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Critical Analysis Report

1. Discuss and finalise the failed project name with your tutor.

2. Find out the causes of its failures and analyse the control systems applied.

3. Critically evaluate the effectiveness of applied control systems and stakeholder's management.

4. Make recommendations for how its failure could have been avoided.

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Project Snapshot

The National Programme for IT initiative (NPfIT) in the National Health Services (NHS), is considered as the largest IT programme that was ever attempted within the public sector, in the United Kingdom. The programme was initially budgeted to be approximately £6 billion which was allocated over the lifetime of the key contracts. Due to a series of delays, implementation issues and stakeholder oppositions, the programme was eventually dismantled in 2011, almost after 10 years, by the Conservative Liberal Democrat Government. The project was initiated in 2002 at a seminar, by then Prime Minister Tony Blair, in Downing Street. The fundamental aim of the NPfIT programme was to develop the use of information technology by NHS towards the twenty first century (House of Commons, 2007). The focus was to introduce integrated electronic patient records systems, computerised prescription systems, computerised referrals, underpinning network security and online "choose and book" amenities. Despite the failure of several of these services that were needed to be delivered, the taxpayers as well as the government had incurred substantial expenses for the programme, that also include the contract transition along with exit expenditure that continued to accrue through 2013/2014 (House of Commons, 2007).

Introduction

The current report has focused towards understanding the various aspects that were associated with the project of National Programme for IT initiative in the NHS (NPfIT). The main aim of the current report is to develop a critical case study on the analysis of the failure of the NPfIT project and determine those factors that provide the overview regarding the failure of the project. The NPfIT in the NHS was considered as the largest IT program that was ever attempted in the public sector of the United Kingdom. The budget for the project was acquired from various contractors that majorly comprised of various biggest players of the information technology industry, that majorly comprised of Accenture, Atos Origin, BT, CSC and Fujitsu. NPfIT is considered as the single largest IT investment that was made in the UK till date that has had an expenditure of about £12.4 billion, over the 10 years, until 2013-2014 (House of Commons, 2007; Dolfing, 2019).

Although the NPfIT in the NHS has been dismantled, the same remains effective as a separate component programmes that have continued to incur significant expenditures. The statement of the Department of Health on the benefits that were expected from the National Programme portrayed that majority of the reimbursements are yet to be delivered and there also prevails the risk that the assistances may not materialise ever (House of Commons, 2014). The Department of Health is needed to learn from the lessons they have learned from the failed National Programme so that they are able to deliver the novel vision of paperless NHS in the near years (House of Commons, 2009). The following report that shall focus towards exploring the various aspects of the National Programme for IT (NPfIT) initiated in the NHS so as to identify the major causes of the failure of the project and the elements that could have been considered for ensuring its success.

Major Issues or Reasons for Project Failure

The National Health Services (NHS) was in the need for the modern information technology for enabling it to provide the patients with high quality services. The National Programme for IT (NPfIT) in the NHS was established for providing such kinds of services, with the help of centrally managed procurement, for providing impetus towards the uptake of IT as well as for securing the economies of scale (Justinia, 2017). The central vision of the programme was the NHS Care Records Services that was designed for replacing the local NHS computer systems with the more modern and upgraded integrated systems that would make the key elements of the clinical records of the patients available throughout England, via the electronic means. This would allow the data to be shared by all those requiring to utilise the same for providing care to the patients.

The major reasons that have been identified to be the cause for the failure of the NPfIT can be detailed as follows.

1. Funding: Presently, the NHS spends nearly about £850 million every year, locally for supporting the IT and its associated support system. On the other hand, for the NPfIT, the budget that was originally estimated was about £6 billion in the year 2002, which eventually increased to about £12 billion by 2012 (Parliamentary Office of Science and Technology, 2004). However, the central funding was not sufficient to cover all the aspects of the delivery of the national programme and therefore, it was unclear as to what proportion of the funding is to be required to be found locally. Moreover, the industry groups were concerned regarding the ‘planning blight', whereby the local Trusts had put the procurement of the new systems on hold as they were unsure of the outcome of the programme (Parliamentary Office of Science and Technology, 2004).

2. Procurement: Apart from the speed, the procurement process for the NPfIT had certain other innovative features, whereby at least two bidders were maintained who were running for each of the contract until the last minute, for maintaining the competition as well as for avoiding the price rises. However, defending the procurement being vigorous, it was argued that the process would allow faster improvement of the users and the patients (Parliamentary Office of Science and Technology, 2004). Nevertheless, there remained the concerns regarding the pace with which the programme was headed and it was suggested that more time be spent towards defining the requirements. Moreover, it was also determined that the suppliers had underbid so that they would win the contracts and therefore, were left without sufficient finances to make the actual delivery of the services, thereby affecting the quality of the actual project deliverance (Parliamentary Office of Science and Technology, 2004).

