A National Offender - The Same Old Lessons Have Not Been Learnt

The Public Accounts Committee (PAC) have released their report on the The National Offender Management Information System (C-NOMIS) project.

The C-NOMIS project, originally expected to be delivered in January 2008 for £234 million, was stopped in August 2007 because costs had trebled. Astonishingly, £161 million had been spent but the National Audit Office was unable to determine what the money had been spent on. The scope and benefits have since been reduced and the project is now expected to cost £513 million and be delivered in 2011.

"The way the C-NOMIS project was managed and monitored was completely unacceptable. It is deeply depressing that after numerous highly critical PAC reports on IT projects in recent years, the same mistakes have occurred once again. We question the purpose of our hard work if Whitehall accepts all our recommendations but still cannot ensure a minimum standard of competence. In this report we make further recommendations for how other organisations can avoid the mistakes made on C-NOMIS through identifying risks, monitoring progress properly and taking action to mitigate risks as they emerge."

The Chairman, Edward Leigh, who has reviewed other out of control projects, most notably the NHS Connecting for Health Programme (aka NPfIT), started the proceedings by expressing his exasperation:

"I have had all this before and I just do not know whether there is any point really carrying on frankly...Why did these problems re-occur, the same old lessons have not been learnt; over ambitious, weak project management and all the rest."

The problem was that it was seen as an IT project rather than as a programme of IT-enabled business change and it was badly managed. An analysis by the National Audit Office of the underlying causes of the costs increases and delay indicated that C-NOMIS suffered from seven of the eight common causes of project failure - four in full and three in part.

"In scales of comprehensiveness of incompetence it is largely unmatched."

The recommendations from the report are fundamental to successful delivery of IT-enabled business change:

• Major projects should be reviewed by senior management with sufficient rigour and scepticism to ensure that proposals are well-focused, realistic and take full account of uncertainties. "As usual it is key managers and what key managers do that makes a really big difference."
• Do not wait for blame to follow failure. Ensure proper performance management at all levels.
• A plan showing how business change and new IT are to be integrated should be upfront in the Full Business Case for all major IT projects.
• The organisation's capacity to manage major projects should be assessed and, where appropriate, strengthened.
• Monitor projects closely using reporting systems that are fit for purpose, based on actual evidence of performance.
• Take swift and robust action when reviews, such as OGC Gateway reviews, identify concerns or shortcomings in the management or progress of a project.
• Use existing guidance to avoid repeating the mistakes of the past.
• Negotiate contracts to ensure suppliers match expenditure against deliverables.
• Record and validate benefits and financial savings.

"Clearly this project was handled badly, it achieved poor value for money, many of the causes of delays and cost overruns could have been avoided. I could make some grand eloquent statement about how we never expect to see this happen again in the Civil Service but I suspect I would be wasting my breath." - Edward Leigh

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.

District Health Board software push

I read with interest an article in New Zealand's Computerworld about the NZ Health IT Cluster’s questioning of a Request For Information (RFI) issued by seven District Health Boards (DHBs) for a single patient management system and citing the challenged NHS NPfIT project as a reason to be cautious of this approach.

A point overlooked in this debate is the role of effective governance in the health sector. The article points out that there has been a failure to achieve interoperability through architectural standards, that the RFI is pre-empting the update of the national health IT strategy, and that a single IT system is already deemed to be the only solution– these are significant governance issues. What is going to be done differently to ensure that health sector, or even the DHB collective’s, IT-enabled initiatives will be successful in creating (and not eroding) ongoing value?

Reading the background on the RFI, it is very clear that the health boards place an emphasis on an IT solution, rather than how IT will be used, to deliver benefits. In the absence of sound governance, will anyone even be held accountable for realizing the claimed benefits? Experience and research has proved time and time again that technology is only part of the equation and that desired outcomes can only be achieved with full consideration of the required changes to the business model, business processes, organisational structures and culture, the way people work, and the involvement and commitment of all stakeholders. These are the areas where DHB collaboration must occur and it must be addressed as part of a whole programme of change within a structured and integrated governance framework.

Typically IT drives these initiatives when the clinicians won’t and that should be seen as a red flag — just as it was for the ill-conceived NHS NPfIT project. IT has the potential to improve health care but IT alone will not solve the problem of adoption. A survey found that only 62% of doctors think NPfIT will improve patient care and only 20% of consultants had a card to use electronic records. A US survey of physicians' adoption of outpatient electronic health records found only 13% adoption rates. How can the claimed benefits be achieved given these adoption rates?

Research by the IT Governance Institute is very clear on how organisations successfully create value from investments in IT-enabled change – there is:

• Strategic, leadership-sponsored commitment to IT governance—to align IT decisions with business objectives and to monitor performance with clear accountability for achieving benefits
• Recognition that IT is not just about implementing technology—it is about unlocking IT-enabled business change
• A structured approach to the governance of IT-enabled investments, based on proven practices for doing the right things, the right way, getting them done well and getting the benefits.