By
Richard Mboma, Jennifer Davis-Adesegha and Boniface Okanga
Liverpool, United Kingdom, 3 March, 2026
Even if project managers emphasize the importance of effective project planning, a gap still arises from the fact that most studies and even project managers have often ignored the importance of contingency project planning as part of the critical enhancers of successful project implementation (Zarghami, 2024). Most projects are planned and implemented as if no sudden events may occur to disrupt the successful project execution. Yet in the constantly changing modern business ecosystem, trends are constantly changing. These trends can be easily forecasted and mitigated, while others cannot be easily predicted. This implies that planning and implementation of a project are activities based on guesswork on whether or not the project implementation will be a success. Unfortunately, empirical facts from most failed UK healthcare projects suggest that the formulation and utilization of an effective project contingency plan is never considered part of the essential criteria for enhancing the successful project implementation. As depicted in the failure of the UK’s NPfIT (National Programme for IT) and Care.Data (Takian & Cornford, 2012), most project managers and personnel often assume that things will stay the way they are to influence the successful project implementation.
Project managers just focus on the core project planning processes encompassing feasibility analysis, planning, implementation and monitoring and evaluation of project implementation. The assumption is often that the project implementation will be a success. Sometimes, the guesswork works as some projects become successful even without the use of any contingency plan (Gooding, Bertone, Loffreda, & Witter, 2022). But sometimes it is just luck that works. In most cases, the processes for the implementation of even the well-planned projects are disrupted by the previously unforeseen events. Projects are disrupted by clients’ dissatisfaction that causes the need for change, variation and modifications of project plans in order to respond to the changed clients’ demands. Sometimes, the project plan is modified during implementation because of stakeholders’ concerns, dissatisfaction, and complaints about the project’s failure to respond to some ecological needs.
Some projects may have to be varied and changed from the original plan due to the failure to put in place measures to prevent ecological damage or to protect against the socio-economic damage that it would cause to the surrounding communities (Matchwell, 2024). In certain cases, the designated project plan is changed or modified to accommodate changes in materials’ prices as instigated by the macroeconomic changes introducing inflation or shortages of materials that cause price increases. Apart from the occurrence of natural disasters or pandemics like Covid-19, eventualities disrupting project execution can also arise from scope creep when the project exceeds its scope, budget overruns when the project execution costs more than the budgeted funds, or project delays when the project is delayed due to slow or delayed sourcing of the required inputs (Dolgui & Ivanov, 2021). These sudden changes and eventualities that can affect project execution render the effectiveness of contingency planning essential for bolstering the successful project implementation.
Contingency planning aids the diagnosis and mitigation of the risks of project failures. It is a strategic process of evaluating the nature and dynamics of the project plan as well as its execution processes to discern the complementary, backup or alternative project implementation plan that can be used if sudden eventualities occur to disrupt project execution (Ivanov, 2023). Contingency planning is part of the critical project risk management process that aids identification and mitigation of risks. Even if contingency planning is part of the project risk management processes, it is still largely part of the proactive remedial risk management process. Instead of waiting for disruptions to occur and then respond, contingency planning does not wait. It diagnoses the situation and responds before the eventualities occur to affect the successful project implementation.
Contingency project planning prepares project managers and the capabilities of the project implementation organisations to deal with the challenges and problems that can affect the successful project execution (Zwikael, Salmona, Meredith, & Zarghami, 2022). Contingency planning is often structured according to four steps encompassing proactive analysis, designation of specific actions to take in the event of disruptions, budget, resources and time preparation in the event of eventualities. These are accompanied with monitoring and tracking performance to ensure the successful implementation of the contingency project plan. However, while preparing the contingency project plan, Landau (2025) suggests that project managers can use five steps encompassing risk analysis, sensing and anticipation, action plan preparation, standby team establishment, changing and implementing the required project changes and modifications, and reinforcing change implementation. This improves the success of project execution. It improves the continuity of project implementation to enhance the meeting of the designated cost targets, timelines and expectations (Ivanov & Dolgui, 2020).
