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Unreasonable expectations? A new brand of realism is needed for the NHS's IT programme

The cost of the NHS's IT programme 'Connecting for Health' is predicted to rise to in excess of £18 billion - at least three times the original estimates. But this overrun could have been avoided had more honest and better quality debate taken place in the first place. This is one of the claims by academics from the London School of Economics and Political Science (LSE) and the University of Oxford in the September issue of the Journal of Information Technology.

Connecting for Health, the NHS's mega-programme for IT, has stirred huge controversy. Such is its potential impact that Dr Chris Sauer, University of Oxford, and Professor Leslie Willcocks| of the Information Systems and Innovation Group at LSE, editors of the Journal of Information Technology, devote the entire September 2007 volume to the programme.

Ironically given its name, Connecting for Health has raised anxieties about its impact on patients' wellbeing. Introducing a new system in December and January 2005-06, Oxford's Nuffield Orthopaedic Hospital Trust, highlighted an incident which it judged had the potential to put patients at risk. Other fears have focused on cost overruns. Initial costs were set at £6 billion but by April 2007 the House of Commons Committee of Public Accounts was recording planned national expenditure as £4.1 billion and related local expenditure as £8.3 billion. Dr Sauer and Professor Willcocks predict the final figures will be in excess of £18 billion - at least three times the original estimates.

Their editorial, 'Unreasonable Expectations - NHS IT, Greek Choruses and the Games Institutions Play Around Mega-Programmes', argues that the programme is trapped in a mesh of institutional webs that take a simplistic view of mega-programmes. Three interest groups are involved. The first consists of the relevant government offices and politicians, the second the institutions of the NHS itself, related professional institutes and patient representatives, while the third 'nexus' comprises the 'professional critics' - the press, audit and accountability bodies, academia and the professional bodies.

The power of this third nexus is 'multiplicative', they say. The institutions it embraces 'not only act independently, they feed off each other. Academics pick up on press reports, the press reports on the NAO and PAC. The PAC reacts to what the NAO says. The press co-opts the PAC chairman and reports his opinion together with academic and professional body opinion, for example that of the British Computer Society, and so on.'

Chris Sauer and Leslie Willcocks do not exempt academics from their charge: 'Academics', they write, 'particularly in technical disciplines, tend to view the implementation of their ideas as straightforward and to be intolerant of the argument that practice is messy and complex ... Academics make a better name for themselves by promoting their "knowledge" of how to do things right rather than by focussing on practical dilemmas.'

'Within these three webs,' they continue, 'it is too easy to engage in games of deception of both self and others. We recently heard an ex-cabinet minister talk of a billion-pound project he was promoting, "I knew when I was telling Treasury that it would only cost so much that this was a massive understatement; they knew that I knew this; and I knew that they knew". In other words everyone was complicit in playing a game that deliberately avoided confronting the question of what would be the actual cost and whether the benefits would be worth it. Those who ultimately fund such programmes, whether they be taxpayers or shareholders, deserve that the key players engage in better quality debate about the real prospects for the programme and greater honesty about the reasons for proceeding.

'It was apparent from the outset to any experienced and unbiased commentator that the NHS programme would encounter many storms and would end up being a different deal for the taxpayer,' they conclude. 'That it was not transparent to all concerned that initial statements of cost were only for the contracts with local service providers not for the total transformation that would be necessary to secure significant benefits from the programme was alone sufficient to give the more critical institutions in the web a target.

'It is time for the multiple parties to mega-programmes like Connecting for Health to recognise that all the other parties are intelligent and knowledgeable about programmes as investments and as risks to be managed. Mutual respect and a willingness to talk openly and sensibly about the realities will better serve the interests of the taxpayers and shareholders than continuation of the pretence that there is some significant probability that everything will go exactly as initially proposed. It is time for game-playing to end and mature interaction to begin.'

In 2007 on the basis of citations, the Journal of Information Technology was ranked 11th out of 71 management journals in terms of its impact - well above journals such as the Harvard Business Review and the Academy of Management Executive. For more information about the journal visit www.palgrave-journals.com/jit/index.html|

To view this and other articles in the September issue of Journal of Information Technology, see http://www.palgrave-journals.com/jit/journal/v22/n3/index.html#ed| 



11 September 2007