Select Committee on Health Written Evidence

Evidence submitted by Mr Nicholas Beale (EPR 14)

  In summary I submit that: The problems with the EPR are fundamentally because the NPfIT is not part of a well-conceived change initiative that meets real user requirements led by a senior respected user; long experience shows that such large IT programmes in complex organisations are almost certain to fail. My detailed comments are as follows:

    1.  I have been following IT in the NHS as an external observer since the mid 1990s. I am a liveryman of the Worshipful Company of Information Technologists and have been a member of its Medicine and Health Panel since 1996, though I write in a personal capacity. I was professionally active in IT from 1973-89, and I now advise Chairmen and top-management of FTSE 100 companies on strategic and people issues—not specifically IT.

    2.  Whilst strongly supporting the goal of using IT more effectively to enhance healthcare, I consider that NPfIT was misconceived, and now requires radical re-thinking and re-scoping, with new leadership rooted in the user community.[73] I consider that this is the fundamental reason why delivery of the new systems is up to two years behind schedule and why there are so many other problems—some well-publicised, others less so.

    3.  Long experience has shown that large-scale complex IT systems in large-scale complex organisations can only succeed (ie provide benefits significantly greater than their costs) as parts of well-conceived change initiatives that meet real user requirements, and that pretty well the only way to achieve this is to have a senior and respected user in charge.[74]

    4.  So a National Programme for Information Technology, with a CIO from outside the NHS—however talented—was almost certain to fail. Perhaps it might have been OK if the CIO had reported to a strong and engaged SRO within the NHS—but this has been a revolving door. The present difficulties are symptoms of this fundamental problem. I do not think that anyone, however wise or consultative, could have succeeded coming in from the outside to this role. The fact that inadequate consideration has been given to issues of exactly what information would be held, how it would be protected and used from a clinical and patient point of view is yet another symptom of the underlying cause which is a programme driven by politicians and IT Specialists rather than one driven by Users to meet real User needs in a cost-effective and timely manner.

    5.  In my view the programme needs a fundamental re-scoping so that it is technically, organisationally and managerially feasible and appropriate, with a leader appointed from the NHS with a real user perspective and strong credibility amongst clinical and management staff, who will stake his or her reputation on delivering a re-defined set of benefits within a re-defined timescale and budget over the next 5 years. If the NHS does not employ anyone with the requisite internal background and credibility prepared to do this with the present programme, this is conclusive evidence that it will almost certainly fail in its present form. The NHS must find the best leader it can and scale back the programme to be well within her/his capabilities. The rest can be considered in later Phases, as capability and credibility develop. This course of action may be politically embarrassing and people with a strong financial interest in the programme continuing more or less at present may claim that it is nearly ready. Such claims are always made during large-scale IT disasters and are almost never true.

    6.  I would commend the article Mastering the Three Worlds of Information Technology in the Nov 2006 Harvard Business Review. This distinguishes between:

—  Function IT that assists with the execution of discrete tasks;

—  Network IT that facilitates interactions without specifying their parameters;

—  Enterprise IT that specifies business processes.

    The author says that "all the successful [Enterprise IT] adoptions I've studied have used the same process for avoiding failure, and all the unsuccessful [ones] have not used it: They have decided at the outset how key issues... will be raised and settled. The most important participants in this task are not IT specialists or consultants but business leaders from the areas affected by the new technology. The more areas there are... the more the adoption effort needs a seasoned leader." (by which he means a business leader). NPfIT is currently an "Enterprise IT" project; it has not used the process described and in my view will almost certainly fail in its present form. But if it were scaled down to a Network IT project then it could well succeed.

    7.  Mature discussions with the industry should be able to minimise the loss of public money: frankly, pretty much all of the foregoing was well-known to the IT industry at the time the contracts were let. It is better and cheaper to make necessary adjustments now than to prolong the agony and face a bigger write-off later. There is also a substantial opportunity cost in delaying sound IT systems that will provide real heathcare benefits.

    8.  The new leader should be supported by independent technical, clinical and managerial experts who would function very much as Non-executive directors. They would ideally operate as part of a Board chaired by the CEO of the NHS, with full access to information, and be accountable to the "shareholders" ie the taxpayers and NHS patients. Any NED who resigned should have the right, and perhaps the duty, to explain why to the PAC and/or to your Committee.

    9.  I consider that any competent group of independent advisers who were not pressurised by the DH/NHS and believed that they would be listened to would reach similar conclusions. It might well be helpful if your Committee and/or the PAC established such a panel.

Nicholas Beale

Director, Sciteb

13 March 2007

73   It makes no difference that it is done under the banner "Connecting for Health" which is a classic case of hoping a real problem go away if something is re-branded. Back

74   The congestion charge system was a large and complex IT project but was not in a large and complex organisation. Back

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