Some online links relating to the iSoft/NHS affair
(In reverse chronological order.)
Aaron Sloman
Last updated: 20 Mar 2007

This is an appendix to my open letter to my MP, Lynne Jones,
claiming that all monolithic long term IT projects involving novel
system designs, such as the NPfIT must fail, explaining why,
and offering an alternative approach to long term development.

It took me a long time to find the text of the Open letter written by 23 professors of computer science about the NHS plans in April 2006 (now included below in one of the Computer Weekly extracts). Most of the links below came up while I was searching for it. I may go on adding other links as I stumble across them. The critical tone of the reports in various news publications seems to be escalating, raising all sorts of questions about various combinations of incompetence and possibly something worse, among people involved.
I may prettify this file later.


(Added 19 Sep 2006)

I have just found the 'Down at the EPR (Electronic Patient Records) Arms' web site which includes this page:

It contain's Sean Brennan's interesting December 2005 presentation (alas only available in powerpoint, not pdf) at Bristol and Leicester BCS Meetings.

The problems that the NHS IT project are intended to address are clearly and convincingly presented. My arguments are only about whether the proposed methods have any chance of success.

It provides some useful pointers, including links to the Integrated Care Record Service (ICRS) Specification July 03, which appears to have been the basis of invitations to tender for the contract. The detailed documents are

The model is very different from that presented in my open letter to Lynne Jones. If my arguments are correct, bidders were required to do a totally impossible tendering task for the reasons given here.


"This deal with Novell also reduces the barriers for the NHS in using
Open Source, as it secures access to an enterprise class Open Source
platform along with, more importantly, affordable support, maintenance
and training to help our NHS staff make the transition

NHS Connecting for Health is delivering the National Programme for IT to
bring modern computer systems into the NHS which will improve patient
care and services. Over the next ten years, the National Programme for
IT will connect over 30,000 GPs in England to almost 300 hospitals and
give patients access to their personal health and care information,
transforming the way the NHS works.


This is not a comprehensive collection.
(In reverse chronological order)

Thursday March 15, 2007
The Guardian

    Fitter, healthier, more productive

    Britain's medical practitioners are making lifesaving
    technological advances at local level - by effectively ignoring
    the costly NHS IT programme, explains Michael Cross


    Patients' rights to data

    In Hyde, the revolution in healthcare information may have even
    more profound consequences. It is the first practice in the
    world to invite every patient to inspect their electronic health
    record and, if they want, to have it available online.


    Two triumphs of the 14.6bn NHS programme for IT? Hardly.
    Electronic medical records at Hyde and Portsmouth may be
    achieving what the national programme, conceived five years ago
    this spring, is setting out to do. But they are independent
    efforts, happening not because of the national effort but almost
    despite it.


    None the less, a change of emphasis is about to take place. In a
    tacit admission that the existing contracts do not deliver,
    Connecting for Health is to invite companies to bid to supply
    alternative systems to those from the big contractors. This may
    encourage more local innovation. Meanwhile, the chief executive
    of the NHS, David Nicholson, is talking about giving local
    organisations more say in what elements of the programme they

[This looks like a move in the direction recommended in
my original letter to my MP.] 


IT Management
Politics & Law
Experts strike new NHS warning note
by Tony Collins
Tuesday 10 October 2006

    The government has failed in its attempt to quieten the fears of
    leading computing academics that the NHS's IT programme may be
    heading for trouble.


    however, the government has made only too clear it does
    not want any further independent scrutiny of what is the world's largest
    non-military IT programme.

See also the web site set up by the signatories:

Thursday, 28 September 2006, 13:13 GMT 14:13 UK

    Accenture quits #1.9bn NHS deal
    IT firm Accenture has pulled out of key parts of a beleaguered #6.2bn
    upgrade of the NHS computer system.

    American firm Computer Sciences Corporation has taken over Accenture's
    #1.9bn contract to implement the Connecting for Health programme.

    Accenture had responsibility for the roll-out in the North East and
    East of England but is making big losses on the work and faced fines
    for late delivery.

    Problems at another contractor, iSoft, have delayed the project.

