NHS Care Records Service Failure - Case Study Example

NHS Care Records Service Failure PID (Project Initiation Document) Project Title: National Programme for IT (NPfIT) Project Start & Finish Date: (DD/MM/YYYY – DD/MM/YYYY) October 2002-2018 Budget Information: The project’s original contract was worth £3.1 billion. The Project entailed the delivery of care records systems to 220 healthcare trusts in different parts of England (CAP, 2013:3). Project Manager: 2002-2005: NHS Information Authority 2005 to 2011: NHS Connecting for Health (CfH) Project Objectives: The objective of the project was to deliver a paperless National Health Service by 2018 (CAP, 2013: 3). To allow computerized referrals and prescriptions by health professionals and hospitals (Campion-Awwad, Hayton, Smith and Vuaran, 2014:3). To allow for online access of personal health record and data by the patients. The project aimed at creating a centrally-mandated health care record that would match their information with their NHS Number for all patients in England (Brennan, 2005:21). The record would contain: Demographic information of the patient Summary of the patients health/clinical information e.g. allergies Anonymised Patient Data record to provide statistics for use in health research and planning (Campion-Awwad, Hayton, Smith and Vuaran, 2014:3). Steps of Approach: The Project aimed to connect the records to 300 hospitals and to numerous general practitioners in different parts of England, to offer secure and controlled access of the records to the authorised health personnel (Cabinet Office, 2000:31). The programme divided England into five different clusters (North West & West Midlands, London, North East, Southern and East & East Midlands) (Cross, 2006:657). Each cluster would have a different contractor delivering the services, thus four local service providers were enlisted in the project, to provide the same services simultaneously in the different clusters (Campion-Awwad, Hayton, Smith and Vuaran, 2014:7). Roles & Responsibilities: Name: Role: Position: Contact Information: The Department of Health (DH) Initiating and overseeing the implementation of the National Programme for IT (NPfIT) (CAP, 5). Owner and Initiator of the National Programme for IT (NPfIT) Richmond House, 79 Whitehall, London, England (gov.uk, 2015:n.p.) NHS Connecting for Health Agency (CfH) Co-ordinating and supervising the implementation of the National Programme for IT (NPfIT) in England (Brown, 2001:364) National Programme co-ordinator and Supervisor http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connectingforhealth.nhs.uk/about Strategic health authorities (SHA) The enactment of directives, and supervision of the implementation of the NPfIT policies as offered by the department of Health at the regional level. Regional supervisor and co-ordinator of the NPfIT programme http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx NHS trusts The co-ordination and commissioning of the running of the NHS Commissioner of the NHS services (King & Crewe, 2013:22). http://www.nhs.uk/NHSEngland/thenhs/about/Pages/authoritiesandtrusts.aspx Computer Sciences Corporation (CSC) Provision of the IT services for North, Midlands & Eastern (NME) cluster (King & Crewe, 2013:22). Local Service provider http://www.csc.com/ Accenture Provision of the IT services for the clusters of East Midlands and North East and East. Local Service provider http://www.accenture.com/us-en/pages/index.aspx Fujitsu Provision of the IT services for the Southern cluster (Lærum, Ellingsen & Faxvaag, 2001:1345) Local Service provider http://www.fujitsu.com/global/ BT Health London Provision of the IT services for the London cluster (Brown, 2001:364). Local Service provider http://www.globalservices.bt.com/uk/en/industries/Health Critical review The objectives of the programme National Programme for IT (NPfIT) were noble, since they would have enabled the centralized access of all patients’ healthcare records (Anderson, 1995:5). This would have allowed for ease of treatment, while at the same time allowing for easier and convenient collection of health data for research and planning by the health department (NAO, 2006:7). Further, the involvement of several local service providers through contracting four different firms was a noble idea, since it was meant to forestall the complete delay or failure by a single service provider. However, the major weakness associated with this strategy of contracting is that the different local service providers would easily fall out of the central monitoring of the Department of Health and the relevant agency (NHS Connecting for Health Agency (CfH), resulting in the failure of the programme due to weaknesses in co-ordination of the multiple implementers of the programme (King & Crewe, 2013:24). Stakeholders