Internal reports reveal NPfIT flawed at its launch

As ministers were publicly praising early progress on the NHS IT programme, confidential initial Gateway reviews on the scheme were scathing about poor planning.

As ministers were publicly praising early progress on the NHS IT programme, confidential initial Gateway reviews on the scheme were scathing about poor planning, the approach, specifications and lack of engagement with clinicians.

The first review of the National Programme for IT (NPfIT) in June 2002 - a Gateway Zero strategic assessment of the scheme - also confirms that the government planned for the "whole programme cost" to be around £5bn. The cost is now put at nearly £13bn.

A separate Gateway review in October 2002 - about four months after the National Programme for IT was announced - questioned the plan to appoint five main suppliers.

The review report said that the plan in the outline business case to use five service providers "seems to be an assumption without justification". Just over a year later a small number of large suppliers were given contracts worth £6.2bn.

Last week the Department of Health disclosed for the first time 31 Gateway reviews on the NPfIT - a week after the information commissioner made an unprecedented ruling that a slew of Gateway reviews be published, including some on the NHS IT scheme.

Information is missing from some of the published reports. The traffic-light red, amber or green status of the first Gateway review on the NPfIT in June 2002 is not in the published text, and some paragraphs in other reports end abruptly in mid-sentence. Most of the text has been published with minor redactions, though.

The review reports show that ministers were, in the launch year of 2002,making statements on the NPfIT, and answering parliamentary questions on it, without giving any hint that then-confidential Gateway reviews were raising doubts about the feasibility of the plans and the approach.

Ministers carried out regardless of points raised in the initial two reviews about whether a central approach was a good idea, and whether the programme was being designed "in a vacuum" without engagement of the medial professions.

These criticisms have been at the heart of disenchantment with the programme in every year since 2002.

The initial Gateway review on the NPfIT in June 2002 said the programme's timetable had been referred to as not merely extremely ambitious but "hyper-ambitious". The review report added: "It is that and more."

The government's health spokeswoman at the time, Hazel Blears, told the House of Commons on 15 October 2002 that the NPfIT had "successfully completed" a Gateway Zero review - strategic assessment. But she didn't say that the review had been scathing.

By the time of the first Gateway Zero review a specification for electronic medical records - the Care Records Service - ran to 187 pages. But this first review found that "design work to date has been conducted largely in a vacuum". There has been "little injection of implementation reality and technology viability".

The prevailing sense was one of the programme being in an "ivory tower". The review report said: "There seems to be a lack of awareness of the need to engage at a detailed level with stakeholders and indeed how to do so. In general terms this lack of widespread engagement has led to there being no real perception in the operational areas of what the programme is actually doing."

In October 2002, the Gateway One review for NPfIT e-records said a small number of decided and professional people had worked hard in a short time to produce documents to allow a procurement to begin. "Unfortunately much of this work has not been conducted within a rigorous project management framework".

Some Gateway reports also show that important risks were omitted from NPfIT risk registers.

All Gateway reviews include criticisms - they exist for the OGC to assess independently high-risk projects and programmes. But the criticisms of the NPfIT in the first two main Gateway reviews go beyond pointing to defects: they question the approach and feasibility.

Taken together the reviews point to a flaw in the way the government approves large IT programmes: without parliamentary scrutiny of the cost, plans to cope with excessive complexity and how to bring about change within the NHS rather than just introduce IT.

Another flaw is that ministers can ignore recommendations in Gateway reviews without the public, stakeholders or parliament knowing what the reviews have said until years later, if at all.

The Tories if they win the election are unlikely to solve this problem, as they have announced no major changes to the way projects and programmes are scrutinized or approved.

Was the NPfIT flawed before its launch?

A Gateway One review in October 2002, about four months after the NPfIT was launched, showed a disconnect between the political decision to launch the scheme and the ability of people to manage and implement it.

The review report on e-records said there had been a "grand vision" which was "conceptual" and then a "number of enthusiastic people" had immediately set to work to turn the vision into reality "without the requirement being fully defined and agreed".

The Gateway reviewers compared the approach of the programme to building a car without designing it first.

"The analogy to a group of specialist car builders who are separately providing the wheels, the body, the engine and the transmission for a car that does not have an agreed design is probably relevant."

Prophetically, the same report said: "There is much talk of what the IT programme will achieve but little recognition of the potential impact of this on current practices, procedures and systems, both technical and organisational."

The flaws in the programme at these early stages - which appear to have been ignored by ministers - could help to explain why the main intended result of the NPfIT, a useful e-record for 50 million people in England, is still years away.

NPfIT failed nine Gateway reviews >>

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