Original URL: http://www.theregister.co.uk/2008/05/30/nhs_it_analysis/

NHS IT: what went wrong, what will go wrong

We draw up a handy list of excuses for civil servants

By John Oates

Posted in CIO, 30th May 2008 13:54 GMT

This week Fujitsu pulled out of the £12.7bn National Programme for IT - the government's enormous project to introduce national patient records for NHS patients leaving BT, CSC and iSoft still involved.

How bad must things be for a company to walk away from just under £1bn of government money? And why are we writing yet another story about a government IT project heading inexorably for the rocks taking billions of pounds of taxpayers' money with it? This has happened so many times, and no doubt will again. We all know what the lessons are but for some reason government and civil servants seem unable to listen to even the simplest lessons from past failures.

When the project was started we were told that the use of several contractors meant that competition would drive down prices and the civil service would keep control of costs.

Now that there are only two contractors left for the south of England they can effectively dictate terms to Connecting for Health - the body charged with running the scheme.

One of the core problems of government IT projects - that no one individual is ever in charge - was supposed to be solved by the appointment of Richard Granger as director general. He left at the end of January, ground down and exhausted according to some.

So was the project doomed from the start or was a decently specified project kyboshed by greedy contractors and incompetent civil servants?

Start small

Simon Williams, director of independent consultancy DMW Group, said: "The idea of controlling risk by using several suppliers sounds good but with a shrinking list of suppliers it doesn't work. They should have started small - run a project in one or two small regions with one hospital and two or three GP surgeries in each. Run a prototype project, prove the functionality and show the staff the benefits of it - it is a simple and well trodden route for big projects." The project also failed to consult doctors and nurses who would be using the system, he said.

Williams added that having proved a small scale project works it can, if necessary, be handed over to a bigger supplier to roll-out nationally, once the functionality has been proved.

Martyn Hart, chairman of the National Outsourcing Association, was unsurprised at the problems and questioned whether there was even a need for a national programme. He said Granger gave a talk to the NOA several years ago and the audience was asked afterwards if they thought it would succeed - not a lot of hands went up.

Hart said: "If I live in south London how many times will I need my health records to be sent somewhere else? How many times does that really happen? And even if it does happen then data exchange is old hat - you need some agreement on formats and standards not necessarily a nationwide system."

Granger's macho approach to negotiating with suppliers has also been criticised. Dealing with a company over ten years requires a relationship to be nurtured - not just posturing.

Hart also favours a local, bottom-up approach: "Maybe they should have eaten this elephant in small chunks. That would be better for smaller, local businesses."

Why can't civil servants run an IT project?

Asked why the civil service has such a dismal record on IT projects Hart said: "There are two main reasons. Firstly there's much more scrutiny - you've got the National Audit Office, the Public Accounts Committee and politicians all looking at it. In the private sector it has to become a mega mess before anyone hears about it.

"Secondly it's the way the civil service works internally. It's a blame culture and a question of check lists - you're safe if all the boxes are ticked, even if it doesn't make any sense. There's a pressure to conform - it is very difficult to stand up and say no."

Hart said there was also the issue of "tour of duty" - senior civil servants are typically in post for two or three years and politicians for even less time. Civil servants also need to understand that suppliers exist in order to make a profit - if you force a supplier to cut costs every year then their revenue will fall. If revenue keeps falling the project manager is likely to get moved or sacked.

Norman Lamb, shadow Health Secretary for the LibDems, said: "This is yet another example of a hopelessly flawed, centrally imposed project that has not been properly thought through from the start and was never subjected to a proper cost benefit analysis."

John Pugh, LibDem MP for Southport, told The Register: "Fujitsu's departure shows that despite the government's best efforts at dismissing all concerns there are serious problems with this project."

Pugh sounded the alarm for the project in the future: "Fujitsu have pulled out because they cannot make it work for the price which is on offer. It puts great power in the hands of the remaining suppliers. No doubt someone will step in but they'll step in at the price they want. We're in for further delays or substantial financial overshoots."

The government was likely to try and make virtue out of necessity, he warned, and re-badge the project in some way and spin the different approach as a reaction to doctors' concerns.

Even a change of government was unlikely to make much difference, said Pugh, because so many civil servants are behind the project - classic "Yes Minister syndrome" - that change would be like turning around a supertanker. The Tory party did not respond to Register enquiries. ®