of the Project: 500 words The Contegency Theory of Managament provides that managers make decisions regarding issues facing an organization based on the situation at hand, as opposed to the application of a ’one-fit-all’ approach (Seyranian, 2009:153). Thus, according to this theory, a manegr will take a management decsion based on the most important aspects facing the organization at the moment. Therefore, this theory provides that different managerial positions will demand for a different form of approach while making decisions for the organizations. For example, while a manager who is responsible for managing a higher institution of learning such as a university may prefer to apply a consultative approch, a manager managing a millitary camp will mostly be suited to adapting an autocratic approach (Seyranian, 2009:155). Thus, the NHS Care records service failure is an example of a management situation where the Contingency Theory of Management became applicable. The National Programme for IT (NPfIT) was dismantled in June 2013, after a period of more than 10 years in operation, having not satisfactorily delivered the targeted objectives of the program (CAP, 2013:5). The project was initially meant to consume a total budget of £6 billion and achieve a full implementation of a paperless health record system for England patients (Campion-Awwad, Hayton, Smith and Vuaran, 2014:3). However, after running for a period of close to 10 years and consuming more than the amount that was initially budgeted without delivering the paperless healthcare record system, the programme was dismantled by the government in 2011 (MPA, 2011:12). The programme was estimated to have cost the Department of Health approximately £9.8 billion, although different sources have mentioned a much higher amount ranging from £10 billion to £12 billion, despite the programme having been initially budgeted for £6 billion (Syal, 2013:n.p.). The Contingency Theory of Management applies in this case, owing to the fact that the stakeholders in the programme applied a situational approach while making the decisions regarding the programme. For example, the health staff, who are key stakeholders in the programme made decisions based on the situation at hand back then, by contracting four different service providers to offer the required IT services to different clusters of health in England (Campion-Awwad, Hayton, Smith and Vuaran, 2014:7). Contracting four different service providers was seen by the health officials as an advantage that would deliver competition and avert any chances of the failure of the programme arising from either delays or total failure of a single-large contractor. However, as it turns out, that decision by the health staff was wrong, because it made the co-ordination and supervision of the different service providers very difficult for the relevant ministry and the concerned agencies, resulting in its failure (King & Crewe, 2013:39). On the other hand, the British government and the public applied the provisions of the Contingency Theory of Management, through taking a ‘wait and see’ approach when the programme did not seem to deliver on its objectives (Wanless, 2002:47). Instead of calling for the dismantling of the programme early enough, both the British government and the public, who are major stakeholders in the programme, adapted the observation decision that was suitable at that particular moment when the programme started showing signs of not delivering on its promises. Thus, according to the provisions of the contingency Theory of Management, the government and the public made a decision that suited the situation at that time, but which has proven detrimental to both of them, by losing close to £10 billion in a programme that did not deliver a paperless health system (King & Crewe, 2013:39). Risk and cost: 500 words. Systems Theory of Management provides that any given system is made up of different parts, which work in unison to deliver the desired goals (Stichweh, 2011:72). Thus, according to the Systems Theory, the outcome of a system is considered as the sumtotal of the efforts and working of all its different parts. Thereforethe Systems Theory offers that it is prudent for managers to co-ordinate all programmes and parts of a system to work together as whole, to deliver the target objective or mission of an organization (Stichweh, 2011:63). Thus, the Systems Theory can be applied to assess the risks involved in the National Programme for IT (NPfIT), which would impede its performance and cause it to fail. According to the Systems Theory, all the parts of a system must work together in order for the system to deliver the objecive for which it is made (Stichweh, 2011:72). However, when assessing the National Programme for IT (NPfIT), the major risk that