Why NPfIT failed

(from Campion-Awwad, Hayton, Smith and Vuaran, 2014)
Below is my list of reasons why I think NPfIT failed. NPfIT was the NHS National Programme for IT in health, starting in 2002, with Richard Grainger appointed as NHS IT director. A timeline is published here. NPfIT is generally conceded to have spent £10.7bn by the government in 2013, when it was definitively shutdown. Claims have been made that slightly more than this was delivered in value. Realistic analyses such as the one linked to from the image at the top of this post show that the realised benefits are miniscule. Right now, the benefits for ‘Choose and Book’ can probably also be written off, as it is no longer generally used. I would guess the only benefits that those in the industry would agree were actually realised are N3, the secure NHS network and possibly NHS mail. The Spine supplies some benefits, but is so badly designed and over-complicated that it will undoubtedly be completely replaced in the next 5 years. My view, pretty uncontroversially, is that the programme was mis-conceived from the start. Here are my reasons, which are by no means complete.
  1. The basic requirements were not understood by those running the programme, even though many are actually fairly obvious. The NHS’s favourite published scenario to solve was a Scottish person on holiday in Cornwall getting sick. However the vast majority of all health system interactions are local. A locally devolved but standardised and federated system architecture was required. Instead a nonsensical centralised system (the ‘Spine’) was devised.
  2. The basic science of interoperability of health information had not been worked out. You have to science before you can do engineering. A 5y industrially oriented research programme should have been funded instead for say £250m
  3. The wrong IT standards were chosen, primarily HL7v3 and CDA. I provided a 25 page report in 2005 as to why they wouldn’t work. And they didn’t. This choice killed the possibility of the main problem being solved by any vendor, even had the requirements been properly analysed.
  4. Not one incumbent hospital system supplier had a product even remotely capable of communicating information outside the hospital boundary (other than routine lab data). None had any kind of shared health record concept. And yet they were awarded massive contracts to provide a cross-enterprise health record system.
  5. Not one system integrator company had a single previous installation to which they could point as evidence of experience. And yet they got paid massive amounts of public money to blunder about in the dark. I heard accounts of meetings where it was clear that noone had any idea of how to proceed.
  6. Clinical experts were barely consulted. Without deep knowledge of the information and processes of the domain, building a large IT solution is guaranteed to fail.
  7. Critical errors were made in commercial arrangements, resulting in huge payments to corporations such as BT and CSC, with no adequate requirements definition provided by the NHS, and no proof of prior success by the suppliers.
NPfIT was doomed from the beginning, and quite clearly so for some of us who knew anything about the subject matter. I certainly don’t claim to have known how it should have been done back in 2003, and for precisely that reason I would have funded an industrial research programme at a fraction of the cost, to figure it out, including critically assessing health IT standards. Secondly, I would not have imagined that what was being purchased were ‘solutions’ from corporate suppliers, but instead a permanent development, standardisation and platform-building capability aimed at establishing a component-based supplier economy whose offerings had to obey the platform definition (information models, APIs, domain definitions, terminology etc). Avoiding this kind of fiasco is not as hard as people think. It requires basic questions being asked and addressed: is the problem space understood? Have the requirements been worked out? Has the basic science of a possible solution been done? Have relevant domain experts been engaged? Have standards been determined and thoroughly tested for fitness for purpose and implementability? Has an affordable pilot programme been set up and monitored? Once all this has been done, then you might possibly consider awarding some large scale contracts, although nothing of the size paid by NPfIT is needed. Much more cost-efficient solutions are possible.
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About wolandscat

I work on semantic architectures for interoperability of information systems. Much of my time is spent studying data, ideas, and knowledge, and using methods from philosophy, particularly ontology and epistemology.
This entry was posted in Health Informatics, openehr, Politics, standards. Bookmark the permalink.

4 Responses to Why NPfIT failed

  1. Chris Frith says:

    Agree with the critical errors 1.GPs had been promised a system of their choice in their contracts (NPfIT contractors expected to use their own systems throughout their region) This resulted in no interoperability of primary and secondary care. 2. No GP system was included in the CSC contract at all!

    • wolandscat says:

      Yes, I should really have included the GP supplier situation in the list as well – especially as UK GP systems were some of the most advanced health record systems anywhere in the world and the relevant companies and people undoubtedly knew a lot more about the problem space and its solutions that those actually in charge.

  2. David more says:

    Tom,
    Have you had a moment to pass your eye over the Australian myHealthRecord Program. Would love to hear your views,

  3. Reblogged this on schoutbynacht and commented:
    Good article

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