Journal of Information Technology

, Volume 22, Issue 3, pp 212–221 | Cite as

‘The biggest computer programme in the world…ever!’: time for a change in mindset?

Research Article


In this paper we offer a critique of ‘The National Programme for Information Technology’ (NPfIT) currently being undertaken in the National Health Service (NHS) in the UK. We begin by offering a brief introduction to the project. Next, we review the lessons learned from a wide range of experience with IT and business change projects and comment on why changes in the NHS are likely to be harder than in most other organizations. We then elaborate the implications of these ideas and identify potential areas for change, with particular focus on the current guiding mindset that this project is about the provision of a technical infrastructure. We argue that this is, thus far, a technology project and question whether the current strategy is the most appropriate way forward to achieve service improvements. We suggest changes in the underlying mindset, along with the leadership, ownership, metrics and labelling of the project.


IT business change mindsets National Health Service 



The authors would like to thank Frank Land, Malcolm Peltu and Tom Stewart for their advice and comments on earlier drafts of this paper.


  1. Alter, S. (2006). The Work System Method: Connecting People, Processes and IT for Business Results, Larkspur, CA: Work System Press.Google Scholar
  2. Berry, M. (2004). Facing NHS Problems Head-on, Personnel Today [WWW document] (accessed 6th April 2007).
  3. Bevan, H. (1996). Managing Today while Creating Tomorrow: The paradox of a re-engineering journey. Working article HWP 9630, Henley Management Group, Henley, UK.Google Scholar
  4. Brennan, S. (2005). The NHS IT Project: The Biggest Computer Programme in the World…Ever’, Oxford: Radcliffe Publishing Ltd.Google Scholar
  5. British Computer Society Health Informatics Forum (2006). The Way Forward for NHS Health Informatics, London: British Computer Society.Google Scholar
  6. Brynjolfsson, E. and Hilt, L.M. (1998). Beyond the Productivity Paradox, Communications of the ACM 41 (8): 49–55.CrossRefGoogle Scholar
  7. Checkland, P. (1999). Systems Thinking, Systems Practice: Includes a 30 year Retrospective, Chichester: John Wiley & Sons.Google Scholar
  8. Cherns, A. (1987). Principles of Socio-technical Design Revisited, Human Relations 40: 153–162.CrossRefGoogle Scholar
  9. Clegg, C.W. (2000). Sociotechnical Principles for System Design, Applied Ergonomics 31: 463–477.CrossRefGoogle Scholar
  10. Clegg, C.W., Axtell, C., Damodaran, L., Farbey, B., Hull, R., LloydJones, R., Nicholls, J., Sell, R. and Tomlinson, C. (1997). Information Technology: A study of performance and the role of human and organizational factors, Ergonomics 40 (9): 851–871.CrossRefGoogle Scholar
  11. Clegg, C.W. and Walsh, S. (2004). Change Management: Time for a change? European Journal of Work and Organizational Psychology 13 (2): 217–239.CrossRefGoogle Scholar
  12. Connecting for Health (2005). A Guide to the National Programme for Information Technology [PDF document] (accessed 6th April 2007).
  13. Currie, W.L. and Guah, M.W. (2007). A National Program for IT in the Organizational Field of Healthcare: A example of conflicting institutional logics, Journal of Information Technology 22 (3), in press.Google Scholar
  14. Draka, M., Sadun, R. and Van Reenen, J. (2006). Productivity and ICT: A review of the evidence. Discussion paper No. 749, Centre for Economic Performance, London School of Economics, London.Google Scholar
  15. Goldratt, E.M. and Cox, J. (1984). The Goal. New York: North River Press.Google Scholar
  16. Gibbs, W.W. (1997). Taking Computers to Task, Scientific American 277 (July): 64–71.Google Scholar
  17. Hammer, M. and Champy, J. (1993). Re-engineering the Corporation: A Manifesto for Business Revolution. London: Nicholas Brierley Publishing.Google Scholar
  18. Hawkes, N. (2007). Disillusioned Doctors Say Labour Decade of Reform has Failed NHS, The Times. 19th February [WWW document] (accessed 6th April 2007).
  19. Healthspace, [WWW document] (accessed 6th April 2007).
  20. House of Commons Committee of Public Accounts (2007). Department of Health: The National Programme for IT in the NHS, London: The Stationery Office Ltd.Google Scholar
  21. Kling, A. (2006). Solow Paradox Revisited. [WWW document] (accessed 09.04.2007).
  22. Krumbholz, M., Galliers, J., Coulianos, N. and Maiden, N.A.M. (2000). Implementing Enterprise Resource Planning Packages in Different Corporate and National Cultures, Journal of Information Technology 15 (4): 267–279.CrossRefGoogle Scholar
  23. Landauer, T.K. (1995). The Trouble With Computers, Cambridge, MA: MIT Press.Google Scholar
  24. Laursen, M.A. and Myers, M.D. (1999). When Success Turns into Failure: A package driven business process re-engineering project in the financial services industry, Journal of Strategic Information Systems 8: 395–417.CrossRefGoogle Scholar
  25. McLoughlin, I. and Harris, M. (1997). Innovation, Organizational Change and Technology, London: International Thomson Business Press.Google Scholar
  26. NHS England, [WWW document] (accessed 6th April 2007).
  27. Neely, A., Gregory, M. and Platts, K. (1995). Performance Measurement Systems Design: A Literature Review and Research Agenda, International Journal of Operations and Production Management 15 (4): 80–116.CrossRefGoogle Scholar
  28. Norman, D. (1998). The Post Disciplinary Revolution [WWW document] (accessed 30th June, 2002).
  29. Norton, J. (2006). Quoted in The Way Forward for NHS Health Informatics, A report on behalf of the British Computer Society (BCS) by the BCS Health Informatics Forum Strategic Panel, 15.12.2006.Google Scholar
  30. Parr, A. and Shanks, G. (2000). A Model of ERP Implementation, Journal of Information Technology 15: 289–303.CrossRefGoogle Scholar
  31. Royal Academy of Engineering and British Computer Society (2004). The Challenges of Complex IT Projects – The report of a working group from The Royal Academy of Engineering and The British Computer Society, London.Google Scholar
  32. Royal College of Nursing (2006). Nurses and NHS IT developments – Results of an online survey by on behalf of the Royal College of Nursing [PDF document] (accessed 6th April 2007).
  33. Scott, J.A. and Kaindl, L. (2000). Enhancing Functionality in an Enterprise Software Package, Information & Management 37 (3): 111–122.CrossRefGoogle Scholar
  34. Shepherd, C. (2006). Constructing Enterprise Resource Planning: A thoroughgoing interpretivist perspective on technological change, Journal of Occupational and Organizational Psychology 79: 357–376.CrossRefGoogle Scholar
  35. Solow, R.M. (1987). We’d Better Watch Out, New York Times, July 12th, Book Review.Google Scholar
  36. Willcocks, L. and Grint, K. (1997). Reinventing the Organization? Towards a critique of business process re-engineering, in I. McLoughlin and M. Harris (eds.) Innovation, Organizational Change and Technology, London: International Thompson Business Press, pp. 87–110.Google Scholar

Copyright information

© Association for Information Technology Trust 2007

Authors and Affiliations

  1. 1.Leeds University Business School, The University of LeedsLeedsUK

Personalised recommendations