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National Program for IT Failure in NHS Coursework

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Updated: Apr 4th, 2022

Executive Summary

The National Programme for Information Technology (NPfIT) was planned to deliver better services to the patients and the health institutes. But unfortunately, the programme failed to deliver and had to be stalled due to various reasons that were beyond control. The programme was planned for a period of 10 years (starting from 2002) but it had to be shelved abruptly in 2009. It is understood that the project was able to complete some of the features but the most significant, the Summary Care Records (SCR), could not be completed. The result was very horrifying. Several patients died due to lack of proper care.

The contract for the implementation of the programme was given to CSC but the company was unable to honour its commitment of providing the requisite programme (SCR) to 220 health trusts throughout the United Kingdom. But CSC alone cannot be blamed for the lacuna. Even the NHS failed to provide the required 160 trusts where the SCRs were to be delivered. There has been a lot of rage among the people and the industry about the inefficiency and negligence of the government. Billions of dollars of people’s hard earned money has been thrown down the drain with no clear explanation.

The Leeds Teaching Hospital which is the major health trust of the United Kingdom also faced several difficulties in adhering to the new guidelines and the programme. But due to its sincere efforts, the hospital has been able to cope up with the previous problems and has developed its own networking in order to serve its patients.

Introduction

The National Programme for Information Technology (NPfIT) in NHS was commenced in 2002 and was designed to revolutionize the use of information (pertaining to patients) by the NHS. The programme was expected to be one of the largest IT projects in the global healthcare sector (Coiera 2007) and was scheduled for a ten years’ period. The NPfIT programme’s ultimate motive was to improve the provisions, features, and quality of patient care (Randell 2007). The programme was supposed to furnish various important aspects (such as hypersensitivity and the medication being provided) in the treatment (and follow up) of patients (Hughes 2010). Though some parts of the programme were completed successfully, the others stumbled upon various hurdles that ultimately contributed to the failure of the programme. One of the most significant parts of the programme that failed to deliver was the Summary Care Records (SCR) system (MPs publish report on the dismantled National Programme for IT in the NHS 2013). The SCR system was planned for the benefit of the staff and the patients (Connecting For Health n.d.).

The contract for the NPfIT was awarded to CSC and the initial contract value was £3.1 billion. The contractor was required to handover SCRs to 220 trusts throughout the country. Due to the contractor’s inefficiency and non-compliance of the delivery terms, fresh negotiations were made with CSC. It is noteworthy that even the Department was unable to fulfil its obligation of providing 160 trusts for implementing the CRS (Committee of Public Accounts 2014).

Unfortunately, the SCR programme had to be scaled down in 2009 due to its involved costs and underperformance. It is noteworthy that the government had already spent a whopping amount of £12 billion by the time the programme was scaled down (Charette 2009). The NPfIT was also shelved in the year 2011 (Department of Health 2011). The programme’s failure was not the first of its kind in the United Kingdom (UK); there have been instances where large IT programmes have failed due to heavy costs and not being able to maintain the programme schedule. The failure had great negative repercussions; hospitals were unable to keep track of their patients, especially those who needed immediate medical attention (Doward 2008).

Literature Review

Considering the problems and delays being faced by the patients, the UK government decided to upgrade the existing technology within the healthcare sector. The improved technology was aimed at providing better services to the patients and also to expedite the work of the NHS staff (NHS Trust n.d.).

During the progress of the programme, there were several attempts by the computer scientists involved in the programme to call for an evaluation of the programme’s progress. Unfortunately, the Health Committee, on behalf of the government, rubbished the attempts as being pointless (Ritter 2007a). Several prominent academicians also requested the government to hold an inquiry into the feasibility of the programme (Ritter 2006a). Even the participants of the NHS Confederation research programme were not happy with the government’s decision to appoint negligible number of contractors for the project (Bruce 2011).

By the year 2010 (March), almost 1.25 million records had been updated and it was expected that by the end of 2014, a total of 50 million records would be updated (BBC 2010). The doctors supported the endeavour but were pessimistic about the department’s competence in achieving the target (Computer Weekly 2008). Commenting on the pace of including the data in the database, the British Medical Association commented that the pace was very fast. Moreover, some people were even not aware of such developments and those who were aware, did not have the requisite knowledge of the procedure to be followed (BBC 2010). So, ultimately, the Summary Care Records (SCR) was shelved due to the growing unrest among the sector (Brittain 2010). The politicians are passing on the blame to each other and the public rage doesn’t seem to calm down; this has resulted in the government being in the headlines for the wrong reason (Masters 2014).

Likewise other major organizations, NHS also has a risk management programme but the problem arises when the implicated risks are miscalculated (Jeffcott & Johnson n.d.). There is no specific definition for the breakdown of information technology projects. Breakdowns can take place at any phase of the implementation of the project (Brotherton, Fried & Norman 2008).

