back to article NHS chief explains NPfIT delays

The chief executive of the National Health Service has told MPs that complexity and customisation have been the main causes in delaying England's National Programme for IT. David Nicholson was speaking to Parliament's Public Accounts Committee at its hearings on the programme on 16 June 2008. Committee chair Edward Leigh MP …


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  1. Anonymous Coward

    "complexity and customisation"

    Didn't he anticipate that the applications might be complex and require customisation then? What sort of idiot is he, FFS! Clearly a big one, pulling down a big salary with big perks - unlike most NHS users!

    Perhap, and this is only a wild thought, some of the complexity and customisation requirements might have been evident during the requirements gathering phase - or didn't they do that bit? If they did and missed them then there is definitely no hope that the project can have a realistic budget and timescale now. If they didn't then charges of gross incomptence are approriate for Civil Servants and failure of "duty of care" for the suppliers.

    But, hey, it's only taxpayers money for a gilt edged solution not appropriate to the problem so let's raise some more taxes. Trebles all round.

  2. Juillen
    Dead Vulture

    Free to choose..

    Any patient administration system, as long as you pay a fine of £1m on top of any charges that the other company may make for the system. Per hospital.

    Fujitsu walked away from the whole thing in a contract negotiation leaving a huge vacuum of uncertainty, which probably speaks volumes.

    The whole project was initiated by good ol' Mr. Blair and rushed, to try and get a nice deadline of a couple of years, where he could show himself as the messiah of the NHS.

    Act in haste, repent at leisure.. And with a big fat bill.

    Think the icon is self explanatory!

  3. James Pickett


    "we are close to doing what we have been trying to do for several years"

    I wonder what definition of the word 'close' he had in mind? I doubt if it was shared by anyone else in the room...

  4. Anonymous Coward
    Anonymous Coward

    What we need ...

    Is a government which is willing to bring its IT systems in house and pay appropriately for the people to run it.

    Having worked with some of the vultures involved in this debacle, it's clear that they work from the start to make sure that most of their income comes from "customisation". They're in it for the money and often use "consultants" straight out of uni, for whom they charge an arm and a leg.

    It's not just NPfIT that suffers but every IT project run by civil servants. I'd rather work to benefit my country and its citizens if only they provided a package which suits. I'd even forego the final salary pension for the right salary. But please can someone make the government stop haemorrhaging my hard earned tax to cowboy consultants with no interest in the project, other than how to fleece easy money from the government with no apparent come back. And let's have the top brass of Capita, Accenture, KPMG et al up on fraud charges for a mass defrauding of the tax payer.

  5. Anonymous Coward
    Anonymous Coward


    It would have been helpful if some of the work was specified properly. Certain suppliers were asked to replicate old systems, warts and all which they did. Later they were told to remove or change things that were present in the old system?

    Why not just create something new that meets the requirements of the users?

    The NHS is a nightmare system. So many local policies and costs etc.. the government needs to standardise every PCT's rules. Lets not also forget that Wales and Scotland then have their own rules which have to be taken into account.

  6. Dangermouse

    Complexity and customisation?

    And in other news, bears likely to use woods for bowel movement, some observers say, and the Pope has been seen not to have wooley liberal agnostic tendancies.

  7. Simon Hickling


    "suppliers have found it difficult to deliver products that work"

    Should they not have taken that into account when bidding? What do the penalty clauses look like?

  8. Nomen Publicus
    Dead Vulture


    Given the history of failed government IT projects I guess that nobody involved would wonder if "complexity and customisation" might occur...

    I also think that there is a lot of Not Invented Here going on. After all what other organisations have to manage country wide bed booking systems... apart from international hotel chains that is.

  9. Danger Mouse


    Why are they even bothering with IT when they can't even clean the wards properly? FFS.

  10. Anonymous Coward


    Fujitsu were renegotiating/reseting their contract with the NHS, who didn't like the numbers Fujitsu were quoting. For once the NHS may have been sensible in telling Fujitsu where to go - the NHS is not a bottomless pit of money. They were asking for vast amounts of money to cover the costs incurred in unnecessarily changing systems from one vendor to another and from one technology to another on systems that were already live!!

    If something is working leave it alone. Don't go changing to the latest technology, eg Power6 over Power5, or change to a new vendor, because you mate on the golf course happens to be an overpaid salesman for the new vendor or your architects want to play with the latest kit...

