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Sleuths tangled in NHS-IT can o' worms

NAO report due a year late

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Comment Official auditors assigned to assess the multi-billion pound National Programme for IT* might have been forgiven for thinking that this one was going to be straightforward.

The National Audit Office chose in summer 2004 to "examine the procurement process" for NPfIT, decide whether its supplier contracts would give "good value for money", and determine how well the project had been run.

On the face of it, the procurement, contracting and, by definition, the implementation that followed, were about as simple as it could get for a project of this size: NPfIT said, this is how we are going to do it, anyone who disagrees can get lost; those principles were enshrined in contracts, and everything was rushed through by an autocratic central command.

Already postponed, the investigation was due to report in March. We won't hear a pip from the NAO now until the summer, a year later than originally planned, if it manages to get it out before Parliament goes into recess.

What could be keeping them? One idea being put about is that the NAO underestimated the size of the task. The Department of Health is also reviewing the report, which means it is picking hairs over the findings (negotiating facts and semantics with investigators).

It may be that in tackling the underlying complexities of NPfIT, the NAO has unearthed matters that would have been tackled up front in a more transparent project.

An unaudited glance at NPfIT suggests it is the exhuming of hidden complexities that has taken the NAO so long.

The procurement was hurried and conducted in a secret, some might say blinkered, manner. A lack of transparency characterised the rest of the planning and much else since. The contract writers took their cue from PFI (the Private Finance Initiative), which loaded all the risks for the project onto suppliers. This approach to risk, incidentally, has been proven unreliable and was the reason PFI was subsequently banned for use on IT projects.

When the contracts were let, a lack of NHS experience was evident among the handful of suppliers eventually chosen to take on the work. They were forced into an aggressive recruitment drive to find the staff, but there was already a shortage of experienced people in the industry.

Further pressure was put on industry to consolidate, as much IT work had been done for the NHS in a piecemeal fashion and was now being funnelled through just five sub-contracting agents.

All this must have made it very difficult for the industry to meet NPfIT's high expectations. Having been kept in the dark, suppliers were also unable to plan so they could meet its approval in the future. Those who landed work through NPfIT are a little peeved they still haven't been paid anything.

No wonder the project is running late. What are the chances it's given the NHS value for money?

* The National Programme for IT, having earned a reputation as an autocracy, was rebranded with a name less likely to conjure up images of Soviet-era style project management, "Connecting for Health". ®

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