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NHS Computer System Fiasco Developing? (15 Nov 2005)
The Sunday Times of 13 November 2005 reports that leaked Whitehall e-mails indicate the £20M NHS 'Choose and Book' computer project, that is central to UK health service reforms, is in "grave" danger of being "derailing” the overall £6.2bn national health IT programme (NPfIT).

The warning is attributed to Richard Granger, the civil servant in charge of what is called the world's biggest civil information technology project. When it is fully operational the system is designed to make up to 9.5 million hospital appointments a year. 

To date trials have seriously underperformed with only about 20,000 appointments having been made by patients and their GPs as against the ‘target’ level of 250,000 by December 2004. 

In the e-mail exchanges of last September the blame is placed on a senior civil servant for authorising repeated last-minute changes and a failure to heed advice from above.

The Sunday Times article notes that while Sir Nigel Crisp, the NHS chief executive, admit ted to the Commons health select committee two weeks ago that the booking system was at least a year behind schedule he failed to mention that the delay was having a serious impact on the entire project.

According to ComputerWeekly another leaked e-mail from the chief operating officer at Connecting for Health indicates that the nationaL spine release programme has been "reprofiled' of . This element of NPfIT is a key component intended to deliver electronic medical records nationally.


It could all be seen unfolding long ago:

The following letter was submitted to Sir John Bourne, the Comptroller and Auditor General of the National Audit Office on 10 January 2005 by Trevor Hilder* and colleagues:

"As far as we can tell this project is set to fail in the same way as numerous national IT projects have in recent years, principally because of inadequate requirements investigation. All successful implementations of IT systems have one thing in common – they meet the needs, and take account of the values, of the people who will use them. This is only possible where the requirements are properly understood and the key to this is an in-depth understanding of the work activities of those people. Such an understanding cannot be obtained without very careful study of real people doing their day-to-day work.

"This aspect of requirements definition is a highly skilled activity, but it is also relatively inexpensive, because it requires only a small number of experts to carry it out. If this is done successfully, the risk of later failure is massively reduced. On the other hand, if this activity is neglected, the failure of the project is practically guaranteed. Such failure follows a well-understood pattern, which has been characterized by the engineering expert William Livingston as “The Universal Scenario of Project Failure”

"Oviously, the requirements need to be defined before inviting suppliers to submit tenders for carrying out the work.We can see no evidence that any such study of the requirements was carried out before going to tender. 
Recent independent research.....lends support to our view. In particular, there appears to have been no GP or other user consultation prior to producing a specification, against which contracts could be allocated. Existing software systems (EMIS and others) have been discarded by the NPfIT without any clear statement of their failures and very much against the wishes of their large number of current users. It appears that the NPfIT has taken the “Big Bang” approach to IT projects, which is the equivalent of building a ‘standard’ road, irrespective of where it is being built, then trying to dynamite the landscape to match the road, when the failure of the project starts to be noticed.
"There are those in the IT profession who believe that there is nothing particularly technically challenging in NPfIT, if a common-sense approach to it is taken, and who consider that, for example, the Care Records System, containing about 50 million patient records, is not even a very large database. Yet current estimates of the total cost of NPfIT over ten years range from £18 billion to over £30 billion. If these beliefs are correct then, and had the project been conducted in accordance with the research mentioned above it could easily be carried out for a fraction of this cost.
A proper investigation, along the lines we are suggesting, would prove the case one way or the other." 
Signed by: 
Trevor Hilder, B.A. (Hons) for & on behalf of the following:
Geoffrey M Boult, M.A., MSc.
Aidan Ward, M.A., C.Eng.
Maggie Marum, Consultant in healthcare
Richard Veryard, MA, MSc, MBA, MBCS, CEng. Software Industry Analyst.

* Trevor Hilder of Cavendish Software Ltd  is a key proponent of the First Metre approach and serves as an advisor to MNS.