Does the DH have faulty genes when it comes to running big IT schemes?

Comment:Before David Nicholson was formally appointed Chief Executive of the NHS in 2006 he was warned that the NPfIT would be an important part of his brief. He accepted the challenge and was later appointed the NPfIT’s Senior...

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Before David Nicholson was formally appointed Chief Executive of the NHS in 2006 he was warned that the NPfIT would be an important part of his brief. 

He accepted the challenge and was later appointed the NPfIT’s Senior Responsible Owner, 

To his credit he tried almost immediately to move the NPfIT away from a centralised programme. In 2006 he set up the NPfIT “Local Ownership Programme”. But the NPfIT continued to be dominated by its centralised contracts - which were signed long before Nicholson’s appointment. 

In the main, Trusts bought “interim” systems because the national products from local service providers were not available. The NPfIT continued to slide towards costly oblivion while Nicholson’s Department of Health briefed the then PM Tony Blair in 2007 that “….much of the programme is complete with software delivered to time and to budget”.

Today the DH continues to defend the NPfIT.

“The money we have spent so far I believe has been value for money,” said Christine Connelly, Health CIO, at a press conference at the DH headquarters in Whitehall last September. 

Now the NHS Confederation, which could be said to be politically neutral, has written a paper on the NHS in the digital age, which includes a cogent denunciation of the NPfIT - and the Department of Health’s approach to IT. 

The Confederation says:

“While NHS IT development during the last decade was characterised by immense ambition, so too was it marked by continual failure.

“Vast resources were committed to realising the visions of successive Department of Health IT strategies. Yet the principles governing these plans rested on questionable assumptions about technology and about large-scale organisational change that are, in part, responsible for the slow progress made today.”

ComputerworldUK.com has published a summary of the report of the NHS Confederation. The Confederation acknowledges the NPfIT successes such as the building of a national broadband infrastructure. But one would expect some success for the £6bn spent on the NPfIT so far. The impression given by the NHS Confederation in its paper is that the NPfIT has been a failure. 

"Its [NPfIT's] extensive scope and scale have proved almost unmanageable for the public and private organisations involved," said the Confederation. 

Will anybody be held responsible for the failure of what was once described as the world’s largest’s non-military technology-based programme?

Not the NPfIT's first senior responsible owner who left soon after the programme started in 2002. And not David Nicholson who was knighted in the 2010 New Year’s Honours. Indeed it’s worth asking whether there is any point in a large IT-based project or programme having a senior responsible owner who is, well, not entirely responsible - that is not accountable when things go wrong.  

What happens now?

Victor Almeida, senior health analyst at Kable, says that spending by new consortia on IT related to NHS reforms is likely to peak at £1bn in 2012-13. The DH will be shaping the reforms, and will continue to oversee the roll-out of NPfIT Summary Care Records for the assumed potential benefit of millions of patients. It will also manage the rump of the £4bn NPfIT local service provider contracts and any further new deals with CSC and BT. And it will manage the new vision of giving patients access to GP records. 

If the NHS Confederation is right, and vast resources have been committed to realising the visions of successive Department of Health IT strategies that have been based on questionable assumptions, is there any reason to believe the future will be different?

Any answers please?

Every NHS CEO who has overseen NHS IT change and failure in the past has been knighted; and there is no reason to think anybody will be held accountable for what happens in future, when it comes to IT managed by the DH.

It's inconceivable that a private company would spend large sums on successive, failed IT strategies without holding anyone to account. 

So we should look forward with trepidation to the DH's management of the IT element of Andrew Lansley's reforms. Is there is a way to correct the DH's faulty genes when it comes to managing IT schemes? Any answers much appreciated. 

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