Chronic over optimism in the NHS

It’s nearly 15 years since Mott Macdonald analysed major public procurement and convinced HM Treasury that vast swathes of the public sector were far too optimistic in establishing projects, and three years since the National Audit Office told us we’re all still at it. 

Project optimism is a curious and not uniquely British trait, and certainly in the healthcare sector believing you can achieve miracles in next to no time with very little cash has kept the NHS going for the last 70 years. 

For those of us delivering healthcare projects, improving clinical environments and better patient care, optimism is a double-edged sword. We’ve all been on the receiving end, for example, of one of those Random Acts of Chief Executive – “we need to increase our elderly / acute / paediatric [delete as appropriate] capacity before next winter and we’ve got £3.50 from the centre. Can we quickly squeeze some extra beds into north wing?” 

Great – we have a project emerging from nowhere, and a crack team of professionals who definitely weren’t already overloaded trying to keep the rest of the campus together, raring to go. And that’s where the fun starts. In one well-intentioned direction, we have the key ingredients of a classically over-optimistic project: namely a fixed requirement with an imposed timescale, un-scoped budget, and a high political profile. 

Project optimism is a curious and not uniquely British trait, and certainly in the healthcare sector believing you can achieve miracles in next to no time with very little cash has kept the NHS going for the last 70 years

So what’s the problem? Nothing unique in that request for your average project manager. Except that clearly no one has properly thought it through. North wing is fully occupied, both by some rather unwell patients and also by a plant room inevitably riddled with asbestos. Both need to be sensitively relocated, one almost certainly to a yet-to-be-realised temporary facility in the overflowing consultant car park.

If we’re lucky, the hospital has access to a consultant or contractor framework that can bring a team together in less than six months. If not we can play a game of OJEU roulette, and take bets on when we can actually start work.

So how can we get the best for our tax-dollar and avoid another project doomed to failure? A healthy dose of realism and pragmatism is always sensible in any project delivery, and understanding the inherent opportunities and risks in your campus in terms of capacity and condition, together with a longer-term estate strategy is essential. 

Take time to listen to and trust the judgement of your professional team on what is realistic – letting your clinical team watch back episodes of DIY SOS may help them unwind, but it is unlikely to make them experts in the built environment overnight. 

Finally, avoid at all costs becoming a slave to in year spending constraints unless you’re willing to accept trading up your buying power for a higher risk profile.

Pull this together into some basic feasibility work, provide the foundations for a more formal business case, perhaps even with some different options and price points, and you’re half way home.

Getting the right outcomes for patients and staff has to be a sacrosanct priority, but without properly evaluating the establishment of a project, your project manager will almost certainly be managing unaligned stakeholder expectations until the next Spending Review.

Mark Halstead is director of programme & project management at Essentia, the consultancy arm of Guy’s and St Thomas’s NHS Foundation Trust