NHS Civilian IT Project: A Case Study of Project Failure

This report analyzes the failure of the NHS Civilian IT project, a major initiative aimed at creating an online health record system for British civilians. The project faced numerous challenges, including inadequate planning, cost and schedule overruns, ineffective project execution, and a lack of stakeholder engagement. The report examines the key issues that contributed to the project's failure, analyzes the control systems in place, and explores possible actions that could have led to success. It highlights the importance of comprehensive planning, effective stakeholder management, and robust governance in ensuring project success.

PPMP200010
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Table of Contents
Introduction and Project Information.........................................................................................3
Key issues........................................................................................................................................4
Control System...............................................................................................................................6
Analysis of cost and/or schedule overruns...................................................................................8
Analysis of project execution team...............................................................................................9
Analysis of relationship between overruns and the stakeholders...........................................11
Analysis of possible actions for success......................................................................................12
Conclusion....................................................................................................................................14
References.....................................................................................................................................15
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Introduction and Project Information
The present detailed report is made to elucidate the NHS Civilian project which is a game
changer project of the British government in the healthcare sector to support the healthcare issues
of British civilians. Details about the project and current report are explained below:
Project Details: NHS stands for national healthcare service which is a biggest health care
program in this world. The NHS Civilian IT project is planned to maintain online health record
of British civilians to serve the 4000 GP and 300 hospitals (O’Donnellan, 2016). Government
introduces it to maintain a clouded record of NHS beneficiaries so that hospitals can serve better.
Following benefits was expected from this project:
 All time and online availability of information for hospitals so the doctors can treat the
patient more effectively in an emergency.
 Healthcare professional can accesses accurate information any time about the viral
disease.
 The patient can see his medical test report at home with EPR (Electronic Patient Record)
system.
 It will help in resolving the issues that happen because of insufficient data.
The current report is made to describe the facts which are related to the failure of NHS IT
program. Due to various problems like lack inefficiency project management, project
implementation and stakeholder disagreement which contribute to the failure of the project, it
was closed by the democratic government in 2011 (O’Donnellan, 2016).
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Key issues
Project size: This project was introduced to support the NHS program to maintain online cloud
record of medical patients so that 40000 GP and 300 hospitals can use it to improve the services
under national health system. Research says that proper preparation was not done according to
the size of the project which was highly contributed to project failure.
Project size and cost: This project was introduced to support the NHS program to maintain
online cloud record of medical patients so that 40000 GP and 300 hospitals can use it to improve
the services under national health system. Research says that proper preparation was not done
according to the size of the project which was highly contributed to project failure. A very high
outflow was also expected from NHS project approx. ₤6 Billion and a high burden on taxpayers
was expected from the same. Taxpayers were not so happy with this scheme because due to this
scheme they have to bear an extra burden (Campion-Awwad, et. al., 2014). Additionally, the
benefits of the project were not so clear according to the cost. In this way, cost factor also
contributes to the failure of this project.
Lack of practical approach in planning: NHS’ it project was framed by the government and
the planning was also made at the cabinet level. The targets and aims of the project were
appreciative but on the board of practical execution, several discrepancies were found and the
junior level management team do not make any objection because of political imprecation.
Before the introduction of this Program, an additional system should be introduced to change the
basic structure of healthcare system (Murray, et. al., 2014). Civil employees tried to execute a
planned strategy which was made by the ministers and not appropriate in practical life. In this
way, IT program caused failed.
Political pressure: The NHS was the costly and expensive project which was putting the
unnecessary pressure on the taxpayers which gave the chance to opposition parties to speak
against the government in a rule saying why such schemes were introduced that were creating an
extra burden on Respected taxpayers. Due to the political pressure, the government was not
taking sufficient interest in this project and in this way political pressure was the big reason for
this project failure.
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Selection of service provider: During the selection of IT service provider, the government set
up the harsh policies against the service provider if they failed to provide effective services. The
contract of service was has a clause that if service provider will not able to provide the desired
level of service, his contract will be breached and no sympathy amount will be given to him. Due
to these harsh policies, many IT service providers were not taken interest in this project and
selected service provider was not have sufficient IT capabilities to continuously manage the
technical requirements which were also a reason for the failure.
The attitude of involved authorities: It is true that director and subordinates civil Servant of
NHS IT project was very efficient and capable to complete his duties but the attitude of them
was not so appropriate for their work. They were not made enough discussion about the practical
problems which was faced by the project during the execution process. It is also true that they
were not having cooperative Viewpoint to support each other (Maughan, 2010). It was biggest IT
project in the history of the healthcare sector and there was no person who can take responsibility
for failure which shows the lack of accountability. In this way, the unsupportive attitude of
authorities and less accountability was also a big reason for the failure of the project.
