TECH: Granger on the UK’s NPfIT

On his way out the door Richard Granger is interviewed in CIO Magazine about the NPfIT in the UK’s NHS. A quick summary:

1) The budget scope went up because there was no PACS in the original program. The original program budget has stayed the same and they are paying for stuff as it’s delivered—late deliveries mean no payment so they’ve spent less than 1.5Bn GBP so far

2) Much of the confusion over whether the budget is blown or not  is because (at least in everyone but Granger’s mind) there is no clear budget division between existing programs (e.g. email programs for all the NHS) and Granger’s spend. “We are not paying suppliers a penny more than we were supposed to.” And of course lots of suppliers seem to agree (Accenture has bailed, iSfot is in distress, etc). But that’s not his problem “Did it cost taxpayers money to change contractors? No. We fought hard to protect taxpayers’ interests, to stay focused on getting what we paid for and only paying for what we got. I’d love to meet other CIOs who run a commercial negotiation like that with Accenture. When the news broke, three CIOs rang me to ask how on earth we’d managed it.”

4) The rest of the confusion is because, as has been shown on THCB over the years, no localization and training costs were not built into the system. Any CIO will tell you that training and adaptation tends to cost way more than software and hardware. Granger says that’s essentially not his problem and should come from the operating budget of the NHS. “If someone went on a training course, that got added in as the cost of a system. That’s when they came up with the £12bn number. Under significant pressure, I and the DoH, decided to agree to an NAO report that said the total cost of the NHS Programme would be in the order of £12bn. Notwithstanding that, the costs of the contracts that I manage have not overrun. They are under spent, currently by the best part of a billion.”

5) And what about user needs….Granger says that the suppliers are to blame but that the NHS is going to make sure that they get it right in the end.“We get a lot of views from the end user community about what is right and what is wrong and we must have a mixture of products that hopefully makes their lives easier, although sometimes we fail to do that miserably. Sometimes we put stuff in that I’m just ashamed of. Some of the stuff that Cerner has put in recently is appalling. It really isn’t usable because they have been building a system with Fujitsu without listening to what the end users want. They have taken some account but they then had to take a lot more. Now they’re being held to account because that’s my job.”

Of course now that he’s leaving it won’t be Granger doing that feet-holding.

All in all, it’s a mixed bag on the UK’s project so far. It’s certainly had it’s “good” side—notably writing tough contracts which protected the British taxpayer from massive over-runs familiar to many public works projects. It’s also had it’s bad side—especially ignoring the GP’s current ambulatory EMR vendors and not planning on integrating the local work already done. Whether the whole thing survives Granger and Blair’s passing is an interesting question. But don’t forget that compared to the US they were starting from a point of close to full ambulatory EMR adoption!

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  1. > writing tough contracts which protected
    > the British taxpayer from massive over-runs
    > familiar to many public works projects.
    Not to mention private works projects, and Grainger points this out. I am personally fmiliar with a small project (only $18M) that delivered essentially no benefit to the organization, and I have second hand information about $100M projects that have similarly failed to deliver. Stockholders may care but the Washington Post generally doesn’t.
    Grainger makes a number of other points. He is right that there is a tendency not to admit failure, and to throw good money after bad when things go south. Some of its ass-covering, some comes from wishful thinking, and some comes from a failure to understand the concept of a sunk cost. He is also right to ask the question “Compared to what?”.

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