Incident: Failure of £12.7bn NHS National Programme for IT in England

Published Date: 2010-03-21

Postmortem Analysis
Timeline 1. The software failure incident related to the £12.7bn National Programme for IT in the NHS happened in March 2010 [Article 929]. 2. The decision to end the National Programme for IT was announced in September 2011 [Article 7675, Article 7703].
System 1. National Programme for IT - The £12.7bn National Programme for IT in the NHS failed, leading to its scrapping due to years of delays, technical difficulties, contractual disputes, rising costs, and failure to deliver as originally conceived [7675, 7703, 929, 928].
Responsible Organization 1. Labour government - The Labour government was responsible for causing the software failure incident by initiating and overseeing the National Programme for IT in the NHS, which ultimately led to wasted taxpayer money and a failed IT system [7675, 7703]. 2. Department of Health - The Department of Health, under the government's oversight, was responsible for managing the implementation and progress of the IT programme, which faced delays, technical difficulties, and contractual disputes, contributing to the failure of the project [7703, 928].
Impacted Organization 1. The National Health Service (NHS) - The software failure incident impacted the NHS as it led to the scrapping of the £12.7bn National Programme for IT, causing delays, technical difficulties, contractual disputes, rising costs, and ultimately the decision to discontinue the program [7675, 7703, 929, 928].
Software Causes 1. Lack of fit for purpose software: The software used in the NHS computer system was not fit for the NHS, leading to delays, reduced functionality, and inability to deliver as originally conceived [7675, 7703]. 2. Technical difficulties and delays in software implementation: The core care records systems faced mounting chaos, delays, and technical difficulties in installing across the country, leading to a tipping point and potential implosion of the project [7703, 928]. 3. Inadequate software testing: Preparatory testing at Morecambe Bay failed, indicating potential issues with the software's functionality and readiness for implementation [928]. 4. Poor software performance: Installed software systems brought pandemonium to many trusts, with reports of lost patient records, clunky and unaccommodating software, and recommendations against using the software in a clinical context [929]. 5. Ambitious and changing technology: The ambitious nature of the project, coupled with changing technology, contributed to the failure of the software to meet the needs of the NHS [7703].
Non-software Causes 1. Poor cooperation from NHS Trusts and shifting contract criteria [928] 2. Intense political pressure from Whitehall [7703] 3. Rising costs and contractual disputes [7703] 4. Ambitious and top-heavy nature of the program [7703]
Impacts 1. The software failure incident led to the scrapping of the ambitious £12.7bn National Programme for IT in the NHS due to years of delays, technical difficulties, contractual disputes, and rising costs [7675, 7703]. 2. The failure resulted in wasted taxpayers' money, with estimates suggesting the amount lost could have paid the salaries of more than 60,000 nurses for a decade [7675]. 3. The incident caused chaos and delays in installing core care records systems across the country, leading to financial shockwaves throughout the National Programme for IT [928]. 4. The failure led to delays in delivering core systems managing patient bookings and referrals at acute hospital trusts, impacting patient care and potentially causing harm due to lost patient records [929, 928]. 5. The software failure incident resulted in intense political pressure and financial implications, with potential legal claims against the taxpayer running into billions of pounds [928]. 6. The failure of the IT programme to deliver as originally conceived raised serious doubts about the project's future and its ability to support the delivery of effective healthcare [7703]. 7. The incident highlighted the need for greater public scrutiny of contracts and emphasized the importance of ensuring that new IT systems are driven by a commitment to improving clinical care rather than financial or political expedience [928].
Preventions 1. Proper initial assessment and planning: A thorough assessment of the project's feasibility, requirements, and risks could have prevented the software failure incident. This includes having a well-documented business case and realistic targets [7675, 7703]. 2. Effective project management: Implementing strong project management practices, including regular monitoring, evaluation, and oversight, could have helped in identifying issues early on and taking corrective actions [7675, 7703]. 3. Adequate testing and quality assurance: Conducting comprehensive testing, including user acceptance testing, to ensure the software meets the required functionality and performance standards before full implementation could have prevented the software failure incident [929, 928]. 4. Collaboration and communication: Improved collaboration and communication between stakeholders, including the government, contractors, and healthcare providers, could have facilitated a better understanding of requirements and expectations, leading to a more successful implementation [928]. 5. Flexibility and adaptability: Being open to adapting the project scope, timeline, and approach based on changing technology and requirements could have helped in avoiding the software failure incident [7703, 928].
Fixes 1. Dismantling the National Programme for IT and replacing it with cheaper regional initiatives where hospitals and GPs can choose the IT systems they need [7675, 7703]. 2. Establishing a new national watchdog to ensure that huge sums are not wasted on uncosted IT projects in the future [7675]. 3. Moving to an innovative new system driven by local decision-making to ensure value for money from IT systems that better meet the needs of a modernized NHS [7675, 7703]. 4. Allowing hospitals to use and develop the IT systems they already have and integrating systems purchased through existing national contracts or elsewhere [7703]. 5. Striking IT deals locally and regionally to get the best programs that can be afforded by providers of NHS care such as hospitals and GP surgeries [7703].
References 1. Minutes from early No 10 meetings [Article 929] 2. Department of Health source [Article 7703] 3. Health minister Simon Burns [Article 7703] 4. Christine Connelly, the Department of Health's director general of IT [Article 928] 5. Tory shadow health minister Stephen O'Brien [Article 928] 6. iSoft [Article 928] 7. Andrew Spence, CSC's UK director of healthcare strategy [Article 928] 8. Morecambe Bay NHS Trust chief executive Tony Halsall [Article 928]

