Martyn Thomas calls for a review of the NHS IT programme

Connecting for Health, the NHS National Programme for IT (NPfIT), is meant to ‘deliver better, safer care to patients’.(1) However, it is showing many of the symptoms displayed by large IT projects that have failed in the past.

Twenty-three of us, all professors of computing and systems at UK universities, have called for a review. We have a wide range of IT experience, and have studied many failed projects, as well as many that succeeded. Our professional opinion is that a constructive, independent review is urgently needed, to ensure that the risks to NPfIT are properly recognised and managed.

We are not asking to carry out the review ourselves: we simply believe that professionals should speak out when necessary in the public interest.

Source of most problems

Most IT project disasters stem from problems with requirements or specifications, usually because the future users of the system have not been involved enough. Either the requirements keep changing, or they are a focus of conflict – for example, if the users of the system do not want to adopt new work practices the system will impose. When a project’s requirements keep on changing, the project will be delayed, costs will rise and things may get out of control.

Desperate attempts to contain costs and to keep to milestones reduce flexibility and lead to other compromises, as suppliers interpret their contracts ever more strictly. When milestones slip, the slips typically get concealed by re-interpreting the specification or the milestones, as people often prefer to postpone the day of judgment.

Sometimes, real technical problems arise. It often turns out that the designers had simplistic fault assumptions: the dependability criteria turn out to be wrong, or missed, or both. Even when a working system is introduced, if the specification does not fit the real needs, users may create so many work-arounds that the project’s goals are undermined.

Problems specific to NPfIT

In the case of NPfIT, there are many reports of changing specifications, delays, cost escalation, dependability problems, and significant technical issues. We have made some of these reports available to a general readership.(2)

The Department of Health has acknowledged that the specifications (which date from 2002 and 2003) are now obsolete; as Connecting for Health learned more about users’ real requirements, the specification has evolved significantly. It has become clear that the system will require the clinical professions to work differently. We have heard many clinicians criticise the proposals as impractical, or complain of a lack of information about the system’s current goals.

Costs now appear much higher than anticipated, and Accenture has already left the project. There is sharp technical debate about whether the proposed data standards are fit for purpose. Some early implementations have been criticised sharply on their usability and dependability.

We cannot be certain how serious the underlying problems in the project might be, but our experience suggests that the symptoms may well be the early signs of a failing project.

Action for review

We sent an open letter to the Health Committee of the House of Commons in April last year, expressing these concerns. This led to many people contacting us with specific issues: from clinicians to health service managers to experts in computer companies.

We discussed our concerns with Dr Richard Granger, Chief Executive for Connecting for Health, and the NPfIT management team, who agreed that an independent review could be useful. Dr Granger asked us for draft terms of reference for an independent review; we responded nine months ago but Health Minister Lord Hunt has now ruled such a review out. Two of us met the new NHS Chief Executive in January this year, but he too said a review was unnecessary. Yet every month that passes provides further reports that sharpen our concerns.

There are two possible ways of viewing NPfIT. The optimistic view is that the specification is now stabilising into something that can be built, and that will deliver benefits to the NHS. The pessimistic view is that things have run out of control and that, even if the planned systems are delivered, they will not be worth the costs, or the delays.

We hope that the optimistic analysis is correct, in which case an independent review can help by improving communications and building stakeholder confidence. We fear that the pessimistic analysis may be correct, in which case an independent and constructive technical review can provide evidence and recommendations to help the NHS to recover. Either way, our expert and impartial opinion is that there should be a review.

References

1. See the Connecting for Health programme’s website. SPA asked Connecting for Health to defend the programme, but they were unable to deliver a piece.
2. See dossier of reports relating to concerns about Connecting for Health.

Martyn Thomas is Visiting Professor in Software Engineering at Oxford University and Director and Principal Consultant at Martyn Thomas Associates, and speaks for the 23 professors