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Control System
The planning and strategy is the base for effective and on-time completion of the project. The
inefficiency in the planning and strategy not only increases the cost that is involved but also
affects the time taken which may ultimately result in failure of the project. The NHS IT project
was started with a view to achieving various objectives which were not only a revolution in the
health sector but may also contribute a lot to the communication. The objectives of this project
were to provide online services that save the time through unnecessary travel and delay of the
patients, availability of the important material and knowledge for the purpose of increasing the
effectiveness etc. The objectives that were set by the government were strong and could do real
good to the community but the strategy and targets sets by them were very loose such as the
strategy to integrate and connect all the GP surgeries by the year 2002, transmitting all radiology
reports electronically by 2003 and so on (Campion-Awwad, et. al., 2014). The targets must be
such that the project may be completed in minimal time with the highest efficiency but the target
actually set was much later. There were no proper plans with regards to performance targets,
business case, clarification in the plans in order to evaluate the growth and success of the project
and also consists of lack of understanding among the stakeholders. The process used by the
government for the controlling of cost, schedule, quality and distribution of the contracting
process was also complex. The contracting process was very much rigid with no compromise
policy. There were no changes to be made in the contract of the service and also a rigorous
policy against the service providers in case there was non-fulfillment of the project. There was
involvement of many provisions that restraint many service providers to look forward to this
cause (Maughan, 2010).
The control systems used were not reasonable. Planning is something on which whole of the
project is dependent but the government only focussed on the objectives but not on the pathway
that can result in achievement of the same. The project initiated was very good but it is also
important to execute the same but the targets sets were too below the par. There was not an
effective way of managing the work that has been done and which needs to be carried out which
not only lag the whole process but also resulted in the increase in the cost of government which
is being paid by the taxpayers. The project especially which is of such a large scale requires to be
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effectively managed and must be appropriately handled for which there must be selection of
service provider in an appropriate way but there were harsh conditions put on in front of them
which resulted in backing of the service provider from the project resulting in increase in the
time and the target that was being set up by the government (Maughan, 2010). There was no
proper anticipation and development of the strategy to measure the overall performance that is
being performed which can be stated by the failure of the project.
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Analysis of cost and/or schedule overruns
There were many reasons which have resulted in the failure of this project but the main was
increased in the cost and the schedule overrun. The planning must be such that it facilitates the
decision making and also helps in speedy completion of the work but there were many flaws. It
is important to have a workforce with managers and leaders so that there is the management of
the work performed but it seems that the government was not much focussed over the
development of the same which resulted in an increase in the cost due to change in the service
providers (Rose, 2015). The harsh policies affected the quality of the work that is to be provided
by the service providers and ultimately leads to the closure of the project. The cost rose to a very
high extent and no steps were taken in order to overcome the issues or strategies again so that the
remaining project can be completed in an efficient way. The project must be cost effective for
long-term sustainability but there is no effective management of the cash. It can be seen that
even if their full efficiency achieved there will be an extra £1.5bn a year above the inflation will
be required or £8 in order to overcome the deficit which will be incurred of £30bn by the year
2020-2021 (Rose, 2015). The schedule cost got overrun due to the mismanagement of the budget
which was planned by the government. The process of completion of the project as well as the
contracting policy resulted in an increase in time and delay in processing of the work.
The harsh policies also affected the schedule along with the setting up of the targets that were
prepared for the various steps of the NHS Integration system. The policies resulted in the left of
the project in middle by various service providers which affected the time frame of the objectives
that were established. There was a delay in the achievement of the objectives within the time
frame that was set up by the government as there was not an effective use of the available
resources. There were frequent changes in the service providers which made it difficult to
operate. The accountability of the people involved was not appropriately set up by the
government which led to delay in the work that is being performed. There was multi-sourcing of
the work by the government instead of investment in the existing workforce. The involvement of
the service provider in between the work performed affected the efficiency of the work
performed (Maughan, 2010). It is always better to invest in the existing workforce instead of
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appointment of new personnel but it was not in the NHS project which resulted in the increase in
the time involved as well as the cost incurred by the government.
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Analysis of project execution team
Project execution is the third stage of the project stages in which there is presentation of the
deliverables that are being prepared by the service providers. It is a very important phase with
respect to the completion of the project. The planning is an important aspect of the project but
leadership, management, and governance also plays a critical role as the execution is done by
them. Even if the strategy prepared is effective it is important that the implementation and
execution of the same is in an appropriate way so that the work can be completed in time and
budgeted cost. The work performed can be affected in terms of the finance, quality and the
stability of the project. The reasons for the gap in the project execution can be due to following
issues (Caietti, 2018):-
 Absence of common understanding
 Disengaged executive sponsors
 Misalignment with strategic goals
 Poor change management
 Ineffective governance
 Lackluster leadership
The project execution requires not only the leadership skills that are processed by the
management but also the overall support from the other people involved in the management.
