Via Computer Weekly (Tony Collins).
The National Health Service Programme for IT has released some of its Gateway reviews in response to a Freedom of Information request.
The Office of Government Commerce (OGC) Gateway process is a mechanism by which – in theory – major IT/Change programmes in the UK public sector are governed; providing the owner (senior responsible officer) of the project with the proof that the programme’s management team are following a standard procedure and justifying the release of money to fund the next phase of programme activities.
31 Gateway Reviews are available, with quite a bit of redaction in places.
With some of the reports, it is possible to compare the views of the project team to public statements from customers and users. For example, here’s an excerpt from the 3rd August 2005 “Gateway Review 4” for the Choose and Book system:
There is widespread support for the Choose and Book concept. In addition to improving the patients’ experience and care it is seen as a key enabler of a wider system reform process across the NHS. Many GPs however have still to be convinced that it will work in practice. [..]
The December 2006 target of 90% deployment of a fully integrated Choose and Book system is still achievable providing current deployment issues are quickly resolved.
Here’s an article from BBC Health dated 30 May 2006:
Half of the GPs said the "choose and book" online booking system was poor or fairly poor. The poll was completed by 447 hospital doctors and 340 GPs. […]
Four out of five GPs [surveyed] had access to the computer system, but half said they rarely or never use it.
And finally here’s a Silicon News article from January 2009:
According to research by the British Medical Association (BMA), GPs reported the Choose and Book still has issues with reliability and slowness. [..]
One practice said it took up to 30 minutes to reboot their systems when Choose and Book crashed, while another said the system crashed for 50 per cent of referrals.
Consultants using Choose and Book to review appointments also said they were struggling with its slowness.
Ultimately the buck stops with the SRO (name redacted) but responsibility for a major public sector programmes is inevitably a poisoned chalice. Even the review team remarked:
During our visits and interviews we encountered no one who did not support the underlying concepts, although it is clear there is little pull for the new system from GPs themselves at present.
When you customer is not the user, and the specifications are changing regularly, then the result is pretty much guaranteed to be a failure of budgetary control or failure to reach the final scope. Consider the following paragraph from the review:
Choice was brought into the project after contracts had been signed and has had a significant knock on effect on delivery plans for CAB [Choose and Book]. As implementation of the fully integrated IT system has been delayed the need to deliver Choice by end 2005 has resulted in the requirement for the Indirect Booking Service (IBS). Choice continues to provide the imperative despite somewhat ambiguous messages about the urgency – for example, the lack of clarity over the Choose and Book December 2005 milestone and the PSA [Public Service Agreement] target.
Scary. Originally Choose and Book was intended to be an online booking system to formalise the process by which a GP would refer a patient to a Hospital-based specialist. But half way through, the word came down from Whitehall that the system should also be a means to allow patients to choose their specialist. Quite a change of scope, even assuming GPs actually wanted the original service.
