[nige1]

 paulg, on 2017-May-31, 01:27, said:

It is this basic and naive approach that the Government project managers try to adopt but it completely underestimates the complexity of the project. There are multiple Government departments who are stakeholders, most of whom are in competition with each other and have different goals. Some of the hospital trusts are very big, with budgets approaching £1bn, with hugely competent IT departments and developing and delivering solutions for them is very different to your local GP who unplugs their laptops and has a cleaner who switches off the wifi router at the end of each day.

End-users, like nurses and consultants, had little interest in supporting the project - they are people who care about patients, not IT, and there are always patients who need care and will take priority over responding to your requests for meetings about requirements. They never bought in to the benefits of the programme.

Then there was the conflict between the Department of Health, who basically wanted standardised IT services across the NHS to reduce cost, and the Treasury who wanted the hospitals to compete when providing patient services, again to reduce cost. For the largest hospitals, one of the few ways to compete effective was to deliver better IT services than standardised ones: so they didn't want or need the service. These hospitals were, naturally, the biggest customers and their lack of support due to incoherent government policies ensured that the project could not succeed.

There are very few project managers in the UK who are capable of running these mega-projects. You do not tend to find them in the civil service.

Critics agree with Paulg that the top-down approach can be unsuitable for massive comprehensive IT projects for enormous sophisticated fragmented bureaucracies with convoluted festering internal politics. To commit to such an ambitious project you need adequate preparation. You must be completely satisfied that there is a reasonable prospect of successful completion. For example, in the NHS, you might, instead, decide to pilot such a project at a single hospital. Your pious hope would be to scale it up later (when/if politically feasible). That might give you time to try to tackle seemingly intractable underlying problems e.g. simplifying and stream-lining management. Yes Minister stuff

I fear, however, that incompetence is not the main reason for expensive over-runs. Every fortnight Private Eye (UK satirical magazine) draws attention to conflicts of interest, not just in NHS contract-tendering. For example, when local authorities outsource or grant planning permission. And the impression is that such cases are the tip of an iceberg.

As Diane Eva points out, governments also legislate to sanitize practices that most of us would regard as corrupt. e.g. MPs who accept "consultancy" roles. fail to recuse themselves, "forget" to declare an interest, and so on. During the Westminster expenses scandal, we were amazed at the leniency, with which the Inland Revenue had treated MPs.

A recurrent theme is that bad guys are promoted. At best, whistle-blowers lose their careers.

[barmar]

 nige1, on 2017-May-31, 08:56, said:

Critics agree with Paulg that the top-down approach can be unsuitable for massive comprehensive IT projects for enormous sophisticated fragmented bureaucracies with convoluted festering internal politics. To commit to such an ambitious project you need adequate preparation. You must be completely satisfied that there is a reasonable prospect of successful completion. For example, in the NHS, you might, instead, decide to pilot such a project at a single hospital. Your pious hope would be to scale it up later (when/if politically feasible). That might give you time to try to tackle seemingly intractable underlying problems e.g. simplifying and stream-lining management. Yes Minister stuff

That doesn't really work -- different scales require completely different designs. Something works in 1 or 2 hospitals won't necessarily work in thousands, and you can't just "scale it up".

Projects like this are inherently nebulous.

That said, I think there's a problem that governments these days are not willing to invest and spend as much as they once were. During the space race, NASA probably had practically unlimited funding, so they could hire the best people and as many as were needed. The same thing with the Manhattan Project.

These days, people are more distrustful of governments, and governments are also burdened with huge pension expenses. It's much harder for them to justify the cost of hiring the best people for these projects; they hire the lowest bidder, and get what they pay for. Here in the US we have Trump proposing to slash the federal budget to shreds, cutting projects and agencies left and right.

Again, not really incompetence, just political realities.

[paulg]

 barmar, on 2017-May-31, 08:51, said:

Is it incompetence, or just a project that's so large and complex that it's practically impossible to manage it well?

As an IT person who understands some of the problems, it is easy to think that major projects in other disciplines are easier but I'm pretty sure this is not the case. I'm sure a single vision is always a big help!

[nige1]

 barmar, on 2017-May-31, 09:18, said:

That doesn't really work -- different scales require completely different designs. Something works in 1 or 2 hospitals won't necessarily work in thousands, and you can't just "scale it up".

Simulation can help. I think Barmar exaggerates the technical problem of scaling, nowadays. Integration does imply additional functionality. I guess that the problem is mainly political -- but that can still mean it's insurmountable

[paulg]

 nige1, on 2017-May-31, 09:43, said:

Simulation can help. I think Barmar exaggerates the technical problem of scaling, nowadays. Integration does imply additional functionality. I guess that the problem is mainly political -- but that can still mean it's insurmountable

Although I've been critical of aspects of the project, the technical people were not completely clueless. Of course pilot projects were established and run, but scaling them was a huge issue especially when you consider how different some of the customers were. A large hospital tended to have a reasonable network infrastructure, but not one that could move x-ray images around in any volume. Some GP surgeries had a dial-up connection or slow broadband, so moving any information was problematic. Hospitals and the GPs are 'live' environments and they do not have staff available to help with pilot installations, nor do they permit any interruption to their existing (IT) services.

Everything proves to be far more complex than the simple picture that the politician will present. And, in the end, one of the project killers was privacy and security concerns. The idea is that your medical record is available to clinicians at hospitals and GP surgeries, so that it is available if you are in an accident away from your home area. A Scottish doctor was then caught perusing the medical records of leading politicians. Trust was lost.

Although the mega-project failed, improved networks and security has led to partial implementation of some services as originally envisioned.

[paulg]

I these quotes, from today's The Register, come from someone with similar views (a little editing for language). I think the same problems exist in project management.

Quote

The recent acceleration in reported cases of hacking teaches us a lot about how the private and public sectors approach their IT.

The private sector, which can afford to spend decent money on getting the IT infrastructure right, suffers from one tiny limiting factor: bosses on their multimillion bonuses couldn't [care less] about its customers, only its customers' money, and even then only when it becomes their money. This explains why customer IDs and personal information are leaked freely to hackers with wild abandon while security measures surrounding incoming financial transactions are curiously bulletproof.

Now, the public sector is a very different kettle of worms, as my malapropistic old MacUser editor used to say. Public sector bosses do [care]. Their problem is that they don't have a clue.

This is the opinion of Dr Sandro Gaycken, director of the Digital Society Institute at the ESMT Berlin business school and director of NATO's SPS cyber defence project. When it comes to IT security, governments – and by extension the trusts and agencies they direct – are nothing less than "incompetent", says Dr Gaycken.

"They simply do not understand the problem. They struggle to get sufficient numbers of specialised cyber experts to help – instead relying on hordes of lobbyists, pseudo-experts and opportunists."

The only point I'd add is that I'm sure the UK Government does have a very small number of specialised cyber experts and top people in all areas. They are not used on projects like the NHS.