Category: Resources

The National Programme for IT (NPfIT)

Why did NPfIT fail?

The National Programme for IT (NPfIT) in the UK’s National Health Service (NHS) was one of the most ambitious and costly IT initiatives ever undertaken in the healthcare sector. However, it faced numerous challenges and was ultimately considered a failure. Here are the primary reasons for its failure:

1.  Scale and Complexity: The NPfIT was an extraordinarily large and complex project. It aimed to revolutionise IT across the entire NHS in England, including the creation of electronic health records for every patient and a national broadband network for the NHS. The sheer size and complexity made it difficult to manage.
2.  Top-Down Approach: The program was largely driven from the top down, without adequate consultation and engagement with the end-users, mainly the clinicians and NHS staff. This led to a mismatch between the system’s design and the users’ actual needs.
3.  Lack of Flexibility: The NPfIT was criticised for its one-size-fits-all approach. Healthcare settings are diverse, and a rigid system failed to accommodate the varying needs of different hospitals and clinics.
4.  Technical Challenges: There were significant technical hurdles, including issues with software design and interoperability between different systems. Integrating new systems with existing legacy systems was also a major challenge.
5.  Cost Overruns and Delays: The project faced significant cost overruns and delays. Originally estimated to cost around £6.2 billion, the costs reportedly ballooned to over £12 billion. Delays in delivery and deployment further eroded confidence in the project.
6.  Vendor Issues: The project relied heavily on a few large IT vendors, some of which were unable to deliver as promised. This reliance on external contractors also led to issues with accountability and quality control.
7.  Change in Political and NHS Leadership: The NPfIT also suffered from changes in political and NHS leadership, which affected the continuity, focus, and direction of the program.
8.  Privacy Concerns: There were significant concerns regarding patient privacy and the security of electronic health records, which led to resistance from both healthcare professionals and patients.

In summary, the failure of the NPfIT can be attributed to its over-ambitious scope, lack of user engagement, inflexibility, technical challenges, cost overruns, vendor issues, leadership changes, and privacy concerns. These factors combined to make the program untenable, leading to its eventual dismantling.

Strategies to avoid NPfIT-type failures

To avoid the pitfalls experienced by the NPfIT and ensure the success of a future large-scale IT program, especially in a complex and sensitive sector like healthcare, several key strategies should be implemented:

1.  Stakeholder Engagement: Actively involve end-users, such as healthcare professionals, in the planning and implementation stages. Understanding their needs and workflows is crucial for designing a system that is user-friendly and adds real value to their work.
2.  Incremental Approach: Rather than a big bang approach, adopt an incremental and agile methodology. This allows for regular feedback and adjustments, reducing the risk of large-scale failures and enabling more manageable project scopes.
3.  Flexibility and Customisation: Recognise the diversity within the healthcare system and allow for a degree of customisation in different settings. A flexible system that can adapt to various environments is more likely to be successfully integrated.
4.  Robust Project Management: Implement strong project management practices, including clear governance structures, regular progress reviews, risk management, and contingency planning.
5.  Transparent and Realistic Budgeting: Set realistic budgets and timelines, and maintain transparency about costs and schedules. Regularly review and adjust budgets and plans as needed.
6.  Vendor Management and Diversity: Diversify the range of vendors and avoid over-reliance on a few large suppliers. This can reduce risk and improve innovation. Rigorous selection criteria and performance monitoring should be employed.
7.  Technical Excellence and Interoperability: Focus on high-quality software development practices. Ensure systems are interoperable, scalable, and compliant with standards to facilitate integration with existing and future systems.
8.  Data Security and Privacy: Prioritise patient data security and privacy. Build robust security protocols and involve data protection experts. Transparent communication with patients about how their data will be used is essential.
9.  Change Management: Recognise that introducing a new IT system is a major change. Provide adequate training and support to users, and manage the transition carefully to minimise disruption.
10. Continuous Learning and Adaptation: Establish mechanisms for continuous learning and improvement. Use data analytics and feedback to refine the system and adapt to changing needs.
11. Political and Leadership Support: Ensure consistent support from political and health system leaders. Leadership should be stable, committed, and aligned with the project’s goals.

By addressing these areas, a future program can mitigate the risks associated with large-scale IT projects and increase the likelihood of a successful implementation.

Resources

BIG – Business Integrated Governance

The “Business Integrated Governance” (BIG) methodology within the Praxis framework is a comprehensive approach designed to ensure that the management and governance of projects, programmes, and portfolios are seamlessly integrated with the governance structures of the parent organisation. This methodology is a crucial aspect of the Praxis framework, which is a free, community-driven framework that blends guidance on projects, programmes, and portfolio management into a single integrated guide.