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization, multiple_organization (a) The software failure incident having happened again at one_organization: - The National Programme for IT in the NHS experienced significant delays, technical difficulties, contractual disputes, rising costs, and core system delivery issues [7703]. - The project faced challenges in delivering core systems, such as managing patient bookings and referrals at acute hospital trusts, leading to stalled progress and concerns about software suitability [929]. - The Morecambe Bay NHS Trust faced delays in implementing the Lorenzo patient administration software package, with missed deadlines and failed testing, causing financial shockwaves and potential legal claims [928]. (b) The software failure incident having happened again at multiple_organization: - The National Programme for IT in the NHS was a multibillion-pound initiative aimed at creating a computerized patient record system across the entire NHS, indicating a widespread impact [7703]. - The project involved multiple regional contracts with different companies like Accenture, CSC, BT, and Fujitsu, each facing challenges and disputes, leading to a lack of confidence in the project [929]. - The failure of the NHS IT program was seen as a significant issue affecting the entire healthcare system, with concerns about wasted money, delays, and poor cooperation from NHS Trusts [928].
Phase (Design/Operation) design, operation (a) The software failure incident related to the design phase is evident in the articles. The National Programme for IT in the NHS faced significant challenges and failures due to contributing factors introduced during system development and updates. The project, initiated by the Labour government, was criticized for being too ambitious, with technology changes causing delays and rising costs [Article 7703]. The project's core systems, such as managing patient bookings and referrals, experienced delays and technical difficulties, leading to stalled progress and inefficiencies [Article 929]. (b) The software failure incident related to the operation phase is also highlighted in the articles. The implementation and operation of the software systems, particularly the patient administration software like Lorenzo, faced operational challenges and delays. For example, Morecambe Bay NHS Trust struggled with the installation of the Lorenzo software, leading to missed deadlines and potential financial repercussions [Article 928]. Additionally, the software systems installed at various trusts, such as Barts NHS Trust and Milton Keynes Foundation Trust, caused pandemonium and difficulties in managing patient records, impacting patient care and treatment [Article 929].
Boundary (Internal/External) within_system (a) within_system: - The software failure incident related to the NHS computer system was primarily within the system. The failure was attributed to factors such as technical difficulties, delays, contractual disputes, rising costs, and the inability of the system to deliver as originally conceived [7675, 7703]. - The National Programme for IT, a flagship project, was designed to revolutionize the health service but faced challenges such as stalled core system deliveries, delays in patient administration systems, and software not being fit for purpose [929, 928]. - The failure was exacerbated by issues within the system, including the ambitious nature of the project, changing technology, poor cooperation from NHS Trusts, shifting contract criteria, and underperformance of IT workers [928]. (b) outside_system: - There is no explicit mention in the articles of the software failure incident being primarily due to factors originating from outside the system. The focus is more on internal challenges, mismanagement, and technical issues leading to the failure of the NHS computer system.
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident occurring due to non-human actions: - The National Programme for IT in the NHS faced delays, technical difficulties, contractual disputes, and rising costs, leading to its scrapping [7703]. - The core care records systems installation across the NHS faced mounting chaos and delays, potentially triggering legal claims against the taxpayer [928]. - The software "Lorenzo" faced delays and failures in its deployment at Morecambe Bay NHS Trust, leading to financial shockwaves and intense political pressure [928]. (b) The software failure incident occurring due to human actions: - The National Programme for IT was criticized for being too ambitious, with changing technology and significant amounts of money being wasted on it [7703]. - The project faced delays, with core systems not being delivered as promised, and new systems causing chaos in many trusts [929]. - The project had issues with poor cooperation from NHS Trusts and shifting contract criteria, leading to delays and disputes with contractors [928].
Dimension (Hardware/Software) software (a) The articles do not mention any specific hardware-related failures that contributed to the software failure incident. (b) The software failure incident was primarily due to contributing factors that originated in software. The National Programme for IT in the NHS faced years of delays, technical difficulties, contractual disputes, rising costs, and core systems not being fit for purpose, leading to the decision to scrap the £12.7bn program [7675, 7703, 929, 928]. The software systems, such as the patient administration systems and care records, experienced delays, functionality issues, and failures in delivering the intended benefits, causing chaos and financial losses. The software failures were a significant factor in the overall failure of the IT program.
Objective (Malicious/Non-malicious) non-malicious (a) The software failure incident related to the NHS computer system being scrapped was non-malicious. The failure was attributed to years of scandalous waste of taxpayers' money on a system that never worked, technical difficulties, contractual disputes, rising costs, delays, and the system not delivering as originally conceived [7675, 7703]. (b) The failure was not due to any malicious intent but rather a combination of factors such as the system being too ambitious, technology changes, lack of fit with the needs of the local NHS, delays in functionality, and levels of benefit, as well as poor cooperation from NHS Trusts and shifting contract criteria [7675, 7703, 929, 928].