3. Data Quality: With respect to the NHS Care Record, it was envisaged that certain data would be included from the existing systems of the General Practitioner (GP) practices and the rest was to be added eventually over the years. Along with the expenses of collation of the data, the quality remained the major concern. The NHS Electronic Record Development and Implementation Programme (ERDIP) had employed about 19 demonstrator projects in the varied regions for the identification of the data quality issues (Maughan, 2010). The major issues that were determined included the identification of the source of the data, the difficulties associated with the regular updating of the information, the reliability of the extraction of the patient information from the GP systems, and the necessity for common data incentives and standards for ascertaining the consistency of the data being recorded by the clinicians.

4. Poor Contracting Process: One of the innovations that was initially considered to be praiseworthy, with respect to the NPfIT was the efficacy and pace of the contracting and procurement processes. However, eventually the process became a negative factor for the project. NPfIT had awarded the contracts hastily and was lacking sufficient planning, especially for such kind of large contract (Hendy, et al., 2005). Moreover, the scope of the contract was unclear and much work was needed to be done after awarding the contract, so as to be able to agree to the key contract parameters such as deliverables and scopes (Maughan, 2010). Moreover, the procurement model was based on the no negotiation model that was very aggressive for management of the suppliers, which turned out to be counter productive for the long term relationship with the suppliers.

Control Systems

The programme of NPfIT was focused towards deliverance of an upgraded IT system for the NHS at the national wide scale of the United Kingdom, which would revolutionise the care systems of the NHS. The programme was originally planned to run for a period of two years and nine months, beginning from April 2003. Moreover, the policy documents had predicted that towards the end of period, an almost paperless environment of working would be in effect. However, in reality, the contracted deadlines for the delivery of the key systems were missed in a repeated manner (Dolfing, 2019). Furthermore, the technologies that were initially planned to provide ease and efficacy with respect to the tasks and processes, had emerged to be more time consuming and cumbersome. In certain cases, there turned to be less safe than their counterpart of the papered systems. The initial budget for the programme was estimated to be about £6 billion for the entire project lifetime. However, by the end of the project, towards the year 2012, the project cost had reached an amount of nearly £14 billion, which was much higher than the initial assessments of the project costs (Dolfing, 2019).

Analysis of Cost and/or Schedule Overruns

From the case history of NPfIT, it can be determined that the failure of the programme can be attributed to three main themes, which resulted in the cost as well as schedule overruns. These include haste, design and culture. These aspects can be elaborated as follows.
1. Haste: The programme managers and politicians were in too much of rush to reap the rewards of the NPfIT programme. As a result of the same, they rushed into the process of policy making, implementation and procurement. Due to the same, there were only little time allowed for the process of consultation to be conducted with the key stakeholders and as a result of the same, it led to the failure in dealing with confidentiality concerns (Campion-Awwad, Hayton, Smith, and Vuaran, 2014).

2. Culture and skills: There was a lack of clear direction within the programme of NPfIT, apart from the absence of effective strategies of project management and project exit. This implied that there were inevitable setbacks associated with pursuing the ambitious programmes in such haste resulted in the rapid system wide failures (Campion-Awwad, Hayton, Smith, and Vuaran, 2014). Moreover, the organisational culture within the government in general as well as the Department of Health, was also not very conducive for the swift identification and rectification of the technical or strategic errors.

3. Design: The programme of NPfIT in an effort of reducing the costs and ascertaining instant acceptance at the local levels, the government had pursued an unwieldy and overambitious centralised model that did not take into consideration the manner in which it would affect the satisfaction of the users or the issues associated with user confidentiality (Campion-Awwad, Hayton, Smith, and Vuaran, 2014). In any IT projects or programmes, maintaining the confidentiality is considered as the most significant aspects of the successful completion of the project (Al Ameen, Liu, and Kwak, 2012).

As a result of, primarily, these factors, the initial cost of the project, which was estimated to be about £6 billion with a completion period of 10 years, had eventually risen to £14 billion and was still no where near to the completion process.

Analysis of the Project Execution Team

In 2004, there was to be a review of the arrangements regarding the involvement of the stakeholders that also comprised of the patients and staffs of the NHS organisation, for supporting the efficient implementation of the National Programme for Information Technology (NPfIT) of NHS. There had remained the criticism regarding the NPfIT approach, associated with the involvement of the clinicians, as well as the fundamental aspects that are involved with the implementation of NPfIT. Being a part of the new approach, the NPfIT was focused towards creation of a new Front Line Support Academy for helping the NHS leaders, with the advancing and novel technologies (Kinn, 2004).

The project execution team comprised of several stakeholders that varied over the period of 10 years, starting from the year 2002, until the termination of the project in 2012. The series in the alteration of the project team execution and stakeholder is needed to be discussed from the year 2002, that is, the beginning or initiation of the project. The project of NPfIT initiated with Richard Granger as the appointed NHS IT Director. In 2003, BT was awarded the contract for the development of the national data spine. Moreover, by 2004, BT was also awarded the contract of NHS broadband network (Collins, 2014).

