All right—thank you, convener.
If it is okay, I will start from before I took up the role. In July 2010, the NHS Scotland capital investment group considered the programme initial agreement from NHS 24 and recommended that an outline business case should be prepared, noting that it was to be funded from within NHS 24’s own resources. I make the point that, in my view, the approach of going through the capital investment group was not the appropriate approach, and it would not happen now.
On 16 December 2011, the full business case was considered by the capital investment group and was approved on the basis that NHS 24 engage with other health boards. A contractual process was undertaken, and in March 2012 NHS 24 signed contracts with Capgemini for software for approximately £20 million, and with BT for hardware for approximately £55 million—that is the £75 million starting point.
The go-live date in June 2013 was delayed until September or October 2013—I will say October—because of issues with the performance of the clinical content system, which was the core clinical system supplied by a subcontractor to Capgemini. Basically, the system did not work with 600 concurrent users. In August 2013, the stage 4 gateway review was commissioned by NHS 24 and the programme got an amber rating. In October 2013, the go-live date was deferred again.
In January 2014, I met the chair and chief executive of NHS 24 and sought to understand the issues. Shortly after that meeting, the chair and chief executive alerted me to the fact that they had discovered that not only was the system not performing but the contract itself was incomplete. That was in January 2014.
In February 2014, we implemented our escalation process, following the mid-year review. That was the point at which we jointly commissioned Ernst & Young to report on the state of the system. That report was finalised in March 2014, and in April 2014 the then cabinet secretary, Mr Neil, met the chair and chief executive of NHS 24 to discuss the issues and was provided with substantial assurances on the steps that were being taken.
However, I did not consider that NHS 24 could proceed without an experienced programme director. We identified an experienced programme director, and that person was put in place in June 2014.
There is a lot of detail for the period between then and September 2015, which I will be happy to go through, but the core points are that in June 2014 there was neither a functioning system nor a contract, but by August 2015, when Ian Crichton came in as chief executive from NHS National Services Scotland, NHS 24 had worked with him and others in NSS who had expertise to get to a point at which there was both a functional contract, which could actually be enforced, and a system that provided the functionality that was required. Throughout that period, we ensured that NHS 24 had the support that it needed from NSS to get to that point.
On 7 and 8 September 2015, a system dress rehearsal was conducted—basically, that is a full running of the system. That provided assurance from the staff who were operating the system that it was working successfully. NHS 24 had a successful test of business continuity and undertook a learning exercise from that. It switched on scheduled care services on 28 October 2015, and the scheduled care element of the system worked.
There was a failure, because of a breakdown in the external telecoms, but that was not to do with the core system. However, what became clear when NHS 24 moved to the out-of-hours element—as opposed to the in-hours or scheduled care element—was that although that element functioned effectively in testing, there had not been enough investment in training staff. Staff were not sufficiently familiar with the system to operate it at the speed that was required to give the turnround to patients who were calling in.
I went to NHS 24 to see the system in operation, so I can vouch for the fact that it works. Equally, I can vouch for the fact that I saw staff who had had insufficient training struggling to operate the system at the rate at which it should be operated. I am being completely honest, convener. I see no point in trying to hide any facts here.
At that point, a clinically-led decision was made that although the system was operating effectively, because it could not be guaranteed that the required turnround for ill patients would be provided, NHS 24 would revert to the old system and carry out further testing and training.
I can give you a considerable amount of extra detail about what we did in the interim period, if the committee would find that helpful, but that is the broad summary to October 2015. Subsequent to that, the committee has had access to the lessons learned report and has heard the evidence from Ian Crichton and John Turner.
10:15
We have now put Angiolina Foster in place as the chief executive. Angiolina has considerable experience in running organisations, particularly organisations that have gone through periods of difficulty, which is why she was selected. One of the members of the assurance group is John Brown. Before he took on the role of chair of NHS Greater Glasgow and Clyde, he had experience in the operation and turnround of major call centres.