There was no proper coordination regarding the work that is being performed and the remaining
work. The investment of the funds was much more than the expected returns and the benefit that
can be achieved with the project (Blackall, 2014). It was identified that there was inefficiency in
the management in performing the plans and execution of the same. There was not only
inefficiency in planning but also in the governance of the project that is being carried out. There
were many flaw such as the leadership inefficiency, change in the top level management and the
shift of focus towards the ultimate goal. There were many factors that resulted in the failure of
the project and project execution can be considered as a major one. There were many changes
with respect to the service providers which not only affected the efficiency but also resulted in
inefficient quality of the work and the productivity. The way of providing the contract was also
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very harsh and unique which not only affected the work performed but also mismanaged the
funds. There were many additional requirements which raised the budgets very much high
making the project difficult to complete for the service providers. It also shifted the main goals
and focus of the project as there were many changes made effective the plans and strategies that
were implemented by the service providers (Maughan, 2010). The execution problem was there
which not only affected the overall viability of the project but also resulted in the complete
failure. There were many internal issues such as issues related to financial pressure which
resulted in heavy deficits. The external issues related to the project made it more difficult to
execute. There was not much of the analysis of the factors such as the capacity and the cost
involved for the completion of the project.
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Analysis of relationship between overruns and the stakeholders
The stakeholders are the key component of any project. It can be stated that the communication
and consultation with the stakeholders can result in long-term success of the project. The
presentation of the desirables to the shareholders helps in getting an additional view about the
plans and policies that are going to be implemented. In the case of NHS it could be seen that the
stakeholders did show a concern about the plans and strategies that are being implemented and
also about the risk involved in it. The success of the project also depends upon the
communication and consultation with the stakeholders of the project. There was not much
confident over the system that was being developed in the stakeholders consisting of the doctors
and GPs. It is important that at least the stakeholders are aware about what is to be delivered
after the completion of the project to the people but in the case of NHS it was not. Even the
stakeholders of the company were not sure about how the project will be at the end (Maughan,
2018). There was no effective control and coordination between the overall management and the
stakeholders which at a point affected the efficiency and the productivity of the project. The
inefficiency in the planning process and the ignorance of the risk affected the project and also
resulted in the failure. There was increase in the cost that was involved which has been due to the
ineffective management. It is important to look at the pros and cons of the project instead of just
looking at the way one wants. The changes that were regularly made between the project were
not at all consulted which also created a mismanagement of the process that are being carried out
during the time. It can be said that there was a negative relationship between the overall viability
of the project or the overrun of the cost and time and the consultation with the stakeholders. The
decrease in the consultation with the stakeholders has resulted in increase in the cost and time
due to various reasons (Maughan, 2018). It can be seen that more and more involvement of the
stakeholders would have benefitted the project by establishing a much effective control and
coordination. It could be understood that the stakeholders does have a positive effect over the
project if the decisions and plans are being conducted after consultation. The project chances of
becoming viable and successful increases with involvement of the stakeholders. There can be
analysis of the risk more effectively by the stakeholders which helps in long-term success of the
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project. The non-involvement of the stakeholders in the project has resulted in the inefficiency in
the work that is being performed and also contributed in the failure of the project.
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Analysis of possible actions for success
Planning process – The most important is to have proper planning of the project from starting to
the end which also includes the targets and objectives that are required to be achieved. It has
been seen that the inefficiency in the planning of the project affected the whole project in terms
of the cost and the delivery of the project (Coleman, 2015). The planning is the base of the whole
project that is being undertaken and it provides an assurance about the completion of the project
time and in a cost-effective way. The planning process is the key to successfully frame the
strategies so that the objectives can be achieved.
Distribution of the work – The distribution of the work in a project is very much important as it
makes everybody clear about their duties and the work that needs to be performed by them. In
the case study, there was no proper distribution of the contract and the process was very much
complex with harsh policies which affected the quality (Coleman, 2015). They were not even
clear about the objectives and had frequent changes which hampered the efficiency. The
distribution of the work helps in smooth functioning of the work and steps that need to be taken
care which results in success of the project.
Consultations with the stakeholders – The stakeholders’ viewpoint is also necessary for the
project for the successful completion. It could be seen that there was already concern about the
funding of the project and completion of the same as the project was very big and there were
many issues involved. The risks and the concern of the stakeholders were ignored and there has
been huge funding over and above the budgeted amount. It can be seen that the concern it would
have been understood there were chances that there might be changes made in the strategy and
planning which may be beneficial.
Implementation – The implementation of the plans and strategies plays an important role too.
