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Should the NHS look to for answers to IT success?

1 September 2009

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Start Software

Fellow of the Institute of Analysts and Programmers

Robin is a fellow of the Institute of Analysts and Programmers. He is the director of Start Software, a company that creates straightforward software to help busy organisations to do their business. Robin is a director of Anxiety UK, a national anxiety disorder charity (formally the National Phobics Society). He is also Shropshire’s least able, but most enthusiastic, leg spin bowler, and his googly has to be seen to be believed

It’s certainly true that large IT projects throughout the public and private sectors are often late, over budget and – when finally delivered – not what the users of the system actually wanted in the first place. This is especially true in the NHS, where vast amounts of money continue to be spent on systems that either never materialise or are “not what the doctor ordered”.

The National Programme for IT (NPfIT) is now forecast to be four years late and double the original (already enormous) budget of £12.7bn. That amount of money is utterly mindboggling.
Is this depressing situation inevitable when major new IT systems are developed with complex requirements and where security and reliability are vital? Or are the NHS and other public sector organisations especially inept? hosts one of the world’s leading online shopping sites. It is reliable, fast and convenient. It services thousands of orders an hour, and has done so virtually faultlessly since the day it was launched. Even more impressively, the system was developed by a core team of only 10 people and was available to customers just six months after the development was started.

How can Tesco develop a complex, nationwide, integrated system (linking customers to warehouses to supermarkets to couriers to online payment systems) so quickly, while the NHS seems incapable of doing anything in IT either on time or to plan? Tesco isn’t unique either. Far from it. Businesses across the world launch complex systems efficiently and without fuss every day.

Online flexibility
The first factor is the internet. From a standing start 15 years ago, it has now taken centre stage in so much of our daily lives. The reason for its success is simple – it is based on cheap, reliable, open technology and has always been flexible and useful enough for people to want it.

If you want to deliver a service to lots of people – even services that need to be secure and that hold and transmit sensitive data – the obvious solution is to use the internet. However, risk-averse individuals throughout the public sector deem this to be a bad idea and they build complex, costly, internal networks instead. These same people go home and do their online banking every night and think nothing of it!

Unnecessary complexity
The second key reason for NHS projects being massively complex is that it is in the supplier’s interest for this to be the case. If an IT company can get away with saying that a project needs 200 business analysts and 150 project managers and 50 programme managers and so on and so forth, then it will do so, since this generates revenue for the IT supplier.

However, it also ensures that the project loses focus and is difficult to direct – factors that inevitably cause delay
and mismanagement.

Committee thinking
Finally, big teams mean “design by committee”. Even the largest IT systems can essentially be designed by one or two people working together – the “architects” of the solution. Just as the best buildings are the brainchild of one person, the best software also has one person’s name on the credits. Imagine watching a film directed by a committee… or listening to a song where each verse had been written by a different “lyric design technician”, all brought together by a team of “music production managers”. It would simply be a mess, and software is no different.

An overegged pudding?
I have just turned 40. Since the tender age of 15, I have written software commercially. I have worked in some of the biggest public sector businesses on some of the most important, reliable systems anywhere in the UK. My passion for keeping things simple and avoiding the complexity that drips like poison into NHS IT projects stems from an experience I had 12 years ago, when I allowed myself to believe the mantras of “big is beautiful” and “process is king”.

That system turned into a £50m failure and almost destroyed the morale of a successful and previously thriving organisation. Never again. If something seems overpriced and overcomplex, it probably is.

So, the moral of this story is that next time you buy your groceries online, or send a quick email to a relative in Australia, consider how simple, quick and easy it was. Compare that transaction with something similar promised by the NHS (Choose and Book, GP2GP record transfer, NHSmail, etc) and then ask yourself if that £12bn would have been better spent elsewhere. As Tesco says: every little helps.