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Concerns over NHS IT system costs throws into sharp relief the need to adopt a radically-different approach to public procurement and service delivery

The continuing concern over the cost of the NHS IT system throws into sharp relief the crying need to adopt a radically-different approach to public procurement and service delivery.

Leave aside the scale of the task – how sensible was it ever to aim for an all-encompassing system spanning the whole service? The aims may have been laudable, but experience suggests that a critical factor in successful delivery of IT systems is constant engagement with potential users, taking into account their views as the systems are developed. The NHS may have done its best in setting up proxy groups of users – but that was never likely to succeed unless those users could command the assent of a wide range of colleagues: hospital consultants through to GPs; nurses to local health workers; and administrators, few of whom have to talk to one another regularly across different health authorities.

More generally, those running IT procurements may be skilled negotiators, able to drive a hard bargain in putting contracts in place that appear watertight. But in the end, as bitter experience shows, suppliers rarely lose in these circumstances. Sometimes major companies walk away from the contract. Others will take their chances, and see Government in court. And they’ll have at least a fair chance of winning.

From the Government side, the question may appear clear- cut: have the suppliers fulfilled their contractual obligations? It seems straightforward. Until, that is, you factor in whether there was a clearly-articulated and understood requirement, across policy, Ministers (who may have changed frequently over even the development period), and operational interests? Was there continuity from the commissioning side? Data produced by the Cabinet Office a while ago showed that senior civil servants stayed in their jobs for an average of little over two years. In short, was there one, coherent, voice? And to what extent did changes, introduced for all sorts of reasons, but typically to 'tweak' some aspect of the original requirement, perhaps for political reasons, get properly costed and brokered across all the interests? Cue blame, counter claim, cost, and crucially, failure to deliver anything much that will fundamentally alter the user or citizen experience. How can Government break out of this sort of impasse? The answer is almost certainly not to imagine that the 'waterfall' methodologies, so successful in delivering big systems in the 1980s when command and control prevailed, will cut the mustard today, when people are on the whole more aware of how IT can add real value to their service.

In our report 'System Error', we propose a very different approach, using agile methodologies, focussing on business need, fully involving the users, being prepared to go back to the drawing board and start again instead of entering into inflexible, huge, long term contracts. There are encouraging signs that Government has listened; and that these methodologies for the 21st century are gaining more favour. They’d better, for if the default is to revert to the waterfall in most circumstances, we can all expect a soaking from time to time.

Publisher
Institute for Government

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