The government was warned back in 2004 that immediate action was needed to fix problems in the £12.7bn programme to revamp NHS IT, official reports have revealed.
Fast forward to 2009, and the National Programme for IT (NPfIT) is facing a number of difficulties: key projects to digitise patient records are running four years late, two major suppliers have walked away from the NPfIT, and the Department of Health CIO has given suppliers six months to speed up delivery of IT systems or risk seeing the NPfIT replaced.
The root of the difficulties now facing the NPfIT were laid bare in 31 Office of Government Commerce (OGC) gateway reviews published between 2002 and 2007 and released to the public for the first time on 18 June.
According to a 2004 strategic assessment, one of the major challenges facing the NPfIT was the NHS's decision to roll out systems without satisfactorily engaging with staff.
"A conscious decision was... taken that, counter to the generally accepted wisdom, the approach for the National Programme would be to procure and deliver the new IT infrastructure and only seek to engage the users who would need to be involved in its implementation when there was something specific to present them with and when delivery dates were firm," the assessement stated.
"The vast majority of the user community have yet to be properly engaged. There is therefore a massive challenge in engaging with this large and diverse community such that they are sufficiently prepared (informed and equipped) to implement the new services when they receive their systems," it continued.
"Overall status of the National Programme is Red — to achieve success the programme should take action immediately," it urged.
It also found that there was no practical central mechanism to manage health trusts' expenditure on implementation and training activities.
Later OGC reviews of the rollout of the Care Records Service (CRS) found bad feeling towards the electronic medical records project among clinicians had been compounded by technical difficulties. These included suppliers missing deadlines for rollouts of patient administration systems (PAS) and delays in the deployment of the Spine central database, which limited the tasks the PAS could be used for.
Commenting on the reviews, Dr Grant Ingrams, chairman of the British Medical Association's joint GP IT Committee, said they reflected the unrealistic aspirations of the early NPfIT contracts. "The main problem was that the project was trying to do too much, saying 'let's buy a new and shiny system' even if they do not exist," he said. "You have to ask why suppliers took on a project that no supplier would be able to make work."
The unrealistic demands put on suppliers, coupled with trusts demanding last-minute changes to systems to make them work locally, saw both Accenture and Fujitsu walk away from the programme and BT Global Services write down hundreds of millions of pounds on its biggest contracts, which included its £2.4bn-worth of deals under the NPfIT.
On the question of user engagement raised by the 2004 report, Ingrams added that local health trusts today have far more input into the programme. However, he queried why it had taken an OGC review before the government acknowledged the programme's failings. "It was obvious to us that it was wrong back in 2001 and we had tried to tell the Department of Health but nobody was listening," he said. "They [the DoH] disregarded that advice and then purchased lots of systems that have had to be changed since."
Of the 31 reviews published, nine were given a red status, indicating immediate action should be taken.
Earlier this year, the parliamentary spending watchdog, the Public Accounts Committee, described the Department of Health's progress on CRS as "very disappointing" and said if the deployment of the scheme did not improve, the department should consider abandoning the planned national implementation of it.
"We welcomed the report from the Public Accounts Committee in January this year and its acknowledgment of what has been successfully delivered. The delays involved in implementing the Care Records Service in the acute sector are regrettable, but it is important to point out that these have not been at any cost to the taxpayer," a spokesmand for the Department of Health said.
"Contracts with suppliers are paid on delivery," he added. "The Department of Health's director general for informatics has recently made clear that if significant progress is not achieved by the end of November, a new approach may need to be adopted."
Talkback
Over several decades of interacting with the civil service I became well aware of the civil service syndrome. This describes the somewhat inefficient and indolent civil servant, with enough superficial knowledge of his duties to be dangerous but not enought to be competent (by private sector standards). With IT projects the lack of complete competency and knowledge in executive management and planners can only result in expensive failures. Unfortunately, in the civil service, there is no such thing as failure and those who had responsibility are rapidly promoted and moved around to another post where they again lack proper knowledge and ability.
The Civil Service has for many years been requiring pay and conditions equality with the private sector but refuses to accept the responsibilities (and pensions) that go with this.