  11. Hedley Lamarr
    IT Angle

    @ Anonymous Coward, 13.14

    "the NHS is not a bottomless pit of money"

    Er, it is.

  12. Mike


    Have yet to see some of the basic systems work yet let alone customised ones. Have noticed what a nightmare it is to get anyone to take responsibility when there are problems and that the standard "Have you tried switching it off and on again" that their so called support people dish out are just insulting to the hard working IT depts that try to implement theyre useless "Cut and Shunt" "Software" which is built from several different vendors apps held together with binder twine. Its a f**kin disgrace that these people have been payed so highly for the doing the kind of job an O`level IT School leaver could have improved on.

  13. Dunstan Vavasour

    Develop in public

    I've said it before, and I'll say it again: this is being paid for with public money, so the development should be done in public.

    While the technical documentation won't be of much interest to the GBP, we armshair strategists at the Reg, inter alia, would be able to provide "many eyes".

  14. Dan Clarke

    To be fair...

    If you've ever done any consultancy work in any large-ish public sector organisation, you'll know that half the time on any given project is spent on providing tiny features to replace bizarre paper-based systems that Julie from the Midlands office uses because she's always done it that way. The poster above is absolutely correct when they say that what should be done first of all - way before even the requirements capture - is a standardisation of the paper-based system so the consultants are bringing one system into the 21st century, not fifteen. If the consultants _then_ go on to balls it up...

    Just my $15m. Invoice to the usual address.

  15. RW
    IT Angle

    Customization? Or not?

    Since all NHS trusts are presumably in the same line of "business", one would expect that a single IT system would fit them all. There are only so many ways to record the fact that Mrs. Jones was given a shot of vitamin B12 because she is a strict vegan with a chronic deficiency of the stuff.

    Any MBA would certainly agree.

    But as someone who worked in the front lines of an IT effort that amalgamated something like 100 different offices' systems, I am acutely aware that getting rid of variation in methods is easier said than done unless management is ready able and willing to lop off heads of recalcitrant managers at the drop of a hat. There's more to uniformity than doing a requirements analysis; cries for special handling must be resisted!!!

    Yet... yet... yet... I have a haunting suspicion that the one-size-fits-all approach is false and naive and that different trusts have fundamentally different approaches to doing the job. That there is no one *best* method, that each method has advantages and disadvantages. That circumstances differ in fundamental ways.


    Somewhere in this pointless comment, the risks of a monoculture need to be pointed out.

  16. Max Lock
    Paris Hilton

    National Program for IT

    Code name NPfit.

    Fit for what ?

    Migrating a clinical system is a bigger hurdle than the bureaucrats in the government, at the PCT, CFH or clinical software suppliers seem to realise. GPs are so reliant on their computer systems, they are left feeling naked when forced to work without it.

    Someone will eventually make a mistake, the only question is what will be the cause? The NHS blame culture at the PCT will ensure it is not pointed towards the poor data migration from the old system to the new clinical system, or the fact that the Centralised System may have been unavailable (for whatever reason, spine etc) that day.

    CFH website are disproving everything that has been written in the papers with their own propaganda webpage. Take a look.


    They also seem to think they are under budget by £2.4B as they thought they would have spent £4.4B by now, well I would like them to answer this one. Has anyone of the projects been 100% been completed yet?

    On a lighter side I read about the £1M for clean keyboards being ordered, did they forget that the mouse is also dirtier than the toilet seat. I have a model for sale, its only £129.00 per mouse, cheaper than the keyboard. Slightly copied from the Logitech, but has a germ proof membrane cover which although is aesthetical not very pleasing will make me more money than the "keyboard professor". I must go and order that cling film from Tesco and man the phone.

  17. Anonymous Coward
    Anonymous Coward

    Pete M

    "It would be ludicrous at the moment to drop them when we are close to doing what we have been trying to do for several years," he said.

    The Concorde Fallacy. One of my favourites. Also known as the Sunk Costs Error, and more picturesquely as the Our Boys Shall Not Have Died In Vain fallacy.

  18. Anonymous Coward

    @AC epetition for your argument.

    It'll probably just get ignored, but hey ho.

  19. Anonymous Coward
    Thumb Down

    Centralise the NHS

    We all know and agree that the NHS is full of to much bureacracy and management. Simplifying the IT system to a single central system would ensure less need for managers and ease of use for all involved.