    Accenture will keep responsibility for other parts of the NHS
    programme, including providing a system that will allow X-rays,
    scans and other images to be available at the touch of a button.

    But there are now concerns that its departure could mean further
    delays at Connecting for Health - which aims to link more than
    30,000 GPs with nearly 300 hospitals by 2014.

    The government was last week urged to reconsider the plan.

Tech & Net

The Times   September 19, 2006

Patients left waiting on operating tables by computer failures
By David Brown

    HOSPITAL operations and consultations are being delayed across
    England because the new NHS computer system suffers almost one major
    incident failure every day.

    Patients have been left waiting on operating tables and others have
    had appointments cancelled because of problems with the #12.4
    billion system.

IT Management
Politics & Law

Was NAO report truly independent?
by Tony Collins
Tuesday 19 September 2006

    The National Audit Office's final report on the NPfIT was very
    different to earlier drafts, which criticised the programme. Was it
    influenced along the way?

    ...includes reference to the offer of a body of leading members of
    UKCRC to conduct a review...

IT deals are failing public services
Tuesday August 29, 2006
The Guardian

Includes a letter suggesting that a similar disaster is involved in the
national policy for IT in schools.

Central NHS IT may not work, warns BCS
by Tony Collins
Tuesday 29 August 2006

The British Computer Society has backed calls for a technical review of
the health services £12.4bn IT programme, questioning whether the
schemes centralised approach will work in the complex structure of the

Among other concerns, the BCS says it has doubts about what it calls the
monolithic central national spine the BT-built database which is due to
hold summary records on about 50 million patients in England. The spine
is pivotal to the National Programme for IT (NPfIT).

The concerns are expressed in a private letter to a group of academics
who have called for an independent technical audit of the NPfIT.

The BCSs comments are not consistent with public comments it had earlier
made in defence of Connecting for Health, which runs the NPfIT. And they
will add to pressure on the Public Accounts Committee to initiate a
fresh review of the programme despite the publication of a positive
report by public spending watchdog the National Audit Office.

NAO report: a journey from criticism to praise
by Tony Collins
Tuesday 29 August 2006

When a report was published in June by the National Audit Office into
the NHS's National Programme for IT (NPfIT), it was seen by ministers as
a vindication of the UK's decision to spend £12.4bn on the world's
largest civil computer scheme.

The report was strongly supportive of the scheme and replete with praise
for the Department of Health and NHS Connecting for Health, its agency
which runs the NPfIT. But earlier drafts seen by Computer Weekly tell a
different story to the final NAO report.

 What IT crisis? ministers ask
By Stephen Seawright
(Filed: 28/08/2006)

The Government last night insisted there was no risk to its
multi-billion pound overhaul of the NHS computer system despite its main
software supplier iSoft diving into the red, being investigated by the
City's financial watchdog and openly squabbling with its partners.

In a statement, the Department of Health said: "The NHS IT programme is
not at risk of stalling, in jeopardy or close to collapsing because of
iSoft's recent troubles. It [iSoft] confirmed that it will make its new
software through 2008 - so in no way is the programme at risk."

The news was greeted with incredulity by MPs from both main parties.
Paul Farrelly, Labour MP for Newcastle-under-Lyme, said: "The Department
of Health was alerted to iSoft in parliamentary questions over two years
ago. It responded with a very complacent statement then. This is not the
time to repeat that mistake. From iSoft's results announcement... it was
quite clear that question marks remain over the future viability of the

Richard Bacon, Conservative MP for South Norfolk who is also a member of
the House of Commons' Public Accounts Committee, added: "The idea there
is no risk at all around this project is nonsense."

Who's really to blame for iSoft fiasco?
Simon Watkins, Deputy Editor, Financil Mail
27 August 2006

    THE debacle at software group iSoft is proving one of the most
    extraordinary City accounting fiascos of recent years.

    The group has plunged £383m into the red, has come within a whisker of
    collapse, is being investigated by the Financial Services Authority, and
    accountant Deloitte is still carrying out its own examination of the now
    infamous 'accounting irregularities'.

    On top of all this, the Serious Fraud Office is understood to be waiting
    in the wings.

