NHS IT charade re-played

But does not stand up to PAC scrutiny

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The £12.4bn National Programme for IT might not have been good value for money, said the National Audit Office on the publication of its report on the scheme only 10 days ago.

This story had changed when the report's findings were quizzed by the House of Commons Public Accounts Committee earlier this week. Sir John Bourne, auditor general, said he thought the controversial NPfIT contracts would deliver value for money because they refused payment to suppliers until they had delivered results.

This appeared to contradict Chris Shapcott, director of health value for money studies at the NAO, who said it would not be possible to assess whether NPfIT had been value for money until a proper cost benefit analysis had been done and the project was finished in 2010.

Bourne went further, however, saying it was well thought out, and well managed considering the challenge of such an ambitious scheme.

The PAC hearing then unveiled a string of queries and revelations that appeared to support Shapcott's reserved view of the programme and less so what Greg Clark, conservative MP for Tunbridge Wells called the "most gushing" of 62 NAO reports he had read on he PAC.

The committee heard how the management of the programme was haphazard. The wisdom accumulated from other bodged government IT projects holds that there should be one Senior Responsible Owner, or grand overseer. NPfIT had six SROs since 2004.

NPfIT's vision had already implicitly criticised by the NAO in the one significant criticism levelled at the programme in its report, which was the lack of consultation undertaken with the system's users (clinicians) before the specification was drawn up, the contracts let and development commenced.

Richard Granger, director general of IT at Connecting for Health, and Sir Ian Carruthers OBE, Acting Chief Executive of the NHS, both insisted there had been adequate clinical consultation; yet after the PAC hearing had shot holes in this defence, Granger asserted that consultation had been "ongoing" - on the fly, if you like. That also runs against the principles learned from past IT failures.

Professor Peter Hutton, once a clinical lead on the project, said its early days was "like being in a juggernaut lorry going up the M1".

"It didn't really matter where you went as long as you arrived somewhere on time. And when you'd arrived somewhere you'd go out and buy a product, but you weren't quite sure what you wanted to buy and to be honest I don't think the people selling it knew what we needed," he added.

He found the consultation had been a "sham" after he rang at random ten people form a list of clinicians that Granger said had been consulted: "None have any memory of having any meaningful input into the programme."

Dr Anthony Nowlan, another former programme deputy, said the project specification had been done at "breakneck speed" by grafting details from other reports: "It was not exactly the ideal process to commit this amount of resource," he said.

Taking all the flack for this was Granger, the man brought in to do just the job he did: crack skulls and perform the miracle of pulling off the largest and most complex project of its kind ever attempted anywhere in the world, in record time. The fact that he hasn't pulled it off, that serious questions have been raised and must be taken further, should be answered by the senior responsible owner, if there had been one, or the chief executive of the NHS, had he not just resigned...

The fact is that a project on such a scale, which had to assimilate the many disparate NHS organisations with their very different needs and approaches to IT, and which had the aim of completion in two and a half years (which was 18 months ago), cannot have feasibly consulted its users properly.

In light of this, Sir Ian's explanation for the project's two-year overrun sounds rather disingenuous. The project's central nervous system, the care records system, was late because suppliers couldn't cope with the deadlines and clinicians wanted to pilot it first.

Any project leader could have told you in the 70s that a system should be piloted before it's lumped on unsuspecting users. Then had users been able to take part in a thorough consultation in the first place and a proper specification drawn up, suppliers might have been set realistic deadlines.

It follows that Sir John's admission that the programme should have had the "fullest possible" consultation before it commenced was even more damning than it sounded, because it appeared to concede that there was only so much such a hurried and ambitious project could do according to the book, and this one hadn't even done that.

Even the budget fiasco exposed by the NAO on 16 June was a corollary of NPfIT's hurried start. The cost of development gave us the last official costing for NPfIT of £6.2bn. Implementation of the programme was being left to local NHS trusts, so those costs were discounted.

Yet now the local NHS trusts have become a defence of NPfIT's "top down" approach to systems development - that is, consult users little and give them what you think they should want, or as close as you can get to it in the time given.

When pressed on this approach by committee chairman Edward Leigh, Conservative MP for Gainsborough, Sir Ian said that the development of NPfIT might have been done nationally but the implementation was being done locally. That's like saying you have a bespoke tailored suit when it's provided measured and cut, and all you have to do to finish the job is the stitching.

All of these issues being examined by NPfIT would not be news to anyone who had acquainted themselves with advice laid down in numerous bibles of good practice for IT projects published around the turn of the millennium.

"History tells us that all these rushes to catch up lead to a mess," said one of the committee members. And Granger appeared to to agree, in a way. It was ambitious, he said, in the "awful" amount of work that was being done "very quickly".

"There's a shortage of capacity in the healthcare IT industry and we've had to bring in a lot of resources from abroad," said Granger.

"And some things have unfortunately gone wrong as a consequence of that with some of those suppliers. We knew that was a risk when we started and it will continue. I thought it was going to be a big risk from day one".®

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