The retirement of Sir John Pattison, the senior officer responsible for the national plan for IT, goes against Cabinet Office guidelines. Computer Weekly talked to him.
Sir John Pattison rarely gives interviews, and he was not expecting to give one after he presented IT awards at a healthcare conference at the Queen Elizabeth Centre in London last week.
He had just given a speech in praise of the work of award-winning trusts such as North Bradford Primary Care, Nottinghamshire Healthcare, Tees and North East Yorkshire, and South Yorkshire Health Authority. But he said nothing at the event about the largest civil IT programme in Europe, and for which he is responsible until he retires next year.
The government has assigned Pattison the title of senior responsible owner (SRO) of the £2.3bn national programme for IT in the NHS. He is the most senior civil servant directly accountable for the success of the national programme.
He is also chairman of the board of the national programme. Rumours of his retirement have circulated for some time but he confirmed it in his impromptu interview with Computer Weekly after the awards presentation.
The importance of his role as SRO was made clear in a speech he made in March 2002, when he said, "My most important task is to make the case for IT in the NHS at board level, to ministers on the fourth floor of Richmond House [the headquarters of the Department of Health in Whitehall], across Whitehall to the Treasury and also, importantly, to Number 10."
Pattison made those comments about six months before the appointment of Richard Granger as director general of IT in the NHS.
When the government announced Granger’s appointment from the private sector to run the national programme on a day-to-day basis, the official statement said that he would "report directly" to Pattison. Since then, Granger has become the public face of the initiative and Pattison has melted into the background.
Indeed, Pattison told Computer Weekly last week that he was not directly involved in a recent briefing of prime minister Tony Blair on the progress of the national programme.
Yet Pattison is a crucial figure when it comes to accountability for the programme’s success. After a string of IT disasters, including one at the Passport Office and a £1bn "Pathway" project to reduce fraud over welfare benefits, the Cabinet office announced a series of measures to head off failures.
One of these measures was the appointment on every major IT project of an SRO. This was to ensure that one person would be held accountable for a project almost from start to finish. That person would provide support and continuity, while other officials on the project moved from department to department, as is customary in the civil service.
But Pattison will not be in post to see the delivery of the national programme’s England-wide systems which will include online booking of hospital appointments, an integrated care records service with electronic patient records, e-prescriptions and a new IT infrastructure.
"With the restructuring of the department, I am pulling away from IT and becoming director of research and development again [at the Department of Health]," said Pattison. He added that his presentation of IT awards at the conference was his last formal function as SRO of the national programme. So will his replacement be the head of the national programme?
"That is a very interesting question. Strictly speaking, I am still SRO of the national programme," he said. "I am also still chairman of the national programme, but I will have to work out a migration path [for a successor]."
According to a Cabinet Office document which set out the government’s measures to avoid the mistakes that caused or contributed to past IT disasters, an SRO was to be appointed to every project to "ensure that a project or programme is focused throughout its lifecycle on delivering its objectives and the projected benefits".
The then Cabinet Office minister Ian McCartney introduced this in his department’s document, "Successful IT" in 2000. In its foreword he said that the government needed to "avoid the mistakes of the past".
Citing the lessons from a range of IT successes and failures, the document said the SRO should oversee the business case, the project structure and close the project, ensuring that lessons are documented - or refer problems upwards to top management or ministers in a timely manner. "Crucially, an SRO should be ready to recommend that a project be abandoned or changed fundamentally if necessary."
Pattison’s early departure from his role goes against a Cabinet Office recommendation that the SRO should not change during the project inception and initial implementation, "The SRO should remain in place throughout or change only when a distinct phase of benefit delivery has been completed. Departments should take the need for continuity and previous experience into account when jobs are advertised and appointments made."
Similar advice is given on the website of the Treasury’s Office of Government Commerce which provides independent oversight of civil IT projects.