Usage of an effective contingency project plan improves the confidence and trust that the clients, public and all the stakeholders have in the project implementation firm. In the event of disrupting eventualities, all the stakeholders are confident that the contingency plan can be engaged and used to respond to the disruption and bring back the project implementation processes on track. Contingency project planning requires project managers not only to use issue logs to evaluate the likely areas of disruptions, but also to put in place the contingency budget reflecting the funds and monies that the organisation can spend to thwart the risks (Mayur, 2024). These must be complemented with the establishment of the resources and time reserve to cover the time for dealing with the crisis and the management reserve that offers additional management activities for planning and responding to the disrupting eventualities. However, to avoid wastage of resources, the response to the crisis must be proportional to the unfolding eventualities and risks. It must also be realistic in the context of the unfolding disruptions and proactive to prevent the occurrence of more damage. Even if that is so, empirical facts from the UK healthcare sector imply that the major inhibitors of contingency project planning often still arise from poor forecasting underestimating the scale, scope and impact of the forecasted risks (Baumann, 2021; BBC, 2013; Watton, 2014). It is for that reason that this study was conducted to explore the best practices of contingency planning that could be adopted.
Contingency Planning
When disasters or eventualities occur, chaos sets in to cause confusion and loss of direction. In such situations, the existence of an effective contingency plan improves the preparedness of the project implementation organisation to respond to the unfolding dynamics (Martens & Vanhoucke, 2020). Unfortunately, lack of or poor preparedness is often a challenge affecting the successful development and use of an effective contingency plan. Most project managers do not often have a contingency plan. The project is implemented on the assumption that it will be quite successful. But that has often turned out not to be the case. All of a sudden, the successful project implementation is distorted by a combination of various factors. This is because the project managers are often not prepared with an effective contingency plan. Yet as Saji (2025) notes, contingency planning is quite essential for enhancing the success of the project implementation plan. It improves the diagnosis, modelling and evaluation of various eventualities that are most likely to occur. It aids the evaluation of the probable response of project managers if such a risk occurs. This improves the mitigation of the extensive nature of damage if the risk occurs.
However, problems often arise from the tendencies of most project managers to misconstrue that the use of a framework analogous to the risk management framework is adequate (Zarghami, 2023). That approach has often emerged as the problem. The use of a risk management framework is ineffective because the risk management framework is often used for managing and mitigating less complex risks. The risk management framework is essential for managing smaller risks. If the risk management framework is used as the contingency plan, problems often arise from the fact that project managers fail to effectively respond to eventualities.
Risk management systems are smaller and less suitable for managing more complex systems like disasters that often arise to affect different aspects of organisational operations (Sittig, Gonzalez, & Singh, 2014). Such disasters require usage of a more complex contingency plan. Attempting to respond to such a complex multidimensional problem using just a simple risk management framework has led to failure. It has often left some project managers complaining about lack of adequate resources or technology to handle and mitigate the negative effects of the disaster. The misconception that a risk management framework is a substitute for contingency project planning has also often affected the effectiveness of the contingency plan. To avoid such a problem, Pausch (2025) and Saji (2025) share similar views that the contingency planning process must unfold according to five steps encompassing:
- Risk Assessment
- Scenario Analysis
- Trigger Analysis
- Strategic Actions
- Resuming Organisational Operations
However, from Stewart’s (2025) study on the “Common Pitfalls of Contingency Planning”, problems often arise from the tendency of project managers to underestimate the scope and risks’ effects during project planning.
Inhibitors of Contingency Planning
Stewart explains that problems often arise from the underestimation of the impact of the identified risks. Other challenges arise from mismanagement of the contingency fund, poor communication, failure to update and upgrade the contingency plan and over-reliance on a single scenario as the basis for the development of the contingency plan. During risk analysis, identification and modelling, mistakes can be made for management to assume that though the risks will occur, they will not be quite serious (Zhang & Wang, 2022). This can lead to the putting in place of the contingency plan which is not adequate for dealing with the emerging disruptions. It can also cause under-preparations that affect the preparedness of the project implementation organisation to respond to the unfolding threats and dynamics. That explains why in most cases, the project implementation organisations fail to diagnose and respond to certain risks. This is not because they did not foresee the risks, but because they foresaw the risks and underestimated them. This affected the preparations of management to ensure that the risks are thwarted before their occurrence. Because of the underestimation of the impacts of the risks, most project managers may not also plan for adequate resources and even management structures for responding to the risks. This affects the management’s capabilities to identify and respond to the unfolding risks (Zarghami, 2024).
