National IT Programme in the National Health Service - Methodologies and Concept - Term Paper Example

Project Report for the National IT Programme in the NHS: Methodologies and Concepts Name Course Tutor Unit Code Date Introduction The field of project management has evolved from when people performed their project activities manually with minimal recording. The first evolution started in the 1950’s and much has been achieved to date. Projects have grown in complexity and scope with the increasing desire to cut down cost and completion time but deliver the correct quality. In view of the fact that projects are temporary and unique undertakings, in the evolution of project management has been the development of concepts and techniques to guide project undertakings. One such concept is the project life-cycle management (Duff & Quilliam, 2010). Project life-cycle management is simply a methodical process of project initiation, project planning, project implementation, project monitoring and evaluation, and project closure/termination. This is the conventional approach in project management used to direct project management activities as well as decision-making processes for the duration of the life-cycle of a project. It entails regulating and overseeing the numerous activities carried out in every one phase of the project cycle to certify that project is relevant to the beneficiaries, supports sponsor policies of the sponsor, and is viable and effective (Evaristo & van Fenema 1999). In this paper, I look at the appropriate methodologies and concepts pertaining to the National IT Programme in the National Health Service (NHS) in England from initiation to closure. Phase 1: Project Initiation This is the first step of any project development. The project is generally defined and its impact stated. The scope of the project is outlined indicating the project objectives as well as the expected deliverables (Duff & Quilliam, 2010). Aim and Scope of the Project The National IT Programme was initiated by the Department of Health in 2002. The project was premeditated to make better health services and quality of patient care in England. According to the National Audit Office (2008), the key deliverable of this project was “an electronic care record for patients, the NHS Care Records Service…” This would consist of: (1) A Summary Care Record that would indicate the demographic along with other key medical information for each one patient; and (2) A General Care Record detailing the full particulars as regards the patient’s medical past and cure (Baldwin, 2013). Apart from the Care Records Service, other deliverables would include key systems and amenities such as the N3 national network, an automated booking service, automatic prescription service, together with the Spine. In the course of the project other elements were added to the project. These are (1) the Picture Archiving and Communications Systems for alpha numeric X-rays along with other imageries; and (2) NHS e-mail system (NHSmail) (Brennan, 2005). Impact of the Project The National IP Programme was mainly intended to deliver an IT reform in the NHS. According to the National Audit Office (2008), the programme would deliver a “new NHS policy, operational changes and add new programmes.” The policy and operative changes made work easier and more cost effective. The National Audit Office (2008) indicates that the NHS Improvement Plan introduced a plan in 2004 whereby no patient was required to wait for over 18 weeks between GP referral and being attended to through provision of medical care. In tracking the performance of the systems, it is estimated that NHS Connecting for Health had reached a way out of 111 care record systems as at 31 March 2008 while 60 were left to offer the required data through workaround solutions. Also in complying with the Mental Health Act 2007 there is need to comprehend the complex requirements. It is preferred that the mental health systems offered through the programme ought to back up mental health superintendents. This could be through recording details of Sections in accordance with the Act and permit contribution and reportage on appeals, regrades, renewals, and tribunals with date, time, those in attendance, and results of the meetings. Furthermore, periodic changes would be initiated by the Department to the organisation structure of the NHS. A case in point is the July 2006 reduction in the number of Strategic Health Authorities from 28 to 10 and Primary Care Trusts from 303 to 152. The result of such restructuring resulted in changes in informational requirements. Moreover, the Programme requires to be capacitated to reconfigure data for it to redirect fresh structural borders (National Audit Office, 2008). The project also encompassed a number of additional features of change within the NHS, which had considerable impacts. Key among this was the extensive organisational and cultural transformation. Besides changing the manner in which those working in the NHS would make use of information in dealing