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I've come across this story quite a few times here in the UK:

NHS Computer System

Summary: We're spunking £12 Billion on some health software with barely anything working.

I was sitting the office discussing this with my colleagues, and we had a little think about. From what I can see, all the NHS needs is a database + middle tier of drugs/hospitals/patients/prescriptions objects, and various GUIs for doctors and nurses to look at. You'd also need to think about security and scalability. And you'd need to sit around a hospital/pharmacy/GPs office for a bit to figure out what they need.

But, all told, I'd say I could knock together something with that kind of structure in a couple of days, and maybe throw in a month or two to make it work in scale. *

If I had a few million quid, I could probably hire some really excellent designers to make a maintainable codebase, and also buy appropriate hardware to run the system on. I hate to trivialize something that seems to have caused to much trouble, but to me it looks like just a big distributed CRUD + UI system.

So how on earth did this project bloat to £12B without producing much useful software?

As I don't think the software sounds so complicated, I can only imagine that something about how it was organised caused this mess. Is it outsourcing that's the problem? Is it not getting the software designers to understand the medical business that caused it?

What are your experiences with projects gone over budget, under delivered? What are best practices for large projects? Have you ever worked on such a project?


*This bit seemed to get a lot of attention. What I mean is I could probably do this for say, 30 users, spending a few tens of thousands of pounds. I'm not including stuff I don't know about the medical industry and government, but I think most people who've been around programming are familiar with that kind of database/front end kind of design. My point is the NHS project looks like a BIG version of this, with bells and whistles, notably security. But surely a budget millions of times larger than mine could provide this?


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"all the NHS needs is a database", Sure, of 60 million+ medical records (each involving hard to structure data like doctors notes) spread across a wide geographic area that CANNOT lose any of the data AND must protect it with a layered security model for different types of access. This is seriously hard stuff. Oracle themselves are involved to get the database working. –  Paolo May 28 '10 at 10:15
id,name,address, varchar(5000) job done –  Chris S May 28 '10 at 10:21
It would be good to hear from someone at Accenture - would anyone like to own up? –  Joe R May 28 '10 at 10:50
despair.com/consulting.html –  Andreas Brinck May 28 '10 at 10:53
Accenture hahah, oh this brings back memories... I remember being on their graduate programme, when one of the heads told us "we over charge for our government projects because....we can, there are cheaper solutions out there, but we can charge what we wish and the client can pay it because we are 'Accenture'' ... pure arrogance. –  Dal May 28 '10 at 12:33

2 Answers 2

This sounds similar to the same over-budget ($700M and counting) problems that New York City's "CityTime" Payroll project. http://www.nytimes.com/2011/03/28/nyregion/28citytime.html (Perhaps fraud was not a factor with NHS, but maybe outsourcing, SCRUM, etc.)

Has anyone ever heard of MDM (Master Data Management)?.. As for UK's NHS project, As complicated as it may be, maybe they should've studied how different countries and example: NYC's Health & Hospitals Corp. (NYC-HHC) have implemented their systems instead of re-inventing the wheel. If a proliferation of different formats of information and documents exists, why not standardize all the data you can standardize and temporarily digitize and index the documents so at least health-care professionals can access them?.. It's a starting point so at least the main benefit can be made available, i.e. CRUD.. then as time moves on, the system can continue to evolve!

just to update you on the CityTime project, the project mgr.(a contractor who was being billed at US$640K/yr) just got fired! a common problem that plagues government projects is that governments are unable to attract (as employees) enough talent needed to get the job done right, thus having to outsource projects to contractors! –  FrankComputerAtYmailDotCom May 28 '11 at 3:30
SAI (Science Applications International), the main contractor for New York City's "CityCrime" project, has agreed to reimburse NY millions of dollars from the over-billing that several of their ex-contractors (now criminally indicted) paded the bill! –  FrankComputerAtYmailDotCom Jun 7 '11 at 4:46
New York's Mayor Mike Bloomberg is now suing SAI to reimburse the city over $600M of the $730M+ paid!.. This is the largest fraud committed against the City of New York! –  FrankComputerAtYmailDotCom Jul 6 '11 at 2:10

Poor requirements analysis and constant tinkering. I have seen many a project spiral out of control as just one more feature is added, breaking 3 in the process. It's an endless cycle and I fault the project management people on both side for the brunt of this and the low level programmers for continuing to tinker.

Not being familiar with this exact problem it's hard to point exact fingers, but the above assessment sums up a lot of over budget projects I have worked.

Not being able to say NO is another issue. There are probably 1000's of people injecting requirements etc onto this project and if noone filters them it just grows out of control.


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