Quite often, underestimation of the impacts of the risks may arise from the tendency of management to over-emphasize cost controls and minimization. As the project managers adopt the stringent cost control operational philosophy, it also affects the accurate and objective assessment of every situation. Management may identify risks of devastating effects, but still downplay the impact (Gooding et al., 2022). Quite often, this is just to minimize costs. But as they do so, it affects the effectiveness of the adopted contingency plan. It also affects the adequacy of the contingency plan put in place. The implication is that once the risk occurs, it often becomes difficult for management to deal with such risks. Because of under-preparation, the management may not have the required resources, technology and even management structure to respond and mitigate the risks. If problems are not arising from risks’ underestimation, Stewart’s (2025) study on the “Common Pitfalls of Contingency Planning” indicates that it can arise from the mismanagement of the contingency fund. Some project implementation organisations may put aside the required contingency fund. But as time unfolds and the risks do not occur, some project managers often misuse the funds.
Some project managers may consider using the funds for some other purposes with the hope that the more devastating risks may not arise. Unfortunately, all of a sudden, risks may arise to affect the successful implementation of the required projects. Risks can suddenly occur to require the introduction of adequate resources and technology for the project to respond to the unfolding turbulence (Dolgui & Ivanov, 2021). But because the funds are misused, it often becomes difficult for project managers to deal with the unfolding risks. If the problems are not arising from the misused contingency fund, they can emanate from poor communication. Inconsistent communication can affect the activation of the contingency plan. When a crisis occurs, it tends to cause a lot of chaos and confusion. If management does not remain composed and alert, it can significantly affect the successful implementation of even a more effective contingency plan. The project implementation organisation may have an effective contingency plan. But still, lack or poor communication can affect the assessment of the points or time at which the contingency plan can be activated to respond to the risks.
Crisis management situations introduce new changes (Matchwell, 2024). Without effective communication, it can become difficult for management and ordinary employees to realize the points at which the contingency plan can be activated. Sometimes, as part of the risk response strategies, the management may introduce new changes. But still the ordinary employees may resist or sabotage the implementation of such changes. This is usually because of poor understanding arising from poor communication. Because the ordinary employees do not understand what is taking place, it often becomes difficult for them to take actions and respond to the risks (Ivanov, 2023). This affects the ability of management to activate the contingency plan and respond to the unfolding challenges before they become difficult to reverse.
For projects that are being implemented for a long time, failure to assess the unfolding dynamics and upgrade the contingency plan often affect the capabilities of project managers to respond to the sudden unfolding dynamics. Because the circumstances have changed, even the technology, resources and skills put in place without an upgrade may not be effective for responding to the unfolding dynamics. However, Levinson (2025) notes the problems of contingency planning to arise from poor motivation and poor analysis and diagnosis of the situation. Poor analysis can cause the over-deployment of financial resources in the contingency fund. This can cause wastage of resources to the extent that by the time a serious risk occurs, it often becomes difficult for management to respond. In the event of a crisis, this complicates the process of using the available contingency plan in the way that bolsters the mitigation of the disrupting eventualities. Such problems are not different from the issues that have affected the successful implementation of different healthcare projects in the UK.
UK Healthcare System
In the UK healthcare system, the problems of contingency healthcare projects that motivate this study are derived from the contingency planning problems reflected in the Carillion Hospital construction projects’ case. In the UK healthcare system, Carillion was commissioned to simultaneously build the Royal Liverpool Hospital and Midland Metropolitan Hospital (Matchwell, 2018). However, in the middle of the project, problems soon arose to complicate the processes for finishing up the projects. Unfortunately, as problems and deviations occurred, it emerged that Carillion did not have an effective contingency plan. It had assumed that all would go in order up to the projects’ completion. Even if problems would arise, they did not anticipate that they would distort the successful implementation of the hospital projects for a long time. In case of eventualities affecting the project’s execution, Carillion thought the NHS Trust would come in if there was a disrupting problem. In contrast, the contractors and funders thought Carillion had all the capabilities to deal with any disrupting eventualities during the project’s execution (Davies & Partridge, 2020).
Unfortunately, when the disrupting problems emerged, Carillion could not deal with any of the problems to ensure the successful completion of Royal Liverpool Hospital and Midland Metropolitan Hospital. Instead, as a result of cost complexities that arose, Carillion got liquidated in the process (Ward, 2020). This shows how wrong assumptions can cause the engagement in project conceptualization, planning and implementation without the appropriate contingency plan. Risks may be predicted, but the gravity of their damage may not be easily predictable. This can cause over-preparation for a low risk that can cause wastage of resources or under-preparation that can limit the organisation’s capabilities to respond to more devastating eventualities.