    All this at a company that is a key supplier in the complete overhaul of
    computing under way in the NHS.

    It beggars belief. But it has not made beggars of iSoft's founding
    directors. Between them they have walked away with tens ofms of pounds
    after selling shares.

The Sunday Times - Business
The Sunday Times August 27, 2006

Bidders prowling round troubled health service supplier Isoft
   Dominic O'Connell

   BIDDERS are circling Isoft, the embattled software firm at the centre
   of the National Health Service's multi-billion- pound IT upgrade

   Meanwhile, Accenture, another leading player in the NHS IT scheme, is
   understood to be in talks to renegotiate the terms of its contracts.

   One health-industry source said last night the consulting firm had
   considered walking away from the programme, but that talks were
   continuing with Connecting for Health.

   If Accenture were to withdraw, it would be a crippling blow for the
   6.2 billion IT programme, which has been heavily criticised for
   delays and cost overruns in the past.


How it all started? (Gates inspires Blair)

Is this next item a clue to the seeds of this disaster, and does it fit
a pattern of disastrous high level decisions taken because a prime
minister who mostly does not understand what he is doing, and is more
concerned to have a Churchillian legacy than to understand the problems
faced by the nation, and the world at large, becomes passionately
committed to one disastrous project after another?,,1858787,00.html
Guardian Unlimited Business
   When Bill met Tony, seeds of a grandiose scheme were sown
   Michael Cross
   Saturday August 26, 2006
    The Guardian

   When Bill Gates met Tony Blair at Downing Street in 2001 the seeds
   were sown for the hugely ambitious plan to transform the NHS with the
   power of computers.

   Mr Gates, the billionaire software pioneer, had just written a book
   about how IT could transform economies. The prime minister, determined
   to reform Britain's public services, was hooked.

   Just one year later, representatives of Mr Gates's Microsoft empire
   attended a seminar at No 10 at which the NHS's 12bn IT programme was
   conceived. A core principle of this grandiose plan was that it should
   never rely on a single computer contractor and that the work should be
   carried out by global players.

   It is a measure of the crisis that these principles have been
   sacrificed and the NHS finds itself heavily dependent on one
   contractor, iSoft, a British-based specialist formed only in 2000.

   Mr Granger likens his relationship with suppliers to that of a polar
   explorer with his huskies: he once warned companies that weak
   performers would be fed to the strong. His problem is that he is
   rather short of huskies to shoot.

 NHS delivers fresh blow to sickly iSoft
By Josephine Mouds
(Filed: 18/08/2006)

    Troubled software company iSoft has suffered another blow after an NHS
    trust abandoned the implementation of its patient management system,
    part of the national programme to digitise patient health records, after
    several delays.

    The Sheffield Teaching Hospitals NHS Foundation Trust said it took the
    decision because a number of requirements had not been met before the
    system was due to go live in June this year. The trust is now seeking an
    "alternative solution" but said it was still committed to the national

    This is the third NHS trust to abandon the implementation of the iSoft
    system. A spokesman for iSoft was keen to point out that the trust had
    suspended the contracts with Accenture, which had contracted iSoft.


e-Health Insider
Sheffield abandons iSoft iPM implementation
16 Aug 2006

    Sheffield Teaching Hospitals NHS Foundation Trust has abandoned
    plans to implement a new patient administration system from iSoft,
    the first stage of the local Care Records Service (CRS) software
    being offered to it under the NHS Connecting for Health programme.


    Sheffield's Board finally decided to call a halt to the
    implementation of iSoft iPM on 9 August. In a statement the trust
    told E-Health Insider the decision was reached because: "A number of
    requirements were not met before the go live date of June 2006.
    These requirements were agreed by senior representatives of the
    trust, the LSP and CfH."


    Chris Linacre, director of service development at the trust said
    Sheffield remained committed to NPfIT: "The trust is a complex
    organisation and is in a unique position in that we currently use
    three different PAS systems across two hospital sites. Replacing
    these with a single PAS system is a significant project so we must
    be certain that the new universal system will meet the complex
    requirements of all of the five hospitals."