    HMRC in the early 90s' took this strategy on and whilst its not been perfect it has certainly reduced costs and ensured the goverment can be more reactive!

    Its not rocket science to see that selecting one strategic vision would be an advantage for all parties. NHS staff won't need to retrain, enhancements and rework is simpler for the IT provider and therefore cheaper to the Government.

    I think the more important question is why the hell is the government allowing jobs to be offshored to India! Is that not taking money out of the UK!?!?!?

    Its about time this practice was stopped, Gordon Brown talks about Immigration but he doesn't mention that he is effectively paying for services outside of this country. Employ people in the IT sector in the UK instead of letting it become like the Manufacturing!!!

  20. Anonymous Coward
    Anonymous Coward

    IT in the NHS will always be screwed

    You've got people on the frontline without basic IT skills, their managers - unaware of what their staff actually do - providing the criteria for developers - internal and external - which ensures any product alienates and confuses its intended audience, project managers more interested in covering their backsides than doing their job and lots of middle managers running around trying to justify their existences, and in the knowledge when the games up they can always turn to UNISON to kick up a stink.

    Until the government and the unions agree to go through the deadwood properly, and there is a proper program to educated medical staff and a standard, sane, IT strategy (XML anyone? who cares what systems being used if it exports the correct format with the correct data?) there will be nothing but crap coming out of the NHS's IT systems.

    And from what I've heard of Lorenzo, its laughable.

  21. Anonymous Coward
    Anonymous Coward

    Ever feel like the NHS is just run by idiots

    hopeless lot, if it wasn't public money, and personal data at stake, this would just be comedy, but instead it is a tragedy of epic proportions.

    Hopefully whoever comes in after Labour will just scrap the NHS, it is not like you have a guaranteed cure with them is it, more likely to pick up some disease whilst you are in there than actually find health.

    Complete con from top to bottom is the NHS, bunch of snake oil salesmen.

  22. Anonymous Coward
    Paris Hilton

    Pay peanuts, get monkies.

    Honestly, all the NHS needed was newer, faster PC's; a decent email system and few basic web-based appointment/booking pages setting up....

    Spending billions on complex IT systems that NHS staff didnt want / couldnt understand was pointless from the outset. Replacing systems used by NHS staff for years was never going to work. Staff in the NHS are institutionalised, have been there for most of their lives, are used to manual systems over and never leave.

    Add to that the ridiculous freedom of system choice implemented by the NPfIT (whats the point in spending billions when they can chosoe what system they want anyway!!!), the money wasted on the 4 providers plus a ridiculous Chief Executive turnover rate and its utterly laugable.

    ....and Paris, just cos.

  23. Anonymous Coward

    NHS IT Staff

    I used to work for CSC (but not on NPfIT). One of the reasons for the delays, that I was told about, was because the NHS top brass agreed with the NPfIT suppliers that each NHS region would provide NHS IT staff to work with the suppliers on the project. Unfortunately, no-one informed the regional IT managers, so they said that they could not release staff without the day-to-day work stopping.

    Result - stalemate!

  24. Ascylto


    "There has been speculation that BT would take over the region ..."

    So, the doctor accessing the patient's records will discover ...

    Thank you for calling BT.

    All our Doctors Advisors are busy at the moment. You are being held in a queue and your call will be answered in ... seven ... minutes.

    Please listen carefully to the following 37 options ...

    Your call is important to us.

    Hello, I am Kevin, it is my hoping that we have Mr Smith's medications here for understandings between them both mostly. Oh, just one moment, the computer she is not responsive to my inputtingness. Aahh, back online in just a few moments of waitings. Can we call you back within 24 hours, promise?

    Thank you for calling BT. Your call is importants to us.

  25. Max Lock

    The NPfit project is losing direction.

    The only benefit seen so far is that medical and none medical staff are able to find and book their holidays quicker, reunite with their friends online so they can boast of how much money the NHS is wasting on their salary, update their myspace/facebook pages and shop until they are ready to work. Another hard day on the Public Sector payroll eh?

    AND OH YEA, perform the daily grind of seeing patients, booking referrals, probably not on Choose and Book and boosting the QOF figures so they can get paid more and in turn book more holidays, shop more, boast to their friends .......

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