back to article Latest NHS IT revolution is failing to learn lessons from the last £10bn car crash

The UK government is failing to learn lessons from previous NHS IT disasters, including the £9.8bn National Programme for IT (NPfIT) fiasco, the National Audit Office (NAO) has found. In its report "Digital transformation in the NHS" [PDF], the public spending watchdog said a lack of systematic learning from past failures …

  1. Chris G Silver badge

    Considering all that is in the article, these are the people who want to design and run a tracking app throughout the population of Britain and insist it will all run smoothly and your data will not end up being lost, stolen or sold.

    1. TheSkunkyMonk

      Probably all three with bonuses for all involved. The wastage really is scary though, 12bn should of bought a lot of kit and we only have a thousand or so hospitals, on site servers and one big one really big one shouldn't of cost all that much and general staff normally only use EMIS or whatever it is called these days, cheapo thin clients galore, 12bn? Can we have a break down of costing I'm really curious how much went on hardware and IT staff and how much went on management?

      1. chuBb. Bronze badge

        500m shit thin clients, cat5 and 100mb connectivity to lan and some proof on concept java app masquerading as production

        11.5bn consultants, consultants for the consultants, consultants for the consultant's consultants, junkets, a flashy powerpoint with the word progress in increasingly bigger and bolder varients of comic sans, an nhs owned version of comic sans, brand consultants, golfing based fact finding retreats, additional layers of organisational abstraction (management), and 2 sets of wheels for the big execs mac pro idiot box (destined for bottom drawer of the chest of drawers salvaged from the titanic said exec signed off on as it really tied the room together for the 5 days a year they show up for lunch)

    2. osakajin Bronze badge

      Not allowing that malware anywhere near me.

  2. Whitter
    Unhappy

    Same as it ever was

    Has any large-scale IT project ever learnt any lessons from previous failures?

    Other than the lesson that folks who plan out these repeated failures are none-the-less handsomely rewarded, so it isn't a failure from their personal POV?

    1. Chris G Silver badge

      Re: Same as it ever was

      NHS PHB:

      " We have successfully implemented Phase 1 of the New Digital Age of British Medicine. Everyone in the NHS now has a PC.

      I'm wondering what to spend my bonus on?"

      Minion:" But the PCs are still in their boxes."

      PHB: " That is Phase 2."

    2. Tom 7 Silver badge

      Re: Same as it ever was

      If a large scale IT project had someone capable of learning lessons that person would be bought up by one of the contracting companies and generally kept out of the way.

      The government hasn't gone to all the trouble of arranging things so the NHS cant do things efficiently for people to come along and prove them wrong..

    3. Anonymous Coward
      Anonymous Coward

      Re: Same as it ever was

      No, no they haven't

      From the dev who got a disciplinary for having "Developing tomorrows legacy, today!" as his email signature, while working on a destined to fail BIG IT project

      1. batfink Silver badge

        Re: Same as it ever was

        Serves him/her right for leaving out the apostrophe.

      2. hoola Bronze badge

        Re: Same as it ever was

        It is not just the NHS, it is the same elsewhere. Manglement get to polish their CVs having "delivered" a total piece of shite.

        The people in the companies managing the process are all short term so get out before the scale of the disaster becomes apparent.

        The consultants produce endless flash presentations to justify their (and the parent company's) ridiculous costs that nobody understands but they look cool so it most be good.

        One thing you can be sure of:

        There will be an army of people delivering a process to enable the delivery of the IT. More people will be doing this in a huge arse covering exercise as this is what the client sees. The fact that 90% of the people involved in these projects barely know what a computer is and don't actually deliver any useful IT is irrelevant as they are all making money. The fact that it is largely public money makes it even easier.

        The day that Manglement look back and admit that something either did not achieve its objectives, overspent or did not work due to bad management is a miracle that will never happen.

        The only winners here will be Fujitsu and Captia, they simply cannot lose as they money keeps rolling ing........

