The NHS is part way through one of the world’s biggest IT projects, a colossal £6.2bn programme which won’t be completed until the end of the decade.
So said Business IT website Silicon.com back in January 2006 – nearly four years ago when it reviewed the nine projects making up the Government’s NHS IT revolution, from Choose and Book to the NHS Spine.
As the end of the decade approaches, not only are the NHS IT projects far from completion, but the cost has more than doubled to over £12 billion.
We now hear that the project is to be scaled back, though it’s not clear by how much, and it certainly won’t recover the billions already spent.
Liberal Democrat Shadow Health Secretary, Norman Lamb said:
This whole programme has been disastrously flawed from the start.
It has held back the development of IT at a local level, cost billions and is running years behind schedule.
Labour has been in denial for years and this is a belated and partial recognition of the scale of their failure.
The truth is that the national programme should be abandoned in its entirety, subject to existing contractual obligations, and instead we should start building from the bottom.
What’s gone wrong? It certainly sounds like a good idea: instead of wasting resources developing lots of incompatible local IT systems across the country, do it once, do it right and everyone wins. To make sure it’s a success, bring in top consultants from the biggest specialist companies.
It’s easy to criticise it now, all these years down the line, so it’s worth bearing in mind that it isn’t completely daft. (The Conservatives’ short-lived plan to give Google or Microsoft the job of dealing with all our medical records was utterly loopy, though).
But there are major problems. I don’t have any particular insight into the NHS IT projects, but I’ve been involved in enough large IT projects, in both the private and public sectors, to guess at some of the issues.
First there’s Gall’s Law:
A complex system that works is invariably found to have evolved from a simple system that worked. The inverse proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work. You have to start over, beginning with a working simple system.
Sounds obvious, but national NHS IT projects were never going to have the chance to start as simple systems. Hospitals and GPs already have their own systems and any national system has to at least come close to matching what they can already do, if there isn’t to be wholescale revolt. That means a system that has to be pretty complex from the time it’s started being used in anger, presenting all sorts of challenges.
Then there’s all those legacy systems – the existing computer systems being used in hospitals and surgeries. The new software will have to talk to the old – sometimes a bit, sometimes a lot.
Even getting a new system to talk to one or two old ones can be a job as complex as building the new system. Working with hundreds of legacy systems is a developer’s nightmare.
Those are true of any development – and plenty of private sector systems have foundered on them too.
Unfortunately there’s another problem, and it’s one of the Government’s own making. Since the early ’90s there’s been a deliberate policy of de-skilling the civil service in IT and using external consultants.
Nothing wrong with using consultants and private sector expertise; but Whitehall needed to retain some skills so the people in the civil service fully understood the technical details, could negotiate effectively and keep a firm grip on the projects. Too often that hasn’t happened.
We know the result. Super-projects resulting in billions being paid to the big consultancies and IT companies, running late and over budget and often failing to produce much of value.
Until now the Government has pretty much tried to bluff its way through on the NHS projects. Not all of the nine projects have been terrible, so they’ve concentrated on the successful elements.
Finally, we have some indication from ministers that all isn’t rosy, that the £12 billion might not all be money well spent.
Sadly, Lamb is more or less right. Although there are bound to be chunks of the project worth keeping, the reality is that a bottom-up approach is probably best.
It may offend our sense of neatness. It may go against the Labour conviction that Whitehall knows best. It may even open us up to yet another dreaded so-called postcode lottery.
Allowing Primary Care Trusts, either individually or grouped together, to develop their own IT solutions to meet their requirements and work with their legacy systems, along with agreed national standards for passing data between trusts, will almost certainly produce better IT systems faster and for less money.
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4 Comments
This is very true, and everybody in the industry knows it. The UK government’s IT illiteracy is a running joke, these days.
Every single time, it’s the same story: they go to highly paid consultants. These consultants produce a lot of powerpoint presentations promising the sun, moon, and stars. The government laps up every word of it and throws huge amounts of money at them.
The consultants never deliver what they promised. The whole thing was an elaborate con, as they knew they would never deliver. There are no penalties for not delivering – in fact, they’ve just made millions of dollars – as the government will go right back to them for the next project. Any reasonable technical review of the proposals would have shown in advance that they were impractical and overpriced; either the government is hopelessly naive, or it’s a pork project and they intended this to happen.
I would love to do something about this, but I don’t see what we can do.
The PCTs will screw it up along similar lines, of course – they don’t have the in-house expertise either. But it probably will be faster, better, and cheaper than the central government screwup.
‘NHS IT – has Labour wasted £12 billion?’ – Simply put, yes
I am rather unclear what the Lib Dem policy is on IT projects.
In the past people like Roy Jenkins used to argue that you cannot have European standard public services paid for by US level taxes. At that time the Lib Dems prefered the former to the latter.
Today the party appears to believe the opposite, that you can have both.
It is true that there are some big projects that can be scrapped; ID cards, Trident replacement and so on.
However it appeared with the new enthusiasm for “economic liberalism” that there was also a belief that we could bring in the private sector more to run public services. That was shot in the water now we have discovered the staggering inefficiency of the private sector which has sent us into a terrible recession and is more of a wild animal than we previously thought, and now has to be reigned in by the state with tighter regulation.
Be that as it may, we are now faced with a prospect of having to increase taxes and cut public spending to pay off the deficit.
The idea that the private sector should be brought in to run public services looks far less attractive today, but the pressure is still on to make cuts. In recent times Vince Cable has pointed out that we should not invest in IT projects.
That seemed clear to me, although I was wondering how far this would actually be a principle we would stick to, or even whether it was a good idea. Oddly I found in the last Lib Dem News that Norman Lamb was inspired by an apparently successful IT project in the health service in a part of the USA. Fair enough, but how are the Lib Dems going to save money on IT? How will we judge in advance whether our IT spend will not result in disaster?
When you sponser an IT project you need to consider the Total Cost of Ownership, and the Return On Investment.
The mistakes I notice in IT are
1/ A belief that important parts of the project life cycle are expendable, all that is important is to get the thing through the door. So the requirements gathering and analysis phases are short circuited, as are the testing phases. Developers become programmers. Their code is written quickly and is badly organised, and it is not tested properly, and so full of bugs.
Althogether like building a house without foundations.
2/ A confusion about upfront costs being the actual price of the project. In fact the real costs are found when a project goes live, and bugs have to fixed. It is cheaper to bug fix in development than when it is spotted once live.
3/ No consideration on how to manage change. Requirements for projects often change. However poor design often means making that change is harder.
In IT, it is better to pay more in the short term in order to save money in the long term with low maintenance costs
I wonder how many people in the polical world really understand that. I have to say in the private sector I see the same IT mistakes repeated over and over again.
The ideal solution is merely to agree the interfaces by which systems should talk to each other, then allow everybody to tender to build systems which provide those interfaces, whether at the PCT level or higher.
Smaller implementations also allow smaller, more agile development companies into the tendering market who are more likely to offer additional taxpayer value such as using and creating free software solutions.