The National Programme for IT in the NHS was yesterday abandoned, following a report on the project by the Westminster government’s new Major Projects Authority.
It has described the programme as not fit to provide services to the NHS.
A leaked version of the report says: ‘There can be no confidence that the programme has delivered or can be delivered as originally conceived’; and recommends that the Government ‘dismember the programme and reconstitute it under new management and organisation arrangements.
‘The project has not delivered in line with the original intent as targets on dates, functionality, usage and levels of benefit have been delayed and reduced.
‘It is not possible to identify a documented business case for the whole of the programme. Unless the work is refocused it is hard to see how the perception can ever be shifted from the faults of the past and allowed to progress effectively to support the delivery of effective healthcare.’
Established in 2002 by the Blair administration, the scheme has never worked and has continued to gulp down public money like a gigantic borehole through to down under.
It is not a single contract but a basket of them. Some – like BT’s £1 billion central database project, provide ‘spinal’ services. Others, like CSC’s and BT’s Local Service Provider (LSP) contracts, were intended to create regional Electronic Patient Records (EPRs). Some, like ATOS’s Choose and Book function, provide specific functions.
Any large project split into contractual elements delivered by different companies is liable to hit trouble at the interfaces; and software system interfaces are more problematic than many. Some of the sub-projects were also challenging, some are said by the industry itself to be working ‘more or less’. And that’s the point. Almost a decade after the contracts were let, the integrated system does not exist and does not now engender professional confidence that it will ever work.
The scheme has been patched and pampered at various stages but yesterday the current UK government decided that enough is enough and the cleanest thing is to bin it.
This is a very major government and public sector failure in project management and in the lack of availability of the necessary expertise to scrutinise work in progress in contracts of this kind.
While accepting that it must ‘urgently dismantle’ the scheme, Health Secretary Andrew Lansley says: ‘We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.’
This is likely to include elements of the existing programme where there is reason to believe that they are completeable in the short term and can be shown to operate with competence and reliability in providing some key functions.
A problem with the overall programme – which was serially criticised in reports by the House of Commons Public Accounts Committee – was said to be that it imposed a ‘top-down system’ which did not meet the needs of local health boards.
The government decision will now involve the letting of another series of contracts to deliver on the promise Lansley has now made and, presumably, an uber contract to marry salvageable existing elements, still in development in varying degrees, with the new ones.
It would be naive to imagine that this is not still going to cost unimaginable amounts of public money.
The position of the devolved administrations
Back in 2004, Scotland, Wales and Northern Ireland were asked to participate in the project – meaning contributing to its funding and merging their systems in a single national one.
For whatever range of reason, all refused and must since have been thanking a benevolent deity for their good judgment.
Their refusal meant not only that this became a project funded from the treasury but intended only for England; but that hospitals in England with patients from Wales, Scotland and Northern Ireland have been preparing to have to maintain separate paper-based records systems for these patients after the planned introduced of the electronic patient record and booking systems.
In 2004, a Scottish Government report, Health in Scotland said:
‘In England a radical reform of the NHS is underway, supported by the largest IT project in the world with £6.1 billion being spent over 10 years on software and hardware alone. Implementation costs will be four to five times this amount. All existing systems will be replaced with standard software and all encounters with patients will be reported to the Spine which will accrue a summary record of the patient’s health history. This will be available, on a need to know basis, across England. Scotland will not adopt NPfIT in its entirety but will use some of the solutions: the Drug and Medical Devices dictionary and the SNOMED-CT terminology will be implemented throughout NHS Scotland. Strenuous efforts will be required to ensure that clinical information can be exchanged across the UK.’
Since 2004, the project costs have doubled, the programme remains unfinished and, not fully reliable as such a system must be; and the implementation costs are, largely, still to come.
The industry view
With the scale of government cuts across the spending spectrum, the IT industry has long been engaged in situation analyses of its own, trying to identify which are the contracts most at risk.
It has been evaluating what has been done that is workable, what is most vulnerable in deliverability and how cancellation costs might impact on government decision taking.
The consensus seems to have been that, in practice, it would be difficult to scrap the programme contracts in their entirety and that the cost of cancelling the contracts and compensating suppliers could well outweigh the benefits. We now know that the government has gone ahead and done just that – but we do not yet know the cancellation and compensation costs involved nor the elements completed and working to a level of acceptability.
BT’s spinal database was ‘up and running’ a few years ago and it was then reckoned that scrapping this element would logistically be very difficult because so many other NHS IT systems were already reliant on it to share data.
The Public Accounts Committee was said to be ‘disappointed’ with the performance of CSC, the company contracted to deliver Electronic Patient Records for the North, Midlands and East of England.
It advised the government that it was possible that the supplier was no longer fit for any government work. This is a very unambiguous judgment. Behind it appears to be the hard fact that CSC has only delivered its main patient records system to three large trusts in nine years. Moreover, its representatives were unable to guarantee to the committee that it would deliver the systems to all trusts by the current 2015 deadline.
