Two weeks ago, under the headline “If at first you don’t succeed, try, try again”, this column highlighted the importance of managing expectations in major IT projects.

With the release last week of 31 Gateway project reviews covering the progress of the £12.7bn NHS National Programme for IT, it has become apparent that the response there to attempts to manage expectations was more along the lines of: “If at first you don’t succeed, ignore the problems and hope they go away.”

Reading through the documents reveals persistent warnings about a lack of clinical
engagement, poor communications, and concerns over supplier performance. These have been recurring criticisms of the National Programme, and ultimately have led to the serious delays seen in the most critical project, the Care Records System (CRS).

In the London region in particular hit hard by CRS problems that not only affected the NHS trusts involved but this year contributed to a £1.2bn write-off at BT poor supplier performance was first raised as an issue four years ago.

Within the National Programme then, the concerns raised by clinicians and in the press were being recognised ­but it would seem the warnings were not heeded.
This is therefore not an issue about scrutiny or openness ­the project was receiving scrutiny in all the right areas, and internally at least there was openness and honesty about the problems. But it is an issue about listening, accepting criticism, and here we go again, managing expectations.

For whatever reason, too many people involved in the NHS IT programme clearly did not listen to the warnings they received. They ignored official criticism from the Gateway review teams. And they failed to reset perceptions until it was too late.

The NHS project is enormously complex and controversial, and in many ways most of these problems were always likely to happen, and as we now know, they were indeed anticipated. The big question remains why so little seems to have been done about it until so late.