    Earlier this month Bradford Teaching Hospitals NHS Foundation Trust,
    also situated in the North-east Accenture cluster, went out to open
    procurement for a PAS system. In December 2005 Norfolk and Norwich
    University Hospitals NHS Trust, in the eastern Accenture cluster,
    abandoned plans to implement the CfH PAS choosing to further develop
    its existing McKesson system.


The Register: Management section

NHS IT costs hospitals dear
Fujitsu scores 19m compo

   By John Oates
   Published Tuesday 6th June 2006 14:37 GMT

   More bad news for the UK government's NHS IT programme - cash-strapped
   health authorities are having to pay millions in compensation to
   Fujitsu and CSC .

   When contracts were first set up by central government, NHS trusts
   promised to provide staff to help work on the new systems. But
   according to reports, health authorities in the south of England have
   failed to find enough people so they have to pay Fujitsu $19m
   compensation. The south of England was supposed to find 50 staff to
   work at Fujitsu.


   In the north west and west Midlands, the NHS is contracted to provide
   50 staff but is struggling to find enough people.


   Health trusts are looking at ways to buy their way out of the
   ageements, according to documents seen by Computer Weekly which has
   more details here.'fine'+NHS+over+IT+plan+delivery.htm


   Last week, MPs announced they are considering a full audit of the
   world's largest ever IT project - they fear the budget of 6.5bn will
   overrun. A BBC survey last week revealed that doctors are very unhappy
   with the Choose and Book system supposed to deal with hospital

   What's more, Lord Warner said last month that the patient records
   system was likely to cost 20bn rather than the 6.3bn originally
   quoted, and arrive two and a half years late.

   Government IT projects either fail because of overambitious, and
   under-achieving, suppliers or because of incompetent and feckless
   civil servants. Rarely do they manage to do such damage to both
   suppliers and customers before anything is actually delivered.

Computer says no' to Mr Blair's botched £20bn NHS upgrade
(Filed: 04/06/2006)

    The Prime Minister's dream of a 'paperless NHS', using 21st century,
    state of the art information technology, is in danger of crashing under
    a mountain of problems. Beezy Marsh reports
    Yet the glitzy, "joined-up" NHS remains a low-tech hotch-potch. Doctors
    are largely unimpressed. Dr Richard Vautrey, a GP in Leeds and spokesman
    for the British Medical Association on IT, has struggled for months, for
    example, to get "choose and book" working.

The Register
BBC survey damns NHS IT system
Connecting for Health moves to limit damage
By Kablenet
Published Thursday 1st June 2006 09:40 GMT

    Connecting for Health (CfH) has defended the NHS National Programme for
    IT (NPfIT) against the negative results of a new survey.

    The Medix survey, carried out for BBC programme File on 4, concludes
    that a "significant minority" of doctors were questioning whether the
    current route is the most effective. It shows that over a third of the
    doctors responding and 11 per cent of hospital colleagues were in favour
    of abandoning the programme.

    Half of GPs interviewed for the Medix survey said the Choose and Book
    system was poor or fairly poor. Four out of five GPs said they had
    access to the computer system but half said they rarely or never used
    it. Only one in five said it was good or fairly good.

Tuesday, 30 May 2006, 08:54 GMT 09:54 UK
GPs dissatisfied with IT system

    Half the GPs surveyed did not use the computer booking system
    Doctors have called for a review into the £6.2bn NHS computer project,
    according to a survey by BBC News.

    The IT upgrade aims to link up 30,000 GPs to nearly 300 hospitals in a
    radical overhaul of the NHS IT network.

    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.

    And Richard Bacon, a member of the Public Accounts Committee, said the
    entire project had been plagued by a "whole load of problems", while
    choose and book was "little short of a disaster".

Computer Business Review
Secrecy of NHS contracts begins to unravel
   10th May 2005
   By CBR Staff Writer

    The UK National Health Service's enormous IT overhaul is beginning
    to show signs of strain, only 18 months after the NHS signed deals
    worth a total of GBP6bn ($11bn) with a number of vendors. So far
    though, it is the suppliers rather than the UK government that are
    looking decidedly unwell.