Contingent resources’ mismanagement is the other inhibitor of effective contingent project management. Quite often, there is a wrong assumption that since adequate financial resources are set aside for any eventualities, the project managers can be able to manage and diffuse all threats. Unfortunately, as the UK’s NPfIT’s case indicates, that is often not the case. Poor assessment of the technologies, skills and other resources to be acquired to respond to the crisis can cause resource mismanagement and wastage that affects the effectiveness of the contingent project plan (Baumann, 2021).
Even if the project implementation firm has an effective contingency project plan, inconsistent and poor communication can still affect the effective response to the crisis. When eventualities occur and the team responds, a new management structure arises to change the existing communication and reporting lines. This causes confusion that slows down the contingency plan’s effective response to the unfolding crisis (Mulholland & Agencies, 2005). Amelioration of such problems implies that as the contingency plan is being developed, it must also develop and establish a clear team with a clear management structure and reporting structures and lines. If the project is being implemented for a long time, failure to periodically evaluate and upgrade the contingency plan can also cause the scenario in which the contingency plan fails to be responsive to the unfolding eventualities. If that is not the problem, challenges can arise from the project managers’ tendencies to rely on just a few scenario analyses as the basis for creating the project contingency plan. This causes the exclusion of some more disruptive risks like dissatisfaction and riots of stakeholders or regulatory changes from the serious risks covered in the contingency plan.
Failure to do a comprehensive risk analysis implies that if a particular risk occurs, the project managers may not be able to respond effectively because the organisation is not well prepared for such a risk. During the rapid and haste development of the Covid-19 Test and Trace App, the initiators of the project did not anticipate the project to be affected by technical failures that caused its poor adoption amongst users. This is because during the project’s development, most of the project engineers focused on just evaluating and preparing to respond to a few scenarios. When technical failures arose to affect users’ adoption and usage of the system, the project managers did not have a proper contingency plan for addressing such technical failures. As management failed, it frustrated and complicated the effective use of the Covid-19 Test and Trace App. Besides that, Levinson (2025) reveals that problems also often arise from the poor motivation of project managers to create and use a more effective “Plan B”. Even if a problem occurs, project managers attempt to struggle and stay within the stipulations of “Plan A”. This causes rigidity and inflexibility that affect the effective response of the organisation’s contingency project plan. Such a problem was reflected in the NPfIT (National Programme for IT).
Though NPfIT was meant to improve the cost-effectiveness and operational efficiency of the UK healthcare system, it failed to achieve the desired outcomes. In the process of implementing the NPfIT project, problems of cost overruns, technical failures, stakeholders’ and users’ dissatisfaction emerged as well as wider criticisms of the project as politically motivated (BBC, 2013; Watton, 2014; UK Parliament, 2013). But the project implementers never introduced any new contingency plan to deal with such problems. The view was that since the project managers were in the middle of implementing the project, there was no reversing. The project managers had the view that no matter what, the implementation of the project had to go ahead. To ensure the success of the NPfIT project, the Tony Blair administration had appointed project managers with very strong personalities and ambition. Hence, when the project started to develop problems, they stuck to the original plan (Darwinist, 2025).
But as the managers delayed to introduce the appropriate contingent plan, it only became too late for the damages to be corrected. By the time the contingency plan had been introduced, the overall costs of implementing the project had surged from just £6 billion to £10 billion. For the Carillion Hospital Construction projects, the cost of the Royal Liverpool Construction Project shifted from its original budget of £350 million to £724 million (British Broadcasting Corporation, 2018). These demonstrate how lack of an effective contingency plan can affect the faster and early response to the unfolding disruptions. In the end, the project implementers end up paying more than was previously budgeted and planned. In some healthcare projects, such problems are compounded by the risks of project managers to over-prioritize and focus on some problems when the actual devastating problems are arising from some other sources.
In the UK, these challenges are not different from the problems affecting the effectiveness of the contingency plans used for the implementation of several healthcare projects. From the failure of some major UK healthcare projects like the e-referrals system, GP at Hand, NHS 111 IT System, Care-Data and Carillion Hospitals’ Construction Projects, empirical facts imply that failure to respond to the emerging eventualities that disrupt project completion often arises from poor project management. Other challenges emanate from poor contingency planning to identify and respond to the risks (Takian & Cornford, 2012). Quite often, these complexities are exacerbated by scope creep, cost overruns, procurement delays, changes of government, lack of preparedness and poor risk management culture. Given the fact that some projects like e-referrals, Care.Data and Carillion Projects have cost the UK taxpayers billions (Turnbull et al., 2025; Dawood, 2024). To respond to such challenges, the subsection below offers a critical analysis of selected cases from the UK healthcare projects’ failures, so as to discern the improvement initiatives that must be adopted.