Intent (Poor/Accidental Decisions) poor_decisions (a) The intent of the software failure incident: - The failure of the National Programme for IT in the NHS was primarily due to poor decisions made by the government and involved parties. The project was described as a "monument to Whitehall folly" and a "disastrous" scheme that never worked, leading to scandalous waste of taxpayers' money [7675]. - The project faced delays, technical difficulties, contractual disputes, and rising costs, ultimately leading to its discontinuation. The decision to end the £12.7bn National Programme for IT was made by Health Secretary Andrew Lansley, Cabinet Office minister Francis Maude, and NHS chief executive Sir David Nicholson due to the failure to deliver as originally conceived [7703]. - The National Programme for IT was intended to revolutionize the paper-based systems within the health service and provide visible evidence of NHS modernization. However, poor decisions, delays, and software issues led to chaos, delays, and mounting legal claims against the taxpayer [929, 928].
Capability (Incompetence/Accidental) development_incompetence, accidental (a) The software failure incident related to development incompetence is evident in the articles. The National Programme for IT in the NHS faced significant challenges and failures due to factors like delays, technical difficulties, contractual disputes, rising costs, and poor management decisions. The project, initiated by the Labour government, was criticized for being too ambitious, with changing technology, and a lack of proper planning and execution [7675, 7703, 929, 928]. (b) Accidental factors also played a role in the software failure incident. The articles highlight how the project faced chaos, delays, and technical issues that were not intentional but arose due to the complexity of the project, changing technology landscape, and challenges in implementation. The failures were not deliberate but resulted from a combination of factors such as poor cooperation, shifting contract criteria, and unrealistic expectations from the project [7675, 7703, 929, 928].
Duration permanent, temporary (a) The software failure incident related to the NHS computer system can be considered permanent. The failure was due to contributing factors introduced by all circumstances, such as years of delays, technical difficulties, rising costs, contractual disputes, and the inability to deliver as originally conceived. The decision to scrap the £12.7bn National Programme for IT was made after it was concluded that there can be no confidence that the program has delivered or can be delivered as originally intended [7675, 7703]. (b) The software failure incident can also be considered temporary to some extent. The delays and chaos in installing core care records systems across the country reached a tipping point, with intense political pressure on Morecambe Bay NHS Trust to meet a software "go-live" deadline. The failure at Morecambe Bay could potentially trigger legal claims against the taxpayer, and there were ongoing negotiations with contractors to keep the project alive, indicating a situation where the failure was due to contributing factors introduced by certain circumstances but not all [928].
Behaviour crash, omission, timing, value, byzantine, other (a) crash: - The software failure incident can be categorized as a crash as the National Programme for IT in the NHS was described as a system that never worked and was not fit for the NHS, leading to the decision to urgently dismantle it [7675]. - The article mentions that the core systems managing patient bookings and referrals at acute hospital trusts under the National Programme had stalled, indicating a failure to perform its intended functions [929]. (b) omission: - The failure can be attributed to omission as the software system under the National Programme for IT was described as not delivering in line with the original intent, with delays and reductions in targets related to functionality, usage, and levels of benefit [7675]. - The article highlights instances where new systems brought chaos to trusts, such as patient records being "lost" in the system at Barts NHS Trust and software being deemed unworkable by doctors at Milton Keynes Foundation Trust, indicating omissions in performing intended functions [929]. (c) timing: - The timing of the software failure incident can be seen in the delays and technical difficulties faced by the National Programme for IT, leading to the decision to end the program after years of delays and rising costs [7703]. - The article mentions missed deadlines and delays in installing core care records systems, with mounting chaos and delays reaching a tipping point, indicating issues with the timing of system implementation [928]. (d) value: - The failure can be related to value as the National Programme for IT was criticized for being poor value for money, patchy, and long overdue, indicating a failure in delivering the intended functions correctly [7703]. - The article mentions that billions of pounds were spent on the IT project, but the delivery of core systems managing patient bookings and referrals at acute hospital trusts had stalled, suggesting a failure in delivering value for the investment [929]. (e) byzantine: - The software failure incident can be associated with a byzantine behavior as the system was described as top-heavy, hideously expensive, and not delivering as originally conceived, leading to intense political pressure and potential legal claims against the taxpayer [928]. - The article mentions that the National Programme for IT faced contractual disputes, rising costs, and mounting chaos in installing core care records systems, indicating inconsistent responses and interactions within the system [928]. (f) other: - The software failure incident can also be characterized by a significant waste of taxpayers' money, with estimates of the cost far exceeding the initial budget, indicating a failure in financial management and oversight [7675]. - The failure can be attributed to a lack of coordination and cooperation between the NHS Trusts and the contractors, leading to delays and underperformance in implementing the IT systems, showcasing a failure in collaboration and communication [928].