The failure of the NPfIT by NHS was a massive one that involved huge amounts that are expected to reach £10 billion. The Public Accounts Committee considered the attempt of NHS, to revolutionize the communication system within the health sector, as the worst disaster (Walker 2013). But is should be understood that such costs don’t include the potential costs that might have to be incurred due to cancellation of Fujitsu’s contract (BBC 2013).

Since the programme was expected to expedite the day-to-day jobs, the trusts planned job-cuttings in advance (in order to save money). But this step of the trusts backfired as the programme failed to deliver and there were chaos in the various trusts. Several deaths occurred and the investigations revealed that the major cause was inadequate staff at the respective trusts (Donnelly 2013). According to the Royal College of Nursing, there was a shortage of about 20,000 nurses (Gregory 2014).

Scores of patients suffered due to the negligence of hospitals and hundreds even died as a result of shortage of staff and poor facilities. While wrong medication was administered to some of the patients, some of them were totally neglected (Telegraph 2013). The government, in a bid to save its face, took severe action against eleven hospital trusts that were among those responsible for the deaths of patients (Triggle 2013).

The scandal was revealed when an inquiry was initiated to ascertain the reasons for the death of hundreds of people at Stafford hospital. It is reported that 400 to 1200 patients (mostly aged patients) died at the hospital due to inhuman practices being followed by the staff (Campbell & Meikle 2013). The overall death figure is more appalling; 14 NHS trusts have been held responsible for the deaths of 13,000 patients (Donnelly & Sawer 2013). These 14 trusts have been advised to adhere to the suggestions of the concerned officials (Sky News 2013).

The dilemma met by the Nuffield Orthopaedic Centre should have been an eye opener for the government and the various NHS trusts. But the Department of Health was optimistic and claimed that such problems would not persist. But unfortunately, the experiences of Buckinghamshire Hospitals NHS Trust convey a different story; they were facing great difficulties in the reporting system (Ritter 2007b).

Methodology

This report discusses the reasons for the failure of the NPfIT in NHS (UK) and also the views of various scholars on the implications of the failure. Most of the references have been taken from online articles, news reports and statistics. Considering the significance of the problem, the researcher has referred only authentic websites. The ethical aspect has been considered and no bias has been encouraged in the discussions. In order to explain the implications of the failure of the NPfIT on health institutions, the case of Leeds Teaching Hospital has been discussed. Leeds Teaching Hospital is considered to be the major NHS trust in the country.

Findings/Results

Angel Eagle, Member of Parliament, had informed the parliament that thousands of NHS staff and millions of patients used the NPfIT service. This claim requires a deep thought because the actual number of patients and NHS staff are far more than the numbers she stated. Like for example, it was reported that 87% of the general practitioners were online with the system. But it is also reported that only 22% of the general practitioners were actually using the service (Ritter 2007c). Probably, the MP might have meant 87% of the 22% general practitioners who were using the service. There were political ambitions and reasons behind launching the programme. The intentions were appreciable but the execution was a total disappointment (Maughan n.d.). The government has been receiving criticism for the expensive failure. £2.7 billion of public money has been thrown down the drain and the government has no explanation (Poole 2011).

The case of Martin Ryan is an eye opener for us to understand the severity of the damage that has been done. Ryan was left without food; he could not swallow and the feeding tube was not inserted. The negligence was a result of a communication gap between the staff responsible for the treatment (NHS ‘Failures’: Man starved in hospital care 2009).

At the time when the programme was suspended, the expected cost was £6.4 billion but by the year-end 2013, the cost had risen to £10 billion (Syal 2013). Some analysts estimate the cost to be much higher than this and believe that such amount would have been enough to pay the wages of 60,000 nurses for 10 years (Martin 2011). The suspension of the programme will bring severe monetary problems for the trusts. They will now have to trust their own resources to develop a dependable records system (Hall 2011). It is noteworthy that during the initial stages of the programme implementation, the National Audit Office had suggested that the benefits of the programme could not be judged and it needed time to assess the actual monetary benefits (Bourn 2006).

The NPfIT programme was supposed to be the world’s biggest healthcare IT project but it ended up as being the biggest IT project failure (Flinders 2011a). According to Finkelstein, IT projects fail due to several factors like insufficient users, ambiguous business aims, sub-standard software architecture, undependable statistics, and haphazard implementation (as cited by Flinders 2011b). Yann L’Huillier believes that in order to get approval from the concerned authorities, big IT projects perform well during the initial stages but once they get the requisite approval, the problems start creeping in. Also, there are several unexpected situations that arise during the progress of the project. Such situations have a great impact on the project’s performance (as cited by Flinders 2011c). On the same line, James Martin is of the opinion that IT projects fail due to inadequate requirement of a massive project. Improbable project costs and time-frame also lead to the unsuccessful completion of the project (as cited by Flinders 2011d). According to the NHS, ePrescribing can have repercussions on the lives of the healthcare staff (NHS n.d.).