The implementation of the project if done effectively the inefficiency in the planning may have
been overcome. The implementation of the planned strategies and policies not only helpful in the
achievement of the objective by performing the work as required and understood. The effective
implementation strengthens the whole process that is being carried out. The implementation of
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the process as desired would have saved the overhead cost that was incurred for the project and
also helped to complete the targets that were set at the initial stage.
Governance – Governance is essential for the determination of the performance and the work
which is being performed as the long-term project can attract many issues. The good governance
act as a check over the work that is being performed as well as on the work which is further
going to be executed (Naughton, 2013). Inefficiency in the governance has resulted in the failure
of the project and also resulted in increased overhead cost and time. The governance is important
to measure the work quality as well as the performance at each stage so that there can be analysis
and effective decision can be taken for the benefit of the project.
Analysis of micro and macro factors – There are various factors which surround the project
which is conducted. The factors can be internal as well as the external project. It is important that
there is an effective analysis of these factors so that the steps are taken to overcome these factors
or take action through which the risk involved is kept minimal (Rose, 2015). The analysis of the
micro and macro factors helps in determining the sustainability of the project as well as the cost
efficiency. The analysis facilitates the decision making in the project regarding further course of
action in case of any unfavorable conditions.
Forecast and variance analysis – There must be effective forecast and variance analysis of the
results that are being achieved and the budgeted fund and time provided at each of the
milestones. This is necessary so that it can be analyzed whether there is inefficiency in the work
that is being performed or it is important to change the budgeted figures based on the conditions
prevailing (Rose, 2015). The forecast and variance analysis are used to determine the factors that
have resulted in an increase in overhead cost or because of which the time taken is much more
than the expected time frame. This helps in have a successful project by determining the reasons
for the deviations and decisions through which it can be achieved.
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Conclusion
The conclusion can be made with the help of the report that the project with the objective of
integrating the health system was very much helpful for the community but there were many
flaws which resulted in an increase in the budgeted cost as well as the delay in the project. The
inefficient planning and strategy with the goals set in an inappropriate way resulted in the
wastage of the money which could have been saved by proper control and coordination and good
governance. The project was very much affected by the decisions that were taken regarding the
distribution of the contracts to the service providers or management of the work that was
performed. There were many harsh policies introduced and the last minute changes have resulted
in either the back out of the service providers or there was increased in the cost which was then
disapproved by the government resulting in a delay in the work undertaken. It can be concluded
that the effective management of the work that is being performed through the governance and
control there can be chances of success of the project. It is very much important that there is an
effective analysis of the various factors that can affect the viability of the business both internal
as well as external so that the steps can be undertaken to minimize the risk or overcome it fully.
It can also be concluded that the stakeholder's view is also important for the purpose of the
decision-making process as well as to better manage the project.
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References
 Blackall, D., (2014). Why is project execution so important?. Civil Service. [Online].
Also available at https://civilservice.blog.gov.uk/2014/12/03/why-is-project-execution-
so-important/. [Accessed on 06-06-2018]
 Caietti, N., (2018). 10 Strategies for Successful Project Execution. Project Manager.
[Online]. Also available at https://www.projectmanager.com/blog/project-execution.
[Accessed on 06-06-2018]
 Campion-Awwad, O., Hayton, A., Smith, L. and Vuaran, M., (2014). The National
Programme for IT in the NHS. A case history.
 Coleman, A., (2015). How to spot the signs of a failing project. Reconteur. [Online]. Also
available at https://www.raconteur.net/business/how-to-spot-the-signs-of-a-failing-
project. [Accessed on 06-06-2018]
 Maughan, A., (2018). Six reasons why the NHS National Programme for IT failed.
[Online]. Also available at https://www.computerweekly.com/opinion/Six-reasons-why-
the-NHS-National-Programme-for-IT-failed. [Accessed on 06-06-2018]
 Murray, R., Imison, C. and Jabbal, J., (2014). Financial failure in the NHS. What causes
it and how best to manage it [Internet]. London: The Kings Fund.
 Naughton, J., (2013). Why big IT projects always go wrong. The Guardian. [Online].
Also available at https://www.theguardian.com/technology/2013/apr/21/fred-brooks-
complex-software-projects. [Accessed on 06-06-2018]
 O’Donnellan, R., (2016). 3 Projects that Failed Miserably. Bright work. [Online]. Also
available at https://www.brightwork.com/blog/3-projects-that-failed-
miserably#.WxZz5kiFPIW. [Accessed on 06-06-2018]
 Rose, L., (2015). Better leadership for tomorrow NHS Leadership Review. Government
Publishing. [Online]. Also available at
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/445738/Lord_Rose_NHS_Report_acc.pdf. [Accessed on 06-06-
2018]
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