If the programme is a success, the government and Granger will be entitled to take the credit, because patients will enjoy the benefits of the national programme:, such as electronic records and online booking of appointments. But there are doubts over who would be held accountable if the programme proved a good but flawed idea.
Some IT managers have questioned in e-mails to Computer Weekly the fundamental principles that underpin the national programme, for example the decision by Downing Street, suppliers and the Department of Health to impose on clinicians and IT specialists in the health service a centrally controlled national IT programme which covers the entire population of England.
Concern has also been expressed in board papers of trusts around the UK, questioning whether the timetable was too tight, the scale too enormous, the objectives too diverse, the money too limited or the plans not adequately thought through.
If the programme does not live up to expectations, a new SRO could legitimately argue that it was not his or her programme, that the foundations were laid a long time before they arrived, and that he or she was presented with a fait accompli over the tight timetable for choosing suppliers and delivering systems, the scale of the programme and the diversity of its objectives.
Granger, for example, would be entitled to argue that the main principles behind the national programme pre-existed his appointment by about six months, although he has firmly supported them. Other civil servants or ministers could blame clinicians for not using systems; clinicians could argue that officials had designed systems without sufficient consultation and without taking into account the idiosyncrasies in the way they worked.
And if the programme dies a slow death, a new government after the general election of 2005 or 2006 could declare that the work on the national programme was not wasted: it was being dovetailed into a new initiative, as was the national programme, which evolved from a strategy in 2002, 21st Century IT, which evolved from strategies in 1992 and 1998.
In his interview with Computer Weekly, Pattison had not intended to announce his retirement as a revelation, but rather as a defence against the possibility of our questioning him about the national programme when he was in the throes of retiring.
He smiled when asked if Granger had reported directly to him. "That is what everybody said. I never believed that. I reckon that Richard Granger and I worked side by side. He had lots of skills and I had some skills. I knew the NHS well. I knew the clinicians well."
He said that chief executive of the NHS Nigel Crisp and ministers were last week in the process of making the decision about who would take over when he retired. He added, "Probably what I will do is run in parallel with my replacement for a few months because there is quite a lot of learning involved."
It was hardly the natural setting for an interview. He was surrounded by award winners; delegates were waiting to talk to him and workers were crashing equipment, but he smiled a great deal, was composed, and answered questions with a grace and an openness that was incongruous considering the secrecy over the programme. The Department of Health has warned suppliers against talking to the media about the national programme, and few IT staff in the NHS believe they can discuss the initiative candidly without damaging their careers.
So it was important for Computer Weekly to discuss the national programme with Pattison, if only because IT managers have raised many questions about it which they feel have been ignored, such as how much will it cost our trust to implement new national IT systems? And where will we get the money?
The Department of Health was unavailable for comment on Pattison’s retirement.
The full interview with Pattison will be printed next week
Why the SRO role is so important
Richard Granger, as director general of IT in the NHS, has been the individual most closely identified in the media and IT industry as being responsible for the NHS national programme.
But he has never been the government-nominated senior responsible owner (SRO) for the project, as Sir John Pattison is.
Granger is responsible for the national programme systems and, to a lesser extent, for delivering the business change that will be concomitant with the introduction of new IT. That is one of the tasks of the SRO and emphasises the supervisory importance of the role.
According to the Cabinet Office’s "Successful IT" document, the SRO in all cases "must be the business sponsor of the change that is driving the IT development. This applies to individual projects and also groups of projects making up a programme."
The Department of Health’s Modernisation Agency is responsible for delivering the changes in working practices, although it also has people working on the national programme.
NHS IT plan loses another minister
Pattison was not the only person who was most closely associated with the launch of the national programme. The minister who launched the national programme and chaired a ministerial taskforce to improve the leadership and direction of the programme was Lord Hunt.
He and Pattison attended a meeting at Downing Street in February 2002 where the terms of the national programme were agreed.
But Hunt quit the government’s front bench earlier this year in a protest over the Gulf War. So the two people most closely associated with launching the national programme will not be in post when implementation begins in earnest.