NPfIT
Eighteen years ago this month the UK government of the day announced a massive project to try to turn the NHS into a paperless organisation. Over £5.5 billion of orders were placed with companies including Accenture, BT and Fujitsu in January 2004.
System House, published and edited by Richard Holway MBE, dubbed it the largest UK IT public procurement. It noted that EDS and IBM lost out. The real winner was iSoft which had spun out of KPMG in 1999. “Bluntly,” said System House, “if iSoft had not been chosen as the main software supplier for at least one LSP (Local System Provider) it would not have survived long. As it is this is the best possible outcome for iSoft.” It was chosen for three of the five regions covered in the contracts let that month. Two other parts of the work covered e-booking and a data spine as central services for the regions. Read the Report Here and See Richard Holway Interview Here
All did not go well in the UK’s largest public sector IT procurement. As a House of Commons Public Accounts Committee report published in 2020 said: “The Department’s [of Health] previous attempt to reform how the NHS uses IT, running between 2002 and 2011, was both expensive and largely unsuccessful.” Read the Report Here
“We are therefore alarmed at how little progress has been made against current ambitions. The NHS missed its main target for a ’paperless’ NHS by 2018, and this has now been watered down into a new target to reach a ’core level’ of digitisation by 2024.”
What went wrong?
Why did things go so badly wrong? Some of the problems were with iSoft, as System House had indicated that it may be a weak link in the chain. Its package was late and there were questions about its finances.
But more importantly the largest UK IT public procurement was only one in what seemed like a long line of public sector IT SNAFUs. Others included over the decades The London Ambulance System, the Army Recruitment Partnership Project, The Gov.UK verify system, Universal Credit and more catalogued by Computerworld UK – Read Article Here.
Contributors to the Archives has centuries of experience putting in successful IT systems on a grand scale. Their analysis of why the public sector can fail in IT, and especially the NHS, is essential to our understanding of the complexity of IT.
John Handby worked in the public and private sector and whose first IT job was in 1967 and has extensive experience of leading large scale IT change programmes. He told the Archive: “There is a real problem in the public sector and it comes from the fact that, it’s very difficult in the public sector just to take responsibility for something, executive responsibility and do it. There are always checks and balances, and that tends to be the problem.
“In the NHS it was, it was quite dreadful frankly. The NHS is politically a very difficult organisation to work within, for all kinds of reasons, and obviously, as you will know, not just limited to IT. The NHS, there have been many attempts to look at how you manage it, and whether you manage it in a different way, and how that might be, and every, you know, if in doubt, reorganise. There is the eternal kind of conflict in a sense between the clinical and the administrative. And then, you throw IT in the middle of that.
Handby said: “You know, it’s almost, you’re almost tempted to say, how difficult can that be? I, I have every confidence that a good team of people tackling that without interfering politics, and I don’t mean with a capital P, I mean with a small p, could have achieved that, and achieved it quite easily actually”.
See John Handby Interview Here
Public Sector Projects
Dr Stephen Castell latterly an expert witness in clashes between vendors and their clients over failed IT projects, told the Archive: “Often in the public sector, it’s not so much that they fail, as that they just terminate. They just get cancelled because they’re running on too long and spending far too much money. There has been a common feature that the public sector procurement of IT has not been of the best, to say the least….
“Part of the problem I think is that, the IT industry has always been an industry that’s been controlled by the suppliers, the writers of the code, the builders of the hardware. When you are dealing with a commercial company, they’re already in business, and they know probably in their own business how people control their own value chains, and it may be that they are themselves in a business where they know they control the value chain, because they’re producing, they’re a big supplier in that business.”
See Dr Stephen Castell Interview Here
But the public sector is focused on the services it needs to deliver to the public, and a public it cannot choose. The private sector can select the customers it aims its products and services at. The public sector cannot: it must often aim its services at the most deprived of society. And their requirements for public services are often complex: hence the complexity of the Universal Credit IT system.
The London Ambulance Service
Professor Michael Mainelli when a consultant turned around a failed public sector IT system. He was working at Binder Hamlyn:
“You may recall in 1992 London Ambulance Service (LAS) collapsed. It was an IT failure..” His fellow partners wrote a report on it. It was his job to turn it around “We took 85 people working on the project and pretty much got rid of them and replaced them with two, Chris and one programmer. Now, this is the untold bit of LAS, but, you can go back and look at it. I often laugh at the London Ambulance Service, because, I’ll go to conferences, less, less so these days, but there was a point certainly in the 2000s when I’d go to a conference and some consultant would brandish the report and say, ‘This is the London Ambulance Service report, and what it shows is, that, IT projects fail when you fail to get the staff on board.’ And then the next consultant would say, ‘When you don’t have the right methodology.’ And the next consultant would say, ‘When you, when you use untried systems.’… So, they, they took out of it whatever they wanted somewhere towards the back of the report. One of the things I added to it was the idea that we had to have a causality diagram, and it really is a huge spaghetti diagram, the staff was anti the system, the trades union was anti the system, but it wasn’t necessarily their fault. In addition the programmers hadn’t taken account of the notification needs. And what happened was, broadly, the ambulances were spread around London and got further and further from their base, and the system was trying to reschedule and it just kind of collapsed, sadly resulting in a number of deaths of people who were unable to be collected in time during that golden hour.
“So, what you can see there is, is this notion that these top-down government projects, particularly in IT, do tend to fail. And they tend to fail, in my opinion, and particularly in Britain, and when you compare it with the private sector in Britain which does have a, of course it’s got its failures, but it does pull off some pretty amazing large projects, and that’s because government manages it too much. One of the things I, I frequently said is, you know, I’ve never seen an IT system work where more than three people are involved in the core. Now people find that absurd, certainly the projects bigger than… Yes, it is. There’s a need to go to management meetings; there’s a need to talk to the customers; there’s a need to train people; there’s a need frequently to design lots and lots of screens that are accessing the core system. The core system has always been three people.”
See Professor Michael Mainelli Interview Here
The Benefits of Getting it Right
These are just some of the experiences those contributing to the archives have with public sector IT projects. But the complexity of public sector IT, especially NHS IT can inspire. This from Rebecca George OBE, first at IBM then at Deloitte working for the public sector,
“The NHS is an absolutely amazing organisation, it’s not perfect but it is such a jewel in the crown for the UK, undervalued in many different ways. One of the reasons I’ve always been drawn to the public sector is because the problems are so complicated and everything you touch you have to scale huge. The NHS is the most complex of all of the public sector organisations I’ve worked with and I love the complexity, I love the intellectual challenge, I particularly love the fact that you need to get organisations and systems and processes to talk to each other across big populations, sometimes nationally but quite often regionally, in order to improve outcomes for patients and citizens. It’s that very tangible link to improving outcomes for people that I think is, for me and for many of the people who work in the NHS obviously, so important.
“Still, the work I do with clients is mainly health work and it’s mainly technology, and a lot of the work I do with the NHS is around ‘How do you get an electronic patient records system into a hospital, why would you do it, how are you going to afford it, what will the benefits look like, how do you plan for it and how do you implement it?’ But also how do you connect systems across organisations, across primary, mental, community, social and acute care, how do you gather the patient data to enable people to travel safely across all of these communities? How do you focus on the patients themselves? And then, how do you enable people to start being more self-determining in that system, understanding where their own data is, and how to own their own data and be more personally accountable for both their health and social care? I love it.”
See Rebecca George Interview Here
