By Tony Collins
Far from being dead, the National Programme for IT is on the point of being re-invigorated.
That, at any rate, was the impression given on Monday by senior executives at the two main NPfIT suppliers, BT and CSC, and by two senior officials at the Department of Health, Sir David Nicholson and Christine Connelly.
MPs on the Public Accounts Committee were questioning Nicholson, who is the NHS Chief Executive also the NPfIT’s Senior Responsible Owner, and Connelly, the Department of Health’s CIO, on a report published last week by the National Audit Office on the NPfIT detailed care records systems.
Nicholson and Connelly are among the most highly paid in Whitehall, earning between them nearly £500,000 a year; and the security and seniority of their positions might help to explain their confident replies.
Their allies at the PAC hearing were Patrick O’Connell, President, BT Health, and Sheri Thureen, President UK Healthcare, CSC. All four – Nicholson, Connelly, O’Connell and Thureen – argued for the continuance of the NPfIT. They gave the impression to MPs that the remaining years of the NPfIT, with a total of £4.3bn left to spend, are safe in their hands.
On the other side of the irreconcilable divide were the MPs on the Public Accounts Committee who comprise eight Tory MPs, five Labour and one Liberal Democrat. Labour’s Margaret Hodge chairs the committee. They were allied to the National Audit Office whose auditors say the £2.7bn spent so far on the national programme’s care records systems “so far does not represent value for money and we do not find ground for confidence that the remaining planned spend of £4.3bn will be different”.
At times the animosity between the two sides at the Public Accounts Committee was not concealed; and at one point even the NAO found itself under attack. There were few smiles or obvious signs that each side respected the other despite their disagreements.
To the board of a large private company that was confronting a contract on which a supplier had not delivered, the exchanges at the Public Accounts Committee might have looked odd.
This is because the suppliers and customer – CSC, BT and the Department of Health – were as one. On the whole they were defending the NPfIT against auditors and MPs who were representing taxpayers.
But the board of a private company, facing a contractual disagreement, could ask: shouldn’t this NPfIT dispute be a matter of customer versus supplier?
This could never be because the customer, in this case, has messed up at least as much as the suppliers. Which may explain why suppliers and customer are on the same side, against the people who want to hold them accountable: the MPs and auditors.
Something similar happened after the fatal crash of a Chinook helicopter on the Mull of Kintyre in June 1994, which killed all 29 on board including 25 VIPs. Poor software was a suspected factor in the accident but the Department – the MoD – sided with the helicopter’s supplier in arguing that the equipment and software were sound.
So the MoD and the Chinook’s suppliers were on one side of the divide. On the other side were MPs, families of the dead pilots who were blamed for the crash, and other campaigners who discovered evidence that the Chinook was not airworthy at the time of the accident.
All this shows is that it can be difficult and even impossible to get to the truth after something has gone seriously wrong.
At the end of Monday’s Public Accounts Committee – which lasted about two and a half hours – neither side would have been satisfied. And it’s against this background that £4.3bn has yet to be spent on the NPfIT.
Margaret Hodge made the point that £4.3bn would enable the NHS to employ 200,000 more nurses.
The NPfIT represents change – but some would say it’s for the worse. At Campaign4Change we welcome the independent review of the NPfIT CSC contracts by the Major Projects Authority of the Cabinet Office. The review has already begun.
We recognise there is much pressure on the Authority to approve the contracts and allow the Department of Health to sign a memorandum of understanding with CSC. Indeed the NPfIT minister Simon Burns has indicated that he’d like the NPfIT to continue.
This is the sort of pressure that can make a nonsense of an “independent” Cabinet Office review.
It’s clear to us that the national programme, as structured, pits the Department of Health and its suppliers against anyone who criticises them. In the ring, in one corner, are the Department of Health, Sir David Nicholson, Christine Connelly, CSC and BT, together with consultancies and other organisations and institutions that have a financial interest in the continuance of the NPfIT.
In the other corner are the organisations that represent the taxpayers: the National Audit Office, MPs and potentially the Cabinet Office. Many of these representatives regard the arguments used to keep the NPfIT alive as learned gibberish.
That’s not a recipe for successful change. In the view of Campaign4Change, BT, CSC, NHS Connecting for Health, David Nicholson and Christine Connelly should discuss in a non-legalistic way how to wind down the national programme in a way that minimises the costs to taxpayers and the suppliers. Those at the centre should be setting standards, rather than specifying systems and negotiating contracts that NHS trusts don’t want.
Once a wind-down discussion reaches a conclusion, that can be put within a legal framework. That’s change the NHS can live with. Otherwise the NHS will be locked more securely into suppliers and contracts they hadn’t endorsed in the first place – and the £4.3bn that has yet to be spent may be more good money going into a congenitally bad programme.