Appendix 1 - Ensuring a Project is Managed Effectively

The National Audit Office (NAO) recently published a report regarding the National Programme for
Information Technology (NPfIT). The ICT based projects in the Worcestershire NHS are either directly
or indirectly (through interim or transitional work) associated with the findings of this report and as
such take account of its findings and work toward implementing its findings at a local level.

NAO Report on the NPfIT

The National Audit Office (NAO) recently published a report regarding the National Programme for
Information Technology (NPfIT). The ICT based projects in Worcestershire are either directly or
indirectly (through interim or transitional work) associated with the findings of this report and as such
take account of its findings and work toward implementing its findings at a local level.
The following recommendations from the NAO Report support the need for robust control mechanisms
for projects. Worcestershire will ensure that all projects involving some form of ICT, take on, at a local
level the recommendations of the report and that senior management support the principles of formal
project management techniques, which, for the NHS is PRINCE2.
1. The continuation of strong management of suppliers’ performance, including the imposition of
contractual penalties to encourage suppliers to deliver on their commitments, including if
necessary termination and replacement of contractors.
2. Quantification of benefits, including financial benefits and quality improvements delivered, set
against the costs incurred, will help to demonstrate the actual benefits achieved across the
Programme and improve the transparency of value for money being achieved through its
implementation. It will also highlight where efficiency improvements are being made.
3. Robust training and development programmes should be developed to strengthen capability,
including project management and ICT skills available to the wider NHS, continuing its work with
the Office of Government Commerce. The shortage of such skills is an immediate risk to the timely
implementation of the Programme, and strengthening capacity in these areas will be a long-term
asset for the NHS.
4. Local Programmes should build on the early success of the National Clinical Leads by designating
further Leads using individuals of similar calibre, to help build momentum for the Programme as it
is deployed across the NHS

Why Use a Project Management Method?

Project failures are all too common, some make the headlines, the vast majority are quickly forgotten.
The reasons for failure are wide and varied. Some common causes are:
• lack of co-ordination and inadequate planning of activities with scarce resources
• lack of communication with interested parties, leading to products being delivered which are not
what the Customer wanted
• poor estimation of duration and costs, leading to projects taking more time and costing more
money than expected
• insufficient measurables resulting in a lack of defined achievement
• lack of control over progress so projects do not reveal their exact status until too late
• lack of quality control, resulting in the delivery of unacceptable products
Without a project management method, those who commission a project, those who manage it and
those who work on it will have different ideas about how things should be organised and when the
different aspects of the project will be completed.
An outline business case from the sponsoring service is the first step to ensuring that all parties are
aware of the general direction of travel. It is used to define the information that justifies the setting up,
continuation or termination of the project. It answers the question `Why should this project be done?` It
is updated at key points throughout the project.
Those involved will not be clear about how much responsibility, authority and accountability they have,
and as a result, there will often be confusion surrounding the project. Without a project management

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 method, projects are rarely completed on time and within acceptable cost. This is especially true of
large projects.

The NHS Project Management Technique - PRINCE

A good project management method will guide the project through a controlled, well-managed, visible
set of activities to achieve the desired results. This starts with understanding what the desired
outcomes are and the outputs that will be delivered to support those outcomes. This is based on the
outline business case and ensuring that this is agreed by the relevant parties involved, i.e. the
project is formally adopted.
PRINCE is the project management technique mandated by the NHS. It adopts the following
principles:
• a project is a finite process with a definite start and end
• projects always need to be managed in order to be successful
• for genuine commitment to the project, all parties must be clear about why the project is needed,
what it is intended to achieve, how the outcome is to be achieved, and what their responsibilities
are in that achievement.
PRINCE (PRojects IN Controlled Environments) is a structured method for effective project
management. It is a de facto standard used extensively by UK government and is widely recognised
and used in the private sector, both in the UK and internationally.
The key features of PRINCE are:
• its focus on business justification, though the service based business case.
• a defined organisation structure for the project management team
• its product-based planning approach
• its emphasis on dividing the project into manageable and controllable stages
• its flexibility to be applied at a level appropriate to the project.
Benefits of using a structured project management technique such as PRINCE:
• a controlled and organised start, middle and end
• regular reviews of progress against plan and against the Business Case
• flexible decision points
• automatic management control of any deviations from the plan
• the involvement of management and stakeholders at the right time and place during the project
• good communication channels between the project, project management, and the rest of the
organisation.
Project Managers using PRINCE are able to:
• establish terms of reference as a pre-requisite to the start of a project
• use a defined structure for delegation, authority and communication
• divide the project into manageable stages for more accurate planning
• ensure resource commitment from management is part of any approval to proceed
• provide regular but brief management reports
• keep meetings with management and stakeholders to a minimum but at the vital points in the
project.
Those who will be directly involved with using the results of a project:- will:
• participate in all the decision-making on a project
• if desired, be fully involved in day-to-day progress
• participate in quality checks throughout the project
• ensure their requirements are being adequately satisfied
For senior management, PRINCE uses the “management by exception” concept. They are kept fully
informed of the project status without having to attend regular, time-consuming meetings.

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