UK Healthcare Project Cases
In the quest to analyse how contingency planning is essential for enhancing the successful healthcare project implementation, the outcomes of the integrative review revealed problems affecting the effectiveness of contingency planning to be reflected in the key UK healthcare projects that include:
Case 1: Carillion Hospital Projects’ Case (Royal Liverpool Hospital & Midland Metropolitan Hospital)
Case 2: NPfIT Project: NHS’ National Programme for IT
Case 3: Babylon Health/NHS Partnership Project
Case 4: NHS 111 IT System
Details of each of these are evaluated as follows.
Case 1: Carillion Hospital Projects’ Case (Royal Liverpool Hospital & Midland Metropolitan Hospital)
Cases of how poor project design, poor construction or project implementation as well as underestimation of the required contract costs can affect project execution are reflected in the Carillion Hospital Projects’ Construction Case (National Audit Office, 2020). In a bid to address the problems of the ageing hospital infrastructure in Liverpool and the surrounding areas, the NHS commissioned Carillion to construct the Royal Liverpool Hospital and Midland Metropolitan Hospital. The completion of the hospital projects was considered essential for improving the quality of healthcare services, while also responding to the changing needs of the population. To achieve these, NHS engaged Carillion without a challenging competitive bidding because Carillion had been a renowned provider of the required construction services and facilities for several years (Matchwell, 2018). But that was the problem. Carillion never did a thorough analysis of the potential underlying complex costs of the project. By the time the construction of the Royal Liverpool Hospital was mid-way, it turned out that there were several other costs that had to be incurred. Attempts to proceed with the project’s completion subsequently mutated with the other internal challenges to cause Carillion’s subsequent liquidation in 2018. While offering the modern healthcare facilities and services, the Royal Liverpool Hospital was intended to have 646 beds to meet the healthcare needs of the surging population in Liverpool and the surrounding areas (Lane, 2024). The construction of the new hospital sought to respond to the surging complaints about poor hospital conditions and the declining quality of healthcare services. Likewise, the Midland Metropolitan Hospital was supposed to provide 669 beds to replace two hospitals in the West Midlands and Sandwell.
Financing the construction of the two hospital projects was accomplished using the Private Finance Initiative (PFI), under which private investors raise funds to finance the execution of public projects in exchange for revenues and profits that will be generated from taxpayers when the project commences operation (Davies & Partridge, 2020). The government was quite sure of the funding model since it had used it several times and at the time of engaging the public finance initiative, there were 700 active deals for the private finance initiative being executed in different parts of the UK.
The government’s confidence in this funding model reduced the necessities for doing thorough due diligence to put an effective contingency plan and fund in place. Following a successful open competition bidding process, Carillion was selected by the trust constituted of the Royal Liverpool University Hospitals and NHS Trust (Liverpool Trust) to construct the Royal Liverpool University Hospital. Likewise, the trust constituted of West Birmingham and Sandwell Hospitals NHS Trust (Sandwell Trust) also selected Carillion to construct the Midland Metropolitan Hospital (Ward, 2020). This placed Carillion as the lead contractor that would decide the private companies that would be selected to raise funds for the execution of the hospital projects. Under the private finance initiative, the selected PFI companies raised funding using equity from investors and debt to finance the execution of the two hospital projects. The investors in the PFI companies would start to receive returns from unitary charges that the Liverpool Trust and Sandwell Trust would pay once the hospitals were completed and start operations (National Audit Office, 2020).
In terms of contingency planning, Carillion assumed that with its years of experience and expertise, all would go on well. If any disruptions occurred, it assumed that the disruptions would just be minor ones that could easily be mitigated. Even if Carillion failed, the Trusts, NHS, Cabinet Office and the Department of Health and Social Care assumed that the construction of the two hospitals would still continue. For PFI companies, they assumed that if Carillion failed, the project execution would still continue as new contractors were searched for. In that process, the engaged PFI companies often prepared themselves to take over in case Carillion failed. These predictions turned into realities when Carillion collapsed and got liquidated in 2018 just two years after starting the construction of the Midland Metropolitan Hospital in 2016 (Schouten, 2017).
