Sunday, 8 February 2009

Why NHS IT Won't Work

Let's look at some basic facts about NHS to see there is anything there that explains why the IT Strategy has gone very wrong.
1. It is the largest single IT project anywhere in the world.
2. It is charting new waters and just like Starship Enterprise, goes where no one has gone before.
3. The NHS with its more than 1.5 million employees is the single largest employer in Europe. Only the Chinese Peoples Liberation Army, Indian Railways, and Wal-Mart employ more people.
4. With one exception there is not a single country in the world that uses the UK's NHS model of providing health services. This exception is not Russia (even Stalin wouldn't inflict the NHS in his people) he had the gulags to help deal with them. Mind you given the death rates in some of our hospitals, passe Maidstone General, we might want to reclassify them. It is not Japan, where centralised management and pulling together is a strong ethos. Neither is it any of the socialist Scandinavian countries. It is in fact that country well known for creative management and a people centred view of life; North Korea, which is hardly a role model that anyone would want to boast about. But there you go.
All the above tells us that this is going to be high risk, high spend, slow and very difficult. Yet as the single biggest project in the UK government the NHS IT is not reviewed regularly at any depth by the Cabinet.
So, without a wholesale restructuring of NHS it looks like a recipe for failure to me. Do the English and Welsh have stomach for restructuring? Is there a politician out there capable of articulating what needs to change? Without such a person I am afraid NHS will continue to fail, the IT project will never succeed, and all the investment will be wasted.
As we all know neither the Labour Party not the Liberal Democrats can bring themselves to ever have a frank debate about NHS's issues. Anyone who says anything mildly critical is given pariah status. It is probably left to the Conservatives to come up with something. But as a 'contaminated brand' and 'health pariah' anything they do will always be suspect, no matter how sensible it may be. They also have the problem that Andrew Lansley MP, Shadow Health Secretary, has had a charisma bypass and is almost invisible to the public. What does he stand for? What will he do to improve matters when in power? Is he just waiting for Labour to fail and is keeping quiet because he has so little to add, confining himself to unambitious tinkering at the edges of NHS. It's not a very inspiring picture is it?
I have now drifted away from IT to the much bigger and more complex problem of what to do about the delivery of health services in England and Wales. See further blogs over the next days for some thoughts.
Meanwhile back to NHS IT:-
Let's now discuss the chosen solutions. The one based on iSoft is the place to start. This package was originally designed work within the precincts of a health practise and by all accounts worked quite well. The problem is that it was decided by the solutions providers, CSC and others, to base their solution on this product. Smart move you might say. But unfortunately as anyone with experience in IT will tell you, taking a small scale system and stretching it to a wider geography, across multiple locations, with hundreds, if not thousands, more users, is doomed to failure.
Accenture who should know better had this very experience when they rebuilt a small scale shop application more suited to a local corner shop than to the core of a solution for a stores chain, British Home Stores. That failed and Accenture bailed out once they saw it wouldn't work and would not make money for them. Just like they have done in NHS, and who can blame them! In essence scaling iSoft up to mega health region size is rather like taking a tug boat design and turning it into an aircraft carrier. It might float but will it be fit for war?
In addition, there has been the problem that many of the iSoft founding management left as fast as they could once they cashed in the share options based on an inflated share price due to iSoft being part of NHS IT. Thus we have a complex, overly political customer taking on a much amended and stretched solution. Which is where we are today.
The technical solution to all this is supposed to be Lorenzo. The next version of iSoft's solution. Now what odds am I offered that this will work on time too? How about 100-1?
Those are long odds you say, and given that iSoft has built up all this experience they can surely get the version right. Ok then, let's build on the tug boat analogy. SS iSoft was built in a local boat yard on the Isle of Wight, and now the builders have to move operations to Clydeside to design and build a Nuclear Submarine, something they have never done before, just as the boat yard owners and managers have taken their cash and emigrated to new villas in the South of France. Does 100-1 sound too long now? I don't think so.
But surely the systems integrators with the NHS contracts can make it work? Unfortunately they have found out they have bitten off more than they can chew. As mentioned before Accenture a world class systems integrator has cut and run. Others will almost certainly follow soon. Those left struggling to make this work (which interestingly includes CSC who picked up the failing BHS stores solution from Accenture several years ago) have probably found they have invested several times more than they bid and are suffering cash flow problems as a result. They have also put a huge amount of management focus on getting iSoft up and working (much of it with subcontractors in India) and thus have not spent sufficient energy, cash, and management time to turn their cobbled together HMS iSoft aircraft carrier into a Lorenzo nuclear submarine. They have also got a dysfunctional client to deal with and are not totally to blaim. But they are culpable.
Where does this all leave us? It leaves us with £18bln spent on IT that won't work or won't be used because the client has decided to buy elsewhere, and with NHS trusts who are going to commision their own solutions. Which is where this should have begun. What an expensive lesson?
You know it would be cheaper to give each NHS's 1,500,000 employees £10,000 to buy their own IT to help do their job better, and it would leave £3bln spare.
See later blogs for ideas on NHS IT.

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