By 2005, NHS Connecting for Health (NHS CFH) was established for delivering the NPfIT. In the year 2006, Accenture withdrew as the local service provider, while CSC was awarded with a 9 year contract for the former clusters of Accenture (Dolfing, 2019). In the year 2008, the contract with Fujitsu as the local service provider in the Southern area was terminated and there were certain impending legal disputes that continued. Also, the head of the NHS CFH, Richard Granger left the programme and Gordon Hextall was appointed as an acting head who also left soon after (Dolfing, 2019). Later on, Christine Connelly and Martin Bellamy were appointed jointly as the leading heads. By 2009, Martin Bellamy resigned and Christine Connelly was integrated with the Department of Health Informatics Directorate. By 2011, the programme was eventually terminated and it was estimated that about £2.6 billion was earned as the actual benefit from the over £12 billion that was spent on the programme, as of March 2011 (Dolfing, 2019).

Analysis of Relationship Between Overruns and The Stakeholders

The failure of the programme of NPfIT can highly be attributed to the unrealistic timetable and thee lack of engagement with the privacy and users campaigners. There also were inadequate preliminary works as well as failure of the test systems and check in the progress against the expectations (Brewster, 2011). The stakeholders also failed to recognise the limitations or the risks that are associated with the big IT projects of the extent to which NPfIT belonged. Moreover, the initial plan of extending the programme for 10 years had failed to recognise that the longer it takes to complete the project, the more likely it would be to get overtaken by the novel and more advanced technologies.

The Front Line Support Academy was supposed to comprise of simulators for mocking up the health service environments such ass surgeries of GPs (General Practitioners) and hospital wards. The clinicians were to be able to learn regarding the best use of the systems with the role of patients being played by actors (Kinn, 2004). It was acknowledged by the health minister that the complexity and scale of the programme implied that there would be utilisation of the various equipment, however, the most important and primary concern included the engagement and built of the trust, with a varied range of the stakeholders (Kinn, 2004).

With respect to the project of NPfIT, it can be determined that there existed a lack of clear leadership due to the changes it had experienced over the year, with respect to the Director and programme head. Moreover, there existed the major issue of not providing appropriate training and the lack of commitment towards the necessary budget (Wright, 2011). There also existed lack in the project management skills that was reflected on the overall quality of the programme (Greenhalgh, and Keen, 2013). The stakeholder engagement, that majorly comprised of the GPs, doctors and other health care providers, was not sufficient with respect to the programme of NPfIT and the same had resulted in the ineffective progression of the project.

Analysis of Possible Actions for Success

The possible actions that could have been taken by the programme and project management team of the NPfIT can be elaborated as follows.

1. Employing the Right Procurement Model: The process or strategy of central procurement of the contracts had resulted in the vigorous competition of the suppliers that although saved £4.5 billion, but it also implied that the NHS was unprepared in the areas of the key policies such as information governance, standards like clinical coding and messaging, and the architecture of the system. Moreover, the vagueness of the specifications associated with the contracts had resulted in the loss of about £30 million for sorting the legal aspects (Coiera, 2007).

2. IT Safety and Security: IT is a powerful enabler and in situations where it is poorly used or implemented, can result in harm of patients, with respect to the context of health care sector. Despite of the same, system security was not included in the initial specifications of procurement. Moreover, the program failure could have had triggered massive legal claims. Therefore, it can be suggested that delayed common user interface should have been employed as the additional safety benefit (Coiera, 2007). This would also result in less training time and enhanced effectiveness of the clinicians, along with safer practices.

3. Enhancement of the Skills: The shortage of the skills and expertise of the entire workforce of the programme had highly affected the overall quality. Therefore, it is recommended that the project or programme team should have selected those stakeholders for the project who had the required skills and expertise for fulfilling the requirements of such a large scale IT project (Coiera, 2007).

4. Clinical Engagement as a Significant Aspect from the Beginning: Clinical engagement should have been considered from the beginning, rather than taking into consideration after the procurement process. The engagement of the clinical community from the initial stage would have aided in determining all the necessities of the procurement process from the beginning (Coiera, 2007).

Conclusion

The case of the National Programme for Information Technology (NPfIT) for the National Health Services (NHS) have provided an insight regarding the various aspects that are needed to be taken into consideration from the initial stage of the project, especially in cases of long term and complex IT (information technology) implementation projects. The different processes of project management that are employed by the project or programme management team, plays crucial role in ensuring the project is completed in a successful manner, while maintaining the quality and the project cost and schedule. With respect to the case of NPfIT it can be determined that the programmed lacked several foundational aspects of project management practices such as efficient leadership, qualified and experienced skill force, effective procurement and contract processes, efficacious stakeholder engagement and so on, which eventually resulted in the downfall of the program. The failure of the programme of NPfIT had provided the lessons that in cases of complex and complicated large scale IT projects, it is important to maintain a short duration of the project, as the technology progresses very rapidly in the modern world and delaying the completion of the project would result in substantial drawbacks of the quality of the programme due to the need for constant upgradation of the technology that would result in increase of the project cost, which was majorly witnessed in the case of NPfIT.

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