Even if the construction of the Midland Metropolitan Hospital was supposed to be completed in October 2018, Carillion’s disagreement with its subcontractor Aecom over the design of the plumbing, mechanical and electrical systems as well as how the flow of IT, gas, water and electricity would fit into the designated space delayed the project (National Audit Office, 2020). Not anticipating that it would liquidate in 2018, Carillion changed the project completion date to February 2019. In response, Aecom attributed the delay to poor management as Carillion failed to effectively manage the contracts (Davies & Partridge, 2020). While delaying to appoint the subcontractors and suppliers, Carillion was also accused of making several design changes that extended the scope of work for the subcontractors. This caused disagreements and delays that affected the completion of the project by October 2018.
While the construction of the Midland Metropolitan Hospital was experiencing such challenges, the Royal Liverpool Hospital construction also had problems. After starting the project execution in February 2014 with a completion date of March 2017, Carillion found large deposits of asbestos on the site in May 2014 (Matchwell, 2018). Combined with the complaints about bad weather, poor power supplies and the discovery of more asbestos, Carillion contacted the Liverpool Trust for cost adjustments. But Liverpool Trust disputed this. This caused delays of 11 months.
Though Carillion and Liverpool Trust subsequently agreed to completion date adjustments, further delays emerged from the discovery of cracks on three beams on the third floor that supported the upper floors. Yet as Carillion got liquidated to complicate the overall nature of the hospitals’ construction projects, Arup which was commissioned by the PFI company that took over, did 3D modelling to assess the implications of the beam cracks on structural designs and the safety of the upper floors (Gayne, 2022; Lane, 2024). Results indicated serious design, structural and safety issues that needed reworking in several areas to resolve the problem. Combined with redoing the cladding of the building to meet fire regulations as well as reworking the faulty electrical, plumbing and mechanical systems which were also found to be faulty, Arup noted that this would significantly increase the costs of project completion.
Upon Carillion’s liquidation in February 2018, only limited interior work was remaining for the project to be completed. However, the reviews still indicated that it was impossible to complete the project even as agreed in the rescheduled date for 2019 (Matchwell, 2018). To complicate the matter, Carillion was no longer in the picture and the PFI companies could not take up the risk of completing the two projects. To respond to these dynamics, the Liverpool Trust and the Sandwell Trust had to weigh three options of re-financing the existing PFI companies, re-tendering or using the direct public financing of the projects’ completion. The trusts opted for direct public financing and termination of the PFI contracts. This led to the selection of Balfour Beatty by Sandwell Trust as the new contractor to finish up the construction of Midland Metropolitan Hospital. Likewise, Laing O’Rourke was selected by Liverpool Trust to complete the construction of Royal Liverpool Hospital (National Audit Office, 2020). These depict how poor planning, project design and execution as well as underestimation of costs and lack of an appropriate contingency plan can affect the successful project execution. Yet as projects delay, it also increases the costs of project execution.
Case 2: NPfIT Project: NHS’ National Programme for IT
NPfIT Project, introduced by the NHS as the National Programme for IT in 2002, represents a clear case where project initiators can come up with a project, and even gain the confidence to ensure it is implemented no matter the circumstances (Baumann, 2021). Even without the development and use of the appropriate contingency plan, NPfIT was initiated by the Tony Blair administration as an over-ambitious programme that would score political goals of improving the trust and confidence of ordinary citizens. For that reason, NPfIT was ahead of the modern IT development and evolution by 10 years. The Tony Blair administration sought to use the improving advancement of information technology to develop and build an integrated IT system that would improve NHS’ operational efficiency (UK Parliament, 2013). To achieve that, NPfIT sought to create an integrated electronic healthcare management system that would facilitate effective:
- Healthcare records’ management system
- Electronic prescriptions (e-prescriptions) of the required drugs
- Provision of different digital imaging services
- Online patients’ access and booking
- Integrated NHS system
- NHS’ IT infrastructure
- Modernisation of NHS’ services
- Cost-minimization and improved operational efficiency
In terms of the healthcare records’ management, the NHS sought to create and provide patients and healthcare professionals with more accessible healthcare records. It sought to create an integrated healthcare record for each individual patient and healthcare personnel (BBC, 2013). This healthcare record was aimed at solving the problems of effective management of the patients’ records. After creating such a record management system, it sought to ensure that just like patients, the healthcare professionals could also access the records if required for conducting the required healthcare evaluations. For that reason, the system sought to improve information sharing and exchange between the patients, GPs and the community if required for the accomplishment of any healthcare activities (Mulholland & Agencies, 2005). Using such an approach, the NHS and the Tony Blair government were thinking quite ahead of time. Even if the concept of Enterprise Resource Planning systems first emerged in the 1960s, it was only improved to a true ERP system in the late 1990s. It was at this time that the Tony Blair government was also thinking of the need to create an integrated Healthcare IT system even if the technology to support the creation of such a system was still in its infancy.
