How to deal with bad news – and a case study on mismanaging it

– A case study on NHS Connecting for Health’s handling of news of £5m worth of penalties accrued under the NHS National Programme for IT

Comment and analysis

Officials at NHS Connecting for Health who run part of the £12.4bn National Programme for IT [NPfIT] are deeply committed to the success of the programme: they’re doing their best in trying circumstances.

When they make public statements on the state of the NPfIT they have no wish to deceive. So why, when we ask difficult questions on the NPfIT, do they respond by reaching for a form of words that is anything but an affirmation that problems exist?

The reason, it seems, is that they’re hidebound by Whitehall’s convention of sidelining openness and honesty as two naughty schoolboys in a classroom of gifted pupils.

A culture of introspection and defensiveness reigns. It means that officials are allowed to answer difficult questions from journalists with statements that are succinct or prolix, imaginative or dull, but not artless and simple.

The latest case is that of the £5m worth of penalties from CSC in the North, Midlands and East of England where the supplier is the local service provider.

That penalties have accrued from CSC is not in doubt. The penalties were reported to a regional board of the NPfIT in the North West of England. The board was told:

“With regard to the arrangements for managing financial consequences arising from deployment delays, it was noted that to date, approximately £5 million of penalty payments from CSC had accrued across NME.” NME is the North, Midlands and East of England region of the NPfIT.

The board was also told that the NME board has decided to retain the £5m rather than distribute it to strategic health authorities, or buy additional services from CSC, though this would be kept under review.

When I asked NHS Connecting for Health about the penalties its statement was anything but elucidatory. Its response made me more unsure of the ability of NHS Connecting for Health, or the Department of Health, to manage NPfIT communications.

Adept managers of bad news would have explained what CSC’s penalties were for and why they’re small in the context of a £12bn programme. But this was the NHS CfH statement to Computer Weekly:

“We are not aware of any penalties paid by local service providers due to delays in deploying new systems to Trusts.”

And the statement’s next sentence might have meant something to its author. To me it was meaningless. I had asked about penalties. NHS CfH said:

“A framework does exist to manage changes in deployment and both suppliers and the NHS continue to work together to manage any changes in planned deployments.”

This statement was in the mould of a denial by a householder of a report in a local paper that a cat has fallen from his tree. He knows a cat has fallen from his tree. But he also knows there are no high trees in the area. So he issues this statement: “There’s no evidence a cat has fallen from any high trees in this area.” It’s semantically true. But it’s misleading.

Penalties of £5m are small when compared to CSC’s NPfIT contracts which are worth potentially about £2bn – if it delivers everything expected of it. Even so £5m is a sizeable sum to come out of net profit; and it shows that CSC is finding things far from straightforward.

I’d asked NHS CfH several questions about the penalties on 2 January 2008. It didn’t reply until 7 January. These were my questions and NHS CfH’s answers:

Q: How much has been paid in penalties in total by local service providers over deployment delays?

A: We are not aware of any penalties paid by local service providers due to delays in deploying new systems to Trusts. A framework does exist to manage changes in deployment and both suppliers and the NHS continue to work together to manage any changes in planned deployments.

Q: Does the penalty paid by CSC over deployment delays open the door for local service provider claims for compensation, penalties or the equivalent of penalties, in relation to a lack of NHS-related business?

A: We are not aware of the penalty to which you refer.

Q: This penalty appears to show, when other problems are taken into account, that the technology for the NPfIT has not largely been delivered, despite claims made by CfH/Department of Health in a briefing last year [February 2007] to the prime minister. Any comment please?

A: As previously stated, we are not aware of the penalty to which you refer.

Delivery of all the aspects of the Programme has been in-line with the previous briefings given. Our web site holds relevant information.”

Were this an isolated case of obfuscatory answers it perhaps wouldn’t have mattered. But the links below show it’s not.

There’s a serious point in all this for the future of the National Programme. A project to build a new air traffic control system at Swanwick in Hampshire was smitten by poor communications. This was highlighted in a government-commissioned report by consultants Arthur D. Little. The NPfIT is also smitten by poor communications.

This was highlighted by a report published in December 2006 by the British Computer Society’s Health Informatics Forum Strategic Panel. The report was called “The Way Forward for NHS Health Informatics – Where should NHS Connecting for Health go from here?”.

The BCS said that the “services deployed so far represent poor value for money”, that political pressure has caused health officials to “deny problems and to defend the indefensible,” and that implementation plans that have “all too frequently ranged from the optimistic to the unreal”.

I believe that officials at CfH understand the NPfIT’s strengths and weaknesses. But if they continue to feel duty-bound to contend publicly that the only real problems are with the media, opposition MPs and ill-informed perceptions, they will continue to feed a suspicion among some doctors that those running the NPfIT are not in touch with reality.

David Nicholson, the Chief Executive of the NHS who is also the overall senior responsible owner of the NPfIT, told a conference that NHS Connecting for Health must emerge from its “bunker mentality”.

He said the organisation was too defensive. His comments were made a year ago and NHS CfH is still ensconced in the bunker.

If doctors and nurses become through official misinformation so distrustful of what they’re told officially about the state of the NPfIT they may assume that even accurate reports of positive developments are suspect. And that on its own could condemn the programme to benign oblivion. Senior officials at NHS CfH and the Department of Health have enough serious problems to deal with. It’s within their power to strike “poor communications” off the list of serious risks to the success of the NPfIT.


Government spin – a worrying precedent

NHS withdraws website report on weaknesses in national IT plan

Government spin – Whitehall tries to disparage our NHS article

How government spin doctors reacted to a CIO’s comments that only 30% of IT projects succeed

Is Whitehall discouraging broadcasters from criticising the NPfIT?

NHS records system delays cost CSC £5m

Statistics and the NPfIT “success”

Whistleblowing for health