  3. macjules Silver badge

    a target to go "paperless" by 2018 has not been achieved.

    It is all about those pesky patients .. sorry, "customers". If they didn't demand appointment times or dates we would not have to worry about sending them letters to ask them to come in for an operation on a certain date.

    1. Mike 137 Silver badge

      Re: a target to go "paperless" by 2018 has not been achieved.

      Once, I got a letter revising the time of a physio appointment by one minute. On arriving, I waited until around 45 minutes after the appointment time without being called, then had to leave as I had to be somewhere else. The lack of control is not just in IT projects.

    2. EnviableOne Silver badge

      Re: a target to go "paperless" by 2018 has not been achieved.

      no the NHS have an even more inventive way of hitting targets, Paperless by 2018, became paperless by the end of the decade, then paperless2020, then paperless2022,now "electronic core services" by 2024

      if you wont hit the target, move it....

  4. Lunatic Looking For Asylum
    Mushroom

    Not Surprised Really

    It will be managed by the same Civil Servants employing the same core group of big gravy train consultancies/accountancies/service providers that have fuktup in the past.

    NHS IT is a cash cow to be milked and the IT management are not fit for purpose. If they were any good, they'd be building their own high quality teams and developing systems the NHS needs, not the latest fashion that Big Monolithic Inc. tells them they want.

    You just know they're going to shove it all in the cloud.

    1. Chris G Silver badge

      Re: Not Surprised Really

      "You just know they're going to shove it all in the cloud."

      But at least it will be in an Agile, blockchain AI cloud!

    2. Anonymous Coward
      Anonymous Coward

      Re: Not Surprised Really

      it not the IT managment, its the entiled general management of the NHS who dont actually realise that they are dependant on it and dont have a clue what they are doing.

      if you want to build your own high quality team, you need the latitude to pay them what they are worth, and with the NHS pay structures tied to seniority and a one size fits all, to pay competent pople what they are worth, you can only afford the hasbeens and the wannabees, not those in the prime of the career.

      so the few who accept being paid less than there worth, bring people in, train them up and see them move on to bigger and better, or catch them on the down stroke where they dont need the money, and can do without the responsibility any more.

      IT in the NHS is a case of miracle working, its a highly realtime service, with life or death impact, and a data set that is a huge target, that is under staffed, under resourced and under respected.

      /AC cos i am one of the few

  5. cantankerous swineherd Silver badge

    nhs this nhs that nhs the other.

    having lost sight of their goals they've redoubled their efforts.

    1. Glen 1 Silver badge

      The beatings will continue until morale improves

  6. Pascal Monett Silver badge
    FAIL

    "lead digital transformation in the NHS"

    From all of what I have read about NHS IT projects, it seems that, in order to fulfill that lofty goal, you need to start by firing everyone above department manager.

    Then you need to get a clear list of needs from the people "on the ground", and then you can start designing an IT system that will do the job and cuddle up to someone's buddy because his wife knows someone high up so it has to be done that way.

    Also, given the cost/benefit ratio of previous IT projects, top-level NHS suits know diddly squat about specifying and following IT projects, so keeping them out of the loop is #1 top priority if you want to get anything useful done.

    Why is there not a ROFL icon ?

    1. hoola Bronze badge

      Re: "lead digital transformation in the NHS"

      Digital Transformation appears to be the latest buzzword for concocting a business case.

      It has the word "Digital" so that means it is high tech so must be good.

      It has the word "Transformation" so the means stuff is going to happen.

      What more could you want?

      The quickest and cheapest way to digitally transform their paper processes will be to type them into a computer with 2 fingers. Upgrade that to 4 fingers or more for those adept at using a keyboard.

      1. Lunatic Looking For Asylum

        Re: "lead digital transformation in the NHS"

        I think there are other connotations for the word Digital in the NHS and I just wish they'd take out ...

