The Treasury has yet to approve the business case for Summary Care Records although trusts have sent letters to about 30 million people informing them of the rollout of the scheme.
The Summary Care Records scheme began in earnest in 2007. Now a Treasury’s Freedom of Information response to GP Neil Bhatia shows that Coalition ministers are, like Labour, allowing Summary Care Records scheme to continue without the Treasury’s approval of the business case.
This is despite a warning by civil servants in the Treasury that allowing major projects to go ahead without business cases is a common factor in project failures.
A month ago David Pitchford, Executive Director of Major Projects within the Efficiency and Reform Group, which is part of the Cabinet Office, listed what he had discovered were the reasons for the failure of UK Government projects. These were the top four factors:
1. Political pressure
2. No business case
3. No agreed budget
4. 80% of projects launched before 1,2 & 3 have been resolved
In a letter to Bhatia dated 11 November 2010, the Treasury says that the “initial” full business case for Summary Care Records was received on 1 February 2010 and that the Government is “currently considering this business case to ensure it meets its priorities set out in the coalition agreement”.
This may imply that the Treasury had approved the business case and that it is being reconsidered to ensure it meets the Coalition’s wishes. At no time, in fact, has the Treasury approved the full business case for the SCR.
Non-approval of SCR business case “biggest risk”
In May 2010, an independent report on the SCR scheme by a team of researchers led by Trisha Greenhalgh said that “non-approval of [SCR] business case is seen as biggest risk to programme by Connecting for Health”.
CfH writes more than one full SCR business case
CfH completed a 45-page Strategic Outline Case for the SCR in October 2007, some months after the scheme had begun. A 143-page full business case was completed in February 2008 and another full business case in September 2009. But the first time Connecting for Health submitted a full business case to the Treasury for the SCR scheme was 1 February 2010.
Was SCR business case too optimistic?
In examining the full business case for the SCR scheme, Greenhalgh’s researchers found that NHS Connecting for Health had been optimistic in its judgment that 90% of GP practices would participate in the programme. Evidence at that time was that about half of GP practices may remain outside the scheme for various reasons.
“The original Full Business Case for the SCR appears to have used relatively
optimistic estimates of the future uptake and use of the SCR,” said the Greenhalgh report “The Devil’s in the Detail”.
What is a business case?
Business cases for the Treasury comprise five parts:
€¢ the Strategic Case which sets out a robust case for change
€¢ the Economic Case which shows that value for money is optimised
€¢ the Commercial Case which sets out why the project or programme is viable economically
€¢ the Financial Case which shows the project or programme is affordable
€¢ the Management Case which shows that the plan can be delivered successfully
It seems remarkably unprofessional for Coalition minister Simon Burns to continue the SCR programme when Connecting for Health and the Department of Health have yet to convince the Treasury that the scheme:
- has a robust case for change
- will be value for money
- can be delivered successfully
The Treasury’s FOI response to GP Neil Bhatia could be interpreted as evidence that the Department of Health, under the Coalition government, is continuing some of the near-anarchic project management practices that the National Audit Office revealed when Labour was in power.
Indeed the Greenhalgh report reveals that the SCR programme went direct from a Strategic Outline Case to the Full Business Case without an Outline Business Case.
CfH itself conceded earlier this year to Greenhalgh and her researchers that it considered the non-approval of the business case to be the biggest risk to the programme.
So why did Simon Burns, the NPfIT minister, announce last month that the SCR programme was to continue? It’s possible that the Department of Health hadn’t mentioned to Burns that the Treasury has yet to approve the business case. Perhaps officials didn’t want to bother the minister with such fine detail.
The DH has a track record of not keeping ministers fully informed. Officials briefed the then Prime Minister Tony Blair in 2007 that the NPfIT was largely complete.
Perhaps the DH’s less-than-complete briefings to ministers help to explain why the NPfIT and the SCR have continued despite evidence to the outside world that they were in danger of failing.
Will the Treasury ever approve the business case for the SCR? Nobody seems to know; and worryingly, that won’t halt the programme. Perhaps the Coalition should learn from Labour’s mistakes, rather than build on them.
HM Treasury reply to Neil Bhatia:
"You asked whether a business case for Summary Care Records had been submitted and consequently approved by HM Treasury. I can confirm that this business case was initially received by the Treasury on the 1 February 2010. The Government is currently considering this business case to ensure it meets its priorities set out in the coalition agreement."
11 November 2010
Is the SCR dead? - publictechnology.net
Greenhalgh report on SCR - Devil's in the Detail
Govt finally approves SCR - BJHC