A few years ago it was the industry view that the EPR contracts held by CSC (£3.3 billion) and BT (£i billion) were the most likely to be scrapped.
Just over a month ago, CSC was still maintaining that its work was going ‘very well’ although without detail of much substance being given.
BT and the Department of Health were heavily criticised by the Public Accounts Committee in early August, for signing an indefensible contract revision in March 2010. This saw BT’s £1.02 billion Electronic Patient Records (EPR) contract for London cut by 7% to £948 million.
In return for that 7% reduction in contract value, BT had its contractual responsibilities cut by significantly well over 50%.
It was to be required to deliver systems only to 15 acute hospitals as opposed to the 31 originally contracted. Furthermore, it was relieved of the obligation to supply a system to the 1,243 GP practices originally contracted; and of its existing obligation to supply the London Ambulance service. And further again, systems for three small hospitals were also removed from the contract.
This arrangement had neither fiscal logic nor responsibility to the overall integrity of the planned system. An umbrella system is useful for that very reason. Who, in a rainstorm, would seek refuge under an umbrella missing a single small panel?
The Public Accounts Committee was deeply unimpressed with both the Department of Health and with BT and also pointed out that the department was drastically overpaying for systems in smaller mental health trusts with BT elsewhere.
Legal implications
It has been known since the beginning of August 2011 that, in the event of the cancellation now decided, the Department of Health is concerned that CSC, BT and Fujitsu could team up against it in a court battle over large amounts of money. This situation was reported at the beginning of August by ComputerWorldUK.com. CSC and BT remained involved with the programme and while Fujitsu left the programme in 2008 it remains locked in legal dispute with the government over its claims for the majority of the contract value.
ComputerworldUK.com’s 3rd August 2011 report stated that: ‘In unprecedented language, health officials wrote in a memo to the Public Accounts Committee that there were serious risks associated with a possible move to terminate BT and CSC’s contracts. They said: “Legal advice provided to the department indicates there is a risk of some unquantifiable ‘collateral damage’ to the Fujitsu existing claim, and the risk of suppliers working in unison against the department is significant.” ‘
At that time, it said that ‘ Department of Health officials revealed that both BT and CSC “have been clear” they were “not willing simply to walk away” from the work.’
At the time of the ComputerworldUK.com report, the Cabinet Office was considering intervention in the contracts between the Department of Health and its suppliers in order to protect local health trusts, each of which might face multimillion pound exposure as NHS systems are reformed.
This story has miles to run. It will be interesting to see how much of it reaches the public domain – but it tells the repetitive tale of the inability of the public sector to engage competently in management functions concerned with private sector contracting and project management. This single inability is what has led over the decades to public sector contract inflation. The world beyond the UK cannot believe the value of the public sector contracts we let.
We know the government, rightly, bit the bullet in avoiding the virtual certainty of throwing good money after bad on this National Programme for IT in the NHS. We do not know how far the contractors who have been well paid for their failure to deliver will yet seek additional and substantial compensation for cancellation. We should be told.
NOTE: This article has been widely researched from UK Government, Scottish Government, IT industry and media sources – including the Daily Telegraph, the Guardian and ComputerWorldUK.com – whose valued work in the field has been credited above and included:
- Government to scrap NPfIT NHS ITprogramme-today
- NHS fears multibillion pound legal fight with BT, CSC and Fujitsu
- Cabinet Office considers body to protect NHS trusts from NPfIT contract exposure
This sorry tale, coupled with the sad story of the consequences of the PFI debacle, and the horrendous “hospitality” bill from the MOD -surely the worst administered of all the Whitehall dinosaurs- puts into perspective the panic in the stock markets and successive UK administrations’ share in that sorry tale.
I suspect that this is the tip of yet another iceberg.
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Maybe there’s scope for another tv series like the highly entertaining ‘yes minister’ – but this time dealing with NHS IT procurement, MOD procurement in general, Edinburgh (only) tram project management, and – dare I say it – public ferry service procurement. On second thoughts, it might be too painful to be funny.
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There is no doubt that most of the blame for the failure of this disastrous project has to lie with the lack of adequate professional knowledge within the Government service. The simple fact is that these huge contracts were agreed with large IT companies on the basis of legal agreements which were totally inadequate in guarding the public interest as against providing profit for the IT industry. The reason for this failure lies in the unwillingness of the Treasury, in the 80s and since, to accept that some of the best minds in the IT industry should be hired to look after the public’s money. They refused to accept that a few people should be hired at competitive salaries to do this job, not to save the country money, which it patently would have done, but in order to maintain the Treasury control over staff salaries and comparative seniority – Mods and Greats couldnt be paid less than IT experienced and proved professionals. And this debacle has been compounded by the refusal of my professional body to expose the unprofessional work done at inflated prices by people and companies who pretend to be for the public good.
Once again, as in so many cases since 1945, the Treasury and the Civil Service establishment, if not its junior officers, have been shown to be incompetent at the highest levels – but will still get their pensions and their CMGs.
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One of the papers today reports the Passport IT project has soared from an estimated £90ml to an actual £365ml and rising.
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