Tuesday, June 23, 2009

NHS Gateway Reviews damn £13bn IT decisions

This article in Computerworld provides a link to the UK NHS website, which has decided to publish the OGC Gateway reviews of the NHS National Programme for IT (NPfIT). NPfIT is 4 years late and £10bn over original budget. Edward Leigh, Chairman of the Public Accounts Committee for the House of Commons once said, "This is the biggest IT project in the world and it is turning into the biggest disaster.”
These Gateway reports highlight many of the common challenges facing most programmes and provide valuable lessons, most significantly the folly of departing from best practice.
From the very start, the first review in 2002, and the subsequent review in 2004, identified the significant concerns and provided best practice recommendations that would fundamentally determine the success or failure of the programme:
  • The capability of the organisation to manage and run a large scale change programme; the ability to manage widespread IT driven change; and the capability to manage procurement on a scale unprecendented in history.
  • The degree of business change not being reflected into the way the programme was structured, the level of engagement with stakeholders, and into the level of planning.
  • Overly complex thinking in important areas such as procurement, design and implementation rather than building one piece at a time.
  • Unfocussed effort
  • Uncertainty and complexity over the implementation and change management costs
  • Lack of engagement and the need to secure the buy-in of the clinicians and managers who will use and exploit the systems when they arrive
In 2004 there were additional concerns that:
  • The guidance represented by the NAO/OGC Common Causes of Failure were not being satisfied in full
  • The Senior Responsible Owner (the Director General for IT) did not have the responsibility, ability or authority to ensure that the business processes/change and business benefits are delivered [he subsequently took the fall for this ill-conceived programme]
  • There was still a lack of engagement with the hearts and minds of clinicians and staff
  • The absence of a coherent and practical benefits strategy creating a serious risk of deferring benefits once the IT systems have been successfully delivered
  • A lack of clarity regarding the organisational structure that would address these problems
Some of the key recommendations were that:
  • Key stakeholders should participate in the business design work and development of the outline implementation plan
  • The management structure should better reflect the reality of how the programme will have to be managed as the emphasis moves from IT procurement to service implementation and benefit delivery [in other words IT should not have been leading this programme]
  • Instructions and incentives be explicitly integrated and coordinated with the performance management regime to ensure it receives appropriate priority
  • A rigorous review is conducted of the programme as a whole against the NAO/OGC Common Causes of Failure
  • A coherent and practical strategy for benefit realization be promulgated
When you compare the Gateway recommendations to the findings in the report to the House of Commons, NPfIT: Progress since 2006, it is interesting to note that few of the recommendations were implemented.
It is so important to have these independent Gateway reviews for large government programmes. It is even more important to implement their recommendations.

4 comments:

Denver said...

Just remember, it starts with the NAME: "NPfIT" ... those last 2 letters were always a big clue as to the likely fate of a massive business and cultural change being mischaracterised as an "IT project".

There is an old Chinese proverb that goes "The beginning of wisdom is to call things by their right names".

The fate of the former IT director is also instructive; if the IT unit (management) gloried in the naming of this project, in its very public perception as an IT project, then it lived and died by the very same two-edged sword.

Let us hope that the days of otherwise sensible business people thinking that IT "investment" can compensate for weak management skills, are over.

Baz said...

Troubled £12bn NHS IT system to be scaled back

Basil Wood, CGEIT said...

NHS £13bn IT ‘close to imploding’

Basil Wood, CGEIT said...

The Department of Health announces a new, modular approach to implementation. If lessons about programmes of change are not learned, will it be simply be a modular, localized approach to project failure?