with each other as well as the patients, the programme would enable collective care of patients through easy access to simultaneous information by every professional attending to a patient (Department of Health, 2002). Moreover, the programme would support broad development of health informatics to improve health results. Opportune information on the treatment outcomes from many patients would improve health and save lives by providing initial warning signs before risks that are not known. This would validate earlier buoyancy especially on treatments that are effective, and consequently make them available to more people swiftly. The programme would also support health informatics (specialist and research area devoted to improving health outcomes by enhancing the use of information) by arranging for more comprehensive, timely and correct data on care outcomes. This includes a ‘Secondary Uses Service’ a constituent of the Spine providing anonymised data for research and analysis of medical requirements. Given that the NHS system is very much devolved, it would require deployment of other systems. Given that key organisations and the Trusts that take the new systems are self-managed with individual governance structures, it is their Boards and Chief Executives who would make ultimate choices regarding the disposition of the new systems in their Trust. Phase 2: Project Planning Project planning entails the development and maintenance of a project plan that offers supportive information to the project description in terms of time, resources, scope, cost, quality and schedules. Also included in a project plan is the technical aspect of the project. It essentially involves the development of the project management plan (Crawford & England, 2004). Project Elements On the whole, the programme was carried out in a very much constantly evolving environment amid policy and legal changes and changes in provisions that impacted operational activities in NHS. The key stakeholders implicated in the programme are: (1) the Department of Health, (2) Patients, (3) Parliament, (4) Health Care Providers, (5) Chief Executives and Boards of Trusts, and (6) 3 Local Service Providers, among others (Department of Health, 2002). The programme coverage was divided into three main areas as indicated in table 1 below; Table 1: Main Areas of Focus of the Programme Area Local Service Provider Approximate Population Served North, Midlands and East Computer Sciences Corporation (CSC) 29.9 million London BT 7.2 million Southern Fujitsu 13.0 million Source: National Audit Office (2008). The key elements embroiled in the programme include: Care Records Service N3 national network (provide IT infrastructure, connectivity and broadband capacity, and networking services) Choose and Book (an automated booking service) Electronic prescription service The Spine (stock patient information, interface with other systems, and offer security) The Picture Archiving and Communications Systems for alpha numeric X-rays along with other imageries NHS e-mail system (NHSmail) HealthSpace (a website) Quality Management and Analysis System GP Systems of Choice Project Budget The entire cost of the programme involved four key elements: (1) Costs of 8 core contracts (London, South, North East, East, North West and Midlands, Spine, N3 network, Choose and Book, plus Amount reserved by Accenture) decided by the Department and suppliers together with ratified add-ons, (2) Costs of products added to the scope of the programme (include NHSmail, Picture Archiving and Communications Systems and GP Systems of Choice, (3) Other central expenses together with the costs of NHS Connecting for Health for running the programme, and (4) Local implementation costs sustained by NHS (Major Projects Authority, 2011). Table 2 below indicates the exact figures; Table 2: Estimated Cost of the Programme at 31 March 2008 (at 2004-05 Prices) Category £ million £ million Total for core contracts 6805.5 Products added to the scope of the Programme 665.8 Other central costs 1599.0 Total central costs 9070.3 Local costs 3585.9 Total 12656.2 Source: National Audit Office (2008). Project Duration When the Programme was initiated in 2002, it was premeditated that the implementation of the systems would be completed by 2010. However, the document setting out the IT strategy for the NHS described the timetable from 2006 as tentative. The Secretary of State for Health indicated that b 2010 each one patient in England would possess and automated care record. The tentative timetable indicated that by the close of 2007, the entire fundamental systems for the Programme would be deployed across the NHS. Improved functionality and integration would come later (National Audit Office, 2008). Technical Aspects of the Project Suppliers are told of the minimum levels of performance in the contracts. There were three key areas of NHS Connecting for Health monitors against targets: I. Level of service availability. Even as the targets would vary from one system to another and, in a number of