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
|
