Don't scrap the NPfIT?

Martyn Thomas, who’s visiting professor of software engineering at Oxford University Computing Laboratory, takes issue with my comment that too much has been spent on the NPfIT to scrap it.

He says:

“This is the ‘sunk value fallacy’ well known to economists. Popularly, it’s called throwing good money after bad.

“The right question, always, is ‘will the money that still has to be spent provide good value?’.

“With NPfIT, it seems no-one can be sure what the answer is – which is why you, and others, have repeatedly called for an open, technical, supportive, thorough review.”

He is right.

About £4bn has been spent on the NPfIT – but that doesn’t mean thelarge central infrastructure costs continue to be worthwhile. Or theadvance payments to some suppliers. Or the costs to the NHS ofpreparing for go-lives which don’t materialise. Or the tens of millionsof pounds spent hiring staff to help restore order after troubledgo-lives.

These are questions that could and should be answered by an independent, published review.

Ministersand the Department of Health have always refused to hold a review, a”hear-no-evil” attitude which highlights one the things thatdifferentiates public and private sector projects and programmes.Companies usually want to know:

– if a big project is in trouble
– if so, why
– if it should be abandoned.

Ministersand permanent secretaries usually want to know everything about bigprojects in their departments except the answer to these questions. And if they do find out they probably wouldn’twant anyone to know, particularly the opposition.

Thank you Martyn for pointing out what should have been obvious to me.


Can Brown or Cameron really make big IT cuts? – IT Projects blog

The NHS 23 still favour an independent review – BCS website

Martyn Thomas Associates

NHS IT wiki

How I got a job with Cerner – (US)

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Martin Thomas is quite right: the current plans for NPfIT are no basis for risking “throwing good money after bad”.

At the Labour Party conference in Brighton, the responsible Minister, Mike O’Brien signalled a significant change in strategy for NHS IT priorities. Sadly, there appeared to be no professional journalists present to report his most interesting views.

At a discussion arranged by the Social Market Foundation on the topic ‘Mobile Technology and the NHS’ both the Minister and Andrew Miller MP, Chair of the Parliamentary IT Committee (PITCOM), stressed how vital it was that new investment was made in mobile communications to support the effective implementation of the Darzi strategy. Mr Miller offered as evidence some of the benefits from the use of mobile communications that he had seen in healthcare in overseas countries.

Just two hours earlier, Gordon Brown had told the Conference that “we will bring together the National Health Service and local care provision into a new National Care Service”.

Mike O’Brien confirmed that substantial investment in mobile communications was necessary to support care in the community for social workers, community nurses, health visitors etc.

The Minister asserted that the economy could not afford any increases in the NHS overall budget. Funds to pay for the mobile communications for care in the community would have to be met by reductions in, and hence savings from, planned budgetary spending elsewhere.

This, he signalled, would come from the acute hospital sector.

Mr O’Brien stated that although, personally, he had thought the National Programme to be achievable, many in the Department felt that it had been “over ambitious”.

Lord Darzi’s report had recommended a reduction in the number of beds and patient activity within the “traditional district general hospitals” and an increase in the number of procedures undertaken in community care and within general practice.

Money had to be redirected from the acute sector to care in the community which would enable Gordon Brown’s “new National Care Service” to herald significant change.

At the end of the discussion, those with NHS information systems experience in the audience reflected that Lord Darzi’s “Clinical Five”, the target for acute hospitals in 2009/10, were not being achieved and would not be achieved in the large majority of hospitals.

Whether changes in priority that would deliver IT support to community care would materialise quickly enough, could depend entirely on how rapidly Ms Christine Connelly redirects funding and guidance.

Dare we actually hope that the opportunity will be taken to stop the trend of “throwing good money after bad” in NPfIT?

Tom Brooks