IT expert argues with Health Committee chairman for independent review of NHS's National Programme

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

Barron saw a technical review of the programme – which Thomas and 22 other academics have called for – as something distinct from a review of human aspects of the scheme.

But when the government in 1998 commissioned an independent review of a troubled project to build systems for the New En Route Centre at Swanwick in Hampshire, it ordered two separate reports, one technical – which encompassed human aspects of the programme – and one that took in the scheme’s finances and management.

Barron began the exchange with Thomas by asking him whether an independent review would delay the NPfIT even further.

Thomas replied: “I really don’t think it would cause delays. It’s a common myth that planning slows things down.”

Thomas added that insufficient planning had been done before the NPfIT started.”The consequence of that is that you have two years slippage and more to come no doubt on the Care Records [Service].

“I genuinely believe they [the programme team] are hampered at the moment by the fact that ministers have made policies; that they have published details of rollout, and the number of acute trusts that will receive certain systems within a certain timescale.

“In order to really deliver the sort of things the NHS needs, and to get the prioritisation right, somehow you have to trade those things off and that means getting away from the spin of how successful things are at the moment.”

One result of this spin was that the programme was being judged on input statistics, such as the number of transactions, rather than “output benefits statistics that actually tell you how healthcare has improved as a consequence”.

Thomas said: “To get away from that [we need] to have a completely independent view as to how well is the specification understood, what can we do rapidly to make the specification of the systems that are going to be built really fit in with the clinical needs. Can we tease apart the issue of providing technical support for technical clinical functions within hospitals from transformation of the health service in managerial terms? Is it possible to separate those issues?

“If it’s not, how can we get the appropriate level of organisational buy-in for the specification of the organisational transformation to make it feasible to put in systems?”

Barron said that Thomas and others had asked for a technical review rather than one that related to human resources. “You asked for a technical review,” said Barron, “That’s what you asked for. Does a practical review include human resource aspects in terms of people in the workplace as opposed to technology in the workplace?”

Thomas replied: “It must start with requirements: and how well founded those requirements are, whether they are compete and whether they are contradictory.”

Barron asked how this could be achieved.

“By talking to people by calling for input, by capturing what the programme says the requirements are for example and analysing them,” said Thomas.

But Barron was dismissive. “By going and talking to people up and down the land?”

Thomas said: “I would start off by looking at the detailed planning, and the internal reviews that have been done. We know that consultants have reviewed aspects of the programme but those reviews have not been published. We know there have been gateway reviews. Those reviews have not been published; the department has refused to release either of these even under Freedom of Information requests.”

He added: “I would start off by trying to find out what the current views of the programme are, and getting a clear view as to what are the detailed plans, the detailed objectives. Let’s do a technical review of those plans. How good are they as technical plans? Let’s have a look at the risk register? The hazard logs? Is anybody doing a dependability test? Has anyone done a decent safety case for the system?

“What plans have been made for the lifetime costs? Is there is a proper business justification, that shows the costs are less than the benefits? If the answer to any of those questions is “no” you have put your finger on something that really needs to be fixed urgently.”

Barron, still sceptical, said: “Do you think that the people involved in the National IT Programme at the moment are conscious of those facts, whether reviews have been published or not? Do you not think they are capable of knowing that as part of their business? Are these people developing it not capable of being able to do that?

Thomas’s reply was impressive.

“I have reviewed a lot of large technical programmes over the years. I want to stress I am not asking to review this work personally – not for a second am I bidding for that job – but my experience of carrying out 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, and what typically happens is that people start redefining what the milestones meant, in order to claim success for milestones and to put off the day when they have to admit that things have gone wrong.

“They start arguing what it was they really were setting out to do at the beginning, so start getting weaselly about what the specification really was, and the whole business justification is lost because the costs have changed, the specification has changed and the balance between what you are going to get and what it is going to cost you has gone wrong in two directions.

“And the people on the programme are not motivated to stand back and say that because they have got this vision that one more heave and we will get there. It does take somebody who doesn’t have a stake in the programme to come in and stand back and say: The reality is this: we need to make appropriate changes if we are to achieve sensible things from sensible milestones.

Barron was still unconvinced. “What you described earlier has more to do with an inquest,” he said.

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