Richard
Holway - A personal view on the NHS
IT Project
Nov
06
Foreword
On 29th Sept 06,
it was announced that Accenture was quitting its involvement in the NHS IT
project. The media was full of comment portraying the project as a “disaster”
– indeed “yet another public sector IT
disaster”. Yet again, Richard Granger, and the way in which he both
procured and managed the project, was at the centre of that criticism.
On 2nd Oct. 06, I
decided that I would break my silence and write an “alternate” view. I was
pretty amazed at the reaction this created. I had more emails on this subject
from readers than anything I have written in years. In essence they all said “It
was about time someone put their head above the parapet and said this”. My
comments were reported extensively in the press and Computer Weekly ran the
article in both their online and print editions and they too had a massive
mailbag. That was interesting, given the negative stance which Tony Collins and
Computer Weekly have had on this project for years. If you Google for articles
linking Tony Collins and the NHS, you get an amazing 44.000 matches. I skim read
as many as I could and couldn’t find one article with a “positive
attitude” that Tony had ever written on the project. So maybe their readers
too were getting fed up with the one-sidedness of the reporting. BT featured my
views in their “News in the Loos” posted in every WC in every BT building in
the UK. A new low for Holway!
Several readers took the
trouble to call to discuss their views. These included the heads of the NHS IT
project at several of the suppliers as well as Richard Granger (who heads the
project for the NHS) himself.
I therefore decided to update
the piece with to reflect their comments (unattributed as I promised)
Preamble
I’ve had an association with practically all the parties involved in this
project right from the start. I’ve known Richard Granger from day one. Ovum
has a continuing contract with the NHS IT project team. I have a close board
level relationship with some of the major players and Ovum numbers everyone of
the major suppliers to the project as its long-term customers. In many
people’s view that would make me biased and/or highly conflicted; the main
reason why I have not made public statements or written pieces on the project
for quite some years.
But maybe there comes a time
when you should stand up and your views be heard.
1
– Supporting the objectives
I have yet to meet anybody who opposes the overall objective of the NHS project.
When it is fully implemented it will be a major force for good. It will save
lives – many lives, maybe yours, maybe your kids. I have little doubt that it
will be looked upon throughout the world as a model to be followed.
2
– An IT project or a Change Project?
Connecting for Health is almost always referred to an “IT project” and,
indeed, projects at the Passport Office, Criminal Records Bureau, Inland Revenue
self assessment, National Air Traffic Services, Dept of Work and Pensions, Child
Support, Magistrates Courts are also described as IT projects too. I choose this
particular list as all these projects are described as “IT project
disasters” too.
But in reality, all these are better described as “change projects”. The IT bits often worked reasonably
well – it was all the other bits which
didn’t!
The Passport Office is a high profile case in point as the media were full of
this “IT disaster” back in the summer of 1999, with pictures of queues
around the block as hapless holidaymakers were forced to wait for the issue of
their passports.
The problem at the Passport Office, however, was rather more to do with HM Government surprise decision to implement passports for children which saw the demand rocket at just the time staff were having to learn to use a new system. The Passport Office, itself, was responsible for “ensuring continuity and quality of service”. Indeed, Siemens, the IT supplier, received hardly any criticism in the ensuing NAO report.
It is also worthy of note that if you apply to renew your passport today, the system will issue it within 24 hours.
The point I am making here is that Connecting for Health is an enormous CHANGE project of which the IT element is but a part. Many of the problems that I know of in the NHS project right now are far more to do with not managing the change correctly, rather than faults in the IT.
The Passport Office fiasco, and most of the others listed above, also point to the fact that once the initial teething problems are overcome, the systems tend to work rather well and we then all take that for granted!
3
– Achieving the Connecting for Health objectives will cause pain
Anybody who has ever been involved in any project – big or small – knows that. Why we have so many media observers who are so naïve as to suggest otherwise, baffles me.
The larger the project, the more “unknowns” there will be – everything from the vagueness of the initial specifications through to the requirement to “invent” something brand new to solve problems along the way. This is NOT an IT problem alone – it has infected every large project known to man. Be it building Concorde, the Channel Tunnel, the new Wembley Stadium, all the way to putting a man on the moon.
