PPARS, it will be recalled, was the high-tech, high-spec replacement for the health boards’ creaking payroll, personnel and scheduling systems; a massive project in which computerisation across the health service was to be linked with radical change in management at every level within it.
It was the health service equivalent of Mao’s ‘Great Leap Forward’ but like the Leap it ended in disaster. In December 2005, the public spending watchdog, the Comptroller & Auditor General, issued a damning report, identifying a string of failures which doomed the project from the start.
In short, the story went like this. Although nobody knew what it really meant to have a PPARS, somebody thought it would be a good thing to have one anyway. The pressure to bring it in quickly came from central government, which at that time had no idea of the size or cost of the health service workforce. But with nobody in control of the project, key decisions were made, not according to need, but by consensus within the group.
In the circumstances, it could not have been any other way: the groundwork necessary to identify variations in pay, processes and other issues, which would have to be changed before the system could work, had not been done. With the focus firmly on the computerisation element, the change component was forgotten.
On top of that was a tendency to add more bells and whistles, even after the business blueprint should have been frozen. Finally, there was a failure to learn all the lessons of the pilot site implementation before the system was rolled out.
It was akin to putting a long-haul jet on a short-haul route, believing it would fly fully-loaded round-the-clock, allowing the pilot to take off with the baggage piled high at the back of the passenger cabin, encouraging the passengers to take the controls whenever they wanted, and then discovering the plane couldn’t land because the gear hadn’t been checked.
Since PPARS, there appears to have been a lot of work done in the Health Service Executive (HSE) in an effort to keep control over its budget for ICT, which is of the order of €140 million a year for the service as a whole. Indeed, the issue is regarded by the C&AG of such importance that he devotes an entire chapter to it in his most recent annual report.
During the course of his audit of ICT spending by the HSE, concern was expressed that the organisation did not have the systems, procedures and practices in place to control ICT spending effectively.
The C&AG highlighted wild fluctuations in the estimates for 2006 as evidence that a coherent ICT strategy was not in place in the HSE, and warned that existing governance arrangements might not be in compliance with the principles recently set down by the Department of Finance.
The HSE’s ICT Directorate has been cleaning up its act ever since and appears to have more robust procedures both for controlling its budget and in respect of big systems projects, which would include PPARS.
Since 2006, the previous early warning system, which was introduced to prevent unauthorised capital spending on ICT, has been strengthened with doomsday communications warning all managers of dire consequences for failing to get prior approval for big chunks of capital spending.
The Head of ICT is now responsible for critical decision-making on strategies, plans and projects, as well as for funding, staffing and engaging of contractors and consultants. The buck stops on his desk.
So could a PPARS-type disaster happen again in the health service? Looking at the recent changes detailed by the C&AG it seems unlikely, although the possibility can never be discounted.
Projects like PPARS fail in the private sector too, often for the very same reasons, but where taxpayers’ money is involved, public attention will understandably focus there.
However, while the procedures appear to be of most use in preventing unauthorised spending from taking place, they offer less assurance that a project, once established, won’t go off the rails because of a failure of strategic leadership within it, an unwillingness to direct resources into areas whose progress is critical to ensuring the success of the total project, or a failure to appoint only the right people to the project in the first place.
In theory, there appears to be a mechanism now in place, which would allow major risks and issues like this to be identified and actioned before they got out of hand. In this, something important has been learned.