this week

Key lessons from the NHS Executive's first information management and technology strategy may not have been learned as the government prepares to spend£1bn on its new one, the National Audit Office has warned.

In a report issued yesterday, the NAO says the 1992 IM&T strategy was hampered by a failure to set a single set of clear and measurable objectives.

'The Executive did not consider how all the projects related to each other and, overall, the strategy lacked coherence,' it concludes.

The strategy was issued without an overall business case, and the NAO says this made it difficult to persuade health authorities and trusts to implement key projects.

It says this also made it difficult to monitor progress or measure costs and benefits.

The report estimates that the Executive's information management group spent£152m on the strategy, but cannot quantify the costs to the wider NHS.

An NAO source summed up privately: 'It looked like a nice aeroplane on paper, but it did not fly.'

The report says the 1998 IM&T strategy, issued in September, 'represents an improvement in design in several important respects'.

It has a single set of objectives, although the NAO feels these are still 'not specific or fully measurable' and 'certain detailed targets' are not 'explicitly linked' to them.

But no outline business case was developed because 'the Executive could not realistically develop a full overall business case and meet the government's commitment to publish a full IM&T strategy in 1998'.

The 1998 strategy was also issued without a lifetime expenditure plan, although the government has indicated that it expects to spend£1bn on the strategy, which runs until 2005.

'They are saying they will spend£1bn, but they cannot be sure what on yet,' said another NAO insider.

The report says more work is now needed to clarify the strategy's objectives and targets and ongoing work to develop a programme management framework should be continued 'as a matter of priority'.

The Executive told the NAO that the 1992 strategy document was deliberately issued without specific objectives because 'the purpose of a strategy document should be to convey a vision and set out a statement of broad principles'.

It also took a decision not to draw up an overall business plan, based on a reading of Treasury guidance.

And it decided not to monitor the wider costs of implementing the plan 'as these were met largely from HA general allocations' and the NHS was under pressure to avoid management costs.

Similar points were made to the NAO with reference to the 1998 strategy. Business cases will be drawn up for specific projects. The Executive will respond to the report at the Commons public accounts committee in May.

The 1992 and 1998 Information Management and Technology Strategies of the NHS Executive. Stationery Office.£11.10.

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