  7. Sam Haine

    Real Time bed booking system hell.

    https://forums.theregister.co.uk/forum/all/2018/11/19/nhs_it_advisory_board/#c_3660788

    This comment from 2018 sums NHS IT up perfectly.

    "Some time ago, my company was supplying an expensive team of software engineers to a firm of management consultants ( who shall remain nameless) to install a real-time bed booking system in a London hospital. A real-time system was costing far, far more than an online service seemingly for no benefit to anyone and it's purpose was a constant cause of speculation amongst the team and was a complete mystery to all involved. As time went by, more and more engineers were thrown at the project to the point additional office space had to be found.

    Eventually, our company became seriously concerned at the sheer size of the monthly cost of running the contract and our financial director was having to seek larger and larger amounts of working capital just to keep the show on the road.

    Just why it had to be real-time and not online was never explained officially but it became increasingly obvious that some senior manager didn't actually appreciate the difference between real-time and online. Vast amounts of money were thrown at an increasingly vain attempt to implement the system, and at no time was any money spent on disaster recovery or even a robust backup system.. Towards the end, it had become obvious to everyone involved that what was required of them was impossible to achieve, and several representations were made to the management that the plug should be pulled, however these were ignored, possibly because everyone involved was making more and more money from the doomed project.

    Eventually, the whole thing collapsed leaving absolutely nothing in usable code and a small mountain of unusable hardware. The strange thing was the seemingly inexhaustible budget."

    1. steviebuk Silver badge

      Re: Real Time bed booking system hell.

      Sounds about right. Not just the carrying it on because they are making money from it. It will also be someone never wanted it to be seen to be a failure while they were still there. So will have kept it going until they can bug out.

  8. big_D Silver badge

    Outside the industry...

    If you look outside the IT industry, if a supplier fails to deliver on time, they usually don't keep getting paid, they have to pay the customer penalties defined in the contract for the overrun. But public sector and IT seem to be just an ongoing cash printing machine.

  9. Andy Denton

    Meanwhile in Wales...

    ...they have a standard system for everything across the country. All software is developed in house by NWIS (NHS Wales Informatics Service). The system was originally developed by people actually working in the hospital and they spoke to clinicians and staff as to what they actually wanted from a system. It's not perfect by any means but it's much better than the farcical state of affairs where staff have to cope with US developed systems that insist on inter-departmental charging and staff have to work against the system. It beggars belief that individual trusts spend millions on different systems that are incapable of exchanging anything but basic patient information with other trust's systems.

    1. AH

      Re: Meanwhile in Wales...

      Interesting, that's the second time I've encountered someone saying that NHS Wales does IT right.

      Spoken to several people involved with NHS Data Safe Havens for patient data, and it seems every NHS region has its own, and all of them have essentially forbidden the install any tools or libraries as they are paranoid about a breach, and even getting access takes months and months for even the most urgent research cases (COVID-19). As a result many millions have been spent housing the data, and noone can look at it or understand it. The few data scientists who do have access code up individual queries for data out of raw python. For my local health board, the DS in question said he was the only person ever logged in. And it was like that for all the other boards too.

      Apart from in Wales. Apparently they have a governance process that let people actually get access and use tools, and are becoming the default destination for researchers. I'm guessing NWIS understand firewalls, DMZs and other basic tools of managing the risk of a breach, and so do their governance board.

  10. Flak

    History doesn't repeat itself, but it rhymes

    (Attributed to Mark Twain)

    There is an experience asymmetry between the buyer (public sector) and the seller which I have seen play out countless times in a neighbouring industry:

    The lead buyer often runs their first procurement of this magnitude and complexity, as each organisation only procures one of these types of projects every few years or so, often accompanied by advisors (e.g. procurement advisors on process, external domain experts, internal stakeholders). On the other side of the table you have sellers who are engaged regularly in these kinds of procurements and consequently have experience - often lots of it - on how to maximise the opportunity for them.

