Sunday, January 20, 2019

Case Study: The £10 billion IT disaster at the NHS

Case Study: A £10 billion IT disaster
The National Program for IT (NPfIT) in the National Health Service (NHS) was the largest public-sector IT program ever attempted in the UK, originally budgeted to cost approximately £6 billion over the lifetime of the major contracts.

These contracts were awarded to some of the biggest players in the IT industry, including Accenture, CSC, Atos Origin, Fujitsu and BT.

After a history marked by delays, stakeholder opposition and implementation issues, the program was dismantled by the Conservative-Liberal Democrat government in 2011, almost 10 years after Prime Minister Tony Blair initiated it at a seminar in Downing Street in 2002.

The core aim of the NPfIT was to bring the NHS’ use of information technology into the 21st century, through the introduction of integrated electronic patient records systems, online ‘choose and book’ services, computerized referral and prescription systems and underpinning network infrastructure.

Despite the failure of many of these services to be delivered, the government, and ultimately taxpayers, incurred significant costs for the program, including contract transition and exit costs which continued to accrue to a total amount of more than £10 billion.

Since NPfIT was a public-sector program, there is a large amount of documentation and press about the case available. If you are interested in reading more about it, I have collected many of these documents here.

This article is a summary of one of these documents that I would recommend any project manager to read: “The National Program for IT in the NHS: A Case History” by Oliver Campion-Awwad, Alexander Hayton, Leila Smith and Mark Vuaran. You will find the document in the directory mentioned above.

This excellently written case history of the NPfIT investigates what went wrong with the program. It identifies three main themes:

1) Haste

2) Design

3) Culture and skills

The rest of this article will look into these into more detail.


In their rush to reap the rewards of the program, politicians and program managers rushed headlong into policy-making, procurement and implementation processes that allowed little time for consultation with key stakeholders and failed to deal with confidentiality concerns. This resulted in:

> An unrealistic timetable

No time to engage with users and privacy campaigners

Inadequate preliminary work

Failure to check progress against expectations

Failure to test systems


In an effort to reduce costs and ensure swift uptake at the local levels, the government pursued an overambitious and unwieldy centralized model, without giving consideration to how this would impact user satisfaction and confidentiality issues. This resulted in:

Failure to recognize the risks or limitations of big IT projects

Failure to recognize that the longer the project takes, the more likely it is to be overtaken by new technology

Sheer ambition

The project being too large for the leadership to manage competently

Confidentiality issues

Culture and skills

The NPfIT lacked clear direction, project management and an exit strategy, meaning that the inevitable setbacks of pursuing such an ambitious program quickly turned into system-wide failures. Furthermore, the culture within the Department of Health and government in general was not conducive to swift identification and rectification of strategic or technical errors. This resulted in:

A lack of clear leadership

Not knowing, or continually changing, the aim of the project

Not committing the necessary budget from the outset

Not providing training

A lack of concern for privacy issues

No exit plans and no alternatives

A lack of project management skills

Treasury emphasis on price over quality

IT suppliers that depend on lowballing for contracts and charge heavily for variations to poorly written specifications

Closing thoughts

When you compare the results of this case study with my personal top ten reasons of technology project failure, you will recognize that almost every one of these ten reasons was an issue within the NPfIT.

1) Poorly defined (or undefined) done.

2) Poorly defined (or undefined) success.

3) Lack of leadership and accountability.

4) No plan or timeline.

5) Insufficient communication.

6) Lack of user and performance testing, or failure to address feedback.

7) Solving the wrong problem.

8) Trying to adapt standard software to business processes instead of the other way around.

9) Continuing to pursue bad ideas.

10) No real decisions and death by committees.

When you want to prevent your own project from becoming a disaster keep this list in mind and do the opposite. You will find further reading in the mentioned article.

On top of these, you should always keep your projects as small as possible. The bigger they are, the higher the chance of becoming a disaster.

Other project failure case studies

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Posted on Sunday, January 20, 2019 by Henrico Dolfing


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