RSS feedsAccording to a recent National Audit Office report, the National Health Service IT project Connecting for Health has been a success, despite its budget more than doubling from £6.2bn to £12.6bn.
Since its beginnings, the project has attracted large amounts of negative press, culminating in reform minister Lord Warner’s recent statement that it could ultimately cost as much as £20bn. But the NAO has refused to censure the project, instead offering several plaudits, as well as advice for taking the project forward. The advice and recommendations also apply to large-scale private IT installations.
Going forward, the NAO offered the NHS and Connecting for Health a number of recommendations to ensure the project remains on course. They include:
• The Department of Health and NHS Connecting for Health should provide greater clarity to organisations and staff in the NHS as to when the different elements of the programme will be delivered. l NHS Connecting for Health should ensure that it has a robust engineering-based timetable for delivery, which it is confident its suppliers are capable of achieving.
• NHS organisations should communicate to staff how such a timetable will affect them and forewarn them of the challenges facing the programme, so that the setbacks and changes of priority do not cause a loss of confidence.
• NHS Connecting for Health should continue its strong management of suppliers’ performance, including its imposition of contractual penalties, where needed, to encourage suppliers to deliver on their commitments, including, if necessary, termination and replacement of contractors.
• The department and the NHS should prepare an annual published statement quantifying the benefits delivered by the programme. Quantification of benefits, including financial benefits and quality improvements delivered, set against the costs incurred, will help to demonstrate the actual benefits.
• The department, NHS Connecting for Health and the NHS should commission a study to measure the impact of the programme on local NHS IT expenditure where systems are now being deployed, and use it to provide an up-to-date assessment of the overall investment case for the programme.
• The department and the NHS should continue to evaluate the experience of NHS organisations that have recently introduced IT systems similar to those to be provided by the programme.
• The department, NHS organisations and NHS Connecting for Health should put in place training and development programmes to strengthen capability, including project management and IT skills available to the wider NHS.
Lessons to be learnt
The NAO also published a “lessons learned” chapter, which other government departments, as well as private companies, could learn from. These include:
• Speed - A swift procurement process increases the likelihood of technology being up to date and benefits being delivered earlier. It also reduces overall bid costs for bidders and the costs of the procurement process.
• Maintaining competition - Negotiating contracts with more than one final bidder maintains a competitive tension between bidders and may offer further reductions in price.
• Not having a preferred bidder stage - This avoids the risk of prices creeping up once suppliers know that competitive pressure has eased.
• Use of templates for financial models - Requiring bidders to complete a template demonstrating their financial model can assist the contracting authority in comparing bids on a like-for-like basis and identifying where bidders could reduce their prices.
• The principle of ‘payment for systems that are delivered and working’ - This incentivises delivery and reduces the risk of the taxpayer having to pay for unsatisfactory services.
• Intrusive management of the supply chain - The contracting authority can rectify problems with delivery by stepping in to the supply chain in the event that suppliers are failing to deliver. Suppliers can be required to replace underperforming subcontractors.
• Acting promptly to address problems - Tight monitoring of performance and robust dialogue with suppliers provide early indicators of where the contracting authority needs to take action.
• Applying tight change control mechanisms - These help to ensure that the changing needs of the NHS can be met and also to prevent suppliers charging excessive prices for changes.
• Ownership of software and transition requirements - In the event of a new supplier taking over a contract, the contracting authority retains ownership of software developed, and suppliers must assist in transferring responsibilities for services to a new supplier.
• Publishing information about progress - Having a dedicated website with project activities, information about service levels, data and forward looks of deployment activity can help provide transparent information to future users about the progress of the project.
• Maintaining continuity of leadership - Continuity has helped with work on the IT system, and its absence has hindered securing NHS organisation and staff engagement.
• Engagement of users and user organisations - Early involvement of users and user organisations helps to ensure broad support for change and increases the likelihood of successful implementation. Transparent communication about progress between system developers, implementers and service users is vital to maintain users’ confidence in what is being delivered.
• Working with existing systems - Introducing new systems alongside existing ones adds an extra level of complexity that needs to be planned for, especially when there is little standardisation among the existing systems.
Much of this Briefing is reproduced from the National Audit Office report:
Department of Health: The National Programme for IT in the NHS
