Academics set up wiki to monitor NHS IT

Tags: A Audit CfH House of Commons Information iS Monitor NPfIT Office Security

18 Oct 2006

The 23 academics who wrote to Parliament outlining their concerns about the progress of the National Programme for IT have set up a wiki to track media reports and act as a resource for NHS IT.

The NHS 23 wiki, available at http://editthis.info/nhs_it_info/, features links to articles tracking problems with various suppliers and coverage of the academics' open letter and the agreed statement. It was developed over the past few months as a resource and reference tool for those interested in the progress of National Programme for IT (NPfIT).

Ross Anderson, professor of security engineering at the Computer Laboratory at the University of Cambridge and one of the 23 academics, told E-Health Insider: "This is something that we have developed for our own use over the last few months. We have finally decided to make it publicly visible."

The wiki contains links to articles by E-Health Insider and other publications collected under themes, as well as primary sources such as relevant official records of Parliament, NPfIT specifications and policies and reports relating to the National Audit Office and Public Accounts Committee investigations.

"This ever-growing set of quotations give just one side of the case, so to speak - no doubt a number of alternative published articles relating to NPfIT could be selected that would paint a somewhat rosier picture," says the wiki.

In April this year, the 23 academics wrote to the House of Commons health select committee, which was investigating NPfIT, calling for an independent review of the programme covering its architecture, design and treatment of data.

Later that month, Connecting for Health (CfH) met with the academics and agreed that a "constructive and pragmatic" review of the programme would be valuable.

The wiki seeks to clarify the academics' own position on the progress of CfH and the call for a review. According to Professor Anderson, the agreement which CfH and the experts arrived at in the meeting that followed their letter was posted on the agency's site with a small but crucial omission, which he argues changed the meaning.

After the first edit, Anderson explained that the agreement was once again altered and republished at a later, unknown date. The academics' wiki contains all three versions of the statement including the one that they say was the original agreed by the two parties.

Professor Anderson stressed that the wiki was intended to be a reference point and not a campaigning platform, and was similar to the links and articles posted on the Foundation for Information Policy Research site.

'Wikis' are online reference pages that can be edited and updated by readers - either by the general public or through a password-protected interface. The NHS 23 wiki is publicly viewable and is edited and maintained a number of the academics.

Links

NHS 23 wiki

Readers Comments

A rather damning catalogue ....

18 Oct 06 08:18

Though "not a campaigning platform", this is a thought-provoking development that serves to starkly and comprehensively illustrate the true extent of the problem that CfH has become.

IMHO, the sooner a campaign begins, the better!

Hardly a representative view

18 Oct 06 09:58

Six are these academics are from universities outside England including four from Scotland leaving 17 people representing just 11 different English universities. There are 126 universities in England so 9% is hardly a representative view.

Not Representative!

18 Oct 06 12:43

Can I suggest that the author of the previous post goes and Googles a few of the names in the list. They will find that they are some of the most eminent software engineers and a computer scientists in the country many with international reputations.

If a firefighter points out that the building is on fire, do you ignore them because they are a representitive sample of the residents of the building? If you read the letter what these highly eminant people have pointed out is that NPfIT has many of the charactaristics of a failing programme. They have asked for a review of what is happening. What ever your view of whether they are right about the problem, to say that they should be ignored because they do not represent a majority of English universities is bizarre in the extreme

Representation and balance

18 Oct 06 12:57

Post #2 above seems to ignore that not every University has a medical school, nor a department with an interest in Health Informatics.

The NHS in England is taking a different route to all other countries, and surely comparative input is worthwhile. Better that than the evidence void, and lack of balance that the case for the CfH approach seems to be built on.

The confrontational, and self-perfection approach does invite criticism, warranted or not, and the evidence I have seen is that the contracts and approach CfH have followed are not good value, not delivering, and miles off the vision of joined up healthcare that we can all subscribe to, and is being pursued worldwide.

In my view, CfH is a millstone and not an enabler for the innovation that we need for the new NHS.

Not representative

18 Oct 06 13:50

Thanks. i did Google them and with a few notablee exceptions they have no genuine experience of large scale IT projects - other than providing commentary after the event - and even less experience of the NHS.

Experience ....

18 Oct 06 15:14

Could it be - perhaps - that their lack of experience of the NHS enables them to view CfH and its problems more objectively? Dare I suggest, in the same way that Richard Granger's lack of NHS experience didn't prevent him engineering CfH's centralised implementation approach when he took up his post in 2002?

Not Representative!

18 Oct 06 16:53

If this were not so indicative of some of the arrogance with which this has been treated I would not bother to follow up. here goes! "with a few notablee exceptions they have no genuine experience of large scale IT projects"

Even if it was only the "few notable exceptions" who were signing this letter, they are notable enough that any other programme would take what they are saying very seriously

"other than providing commentary after the event " So you would rather they waited to comment until after "the event". They offer a vast collective experience of reviewing projects which have failed in one way or another.

"and even less experience of the NHS" The point they are making is that the programme is showing signs of failure common accross a wide range of areas. It does not take particular expertise to fail in the NHS. Even so, who are you comparing their NHS experience with; the Director General, Kellog Brown and Root, Accenture, BT.

I think these people know what they are talking about

18 Oct 06 22:12

Some of these people have been in computing since earliest days of commercial computing and know a good lean efficient system and all about end user consultation and proper planning and implementation. Age and wisdom are not incompatible ....

Ian Sommerville

19 Oct 06 12:40

Coming from a Computer Science background, one name from that list stands out for me.

Ian Sommerville wrote *the* book on Software Engineering, if anybody knows anything about the subject it's probably because Ian taught it to them...