Nonetheless, in addition to creating an integrated electronic healthcare management system, the NHS also sought to create the electronic prescription (e-prescription) system. While linking GPs, patients, clinicians and pharmacies, the e-prescription system was intended to electronically send prescriptions to pharmacies (Watton, 2014). While improving the efficiency of the dispensing processes, the e-prescription system would also reduce errors and enhance safety within the healthcare management systems. In the process of replacing film-based X-rays with digital imaging, the NHS also sought to improve the speed and efficiency of diagnosis, scans and the sharing and exchange of critical digital imaging information.
The NPfIT strove to improve the efficiency of the online patient access and booking (Takian & Cornford, 2012). As patients book hospital appointments from their GPs, it was anticipated to improve the efficiency of healthcare services’ access as well as convenience and the increased choices that the patients have at their disposal. Given the fragmented systems that the NHS was using at the time, the introduction of NPfIT also sought to create an integrated system. This would reduce the rate of system fragmentation that affected interoperability (Justinia, 2017). As coordination of various healthcare activities improved, it also improved the efficiency of the processes for creating and delivering different healthcare services. In this process of creating and promoting the use of a standardized integrated IT system, the NHS also sought to improve the quality of the IT infrastructure. By upgrading the broadband and network systems, the NHS aimed to improve connectivity and reliability of the healthcare information management system (UK Parliament, 2013). Through these initiatives, the NHS would improve the modernisation of the healthcare services by using the latest technologies and approaches for delivering the required healthcare services. This would improve the efficiency of healthcare services management, while also reducing errors and mistakes that can affect safety and quality in different medical processes. All these would lower the overall costs of healthcare management.
But the NPfIT project did not succeed in influencing the achievement of such goals and objectives (Darwinist, 2025). Instead the project failed because it was considered over-ambitious. Due to the zeal of the politicians to score political goals of being ahead of time, the NPfIT project’s feasibility analysis was not based on real facts. Instead it was based on the assumptions that because the Tony Blair government was behind the project, the amount of committed resources would render the project a success. For that reason, the creation and implementation of the NPfIT project were not accompanied by the use of the appropriate contingency plan.
Because the project was implemented in haste to achieve political goals and not the goals dictated by the realities of the project, the process of the NPfIT project did not have phases for evaluation and re-evaluation (Darwinist, 2025). It did not have stages for reflections to assess if all was going well and if not, what else could be done to improve the project’s successful implementation. All the players thought and believed that no matter what, the implementation of the NPfIT would be a success. Unfortunately, it later emerged that because the project was conceptualised in haste to beat political deadlines, it affected the thorough analysis of all that could be considered to ensure the success of the project. For that reason, most studies share similar views that the NPfIT project failed because of hasty planning, centralized project planning, design and implementation, which were further compounded by poor leadership (Justinia, 2017).
In terms of haste implementation, the NPfIT project is said to have been implemented in haste. There was no time for stakeholder consultation. Patients, doctors, GPs, nurses and the general communities were not properly consulted and engaged during the planning and design of the NPfIT project. The effect is that the process of planning and implementing the project was centralized. By the time the NPfIT project was completed, the nurses, doctors and even patients had little information and understanding of how the system could be used at the time (Baumann, 2021). The NPfIT project used the top-down approach to project implementation. In this approach, the project was conceptualized, planned by top management and passed to the NHS and the project implementation consultants and engineers who did not have time to do thorough feasibility studies. This affected the understanding of the complex technical, skills and technological requirements which were essential for executing the project. Such complexities only became apparent when they commenced the process of implementing the project (Mulholland & Agencies, 2005).
