• New CQC chief executive leaves struggling IT project at NHS Blood and Transplant
  • CQC cites “track record of delivering technological innovation at scale” in hiring
  • £23m spent on system that can book appointments and send birthday greetings
  • Review finds project was in “fire fighting” mode, with high senior staff turnover and lack of accountability
  • New CEO linked to second government IT project failure, subject to critical National Audit Office report

The incoming Care Quality Commission chief executive is leaving a struggling IT project in his wake after spending £23m on a system that sends birthday greetings and books appointments.

Ian Trenholm is currently chief executive at NHS Blood and Transplant but will move to the CQC in July.

In appointing Mr Trenholm, CQC chair Peter Wyman cited his “track record of delivering technological innovation at scale in order to deliver benefits for people” as one of the deciding factors.

However, documents seen by HSJ show that while at NHS BT, Mr Trenholm oversaw a multimillion IT project plagued by delays, rising costs, senior management disagreement and resignations, and “a lack of accountability and understanding of the resource needed to deliver the programme”.

It is the second major government IT project that Mr Trenholm has overseen, which has failed to meet its objectives or costs, with a £215m scheme for paying farmers sparking a National Audit Office investigation [see box below].

Documents show that despite £23m being spent on the NHS BT project, known as the Core Systems Modernisation programme, none of the electronic clinical services originally planned are up and running.

The only parts of the project live are a system for sending donors a “happy birthday” message and a venue and appointment booking service, the documents show.

At the time of publication, the project’s status was still flagged as “red” by the board, with concerns about the ongoing costs and resources required to support it.

One source familiar with the project told HSJ that Mr Trenholm’s team had rushed delivery and ignored concerns raised by staff. They said: “The concerns of the staff delivering the programme were sidelined, and the scope of the programme was too ambitious and poorly thought through. The direction set by Ian [Trenholm] and his team was to rush things, without the right building blocks in place which caused many people to leave.”

Responding to HSJ, NHS BT confirmed Mr Trenholm had been the senior responsible officer for the IT project but said responsibility had recently shifted to another senior manager as part of a “long planned move”.

A CQC spokeswoman said: “All appropriate due diligence processes were followed in the appointment of Ian Trenholm, including receipt of detailed references and conversations conducted with senior leaders in the health system.”

CQC did not respond directly to any questions submitted by HSJ regarding Mr Trenholm’s appointment.

Farming payment system criticised

Prior to starting at NHS Blood and Transplant in 2014, Ian Trenholm was chief operating officer at the Department for Environment, Farming and Rural Affairs.

Between November 2012 and May 2014, Mr Trenholm was first of four senior responsible officers for the common agricultural delivery programme, the department’s £215m IT project designed to better delivery subsidy payment to farmers.

The programme has since run into difficulties and been subject to several Parliamentary reviews after the cost rose by 40 per cent and an IT system used to pay farmers on time had to be switched off just months after going live.

A National Audit Office review in December 2015 found that the programme’s original design and vision were too narrow and focused on procuring IT systems and not organisational change.

It also criticised “counter-productive behaviours” among senior leaders, shifting priorities and leadership turnover in the project.

The CSM programme, signed off by the board in July 2016, was meant to replace the organisation’s ageing IT system by the end of 2018-19, with new services gradually introduced in the two years leading up to the switch. This would include a system for handling donors as well as the the supply, processing and storage of blood.

At the time, it was expected to cost £36.6m, with a £6.5m “contingency”, through till 2019-20.

However, board papers in late 2017 show this figure was revised to £45m and flagged project delays and associated costs as a major financial concern for the organisation.

In late 2017, two reviews, including one conducted by PwC, were commissioned to get the project back on track.

A summary of those reviews, seen by HSJ, showed staff were constantly in “fire-fighting” mode and there was disagreement among the programme board about what they were trying to achieve.

Other concerns detailed in the reviews included:

  • Deadlines “continually missed”
  • Development of IT systems “rushed” with poor foundations
  • The objectives of the entire project were “unclear and fragmented”
  • Organisational and governance structures were “not always clear”
  • Staff that raised concerns felt “they were not being listened to”.

These issues were exacerbated by a high staff turnover, with the project losing its programme lead, three delivery leads, three integrated leads, the chief technology officer and several other senior staff.

NHS BT did not directly answer questions submitted by HSJ. A spokesman confirmed that Mr Trenholm was aware of the questions posed by HSJ.

In a statement, a spokesman said the CSM programme had been slowed down to allow more time for “complexities of integration with the legacy system to be addressed”. This had been made possible after the existing IT system supplier said they could stretch support past 2020.

“The complexity and sensitivity of this programme has always been recognised. At the outset, external advice was sought on the best approach to migrating to a new system whilst minimising risk by keeping the existing system running.”

The board was still formulating a new timetable for completing the project, which was why a “delivery risk had been flagged”.

Many of the new CSM IT systems were still being tested and refined, but live systems included “automating a number of our communications with donor and planning blood donation sessions”.

Senior staff turnover with a lengthy and complex project was “inevitable”, he said.