So for me it's very interesting that he's on the board for that Wiki, and indeed speaks volumes of the experience these people have avaliable to them.

Taking a stand

20 Oct 06 04:26

I welcome the publication of the WIKI by the group of Academics and feel I need to participate in this discussion to support their initiative. For my contribution, I would like to share this link.. http://www.cas.mcmaster.ca/~wmfarmer/SE-2A04-01/slides/01-resp.pdf ...to a thought provoking presentation by Dr. David Parnas, who was the renowned academic who stood up publicly (and at personal cost) against the ill-conceived SDI (Strategic Defence Initiative) "Star Wars" programme of the mid 1980's. The presentation is openly available on the web and deals with Personal, Social and Professional responsibility and the conflicts that arise for the 'Engineer'.

There are many parallels with the current debate.

ref: The Professional Responsibilities of Software Engineers - Dr. David L Parnas, McMaster University (accessed October 19th 2006)

Taking a stand

20 Oct 06 10:04

Thanks for the link. It sums up so many of the problems in Health Informatics which go way beyond the current NPfIT issues. Page 23 goes to the heart of the issues which the academics are asking about --Quote-- "Why is software commonly the product of an irrational process? We start to build before we know what we want. We learn what we want as we start to build. Sometimes the basis of our work is a new technology or implementation concept. We make decisions without being able to justify them relative to a statement of goals. We simply do not understand enough to be rational designers. --end quote hmmm

Not just a Healthcare issue.

20 Oct 06 11:00

The problems in that report really reflect the state of Software Engineering in all industries (apart from maybe NASA which do things differently) Although there are some good ideas coming out of the universities, software engieering is currently an Art Form, rather than a science. Just compare with the processes that Mechanical or Electrical Enigneers use, and you'll see. Also couple that with a lack of professional status needed to practice and it shows that the IT industry is still in it's infancy.

And Healthcare too

20 Oct 06 11:55

There are clinicians who would strongly suggest that medical practice itself is an Art, working with interpolation, logic leaps and imperfect knowledge.

Industrialising, standardising and computerising that is unlikely to be an unqualified success, which perhaps goes some way to explaining the struggle yet to come, if NPfIT makes it beyond unpicking all the administrative systems to supporting the clinical staff.

re: Not just a Healthcare issue

20 Oct 06 15:00

I agree for the most part with your point (below)... "...Just compare with the processes that Mechanical or 'Electrical Enigneers use, and you'll see. Also couple that with a lack of professional status needed to practice and it shows that the IT industry is still in it's infancy."..

As an E&EE 'by birth' and just now completing an MSc in IT I would broadly agree with your second point and it opens up a whole 'industrial age' debate. The infancy argument is regularly put forward by the head of CfH as a defence for the continuing problems of the deployment "..it's an immature marketplace".[1]

The fundamental flaw with that statement however is that it forces us to question, from a maturity perspective.. "who is more naive or derelict?" those that claimed to be able to build and implement huge untried systems in a procurement environment that was so onerous without the full buy in from its user base, or the individuals involved in inviting the parties to the table to bid on such a high risk 'outlier' project in the first place . It is foolish to believe that the industry as a collective would duck the opportunity of a once in a lifetime 'pot of gold' opportunity to participate in supposedly the 'biggest IT project in the World' it therefore seems more logical to suggest the 'immaturity' lies fairly and squarely on the Procurers of the system.

Whilst the 'husky' community looks around for the next to fall, a political and legal withdrawl needs to be worked out quickly so that the best of what has been developed and learned can be retained and the free market can once again be established.

Finally, With the BCS, countless communities like this one, and now the 'very public' stance of a group of senior academics all questioning the fundamental architecture, approach and lack of clear vision / credible leadership around this project (despite the NAO's perverse assessment) it proves that 'you can fool some of the people some of the time but you can't fool all of the people all of the time'.

MPs Richard Bacon and John Pugh sum this up well in their recent letter 'What next for NHS IT" when they say "The government is convincing no one that the situation is under control. The National Programme for IT in the NHS is currently sleepwalking towards disaster". I think we all know it is time for change. [1]http://www.computing.co.uk/computing/news/2165641/granger-signals-approach-nhs

Damned if you do?

nhstechie@btinternet.com

20 Oct 06 20:23

I completely agree with the assessment that these 23 academics know their stuff - one of them set up a rather excellent course I was lucky enough to attend.

From the outset NPfIT was a high risk/high potential benefit strategy but, however rose-tinted our view of the past, IfH was never going to deliver much for any but a small percentage of Acute trusts. We had a supplier-dominated market place where proprietory systems seemed deliberately engineered to be incompatible with immense data migration challenges facing anyone changing supplier.

However, I have yet to see anyone propose an affordable alternative to NPfIT which would be all things to all people, or result in improvements to anyone other than the few Acute trusts who did better than average out of IfH (often because they were seen as pilots and received higher than average funding from their LIS boards, HAs, ROs, ERDIP and other well-wishers).

A review IS inevitable in a programme of this size and duration, but I haven't seen anything by the 23 which suggests scrapping NPfIT, simply calls for better transparency, improved clinical representation and an updating of the business model and business case to ensure a good fit with an NHS which has changed rather a lot since the launch of NPfIT.

It seems to me that the one thing all major IT projects in whatever sector have in common is that they will be widely damned in the media - even those which succeed are pilloried for being either too costly or late. The only way to avoid this is to pad out project budgets and timescales - which almost inevitably means the bean-counters will reject the business case as too costly with too long a gap between initiation and benefits realisation.

Damned if you do - damned if you dont! Let's revert to card index systems and biros.