    The outcome is varied and while there may be a postmortem after the procurement and implementation, lessons learned are forgotten (by the organisation), because the next procurement is a few years away, the lead buyer has changed through promotion or retirement and a new lead is in place, possibly with new advisors and stakeholders.

    And that is why history rhymes...

  11. Lunatic Looking For Asylum
    Coat

    ANybody can do IT

    It all goes back to the fact that anybody can do IT. When I was studying, great pains were made about systems design and implementation but the golden rule was that you give the user what the user wants, not what you think they want.

    All these projects are imposed on the NHS, nobody asks the staff what they want or how their lives can be made easier, some empire building manager / politician who is proud of the fact that they can't do much more than turn the telly on let alone program the VCR (I know it's an old cliche) just decides that it's what we need and signs it off.

    Generally, the people making the decisions and driving it all forward are not IT people, they'e Oxbridge Arts/Classics/Law graduates. It's rife across all levels of the industry, if you can turn a PC on you're an expert and that seems to be the entry requirement level. Maybe I'm getting too old :-(

    I always remember a Giles cartoon from c 1978, it showed a kaftan clad student with long hair and cigarette and a couple of old engineering blokes in the foreman's office, the caption was "Six 'O' Levels and a Diploma in the History of Ethiopean Potery in 3000BC should stand you in good stead as a riveter's mate lad"....

    1. Roger Greenwood

      Re: ANybody can do IT

      Giles was good wasn't he? Today we have Matt, but all you folks under about 40 should go look him up.

    2. Roger Greenwood

      Re: ANybody can do IT

      "..asks the staff what they want.." has it's dangers though. If I ask 3 people their opinion I expect at least 5 answers, all conflicting.

      Reminds me of an NHS project I heard about some years ago to do data entry directly for new births instead of numerous bits of paper. They used a midwife as a consultant and tester etc. Proper job. Then it went live. When a baby was whisked away by pediatrics they didn't get a weight so had to resort to paper - no option to proceed without a weight. Same if twins arrived - no option for 2nd baby. The reason was they had used a community midwife who just didn't see these things every day and nobody asked her the right questions. Ask carefully...

      1. Terry 6 Silver badge

        Re: ANybody can do IT

        No. The point is not to ask what they want. Because that doesn't get any kind of useful answer.

        The professional equivalent of I want a pot of Smarties with all with all the blue ones taken out.

        You need to ask front line staff what they do. How they do it. What is making it harder for them to do it. And. Could it be done better.

        You do not want to ask the senior managers this. Those people do not know; what the various job roles actually do, what are the numerous extra bits of the various jobs that people just do because they have to even though it's not written down anywhere, what those joblets are called, where and when they do that stuff - or how they do it.

        Without that you can't match an IT tool, or even a staff canteen for that matter, to their needs.

      2. Lunatic Looking For Asylum

        Re: ANybody can do IT

        I do suspect that most staff would reply "Bin it" to the question "How can IT best help you in your job ?"

        It shouldn't be like that because there are probably fantastic ways that IT could help but it's been so badly provisioned that nobody now trusts or believes in it.

  12. Warm Braw Silver badge

    No one seems to understand who is responsible for what ...

    ... in terms of NHS anything.

    It's never going to be possible to have a successful IT project unless there is a clear understanding of what it needs to deliver. There doesn't even seem to be a commonality of purpose about clinical outcomes and how best to achieve them: every time there is some danger of consensus arising the NHS gets reorganised so that chaos can be restored. We have a messy patchwork of private businesses (such as GPs), hospital and mental health trusts whose boundaries do not match each other or obvious local political units, social care, district nurses and public health all under the separate control of local authorities and a complex and largely unnecessary system of cross-billing that actively prevents referrals and treatment. You'd almost think it had been designed to prevent anyone being held responsible for it.

    You don't start to sort that out with IT.

