Building the Management Team
Like any buyer of IT services, NHS’ first step was to identify a set of right partners who had the experience of implementing IT programs in both private and public sectors. In Oct. 2002, Richard Granger was appointed as Director General of IT by NHS to drive NPfIT. Granger’s responsibilities included procurement, development and implementation of modern, integrated IT infrastructure and systems for all NHS organizations in England by 2010, with the help of various teams in the NHS, Department of Health and third-party vendors.

The next step was to set up the director’s team and the team members’ roles. As the NPfIT project was based on Public Private Partnership model aka PPP, it was necessary to include people with the experiences from both private and public sectors. So after analyzing the necessity, Granger recruited a management team drawn from the private and public sectors.

The entire management structure was defined and the information was made available in the report Delivering 21st Century IT Support for NHS, published by Department of Health in June 11th, 2007. The report structured the management team at three levels — national management (responsible for program management, funding priorities, procurement execution regional, etc.), regional management (responsible for funding flows to program management of IT in their regions) and local management (selection and implementation of IT complying with national data standards, systems specifications and infrastructure requirements). The roles of National Program, Strategic Health Authorities and individual NHS Trusts were clearly defined in the procurement-approach document published in Jan. 2003 released before the commencement of NPfIT.

Everything seemed to going fine but in June 2007, Granger announced his decision to leave the project by end of 2007. Since the announcement of Granger’s departure, NPfIT has become a big concern for all, especially for the stakeholders. The program’s leadership responsibilities are now being seriously discussed everywhere. There was no clear second-in-command who could take over from Granger.
It is not clear whether independent reviews were conducted to examine the impact of Granger’s departure. Such reviews could not only reveal the strengths and weaknesses of the program, it could also be an occasion for cutting down the scope and scoring some early wins.

Best practices to avoid failures, delays and cost overruns

The government's commitment to commissioning and contestability does not address any of the fundamental causes, and will only make matters worse for ICT projects in the next decade, particularly in shared services projects. The remedies do not lie in tinkering with the procurement process but with root and branch change in the modernization of public services.

In place of 'wider and deeper' private sector involvement in public services promised by Gordon Brown, the Prime Minister of the United Kingdom of Great Britain and Northern Ireland, the government must have a radical rethink of the public-services transformation strategy. Outsourcing, the creation of contestable markets and the obsession with one-stop-shop contact centers should be downgraded with priority given to funding and integrating core frontline services.

Options appraisal must be revamped with a requirement to examine all options  (including in-house delivery combined with best-in-class external support) using comprehensive social, economic, health and sustainable development impact assessment.

Building in-house capacity must be prioritized. Too many public sector managers rush to use management consultants who predictably encourage outsourcing, yet their evidence and conclusions are rarely subjected to rigorous assessment. Consultants should only be used with a skills/knowledge transfer agreement.

More effective scrutiny at key stages which must have the resources to provide an effective challenge in the decision making process. Gateway reviews too narrowly focused on procedural implementation of the original decision.

Procurement must be democratized. Whilst public and private commercial confidentiality must be safeguarded, service user, staff and trade union involvement should be a prerequisite.

A developmental and incremental approach is likely to be more desirable, effective and economical. Public interest and reducing inequalities should replace the discredited 'what works' ideology.

By Dexter Whitfield, Director, European Services Strategy Unit and Adjunct Associate Professor, Australian Institute for Social Research, University of Adelaide