Why is the NHS Bad at Infrastructure IT Projects?


No one will have been surprised at the delay to the launch of the latest NHS IT “solution”.

Computer World UK wrote this week that

The new NHS e-Referral service will launch in June, the Health and Social Care Information Centre (HSCIC) has announced. The service was due to go live in November…

The ereferral service will replace the much maligned and under used “Choose and Book” system. But the introduction is 7 months late, and follows a damning review of the process by the Government Digital Services when the project failed 11 of 26 agreed criteria.


The hope is that the service, currently needed by 40,000 patients every day, will allow for expansion and better management of waiting lists.


So why is the NHS so bad at big infrastructure IT projects? The service has lots of expertise and good people working hard to achieve positive outcomes. But again and again these projects seem to fail, or be abandoned, or are hugely delayed.


Let me suggest three reasons:


Project Management is an under rated skill. People see project management as something that everyone can turn their hand to. It is seen as just being well organised or understanding Excel. In fact, good project management is a profession which requires considerable skill, and not everyone has it. It is a whole systems way of looking at processes, organisation and governance, reducing risk and increasing efficiency. It should bring about changes which deliver benefits to the organisation. It is not easy, but it makes a significant difference if it is done well. To deliver good project outcomes on budget and on time, we need to have excellent project management.


Implementation is expensive. Big projects need dedicated time and resource. It is not enough to get your best people and ask them to come to a meeting once a month. Secondments can work, but additional resource must also be identified. It is more expensive to try and muddle through than bite the bullet, appoint the correct amount of suitably experienced staff and agree delivery.


Do we really believe in IT? Probably more contentious this one! Does the NHS really believe in IT as a way to improve patient safety? We all talk about it; we all go to conferences on it. But when push comes to shove are we committed to the principle that good information technology used well can actually improve the clinical outcomes for patients? If not, why do we bother?


So I hope the e-referral system launches on time and is completely successful, increasing effectiveness and efficiency and making it easier, quicker and smarter to book appointments and manage waits.


But if not, let’s not go round this circle again without some serious re-thinking.

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