    1. Evil_Goblin

      Re: No one seems to understand who is responsible for what ...

      Precisely, you can't "digitise" business processes until those processes are fit for purpose, and clearly understood, documented, and accepted by all

    2. Lunatic Looking For Asylum
      Pint

      Re: No one seems to understand who is responsible for what ...

      > You don't start to sort that out with IT.

      Beautifully put :-)

      But why don't the upper echelons get it :-(

      Why do they think it's an IT problem ? Is IT just a convenient scapegoat ?

      We seem to accept big projects and big fails as "It's big IT what do youi expect", I wish I knew what the answer was.

      Have a beer :-)

      1. BenM 29
        Coat

        Re: No one seems to understand who is responsible for what ...

        >>But why don't the upper echelons get it :-(

        They do. The Govt. is idealogically opposed to the NHS. They are breaking it using 'death of a thousand cuts'

        >>Why do they think it's an IT problem ? Is IT just a convenient scapegoat ?

        Got it in one. Eventually it will be a cry of "Its tooo hard for Govt to do we are going to give it to MegaHealthCorp"

        Mine's the one with "Too old and cynical to not see through the Govt. strategy for the last 10 years" on the back.

  13. Anonymous Coward
    Anonymous Coward

    I worked on this fiasco ...

    ... My company had thousands of staff on the payroll. Probably very few more than the nearly 100 on my Sametime contact list did anything worthwhile at all.

    Almost everything they did was wrong. I could go into details but probably not without compromising my anonymity which I probably need to maintain as I am convinced my company's mismanagement of this was borderline criminal.

  14. reubs007

    There are simpler ways to transfer public money to private companies

    Rather than going through the rigmarole of creating yet another disastrous IT project, why not just give suppliers the money directly? I mean it's not like the NHS needs the money for more doctors, nurses or kit like ventilators. FFS.

    1. Evil_Goblin

      Re: There are simpler ways to transfer public money to private companies

      Giving it directly breaks EU state aid rules...

  15. Robert Grant Silver badge

    Although the government said it had gained insight from the past, "the national bodies have not systematically recorded all the main lessons from digital implementation, for example in a central database that could be updated as new lessons are learned".

    Sadly, the first lesson was "don't overcentralise", and so the database could not be procured. But if it had, I bet Capita would've got the gig.

  16. steviebuk Silver badge

    Don't get me started.

    I think it was a Fujitsu project around the time I was in the NHS, along with NPfit. Speaking to one of the people involved in the Trust about it they said Fujitsu are getting increasingly annoyed. Each month they have to speak to a different manager as the turn over it so high, each time they are requesting more and more being added to the system but don't want to pay Fujitsu for it.

    Eventually, Fujitsu got pissed off and pulled out. NHS tried to sue Fujitsu. That's a very basic very of what I saw. Who knows how accurate it was, but sounded legit asking for more and more features but not wanting to pay sounded like that Trust.

    Doesn't help the people managing the IT were as bent as fuck. We have a director who I still suspect was taking back handers for contracts, giving jobs for his mates, getting "gifts" from HP to use them as the laptop providers over Dell and never declaring the "gifts". HP magically won the contract. His management team order massive TVs for the office for "Presentations" then one or two of the TVs "disappeared".

    Treating contract IT staff like shit, so shit and disorganised (and I'm not suggesting at all it was right) that said contracting staff decided to "make some of those roll out PCs disappear because no one records the roll out of them properly". It was just targets, targets, targets. We must reach our targets. When you treat staff with respect, you tend to get engineers that do work properly. When you treat them like shit, you get rogue thieves. And when you get pulled under the bus for reporting an issue with some netbooks, only to be ignored for 3 months, then have an attempt at a disciplinary 3 months later for them ignoring you, you can't blame that engineer for sitting back and not report the thieves.

