Select Committee on Health Written Evidence

Evidence submitted by Computer Weekly (EPR 64)

  Computer Weekly supports the main objectives of the NHS's National Programme for IT NPfIT], particularly the aim of providing an accurate, useful and up to date electronic health record that is always available to clinicians when they need it.

  Some of our readers have told us how the treatment of their relatives was not what it should have been because the paper records were not available.

  However—and this is one of our biggest concerns about the NPfIT—strong, well supported objectives do not justify a flawed project.

  For more than 15 years we have investigated the common factors in IT-based projects and programmes that succeed or fail to meet expectations. We hope the NPfIT succeeds and there have indeed been some specific successes. On the whole, however, the programme has already fallen into traps that have ensnared some other large, high-risk IT-based projects and programmes. There are doubts it will work as originally intended.

  For these reasons we believe that there should be a published and genuinely independent review of the NPfIT. If all is well the results of the review may placate those who are concerned about the £12.4 billion programme. It may also provide evidence with which to market the programme's benefits to doctors and nurses.

  If all is not well, a review would provide evidence of the need for a rethink; and the sooner the better, before billions are spent without commensurate benefit to the NHS and patients.

  In 1998 Computer Weekly urged the Transport subcommittee to ask the government to commission an independent review of a project to build air traffic control systems at Swanwick in Hampshire. That review's recommendations arguably made the difference between success and failure.

  The Swanwick project had then been running about four years behind schedule. Our call for an independent review was opposed strongly by National Air Traffic Services. Its directors told the Transport subcommittee that a review would be an unnecessary distraction—the argument put forward by the Department of Health in opposing a published independent review of the NPfIT. In the case of the Swanwick systems, the government decided in 1999 to commission independent reviews in opposition to National Air Traffic Services.

  The Department of Health's rejection of a published independent review of the NPfIT is one of our main concerns about the programme. We are advised by senior members of the Association for Project Management that a high-level review of the NPfIT could be carried out in less than a month and by no more than six people if they are given access to the right documents and senior personnel. It would establish the health or otherwise of the programme.

  Below we list some of those traps and some of chief concerns expressed to us about the NPfIT:

  1.  The delay in the delivery of core software, which in the case of the NPfIT includes a Care Records Service, has proved in some past projects to be a symptom not of teething difficulties but deep-rooted defects in design, scope and ambition that could affect the successful outcome of the programme.

  2.  Delays in the delivery of core software were symptoms preceding the failure of the Libra project, the main aim of which was to install a unified case management system for magistrates' courts across the country. Today, more than 15 years after the initial project attempt failed, no single system has been rolled out across the country, though there have been several attempts. One problem is complexity: magistrates' courts have different ways of doing things—as have hospitals. And despite Libra's complexity, it is a tiny project compared with the NPfIT. Libra's case management system is a fortieth the size of the NPfIT.

  3.  Long delays in the successful delivery of core technology were also symptoms in the failure of a system for the Performing Right Society. The Society's overly ambitious PROMS system—Performing Right On-line Membership System—had to be scrapped, largely because the new business processes that accompanied the IT had not been thought through adequately. We can provide other similar examples if requested.

  4.  Two major suppliers have withdrawn from the NPfIT programme for reasons that have never been fully ascertained. We believe that Accenture and IDX should be asked why they withdrew. Over-optimism among suppliers and government agencies is a common factor in IT-related failures. For example, after a Single Payment System failed to meet its original objectives at the Rural Payments Agency, two ministers told Parliament they were given over-optimistic reports from their civil servants on the state of the IT project. We believe that directors of suppliers who decide to pull out of projects should have their concerns aired and taken into consideration. Instead, it seems to us, the views of executives at Accenture and IDX have been sidelined or not even sought.

  5.  The complexity of the NPfIT, and whether its objectives are achievable as originally configured, may have been factors in the withdrawal of Accenture and IDX. There are, for example, concerns about whether it is possible for software that has been designed for a small number of individual sites to work at many health sites with diverse needs.

  6.  We and the National Audit Office have studied common factors in project successes and some things stand out: a clear objective (which congestion charge has for example) and simplicity of design and ambition. The NPfIT, it can be argued, does not have a clear objective and it has labyrinthine complexity. Its ambition, complexity and cost make it the largest civil IT-based programme in Europe and perhaps the world.

  7.  Truth and openness become the first casualties in projects that are in serious trouble. Defensiveness and a resentment of criticism—and the critics themselves—have characterised the NPfIT.

  8.  The Department of Health and Connecting for Health have put much information in the public domain, but not the key facts we have requested. Our NPfIT-related requests under the Freedom of Information Act have been rejected. And though Connecting for Health publishes statistics it does not publish any details of the specific high severity incidents that affect the hospitals that install new national systems. These incidents can affect the care and treatment of patients.

  The Department of Health has declined to publish the results of its reviews on the NPfIT, including those undertaken by consultants and, separately, by the Office of Government Commerce. If any of these highlight fundamental flaws in the programme, it is in the public interest that they are published.


  We would expect Connecting for Health to argue that our concerns are misplaced and that the programme is headed for success. To this we would suggest that it publishes evidence of success in the form of the published results of a genuinely independent review. We believe that the review carried out by consultants Arthur D Little report on the Swanwick air traffic control systems was a model exercise. As we said earlier, we believe that this report made the difference between success and failure.

  We would like the NPfIT to succeed, and so we would urge the Health Committee to ask the government to commission a published, genuinely independent of the NPfIT.

Tony Collins

Executive Editor

Computer Weekly

19 March 2007

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