    The companies involved are being gagged by some totalitarian-style
    privacy rules, but news of problems is beginning to surface.

   Public-sector contracts in the UK have become synonymous with cost
   overruns, and the government has suffered embarrassing high-profile
   failures at a number of its departments including the Child Support
   Agency and the Inland Revenue. Because the NPfIT is the most expensive
   and most ambitious public-sector project in the world, the government
   is under intense pressure to make it succeed.

   Controversially, the government has deemed it necessary to demand that
   suppliers keep secret the details such as delivery deadlines of the
   contracts, hoping to avoid the bad publicity it has suffered
   previously. So far, very little is known about the structure of the
   deals, but this could change.


Did Blair approve NHS scheme without knowing the full risks?
by Tony Collins
Tuesday 3 May 2005

The risks involved in rolling out the worlds biggest civil IT programme
were significantly underestimated when ministers initiated the project
in 2002, according to evidence unearthed by Computer Weekly.

NHS IT refresh to face independent inquiry

Concern over "viability" of multi-billion pound upgrade...
  Printer Friendly  Email Story

    By Tom Espiner and Graeme Wearden
    Published: Tuesday 25 April 2006
    An independent inquiry will be held later this year into the
    government's multi-billion pound upgrade of the NHS IT systems, which
    has been widely criticised by experts.

NHS Focus: Top UK IT experts demand audit of troubled system
by Tony Collins
Wednesday 12 April 2006

Leading computer science experts are this week writing to parliament
calling for an independent audit of the NHS national programme for IT

The signatories, 23 of the UK's top academics in computer-related
sciences, are concerned about the technical feasibility of a fully
integrated national programme.

Signatories to health committee letter
Tuesday 11 April 2006

Questions that need to be answered on NHS IT plan
   by Tony Collins
   Tuesday 11 April 2006

   Four years ago the government announced to a grateful NHS a national
   IT programme that would become the world's largest civil computer

   But after a breathless start, delivery dates for key software were
   missed, the full costs of implementation have always been unclear, and
   experts are divided over whether the scheme is too ambitious to ever
   work as originally planned.

   Now the IT community's leading academics have written an open letter
   to parliament's Health Select Committee calling for an independent
   audit of the national programme for IT. In doing so they are echoing a
   campaign launched by Computer Weekly last year for an independent

   Below we publish the letter in full, together with a list of its
   signatories. On pages 16 and 18 we summarise our coverage of the

Questions that need to be answered on NHS IT plan
by Tony Collins
Tuesday 11 April 2006

The open letter:


    The Select Committee may be aware of the concerns of health
    professionals, technologists and professional organisations about
    the £6bn NHS National Programme for information technology (NPfIT):

    * The NHS Confederation has said, "The IT changes being proposed are
    individually technically feasible but they have not been integrated,
    so as to provide comprehensive solutions, anywhere else in the

    * Two of NPfIT's largest suppliers have issued warnings about
    profits in relation to their work and a third has been fined for
    inadequate performance.

    * The British Computer Society has expressed concern that NPfIT may
    show a shortfall of billions of pounds.

    * Various independent surveys show that support from healthcare
    staff is not assured.

    * There have been delays in the delivery of core software for NPfIT.

    Concrete, objective information about NPfIT's progress is not
    available to external observers. Reliable sources within NPfIT have
    raised concerns about the technology itself.

    The National Audit Office report about NPfIT is delayed until this
    summer, at the earliest; the report is not expected to address major
    technical issues.

    As computer scientists, engineers and informaticians, we question
    the wisdom of continuing NPfIT without an independent assessment of
    its basic technical viability. We suggest an assessment should ask
    challenging questions and issue concrete recommendations where
    appropriate, e.g.:

    Does NPfIT have a comprehensive, robust:

    * Technical architecture?
    * Project plan?
    * Detailed design?

    Have these documents been reviewed by experts of calibre appropriate
    to the scope of NPfIT?

    Are the architecture and components of NPfIT likely to:

    * Meet the current and future needs of stakeholders?
    * Support the need for continuous (i.e. 24x7) healthcare IT support
    and fully address patient safety and organisational continuity

    * Conform to guidance from the Information Commissioner in respect
    to patient confidentiality and the Data Protection Act?