4
– Avoid “one-sourcing”
I have written many articles
over many years against the concept of what I dubbed “One-sourcing” – ie
putting all your eggs in one supplier’s basket. Indeed I’d stake a claim on
being one of the first to advocate “multi-sourcing”. NHS IT is the most
advanced example of just that. Accenture failing and CSC picking up the pieces
is an example of the benefits of the
approach NOT of its failure!
5
– Avoid paying suppliers for their failures
How many times have you read of public sector contracts failing and us, the tax
payers, picking up the costs of that failure? How many times have
“One-source” suppliers been able to extract huge extra sums from HM
Government to correct their own failures? Granger went out of his way to avoid,
or at best minimise, this possible eventuality on the NHS IT project.
Michael Cross writing in The
Guardian on 19th Oct 06 observed ”Of
all the bidders, Accenture should have gone into the NHS contracts with its eyes
widest open. That it signed up anyway suggests that somewhere up the line it was
assumed that government contracts can be topped up with extra services if things
go awry. That almost always happened in the past. But Granger negotiated the
contracts precisely to avoid getting held over such a barrel. That’s why the
neighbouring contractor, CSC, was able to step in”
6
– Extracting maximum value from suppliers
Granger has undoubtedly been very hard on T&Cs from suppliers. He has saved
millions with the deals he struck with suppliers like Microsoft. If only that
approach really had been adopted throughout the public sector, again the savings
would have been huge. Current takeup of shared services and collective buying
across all Govt departments is still lamentably slow.
The problem is that charging
customers less is hardly in the interests of either suppliers or their trade
associations. Perhaps one of the reasons why so many in the industry are against
any wider adoption of Granger’s procurement methods.
7
– So was Granger “too hard” on
these poor, weak suppliers?
Firstly, we are not talking about naive start up companies here. Accenture has had more experience of (and money from) large Govt IT contracts than most. I refuse to have any sympathy with complaints about the contracts they willingly entered into.
Secondly, if ALL the main
suppliers were now bleating (or bleeding), I’d pay more attention. But they
are not. CSC was rather pleased and happy to take over from Accenture. Indeed,
it’s pretty much in the public domain that BT would also have been happy to
take over too.
Win-win,
not lose-lose
I full-heartedly agree that the best user-vendor relationships are where both
“sides” are winners and the vendor makes an acceptable profit. I have always
considered litigation as a statement of failure by BOTH parties. Again, I
actually think Granger understands and complies with that. As far as I know
Granger hasn’t actually litigated against any supplier yet – preferring the
kind of arrangement which led to Accenture’s exit.
“Mistakes, we’ve made a few”
Now, don’t get me wrong, I
too can write much about the mistakes made in this project. I have long
criticised the lack of early involvement and commitment from the medical
profession; something which the project was far too slow to address. I can
criticise, in particular, the decision to add choice onto electronic booking. It
added another level of complexity for something, actually, neither doctor nor
patient actually wanted. Also the plan to sweep out all the existing systems and
suppliers was also misguided. Something which has since been addressed. I
could go on…
HM Government too must accept
criticism. It was naive to believe or announce that the “only” costs of the
project were those related to its procurement. Training and implementation has
cost much more than the initial procurement costs in every IT system I have ever
been associated with. The
timescales imposed on this project, as ever, were initially for political
expediency rather than having any relationship to common sense.
Attitude
“In my experience, success is based on whether people WANT projects to
succeed – it is all down to attitude”. So says Partick O’Connell who
manages all of BT Global Services NHS IT projects. He should know as he has
spent the last 25 years being responsible for some of the largest projects
around.
In my own 40 year experience,
I couldn’t agree more. What Connecting for Health needs is a change of
attitude – in the media and throughout the NHS.
What it certainly does NOT
need is a change of direction – either in terms of personnel (where even the
project’s greatest critics think that removing Granger at this point would be
a disaster) or in its reporting structure. We have heard rumours to the effect
that much of the responsibility for the project will be handed back to the NHS
Trusts next year, allowing them to introduce new suppliers or retain existing
systems and practices. We sincerely hope that will not happen as to make that
level of change at this crucial stage would be to the considerable detriment of
the project’s main aim – “to produce
a new integrated system to modernise the NHS”.
I may be biased and
conflicted. But I feel passionately that the aims of Connecting for Health is
something we should all now develop a “positive attitude” towards.
(Richard Holway)