can be identified is the risk of contracting four different IT firms as the local service providers for the different clusters of the England healthcare system (Campion-Awwad, Hayton, Smith and Vuaran, 2014:14). Contracting four different service providers increased the risk of poor co-ordination and supervision of the service providers by the relevant ministry and agencies, as opposed to when the programme would have contracted only a single large service provider to run the full service provision in all clusters (King & Crewe, 2013:34). Additionally, according tom the Systems Theory, managers should cordinate the working of the different parts of a system to work together as a whole, in order to realize the objective and mission for which a system is made (Stichweh, 2011:77). Nevertheless, in the National Programme for IT (NPfIT), the programme was not co-ordinated to work together as a whole, since it was initiated by the Department of Health, which in turn delegated the national supervision to the NHS Connecting for Health Agency (CfH) and the delegation continued downwards (King & Crewe, 2013:41). This system of decentralizing the supervision of the programme increased the risk of the system failing to work together as whole, which then resulted in the NHS Care records service failure (King & Crewe, 2013:36). Thus, the risks of poorer co-ordination and supervision, as well as the risk of the whole programme not working as a whole would have been mitigated through contracting a single large service provider for all the clusters. The cost of the total completion of the National Programme for IT (NPfIT) was initially budgeted at £6 billion (CAP, 2013:3). However, by the time of dismantling the programme in 2011, the project had already consumed between £10 billion and £12billion, and was still set to consume some £2.2 billion more, according to the parliamentary report on the state of this project (CAP, 2013: 5). The major cost risk associated with the project emanates from the difficulty in monitoring the spending of the four service providers that were contracted as providers of IT services for the project. Additionally, the cost risks was increased by the fact that contracting four service providers increased the costs of contracting through different legal expenses of contractual agreements, while also increasing the cost risk associated with the breach of contract, whereby for example, the programme has suffered £31.5 million as the cost of terminating Fujitsu’s contract (CAP, 2013: 5). The cost of the project could have been reduced through contracting a single large IT service provider for all the clusters of health in England, since the costs of supervision, legal agreement fees and the cost of settling legal claims would be minimized through thorough co-ordination and supervision of the single large service provider. References Anderson, R. (1995). NHS-wide networking and patient confidentiality. British Medical Journal, 311, 5-6. Brennan, S. (2005). The NHS IT project: The biggest computer programme in the world... ever! Oxford, UK: Radcliffe Publishing Ltd. Brown, T. (2001). Modernisation or failure? IT development projects in the UK public sector. Financial Accountability & Management, 17 (4), 363-381. Cabinet Office. 2000. Successful IT: Modernising Government in Action. Modernising Government. [report] London, UK: The Stationery Office Ltd. Campion-Awwad, O. Hayton, A. Smith, L. & Vuaran, M. (2014). The National Programme for IT in the NHS: A Case History. University of Cambridge. Committee of Public Accounts (CAP). (2013). The dismantled National Programme for IT in the NHS: Nineteenth Report of Session 2013–14. House of Commons, London: The Stationery Office Limited. Cross, M. (2006). Keeping the NHS electronic spine on track. British Medical Journal 332, 656-659. King, A. & Crewe, I. (2013). The Blunders of our Governments. London: Oneworld. Lærum, H., Ellingsen, G. & Faxvaag, A. (2001). Doctors’ use of electronic medical records systems in hospitals: cross sectional survey. British Medical Journal, 323, 1344-1348. Major Projects Authority (MPA). 2011. Programme Assessment Review of the National Programme for IT. [report] London, UK: MPA. National Audit Office (NAO). 2006. Department of Health: The National Programme for IT in the NHS. HC 1173 [report] London, UK: The Stationery Office Ltd. Seyranian, V. (2009). Contingency Theories of Leadership. Thousand Oaks, California: SAGE, 2009. 152-56. Stichweh, R. (2011). Systems Theory. Sage New York. Syal, R. (18 September 2013). Abandoned NHS IT system has cost £10bn so far. The Guradian, Available at: http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn Wanless, D. (2002). Securing our Future Health: Taking a Long-Term View. [report] London, UK: The Stationery Office Ltd. Read More