    Have realistic assessments been carried out about the:

    * Volumes of data and traffic that a fully functioning NPfIT will
    have to support across the thousands of healthcare organisations in

    * Need for responsiveness, reliability, resilience and recovery
    under routine and full system load?

    We propose that the Health Select Committee help resolve uncertainty
    about NPfIT by asking the government to commission an independent
    technical assessment with all possible speed. The assessment would
    cost a tiny proportion of the proposed minimum £6bn spend on NPfIT
    and could save many times its cost.

Comment by A.S.:
If the analysis I have presented is correct, the project management requirements referred to in that letter are not nearly radical enough, though of course the questions raised in it are very important.
The letter was signed by the following:
    Ross Anderson
    Professor of Security Engineering
    Cambridge University

    James Backhouse
    Director, Information System Integrity Group
    London School of Economics

    David Bustard
    Professor and Head of Computing and Information Engineering
    University of Ulster

    Ewart Carson
    Professor of Systems Science
    Centre for Health Informatics
    City University

    Patrik O'Brian Holt
    School of Computing
    The Robert Gordon University

    Roland Ibbett
    School of Informatics
    University of Edinburgh

    Ray Ison
    Professor of Systems
    The Open University

    Achim Jung
    School of Computer Science
    University of Birmingham

    Frank Land
    Emeritus Professor
    Information Systems Department
    London School of Economics

    Bev Littlewood
    Professor of Software Engineering
    City University

    John A McDermid
    Professor of Software Engineering
    University of York

    Julian Newman
    Professor of Computing
    Glasgow Caledonian University

    Brian Randell
    School of Computing Science
    University of Newcastle

    Uday Reddy
    School of Computer Science
    University of Birmingham

    Peter Ryan
    Professor of Computing Science
    University of Newcastle

    Geoffrey Sampson
    Department of Informatics
    University of Sussex

    Martin Shepperd
    Professor of Software Technologies
    Brunel University

    Michael Smith
    Visiting Professor
    Department of Computer Science
    University College London

    Tony Solomonides
    Reader in Computer Science and Medical Informatics
    University of the West of England

    Ian Sommerville
    Computing Department
    Lancaster University

    Harold Thimbleby
    Professor of Computer Science
    Swansea University

    Martyn Thomas
    Visiting Professor of Software Engineering
    Computing Laboratory
    Oxford University

    Colin Tully
    Professor of Software Practice
    School of Computing Science
    Middlesex University

Some of those who signed the letter also wrote to me after reading my open letter. Their letters are included here.

April 11, 2006, 13:25 BST

A group of UK technology experts have urged MPs to take a close look at
the NHS National Programme for IT, amid growing fears over the scheme's

A group of UK computer science academics have called for the Government
to rethink its strategy for reforming the technology infrastructure of
the NHS.

In an open letter sent to the Parliamentary Select Committee on Health
on Tuesday, 23 academics highlighted their concerns over the changes
proposed by the Government in the £6.2bn National Programme for IT
(NpfIT). They called for a "thorough, independent technical review" of
the scheme.

Signatories to health committee letter
Tuesday 11 April 2006

Top UK IT experts call for audit of NHS programme
by Tony Collins
Tuesday 11 April 2006

Leading computer science experts are this week writing to parliament
calling for an independent audit of the NHS national programme for IT

Health IT review

Published: 11 Apr 2006
By: Victoria Macdonald

There are calls for a review of the NHS's new IT system after fears it
could end in disaster.


The items collected above are merely samples, discovered during some of my trawling for information about the iSoft affair and the project to reform the NHS. Gradually I learnt that the problems were far worse than I had thought, and perhaps far worse than anyone realises, because news of what's going on trickles out in pieces. A clue to how the nation got into the mess may be the report above of the discussion between Gates and Blair, which reminds me of many decisions taken by this government apparently because someone near the top happens to have a vision of how the world should be.

Maintained by Aaron Sloman
School of Computer Science
The University of Birmingham