Another £72million wasted

A lecturer in health informatics writes:

I have today received a copy of the report by Sir William Wells into the NHS university which I have been trying to obtain since 2004. It paints a damming picture of an organisation lacking in clarity of purpose, and failing to engage with stakeholders while managing to spend 72 million pounds of taxpayers money.

As readers of this blog will know, the NHS university was proposed in the labour manifesto of 2001 and established as a special health authority in 2003. It's demise was announced on November 30th 2004 by the then Health Secretary John Reid, following a report into it's progress and performance by Sir William Wells.

I asked for a copy of the report in October 2004 and my MP received a letter from John Hutton in November 2004 saying that it was the Department of Health's intention to publish their findings "shortly".

When the Freedom of Information Act came into force on 1st Jan 2005 I wrote, under the new mechanisms, requesting that the report be disclosed which the department of health refused to do. I then appealed to the Information Commissioner who ruled in Nov 2006 that the department should disclose the document. The Department of Health then appealed against that decision to the Information Tribunal. Last week, just before the hearing, they withdrew their appeal.

The covering letter, which I received with the report today, suggests that "the Department has undertaken a full review of the determination of the public interest in this case". They argue that release in early 2005 would "prejudice any future reviews which might be conducted by the Department into the economy, efficiency and effectiveness of sponsored bodies", but that two years later this has changed. There is no explanation of what has changed since they appealed against the Information Commissioners ruling in November 2006.

The report itself is in two parts, the first detailing progress and performance and the second forward to the creation of the "NHS Institute of Healthcare Innovation and Education".

It starts by setting out the original concept behind the NHSu, but even on page one criticises the lack of clarity about where the NHSu fitted into the "already crowded healthcare education and training sector" and what its role should be. It goes on to describe tensions between strategic objectives and potential roles as a provider or broker of training. The lack of understanding of the wishes of customers (eg Strategic health Authorities) , is highlighted as a reason for the lack of support and integration with the wider NHS.

The quest for University title is highlighted as a major problem which was not understood by senior staff in the NHSu or ministers and added to confusion over the NHSu's role.

A major part of the report is devoted to delivery and value for money, which deals with a range of issues including; the staff complement of 412, learning services, and academic partners. It gives some numbers of the limited take up of NHSu courses and predicts that these would not meet the projections, particularly once the courses had to be paid for. Comments from a variety of stakeholders about the lack of a clear business plan caused Sir William concern as did the processes for governance. The 30% of staff involved in corporate services "seems disproportionately large" especially when viewed in the light of comments about the "culture and style of a start-up enterprise" and the lack of focus on structure and systems. Frequent changes of structure and individual roles were seen as another barrier to the establishment of effective working.

The report concludes with some answers to crucial questions about whether the investment was appropriate and over what timescale it is likely to bear fruit. The answers are damming and relate to lack of clarity of purpose, the absence of market surveys or prices, governance, pursuit of the University title, and engagement with stakeholders.

It suggests that in the light of the £72 million investment up to March 2005 "the Department of Health is exposed to significant embarrassment if the value for money delivered by the NHSU were to be probed".

I suspect this might be the reason that the report has taken so long to see the light of day - but I hope that now it has, it will be used to inform future decisions and avoid making the same mistakes again.