cases, over time, the prevalent target was 99.9 per cent equated to a system being accessible be all for 45 minutes in a 31-day month; II. Response times, which is the lapsed time for the system to process a message. This target would vary depending upon the type of transaction. For instance, 95 per cent of transactions involving the identification and searching for a patient on the Personal Demographic Service (a component of the Spine) ought to be over and done in 1.05 seconds; and III. The time span required to fix glitches, referring to the lapsed time between when an incident is reported and it being fixed, but the target would vary depending upon the harshness of the occurrence. Typically, the most severe incidents would be fixed within 2 hours. Project Risks The Programme was centrally developed but its application was in a much decentralised environment, with propensity to boost decentralisation to the local level (Baldwin, 2013). As a result, unavoidable forces would emanate and impact some areas such as: Contracting: At some point the Programme’s contracts were based all NHS Trusts, but the Foundation Trusts cannot be compelled to make use of the Programme otherwise there would be financial implications not only to the Trusts embroiled but also the Programme. Deployment plans: The decision to ‘go live’ is made by the Trusts. If its timing is wrong it poses serious risk to patients as well as the general operations of the Trusts given their sensitivity. Benefits realisation: It would be hard to enjoy the benefits of the new systems in a centralised process. Plurality of provision: The Programme would necessitate the involvement of various organisations that creates additional complexity. Phase 3: Project Implementation At this phase, the work elements are assigned to project teams, sub-teams and groups, which have the subject matter expertise in different areas. In essence, the project management plan is translated into action. Implementation success or failure depends on the quality of the project management plan. According to Ottosson (2012), a number of the project elements were completed earlier than expected based on the schedule. Figure 1 below (Gantt chart) indicates project element with the days completed (blue) and days remaining (orange): Figure 1: The Programme Gantt chart as at 31 March 2008 Phase 4: Project Monitoring, Evaluation and Control The Programme was implemented and progress was monitored based on time, care records, N3 Network, Spine, Choose and Book, Electronic Prescription Service, Picture Archiving and Communications Systems, HealthSpace, NHSmail, Quality Management and Analysis System, and GP to GP transfer (Nokes, 2007). The National Audit Office (2008) indicates that the NHS Connecting for Health hired the University of London to evaluate the early adopter programme foe 1 year. The evaluation report was made public on 6 May 2008. It mainly involved gauging the efficacy of the public information campaign. This evaluation would enlighten the nationwide roll-out of the Summary Care Record to 147 Primary Care Trusts. Control would be under the NHS Connecting for Health’s National Programme that would also offer management services to facilitate planning and reporting of the Programme. Phase 5: Project Closure The project had not been completed seeing as not all elements of the Programme had been finalised. However, the review report put down a number of recommendations to help contain the challenges and assure successful completion of the remaining elements of the Programme. These include: Limiting leadership changes and improving governance. The leadership were merely focused on delivering an IT system rather than having a broader thinking of hot it would be applied to enable business change. To improve governance, it is suggested that the Department ought to spell out accountability and responsibility for the local execution of the Programme. The objectives, authority and resources would be clearly explained to the Chief Executives. Successful enjoyment of the Programme’s benefits require that patients personal as well as health information should be confidential and secure. The Department should enhance communication with NHS staff, particularly the clinicians to avoid resistance. Reviewing the suppliers’ capacity to deliver would ease of the pressure placed on them by the Department furthered by the withdrawal of Accenture. The suppliers’ performance must as well be reviewed. Furthermore, procurement processes must be reviewed. In a nutshell the diagram below capture the network diagram for the Programme right from initiation to closure; Figure 2: Summary for the Project in a Network Diagram from Initiation to Closure References Anderson, R., Randell, B., Backhouse, J., Reddy, U., Bustard, D., Ryan, P….Tully, C. 2010. The NHS’s National Programme for Information Technology: A Dossier of Concerns. [online]. Available from: http://homepages.cs.ncl.ac.uk/brian.randell/Concerns.pdf [Accessed 12 January 2015]. 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