NHS 24 IT System overspend by £41.6m could have been prevented by them following ISO 9001

MANY of you will know the background on this one, but for those that don’t, I will recap the story so far.

In March 2012 the former chief executive of NHS 24, Mr John Turner, signed a contract for a new call handling system for NHS 24 called ‘Future Programme’ which had a budget of £75m and was aimed at making NHS 24 more efficient. Since then it has had some issues which I have detailed the highlights (or should that be the low points!) below:

The project ran £41.6m over budget.

When it was introduced on the October 28 2015, it ran into difficulties within a matter of hours. This resulted in the system being shut down and staff reverting to handling calls using pens and paper for a number of hours.

In the early hours of the October 29, NHS 24 decided that they would revert back to their old computer system and the decision was made to delay reintroducing the new computer system until ‘it is safe to do so’.

An NHS spokesperson stated “it has proved extremely challenging” and “a huge amount of planning, system testing and staff training was undertaken”.

Mr John Turner, chief executive resigns over the issue as does the chief financial officer.

On November 13, interim chief executive Ian Crichton stated that continuing to use the new IT system would be unsafe for patients. It was therefore decided to continue using the existing IT system and to shelve the new ‘Future Programme’ IT System whilst they continued to develop the system offline with the aim reintroducing it at a later date sometime in 2016.

Mr John Turner, chief executive admits to an enquiry that the paper copy of the 1000-page contract that he signed didn’t match the electronic copy and that he was very sorry and felt let down.

Mr John Turner, chief executive has stated that he was not informed of a fundamental flaw in the system being delivered for 22 months adding “other junior staff were aware of the omissions but didn’t tell me”.

How much will the new IT System eventually cost? As it was £41.6m over budget in October 2016 and is still not operational, so we may never know how much more money the tax payers will eventually pay for it.

As you can see it has not been an easy or successful project and has resulted in much criticism including being called a ‘mismanaged shambles’ by Jackson Carlaw, Scottish Conservative health spokesman.

There is currently a public enquiry being undertaken to ascertain what went wrong, however the Scottish government has history of over-spending on other projects as well so the NHS 24 IT system is not new:

The cost of a new office block for MPs, Portcullis House, rose from £60million in 1991 to £234million by the time it opened in 2001. The National Audit Office watchdogs later found 7,500 defects in the structure.

The Scottish Parliament building at Holyrood opened in 2004, three years late. The final bill, £414million, was between 10 and 40 times higher than original estimates. A public inquiry into the massive over-spend found there had been failings throughout the project.

So what can we learn from this? Well if the government and NHS 24 had utilised effective management systems then many of these issues could have been prevented. I could document a long audit report with many non-conformances but lets consider some of the requirements of ISO 9001: 2008 that could have prevented this and other over spending on projects.

Req. 5.1 ‘Management Commitment’ – managers did not ensure quality objectives were met.

Req. 5.2 ‘Customer Focus’ – were customers interests taken into account (or the tax payers that finance such projects).

Req. 5.5.3 ‘Internal Communication’ – senior managers and junior members of staff failed to communicate for 22 months about fundamental issues.

Req. 5.6 ‘Management Review’ – failure of ongoing review of issues and overspend; it was left to run out of control for 22 months; and longer.

Req. 6.2.2 ‘Competence, training and awareness’ – it is obvious that there were many people involved that were not competent in reviewing contracts and correctly managing such large projects.

Req. 7.2.2 ‘Review of requirements related to the product’ – again rather obvious that this wasn’t taken into account with regards to signing a contract that didn’t match the electronic copy and also obvious that Mr John Turner may not have understood what he was actually signing.

Req. 7.3 ‘Design and development’ – lack of planning, reviews, verification and validation.

Req. 7.4 ‘Purchasing’ – total failure of reviewing of information with the supplier and further failure of verification of purchased product.

ISO 9001: 2015 can further prevent such future over spends and project failures as the new standard introduced:

Risk Based thinking – which would ensure that inherent risks are established and managed; not just health and safety but quality, operational and financial.

Req. 4 ‘Context of the Organisation’ – understanding who the interested parties are and what their needs and expectations are.

Req. 4.4 ‘Quality Management Systems and its Processes’ – process based management systems and business models would ensure that projects are better managed.

Req. 5 ‘Leadership’ – now requires much clearer leadership and commitment from the top and in the case of 5.1.2 ‘Customer Focus’ would ensure that requirements are determined, understood and met as well as risks determined and managed.

Req. 6 ‘Planning’ – now requires that risks are determined and managed with regards to interested parties and their needs and expectations are met.

Req. 8 ‘Requirements for Products and Services’ – now has improved and clearer requirements governing the selection, purchase and review of products and services, including design input, output, controls and changes.

Req. 8.5 ‘Control of Changes’ – did NHS 24 best manage the change? This is unclear, however it would be safe to bet that better Management of Change would have helped reduce the risks.

Req. 9.3 ‘Management Review’ – a lot of the issues that NHS 24 encountered could have been better managed if regular management reviews and project reviews had been undertaken.

As stated previously I have not tried to detail all failings and non-conformities as that would be a sizeable document indeed.

So in summary, if the Scottish Government developed and utilised a Quality Management System based on the requirements of ISO 9001: 2015 that is independently certified by a third party then future over spends of tax payer’s money can and would be either prevented or at least limited.

If this had occurred in a public and private limited company in any business sector then questions would be asked, people would be dismissed and in some cases the company would no doubt face closure due to gross mismanagement; however, most companies operate good management systems against ISO 9001 and have to answer to their customers, as if they don’t, the customer would stop using them and they gain a bad reputation and lose more customers and potential customers go elsewhere – but in the case of government bodies they are immune to such outcomes as we as tax payers will pay our tax and accept it.

I will leave you with the following thought – the project over spend of £41.6m could have paid for 1900 nurses, or better facilities and hospital equipment, or shortened waiting times for surgeries!