    When you have an argument with a PHB because they want you to "No longer cherry pick calls. But pick the low hanging fruit calls and do those first". That is FUCKING CHERRY PICKING. He insisted it wasn't. I insisted it was. He was a dick.

    When senior management decide to create a desktop background for XP that is eye bleeding and makes it near impossible to fucking read any text that is on the desktop. To be constructively have this pointed out, only to be told "Its not changing, get on with rolling out the PCs". Until user after user told me how shit it was and I had to go to a director in the Trust to tell them, they aren't listening to me so you'll need to tell them. To it then suddenly changing.

    To suggest "Its cheaper if we get in a HDD crushing machine and do it ourselves. Then we know for sure they are all crushed and not just assuming this certificate from this company is legit". Yeah, whatever contractor scum, have you not realised we don't listen to you. To hear, several years after I left, with great joy, that a Trust requested some drives be crushed but IT couldn't so suggests a company. Granted that trust ignored that, gave them to a company that wasn't vetted who then sold them on. Someone picked them up off ebay and found medical records still on them. That trust got the biggest fine anyone's seen. Shortly after they got their own HDD crushing machine :) knobs.

    When you decide to randomly move one engineer who's been helping the 2nd line for a few years & was good on a not great pay (I was clueless at the time) to another role and say "Well if you want to stay you have to now do this role. But as you're a contractor, we're gonna pay you less." (I'd have got the same money per hour working in a fucking supermarket.) and really wanting a career in IT so stupidly stayed. You can see why I'm bitter.

    Glad I'm out of it. Walking away from the PC before I get more angry.

  17. steviebuk Silver badge

    When...

    ..you have A GP calling up to complain her PC has been taken away that had patient data on it because her new PC arrived while she was away. For me to have to waste time explaining the engineer I sent out already asked your PA if it was OK to remove your PC, as it was already booked in and agreed with you to take it away that day. To finally remind you that NO patient or any data is to be left on the PCs, this has been best practice for a few years and you know this. So why were you ignoring it? And yes, you're machine is now here in the office and will be securely wiped.

    She was only complaining cause she was trying to cover up her fuck up of leaving data on the PC*

    Doesn't help when you're doing a temp role and sitting in A&E to install a blood printer (small label printer that prints out labels they stick on your wrist). A fucking printer that just needs a static IP address, that is all. Something you've been doing for years in your last place so know what the fuck you are doing only to be told. "No. 3rd line do that. You have to wait in a&e, call 3rd line, give them the mac address and get them to do it" OK, this is fucking stupid. I've been doing this for years in last place I temped, do you not trust my experience on my CV? Then why did you fucking hire me? I know what I'm fucking doing. Is it because I'm temp scum and showing the fact you are so set in your ways at doing shit because "Its how you've done it for years, and I can't expose how pointless it is as you want to keep your job". So instead you keep me waiting in a&e until your knob 3rd line engineer gets out of his fucking meeting. I argue later for permissions to do this myself next time. "No. 3rd line need to do this". I fucking give up. Clearly NHS IT hasn't fucking changed, all the time I was away from it.

    When you get given a job with no ticket because its a pet project of the IT directors daughter. Right at the end of a Friday. And wonder why. Its out of scope of why we're hired to be there. But sure, we'll take a look. To find you have no rights to the building you were asked to go to. Find the daughter also has no rights to the building. Eventually gain access to be told by the nurses about the kit you're there to move "Other engineers were here earlier but they just took the keyboard and mouse". To finally realise, the lazy cunts in 2nd line couldn't be bothered to move the rest of the kit themselves so had said "Get the temp guys to do it. Yes we're aware that's not what they're paid to be here for but we want to leave early, its Friday". What a bunch of cunts. And to top it all off, when you get it to the department its going to. The daughter has now fucked off without the job being completed and the person in the department you took it too who was told was your contact, knew fuck all about it.

    NHS IT is as incompetent as ever.

    *Was back in XP and proper group policy wasn't in place to lock local saves.

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