UK health service abandons massive IT centralization plan

The UK Department of Health (NHS) announced plans to scrap a single, nationwide health IT system, signaling an end to the "greatest IT disaster in history."

The UK Department of Health (NHS) announced plans to scrap a single, nationwide health IT system in favor of "a more locally-led plural system of procurement." The move will save over one billion dollars and signals an end to "the greatest IT disaster in history."

According to a brief NHS press release, the reconfiguration will let local departments act with greater speed and agility in response to their specific requirements:

A new approach to implementation will take a modular approach, allowing NHS organisations to introduce smaller, more manageable change, in line with their business requirements and capacity. NHS services will be the customers of a more plural system of IT embodying the core assumption of ‘connect all’, rather than ‘replace all’ systems.

[I]n line with the broader NHS reforms, the National Programme for IT will no longer be run as a centralised national programme and decision making and responsibility will be localised.

The National Programme for IT (NPfIT) website offers this statement:

A Departmental review of the National Programme for IT has concluded that we deliver best value for taxpayers by retaining a national infrastructure and applications whilst devolving leadership of IT development to NHS organisations on the principle of connected systems and interoperability with a plural system of suppliers.

STRATEGIC ANALYSIS

The nationwide IT plan, which dates back to a report issued in 2002, suffers from several substantial flaws that contributed to ongoing deployment problems.

Enormous size and scope. A 2007 report issued by Parliament, describes the £12.7 billion ($19.6 billion) program:

The National Health Service (NHS) needs modern Information Technology (IT) to help it to provide high quality services to patients. The National Programme for IT in the NHS ("the Programme" or NPfIT) was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale. It constitutes the largest single IT investment in the UK to date, with expenditure on the Programme expected to be £12.4 billion over ten years to 2013-14.

Practical experience and common sense tell us that projects of this size usually fail.

Long implementation period. The long implementation period substantially reduced local authorities’ autonomy and flexibility in the face of changing needs and technology. In this case, the program did not adequately consider the Internet's role in establishing a common national infrastructure.

Computer Weekly describes the impact of changing technology during the long deployment period:

At the time the programme was initiated, way back in 2003, the concept of regional providers with some national applications was pitched as a compromise between total centralisation and complete decentralisation. In truth, it was what the technology available at the time was best at delivering.

Since then, the internet has connected everyone, and if you started NPfIT today, it would be blatantly obvious that you set common standards, and allowed everyone to do their own thing with a standardised, interconnected infrastructure.

Excessive centralized control. In an effort to consolidate procurement, the original plan called for building a centralized infrastructure across the UK. This attempt to reduce costs had the immediate effect of placing central mandates over local requirements and decision making.

In a clear response to this issue, the press release contained a statement on this topic from Health Minister, Simon Burns:

We will allow hospitals to use and develop the IT they already have and add to their environment either by integrating systems purchased through the existing national contracts or elsewhere.

My take. The NHS plan consists of a veritable roadmap for IT failure. Despite lofty and worthy goals, the architects of the plan seemed to forget the practical dimension of system deployment.

A short blog cannot possibly express the delays, complexity, and screw-ups embodied in this colossal waste of money.

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