Budget cash puts spotlight on NHS ITproject management

Voters may have taken a generally positive attitude to the increase of 1% on their national insurance contributions to pay for...

Voters may have taken a generally positive attitude to the increase of 1% on their national insurance contributions to pay for NHS improvements, but they will expect the money raised to be well-spent. James Rogers reports on the pressure for NHS IT projects to succeed

The NHS has reached a turning point in its history. The billions of pounds from chancellor Gordon Brown's budget last month will boost UK health spending to the levels that are already taken for granted in continental Europe.

But money cannot improve patient care overnight. Nurses and doctors take between five and 10 years to train and the public will want to see results from their increased national insurance contributions before the next election. If Labour is to have the chance to let its health policy run its course NHS IT will have to produce measurable benefits.

The answer is to improve efficiency, and an obvious place to start is to make better use of information, according to Derek Wanless, the author of the report, published on budget day, that is informing Government thinking on health spending.

As part of last month's budget Brown announced the largest-ever sustained increase in NHS funding, with spending set to rise from £65.4bn in 2002-2003 to £105.6bn in 2007-2008. Brown also agreed with the findings of the Wanless Review, which called on the Government to devote £2.2bn to NHS IT in 2003-2004.

Given that current NHS IT spending is £1.1bn, this could launch one of the largest IT investment programmes ever. But clearly, the danger of mismanaging the spending is as great as the opportunity to improve efficiency. Effective IT project management will be critical if the health service is to make the most of its £1bn windfall of IT funding.

One IT manager in an NHS hospital trust said, "I think that the Government should clearly set out what its targets are and provide resources with a central project management scheme and enough power and authority to make it work." Lack of effective project management has held up NHS IT development in the past, he added.

There is no doubt that NHS IT projects have a chequered past. The Hospital Information Support Systems initiative, for example, lost up to £103m in the early 1990s, prompting criticism from the Commons Public Accounts Committee.

In 1992 Wessex Regional Health Authority's Regional Information Systems Plan lost up to £63m after the region and the NHS Executive sought to impose systems without user buy-in.

This was followed by other expensive IT disasters, such as the failure of a £32m Read Codes version 3 project in the mid-1990s.

The major problem that governments face when attempting to improve NHS IT is the scale and complexity of the organisation, which employs about 1.1 million people throughout the UK.

Even the Gateway Review process, which is applied to all major government IT projects, is yet to be applied to the behemoth of the NHS.

Murray Bywater, managing director of IT healthcare specialist Silicon Bridge Research, said, "It is not as easy to implement the Gateway Review process in the NHS as it would be in a smaller organisation."

An official at the Office of Government Commerce, however, confirmed that implementation of the Gateway Review in the NHS is under discussion, although he was unable to provide any details.

Of course, there is more to implementing new IT systems than just project management. According to Bywater, "Even with good project management, projects can fail if they don't improve business processes, such as hospital administration."

Unless processes are improved, IT projects will not improve efficiency, no matter how effective the project management, he added.

Whether the Gateway Review or another government project management methodology, such as Prince2, is used in the NHS, there will still be other hurdles to cross.

A major challenge for the NHS is recruiting people with the correct project management skills and experience to help implement such methods across the service. IT recruitment is an ongoing problem for the health service, which often loses candidates to the lure of the private sector.

One NHS IT manager said, "There are a lot of highly skilled people in the IT area and they are looking for market rates. I don't think that the NHS currently has the funds available to pay those market rates," he added.

There are examples, however, of where the NHS has been able to get the right people on board to help to deliver major IT projects. One example of effective project management is the health service's ambitious electronic staff record project, which aims to bring together more than 30 different IT systems covering all NHS staff.

In February the NHS Shared Services Executive, which is overseeing the project, appointed Viv Martin as project manager. A spokesperson for the Shared Services Executive said, "Martin is from the private sector and he is very experienced. His forte is large-scale project delivery.

"We are very happy with the progress of the project and we are taking the whole issue of project management very seriously", the spokesperson added.

This is set against a background of poor IT services. Wanless described the UK's "particularly poor record on the use of information technologies in the health service", and reported that the service's annual spend per employee was lower in 2000 than in any other sector of the economy he had looked at. He identified areas such as IT infrastructure, clinical governance support systems and electronic patient records as having a crucial role to play in the health service's future.

The report provides little detail on how these projects should be managed, and there is a feeling in the health service that this will be crucial, especially for the newer schemes such as electronic patient records.

For its part the Department of Health has yet to shed light on this problem, although an official did confirm that it is looking at a new programme for managing IT across the NHS.

With the Wanless Report calling for the UK to devote a significantly larger share of its national income to health care over the next 20 years, the quality of management in IT projects will be just as important as the money itself.

The Wanless Report is at www.hm-treasury.gov.uk/

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