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By the time the official audit of the government's £6.1bn NHS IT modernisation is published in the summer it will be too late to be of any the cash-strapped NHS, said a leading contributor to the investigation.

However, the National Audit Office report might contain a valuable lesson for other arms of the public sector undergoing programmes of modernisation similar to the ambitious NHS National Programme for IT* ,said Glyn Hayes, chairman of the Health Informatics Committee of the British Computer Society.

And the lesson is: programmes driven by a political imperative are more likely to run into problems.

Hayes, who represents over 2,500 clinicians, academics, professionals and suppliers, contributed to the NAO investigation in late 2004. The NAO report that digested this submission was due last summer and will now be delivered a year late.

"One problem is that it will be out of date because the problems we were talking about have either been addressed or are now not relevant," said Hayes.

The NAO is very sensitive to these kinds of accusations because it works hard to ensure its publications are current, not least so they can't be trumped by politicians who would benefit from having some report or another discredited.

The NAO has investigated the procurement for NPfIT, which was notoriously secretive and was accused of failing to consult either the clinicians who would use the systems or the hundreds of indigenous suppliers who knew the most about NHS IT, whose livelihoods were threatened by the programme.

"There's little doubt there are lessons to be learned about how the National Programme was put together because it was done without following good principles for big IT projects," said Hayes.

"Connecting for Health in its early days didn't stop for any of those because it was driven politically," he said.

The the McCartney report stressed that ambitious IT projects, none of which at that time had come anywhere the size and scope of NPfIT, should be approached with caution and implemented in considered, bite size stages.

Special care should be taken for a project to progress at the pace at which the organisation could handle the change, not a pace determined by the project leaders, it said.

Reports about NPfIT's progress since its inception two years after the McCartney report have often described an authoritarian approach to project management more concerned with its own artificial deadlines than any practical design or schedule.

A Public Accounts Committee hearing into the work of the NAO in February, revealed that the NAO's report on NPfIT will be critical of its approach.

Committee member Richard Bacon, MP for Norfolk South, said NPfIT "exhibits all the classic signs of a huge IT failure" because "it was ordained from the centre, there was no consultation".

Sir John Bourn, Comptroller & Auditor General, responded: "In the report that I produce it will make clear the failure to take the people in the National Health Service with them. All the things that you say, the idea of having it wished on them, the idea of having to pay for something they do not want, are there."

Bourn described "dissension" in the NHS over the programme, the extent of which has become apparent in recent weeks with Northumbria Healthcare NHS Trust requesting tenders for its own systems instead of waiting for the late delivery of those developed by NPfIT; and United Bristol Healthcare NHS Trust asking NPfIT to pay for the arrangements it is having to make with IT suppliers to keep its existing systems going until NPfIT delivers.

NPfIT has started recording successes, appearing to have overcome the problems that beset its early years. So it might be too late for anything in the NAO's study to prevent public money being squandered on the badly executed £6.1bn Programme.

Another report repeating guidance given numerous times before and after McCartney might prevent the same mistakes from happening again. But the political pressure for radical transformation of public services using IT is in greater evidence than ever with such initiatives as the efficiency drive, shared services and e-government.

"The money they have spent could have achieved more, earlier," said Hayes. "The political drive was a problem. The timescales, the scope and everything else was determined by the politicians."®

* Now called "Connecting for Health". Its name change appeared to be a vain attempt to wash off the lousy reputation that had been accumulating around the project like bad bacteria

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