Anatomy of a Failed Project: The NHS National Programme for IT

When we talk about project failures, there's one that stands head and shoulders above the rest - the NHS National Programme for IT (NPfIT). At £11.4 billion and counting, it's often cited as the biggest IT failure in public sector history. But more importantly, it offers us invaluable lessons about how projects go wrong.

The Vision

On paper, it seemed straightforward enough. Launch a unified electronic health records system for the NHS, allowing any healthcare provider to access patient information anywhere in England. Brilliant idea, desperately needed, strong political backing. What could possibly go wrong?

The Warning Signs

Looking back, the red flags were there from day one. The programme was announced in 2002 with virtually no consultation with healthcare professionals. It's like trying to build a house without talking to the people who'll live in it. The first lesson? Stakeholder engagement isn't a nice-to-have - it's essential.

Scope Creep Gone Wild

The project started with electronic health records but quickly ballooned to include:

• Choose and Book (electronic appointment scheduling)

• Electronic prescription service

• NHS mail system

• NHS spine (central database)

• Network infrastructure

• Local service provider systems

Each addition made sense in isolation. Together, they created a monster. It's a classic example of how good intentions can lead to catastrophic complexity.

The Leadership Carousel

Over its lifetime, the programme saw five different Senior Responsible Owners. Each brought their own vision, priorities, and approach. Imagine trying to build a house where the architect changes every few months, each with a different view of what the house should look like.

The lack of consistent leadership meant no one was there long enough to see their decisions through or be held accountable for their consequences.

The Contractual Nightmare

The contracts were a masterclass in how not to do procurement. Rigid terms, penalties that didn't incentivise the right behaviours, and unrealistic expectations led to a situation where suppliers were set up to fail.

One supplier, Fujitsu, ended up in a legal battle that cost the taxpayer £700 million. When your contracts lead to courtrooms instead of collaboration, something's gone seriously wrong.

The Culture Problem

Perhaps the most damaging aspect was the culture that developed. Criticism was seen as disloyalty. Bad news was buried. Optimism bias ran rampant. Problems weren't acknowledged until they were too big to ignore.

I've seen this pattern repeat in smaller projects - when people become more focused on protecting themselves than solving problems, failure becomes inevitable.

The Cost of Complexity

The programme's architecture was so complex that making changes became nearly impossible. Simple updates required coordinating multiple suppliers, systems, and stakeholders. It's like building a car where changing a tyre requires consulting three different manufacturers and getting approval from a committee.

The Missing Users

Remember those healthcare professionals who weren't consulted at the start? Their absence continued to haunt the programme. Systems were delivered that didn't match workflow requirements. Training needs were underestimated. User resistance grew.

One GP famously commented that the system "added two minutes to every patient consultation." In a busy practice seeing 40 patients a day, that's over an hour of lost time. No wonder adoption was poor.

The Death by a Thousand Cuts

The programme didn't fail in one spectacular moment. Instead, it died slowly through:

• Missed deadlines

• Mounting costs

• Decreasing stakeholder confidence

• Growing user resistance

• Political pressure

• Media scrutiny

Learning from Failure

So what can we learn from this expensive lesson in project management?

Start with the Users

No matter how brilliant your technical solution, if it doesn't work for the people who'll use it, it's worthless. Engage early, engage often, and really listen to what you hear.

Keep it Simple

Complexity is the enemy of success. Break big problems into smaller, manageable chunks. Deliver value incrementally rather than betting everything on a big bang.

Culture Matters

Create an environment where bad news can travel quickly and safely. Problems caught early are usually problems that can be fixed.

Leadership Continuity is Crucial

Major transformations need consistent leadership. If you must change leaders, ensure there's proper handover and continuity of vision.

Contracts Should Enable, Not Constrain

Your commercial framework should incentivise collaboration and problem-solving, not create adversarial relationships.

The Silver Lining

While the NPfIT is remembered as a failure, it did deliver some valuable components. The Spine, NHS Mail, and the Electronic Prescription Service are still in use today. Sometimes success can emerge from the ashes of failure.

Final Thoughts

The NPfIT wasn't doomed to fail. At each point where the programme took a wrong turn, there were people raising concerns and suggesting alternatives. The failure wasn't in not knowing what to do - it was in not listening to the right voices at the right time.

As project professionals, our job isn't just to manage schedules and budgets. It's to create an environment where success is possible and failure can be caught early. Sometimes that means being the voice that asks the uncomfortable questions or challenges the optimistic assumptions.

Remember, learning from failure is valuable, but learning how to spot potential failure - and prevent it - is priceless.

Here is some excellent further reading on this by Henrico Dolfing.