Case study: Leeds Teaching Hospital NHS Trust

Leeds Teaching Hospital is the major NHS trust of the United Kingdom. The hospital has a teaching faculty that is considered to be the largest in Europe (Leeds Teaching Hospitals NHS Trust 2013). The hospital has a well organized IT department that tries to fulfil the requirements of the NPfIT. The hospital has been able to successfully implement some of the features of the programme such as the online availability of prescriptions and appointment booking. But there are other features that are yet to be fulfilled such as the online availability of patient records (Ritter 2006b).

The increased costs of the project implementation by Leeds Teaching Hospital (and others as well) has had an impact on the services being provided. Leeds Teaching Hospital had to redesign its management system and the process. The staff had to be given ample training for being acclimatized to the new system. Even the existing data had to be changed. All such tasks involved great expenditure. Moreover, the absence of Patient Administrative System was a big hurdle for Leeds Teaching Hospital in meeting the booking objectives (Ritter 2006b).

In spite of all such impediments, the Leeds Teaching Hospital is trying to prove itself. The hospital has been able to facilitate access to the SCR by the pharmacists (Barr 2012). The hospital is all set to compete in the new NHS scenario and aims at delivering best services to its patients. The hospital has plans to improve its information system and communicate better with the general practitioners and the patients (Thorne 2012). The hospital has recommenced its ‘digital dictation and speech recognition project’ (Evenstad 2013a). The hospital is now at the final stages of its contract with the NPfIT and has entered into a fresh contract with Accenture. The new contract will be for the hospital’s communications system (Evenstad 2013b). Recently, Leeds Teaching Hospital has been able to abolish the use of paper work and uses Emis Web (Evenstad 2014).

Discussion

Previous examples show that the success rate of IT projects is negligible as compared to the cost (Ambler 2010). The NPfIT of the NHS also got affected by the numerous problems pertaining to large IT projects. Probably, an absence of a transparent link between the priorities of the project and the actual project implementation was one of the main factors that lead to the programme being stalled. There was no proper leadership and guidance for the executing body. Another problem was the inefficiency of the involved people in maintaining the time-frame. The future risks were not considered and as such the programme came under the impact of such risks. The future rise in price (of various commodities and services) was also not considered that resulted in a finance crunch. A crucial factor was that the government funds were not enough for the trusts to carry on with the programme (Hendy et al. 2005).

Recommendations

The earlier framework of the programme had only a few contractors, who had the monopoly. If more small and medium enterprises are involved in the programme, the results could be encouraging. It would have been effective if the stakeholders would have been involved rather than the bureaucrats who were not concerned with the services. Instead of launching such a massive programme, the government should have made it mandatory for hospitals to develop their own record systems that were compatible with the set guidelines. The record systems of various hospitals could then be centralized for use by the general practitioners and the people.

References

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Barr, F 2012, Leeds hospital pharmacists access SCR, Web.

BBC 2010, , Web.

BBC 2013, , Web.

Bourn, J 2006, , Web.

Brittain, N 2010, , Web.

Brotherton, S, Fried, R & Norman, E 2008, Applying the work breakdown structure to the project, Web.

Bruce, S 2011, NPfIT failures have left NHS IT “stuck”, Web.

Campbell, D & Meikle, J 2013 , Web.

Charette R N 2005, Why software fails, Web.

Coiera, E W 2007, ‘Lessons from the NHS National Programme for IT’, The Medical Journal of Australia, vol. 186. no. 11, pp. 1-2.

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Connecting For Health n.d., Summary Care Records deliver improved performance and time savings in Leeds, Web.

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Donnelly, L 2013, Shortage of 20,000 nurses in NHS, report warns, Web.

Donnelly, L & Sawer, P 2013, 13,000 died needlessly at 14 worst NHS trusts, Web.

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Flinders, K 2011b, The NHS IT project is dead, but why do large IT projects so often fail? Part 2, Web.

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Poole, R 2011, ‘System failure’ – £11 billion NHS IT system finally abandoned, but not before slamming a high bill on taxpayers, Web.

Randell, B 2007, A computer scientist’s reactions to NPfIT, Web.

Ritter, T 2006a, How the Health Committee took decision to hold NHS NPfIT inquiry, Web.

Ritter, T 2006b, Confidential NHS paper on the health of the National Programme for IT, Web.

Ritter, T 2007a, Health Committee MP criticises report on NPfIT electronic patient record, Web.

Ritter, T 2007b, Whitehall officials pledge not to repeat troubles of Care Records Service go-live at Nuffield hospital – but similar problems have already occurred at another hospital, Web.

Ritter, T 2007c, Statistics and the NPfIT “success”, Web.

Sky News 2013, NHS report: Teams sent in to 11 failing trusts, Web.

Syal, R 2013, Abandoned NHS IT system has cost £10bn so far, Web.

Telegraph 2013, Mid Staffordshire Trust inquiry: how the care scandal unfolded, Web.

Thorne, C 2012, Leeds changes directory in IT refresh, Web.

Triggle, N 2013, Hospital trusts rapped over major failures, Web.

Walker, C 2013, Costs of failed NHS IT project continue to rise, Web.

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