The national press of U.K. and the business press at large have reported on this project and its various developments for seven years. The transformation of National Health Service (NHS), U.K. and the impact of the project on the British people is very visible, but the controversy rages on. Neither NHS nor any of the service providers — Accenture, BT, Fujitsu agreed to speak with Global Services for the story. With the help of public reports, we pieced together the NHS story to make it a case for learning than for criticism. Consequently, because the sources are unverified, there may be discontinuities in facts and figures, times and places, opinions and allegations, in this attempt to showcase the project.
It was year 2001, when Bill Gates and Tony Blair, the former Prime Minister of the U.K., together decided to transform the NHS using the power of IT. The undertaking led to the conception of a mammoth outsourcing project. In June 2002, NHS’ launched a £12.4 billion National Program for IT (NPfIT) to provide the best health-care services to England’s population, which is about 60 million today. This government-funded project is one of the biggest contracts ever conceived in the international health IT to improve the patient experience and the quality of care; configure support-service with modern IT; improve the capacity of NHS to deliver change and reform; change working and clinical practice; and support frontline clinicians in delivering improved patient centered care.
When NPfIT was established, no one had had even thought that the U.K.’s largest outsourcing project would soon become the world’s most controversial too. Since its inception in 2002, the media has been pummeling NPfIT at every phase. Despite the fact that the program has been able to save £4.6 billion (as NHS revealed to Global Services) in health care costs, and also promises many advancements in patient care, the project has seen a barrage of negative reports in the media. The most recent one published on Jan. 2008 [on Computerworld’s website] revealed that U.K. Conservative Party leader David Cameron attacked the government and said in a public assembly that NHS has not been able to deliver improved health services, but has certainly been able to install malfunctioning computers. As reported, Cameron claimed that “ministers had “fallen for the sales patter” of IT suppliers and consultants ... “shoddy jargon-ridden schemes served up on PowerPoint and swallowed whole” by the government accusing ministers of “hopeless gullibility.”
However, there’s almost always a fire behind the smoke. As recently as mid week of Dec. 2007, many online forums reported loss of security of patient data when nine of NHS trusts reported losing patient data. In fact, the Department of Health admitted this fact. And, the incident raised questions about the security-related risks associated with the new IT program that also includes a centralized patient records database. But, as expected, the chief executive of NHS David Nicholson defended the project and urged to go it on.
Besides media, there are many industry pundits who often refer this project as one of the most over-ambitious and complex outsourcing program ever executed. One of them is Dexter Whitfield, Director, European Services Strategy Unit, who not only tagged NPfIT among the world’s most over-ambitious projects in his recently released study Cost Overruns, Delays and Terminations: 105 Outsourcing Public Sector ICT Projects, but also told Global Services that “the project was totally underestimated in terms of its financial size that led it to so many controversies.”
A Scope Too Flexible
The NHS project seems to be a perfect text-book case of how not to define the scope of a project.
The NPfIT program was incepted as a linear, phased, evolving project to handle three types of services — prescription services, bookings services and life-long health-record services. Within each of these services, the scope could vary and it did vary widely. It became the primary factor causing overruns to the original services implementation. As of now, NPfIT’s scope has expanded like an amoeba to handle many new functionalities such as NHSmail (e-mail and directory services), PACS (picture, archiving and communication systems), bowel cancer screening and payment by results. In fact, various additions were made to some of the projects being delivered to the program. For instance, the choice element of Choose and Book — an electronic referral service, which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic.
Time for some kudos. More than half of the new services that were added later to the NPfIT program have been 100 percent completed on time with minor or no hiccups. Hats off! But, of all three services defined initially, not even two are completed yet. In spite of this, NHS Connecting for Health’s hopes continue to be high. It has set a target — to finish the project in the next two years (as stated in the 2007 Status Summary of NPfIT) — for achieving more than what it has been able to achieve as of now.
Any case of scope creep calls for smart project management. All evidence proves that the NHS project was far from being professionally project managed to contain scope creep.
However, NHS has never shied away from releasing information into public domain about the status report on the project. As of Jan. 25th 2008, 153,097 summary care records have been uploaded to the spine- central information repository; 438,314 users registered for access to the spine; 63,110,500 prescription messages have been transmitted using the Electronic Prescription Service (EPS); 6,979,750 Choose and Book bookings; 550,939,039 images stored using PACS; 26,326 National Network (N3) connections; and 318,149 registered NHSmail users, according to the latest deployment statistics of NPfIT.