Components of BIG

Key components of the Business Integrated Governance methodology in the Praxis framework include:

Alignment with Organisational Objectives: It emphasises aligning project, programme, and portfolio management with the strategic objectives of the organisation. This ensures that all initiatives contribute effectively to the overall business goals.
Stakeholder Engagement: Central to this approach is the engagement of stakeholders at all levels of the organisation. This includes not only the project team and management but also executive-level stakeholders, ensuring that decisions are made with a comprehensive understanding of their impact across the organisation.
Governance Structures: The methodology advocates for clear and effective governance structures. These structures should facilitate decision-making processes that are both agile and robust, allowing for rapid response to change while maintaining control and alignment with strategic objectives.
Integrated Processes: It calls for the integration of processes across different levels of project, programme, and portfolio management. This integration ensures that practices and procedures are consistent and that information flows smoothly across different levels of management.
Performance Management: A strong emphasis is placed on performance management, including the use of key performance indicators (KPIs) to monitor and measure the success of projects, programmes, and portfolios in alignment with business objectives.
Risk Management: The methodology incorporates comprehensive risk management strategies to identify, assess, and mitigate risks at all levels, ensuring that they are managed effectively within the broader context of organisational governance.
Resource Optimisation: It emphasises the efficient and effective use of resources across projects, programmes, and portfolios, ensuring that they are allocated in a way that maximises value and supports organisational priorities.
Continuous Improvement: The Business Integrated Governance approach promotes a culture of continuous improvement, encouraging regular reviews and adaptations of governance practices to ensure they remain effective and aligned with the evolving needs of the organisation.

In summary

In summary, the Business Integrated Governance (BIG) methodology is about ensuring a harmonious and effective relationship between project-level management and the broader organisational governance.

It strives to align projects, programmes, and portfolios with the strategic goals of the organisation, ensuring effective use of resources, stakeholder engagement, and risk management, all within a framework of continuous improvement and adaptive governance structures.

Resources

Lessons from Transport for the sponsorship of Major Projects

It is vital that we are constantly challenging ourselves to learn from experience when things go right, and perhaps even more importantly, when things go wrong.

Link to the report with the five themes and twenty four lessons is here.

Theme 1 – Accountability must be unambiguous:

Ensure clarity of role and extent of autonomy
Hold the Delivery organisation’s Board accountable for controlled Delivery
Evolve Governance and personnel across the lifecycle stages
Maintain a stable scope and operating environment
Joint sponsorship requires careful design and operation
Join up across Departments

Theme 2 – Behaviour matters more than process:

Act decisively when in exception
Invest in building relationships between leaders
Use control gates to step back and consider status objectively
Challenge the objectivity of delivery confidence assessments
Recognise both the value and limitations of independent assurance
Invest in preparing contingency plans for the most significant risks
Identify, capture, share and apply lessons

Theme 3 – Control schedule and benefits as well as cost:

Use an evidenced range rather than a single target date
Set a realistic cost envelope
Protect benefits
Test value for money through benchmarking
Increase focus on managing schedule

Theme 4 – Deal with systems integration risk:

Ensure clear organisational accountability for systems integration
Reduce systems integration risk by controlling complexity
Protect the test phase diligently

Theme 5 – Enter service cautiously:

Ensure clear accountability for the decision on whether to commission
Manage the whole portfolio to protect other projects and service users
Prepare to recover from disruption when new services are introduced

Resources

Lessons from Major Service Transformation

This NAO Briefing Note (2015) outlines the major lessons of service transformation and can be found here.

Lesson 1 – transformation programmes raise the greatest risks of failure
Lesson 2- set realistic goals and be honest about what really matters
Lesson 3 – policy development must take account of implementation
Lesson 4 – don’t be tempted to score benefits early
Lesson 5 – do identify tangible short-term gains
Lesson 6 – recognise the (senior) organisational cost of transformation
Lesson 7 – don’t underestimate what you can learn from engagement
Lesson 8 – recognise the value of learning and market development
Lesson 9 – do anticipate the need to make changes in live running
Lesson 10 – recognise the opportunities and limits of technology
Lesson 11 – set out clear decision-making and challenge

Resources

NAO Framework to Review Programmes

Four key elements:

Purpose – is there a strategic need for the programme and is this the right programme to meet the business need?
Value – does the programme provide value for money?
Programme set-up – is the programme set up in accordance with good practice and are risks being well managed?
Delivery & variation management – are mechanisms in place to deliver the intended outcomes and respond to change, and is the programme progressing according to plan?

Under each of these four elements there are a series of 18 ‘Key questions’ that are asked covering Stakeholders, dependencies, resources, benefits, external change and lessons learned among others.

Link to the framework is here.