IoT System Layer

Layer Option Rationale
Perception None None
Communication None None
Application None None

Other Details

Category Option Rationale
Consequence property, delay, non-human, theoretical_consequence (a) There is no information in the articles suggesting that people lost their lives due to the software failure incident. (b) The articles mention that the software failure incident led to delays and problems in managing patient bookings and referrals at acute hospital trusts, potentially resulting in delayed treatment of urgent cases and damaging patient care [929]. (c) The software failure incident did not directly impact people's access to food or shelter. (d) The articles discuss how the software failure incident resulted in significant financial losses, with billions of pounds being wasted on the failed IT project [7675, 7703, 929]. (e) The software failure incident caused delays in the implementation of core care records systems across the NHS, affecting the delivery of IT systems and patient care [7703, 928]. (f) Non-human entities, such as the NHS IT systems and software, were directly impacted by the software failure incident, leading to chaos, delays, and technical difficulties in the implementation of the computerized patient record system [7703, 928]. (g) The software failure incident had real observed consequences, including financial losses, delays in patient care, and chaos in the implementation of IT systems, indicating that there were consequences of the failure. (h) The articles discuss potential consequences of the software failure, such as legal claims against the taxpayer running into billions of pounds, financial shockwaves throughout the National Programme for IT, and potential profits warnings from companies involved in the project [928]. (i) There is no other consequence of the software failure incident described in the articles.
Domain health, government The software failure incident discussed in the articles is related to the **health** industry. The failed system was the £12.7bn National Programme for IT in the NHS, which aimed to create a computerized patient record system across the entire NHS [Article 7675, Article 7703, Article 929, Article 928]. The system faced delays, technical difficulties, contractual disputes, rising costs, and ultimately failed to deliver as originally intended, leading to its scrapping by the government. The project was intended to revolutionize the paper-based systems within the health service but encountered significant challenges and criticisms, ultimately resulting in its dismantling.

Sources

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