chronicling dozens of IT-related project failures)

1) “It’s after all the biggest project of its kind.”
2) “So milestones have been put back a few times, objectives have changed, and perhaps undue importance has been ascribed to secondary benefits, but that’s not seeing the achievements in context.”
3) “No serious difficulties just teething problems.”
4) “We always welcome criticism if it’s constructive.”
5) “Turnover of team leaders is very low, considering.”
6) “It’s an exaggeration to say that when we're asked how things are going, we talk about how they will be in future.”
7) “No, the project isn’t sinking. It’s important to look at the specifics, such as what hardware and software to choose. That’s the big picture taken care of.”
8) “We don’t need stop-go decisions on this project. There’s no question of stopping.”
9) “There’s nothing to be gained from an independent review.”
10) “We're within the [latest] budget."
11) “Who looks after press inquiries?”

Many people inside and outside the NHS are asking: who is going to replace Richard Granger as head of NHS Connecting for Health?

The assumption is that whoever replaces Richard Granger will be in charge of the £12.4bn National Programme for IT [NPfIT]. That may not happen, however.

A useful general principle of project management is highlighted by a reader of E-Health Insider.

The comment was made in response to a media interview given by Richard Granger, Director General of NHS IT. I don't think the comment is fair in relation to Richard Granger, but it is useful in the wider context of project management generally.

It refers to Jim Collins, a US management guru, who suggests that when things go wrong great leaders look in the mirror rather than out of the window.

A medical organisation cited by the Department of Health as a reference site for the NHS Care Records Service has been criticised by a US regulator after 1.3 million sensitive files went missing.

Comment:

A report of the US Office of Inspector General on the loss of more than one million health records recommends that action be taken against individuals after a hard drive containing sensitive information went missing.

It highlights systemic weaknesses in government security policies; it singles out failures of an IT specialist and particular directors. It recommends that action be taken against them. A government-funded report as uncompromising in its findings is unlikely ever to be published in the UK.

There's every reason to believe that staff at the National Audit Office are at least as competent and investigative as the researchers at the Veterans Affairs Office of the Inspector General in the US. But there's a different approach in the presentation of reports.

Ministers who are appointed as spokespeople for the NHS's National Programme for IT [NPfIT] come and go.

This is the roll call so far: John Reid, John Hutton, Lord Hunt, Liam Byrne, Hazel Blears, David Lammey, Lord Warner, Caroline Flint, Rosie Winterton, Andy Burnham, Ivan Lewis, Patricia Hewitt.

All of these have made statements to Parliament on the NPfIT. All have moved on since, except Ivan Lewis. Having left the Department of Health, they perhaps cannot be held accountable for the accuracy of what they said about the NPfIT when they were in office.

It's even more unclear whether they can be held accountable for what they say about the NPfIT when they're in office.

On this blog on 16 July 2007 I posted a piece that asked whether the public spending watchdog the National Audit Office is too timid. A reader has posted an excellent reply.

1. Lack of clarity - about roles, responsibilities and requirements
2. Lack of defining and managing project requirements and failure to communicate these from project sponsors to developers
3. Inability to define/articulate problems
4. Poor design/implementation

The Department of Health has begun an investigation into how an "unauthorised" sponsored link on Google was acquired for NHS Connecting for Health which runs the NHS's £12.4bn National Programme for IT [NPfIT].

The companies that advertise on Google by way of links that are usually paid-for include eBay, Experian, Yahoo, Time Warner Inc, Pickamortgage, Best-Chat.net and Amazon. It is unusual for a government department or agency to advertise itself on Google.

A sponsored link for NHS Connecting for Health had appeared in a panel on some Google search results. It's unclear whether the cost of the advertising - which a minister denies was borne by taxpayers - would have been in line with the potential benefits to patients.

Sponsored links in general appear in a coloured panel at the top of the search results page, and in a narrow column on the right-hand side of the page. Both areas include a small heading identifying the results as sponsored.

In answer to a question by Stephen O'Brien, Tory Shadow health minister, the then health minister Caroline Flint said:

"This link was established by a communications agency contracted to NHS Connecting for Health without authorisation and without consultation on the search criteria used. This was part of a wider programme of initiatives to improve communications about the Connecting for Health programme. The arrangement has been terminated. No costs have been borne by NHS Connecting for Health or indeed by the taxpayer.

"We are exploring with the agency concerned the circumstances under which this arrangement was made and the terms under which it operated, including the search criteria." The results of the government's investigation will be placed in the library of the House of Commons, said Flint who has since switched ministerial jobs and is no longer in the Department of Health.

One result of the floods is that a GP practice in North East Lincolnshire is working from a neighbouring practice, and another is working from a local hospital's accident and emergency department.

It's said that praise shouldn't consist of a stream of adjectives. Praise lies in the facts and the way of telling them.

HM Revenue and Customs struggles sometimes with the way it presents facts. Which could explain why some of its urbane comments about its ASPIRE IT suppliers have missed the mark.

BBC's Radio Four's File on 4 documentary series is broadcasting a programme tonight [31 July 2007] on the ID cards scheme and whether it's likely to work. Computer Weekly staff contributed to the programme.

File on 4 is broadcast Tuesday 8pm and is repeated on Sunday at 5pm.

Link:

BBC File on Four - will ID cards prove a flop?

Analysis

NHS Connecting for Health has published on its website one slide from a “confidential” briefing presentation to the former Prime Minister Tony Blair on the NHS’s £12.4bn National Programme for IT [NPfIT], following inquiries by Computer Weekly.

Other slides in the presentation to Blair, which Connecting for Health hasn't published, give an insight into how officials wish to counter criticism of the programme.