Problems also arose from the fact that in 2002, it was a time when the use of information technology had not yet been adopted and cascaded throughout the UK. Hence, there was little information technology literacy and culture of information technology use. Unfortunately, the NPfIT was introduced with limited training and improvement of the skillfulness of the ordinary employees and even the general public on how to use the newly created NPfIT system. This affected the acceptance and adoption of the technology amongst doctors, nurses, patients and the general public in the UK. In the modern era, the implementation of the NPfIT project would have been successful because the kinds of technology that were required are now available.
However, in 2002, the kinds of technologies required for implementing the kinds of projects that the initiators of NPfIT were conceptualizing were not available (Baumann, 2021). The UK government under the Tony Blair administration had all the required funds, but there was a lack of skills and information about the required technologies. This affected the success of the project. The over-ambitiousness of the NPfIT project led to the design of the project that could not be implemented. Everything got mixed and combined with disputes and the costs of redoing some things to render the project a success, and the overall costs of delivering the project shifted from £6.4bn to £9.8bn. Even with that kind of money spent, the NPfIT project was still not very responsive to its users’ demands and needs (Takian & Cornford, 2012).
Besides the problems of poor contingency planning, most studies share similar views that the failure of the NPfIT project arose from a lack of user engagement, over-ambitiousness of the project, poor leadership, technical problems, vendor issues and cost overruns. As poor leadership was the problem, it affected the development and use of a clear plan. In the first instance, feasibility analysis was not done to ensure the success of the project just because the initiators of the project wanted it to succeed, no matter the circumstances (Watton, 2014). Because the project was failing and threatening not to succeed, the problems of poor leadership were exacerbated by the periodic change and re-changing of the project objectives and scope. This kept causing disputes as the consultants and subcontractors were required to do more to ensure the success of the project. Combined with poor project management skills, technical incompetencies and inadequate budget allocation, problems also arose from the Her Majesty’s Treasury’s emphasis on prices over the quality of some aspects of the project. In the long run, these problems mutated to undermine the successful implementation of the NPfIT project (Baumann, 2021).
Yet as the project was in the last stages of implementation and users found that the NPfIT system was not usable, criticisms emerged from all the major stakeholders. Poor stakeholder management affected the effective response, change and modifications which were essential for responding to the major concerns of the stakeholders. Instead of addressing the issues that the stakeholders were raising, the implementers of the NPfIT project ignored the concerns being raised. Failure to respond to such concerns even fuelled dissatisfactions and criticisms from ordinary citizens, specialist doctors and nurses to create an unfavourable environment that affected the implementation of the NPfIT project (BBC, 2013).
These were some of the issues that the developers of the NPfIT project did not contemplate. When such hostile public opinions started arising to create situations that affected the NPfIT project implementation, the NHS did not have a contingency plan for how to deal with such eventualities. To ensure the successful implementation of the project, the implementers of the NPfIT project did not anticipate that poor contractors’ management and motivation would emerge as one of the limitations affecting the success of the NPfIT project’s implementation (Mulholland & Agencies, 2005). During the contracting stages, the management dictated every term of the contracts to the contractors. The contractors were not consulted about the terms of the contract. Instead the contractors were engaged to do as instructed by management.
Some of the contract terms required the contractors to complete all the work upfront before demanding payment. Some terms required some contractors to bear certain risks. Because most of the contractors were scampering to be part of this mega contract, most of them accepted and signed the contracts. But along the way as the NPfIT project was being criticized for other reasons, most of the contractors were also experiencing difficulties in completing the allocated project tasks (Takian & Cornford, 2012). Because of unfair contractual terms and conditions, they had used all the money and even borrowed funds for the accomplishment of various project activities (Maughan, 2010). Now that they had come halfway and the management was unwilling to give some advance payments and get the work done, it became difficult for them to go ahead with the accomplishment of the required project activities.
The effect is that most of the contracted or subcontracted project activities were not executed and completed within the scheduled time (Watton, 2014). However, without the contingency plan for managing such a situation, it became difficult for the NHS to discern how to deal with such a situation. By the time the NHS realized that the NPfIT project was going to fail, the cost of the project’s implementation had shifted from just £6 billion to £9.8 billion. In the event of contractors’ dissatisfaction, the conceptualizers of the NPfIT project implementation had anticipated that usage of a multisourcing approach would aid the quicker termination and replacement of the dissatisfied contractors with new ones (UK Parliament, 2013). Unfortunately, that turned out not to be the case. Wider negative publicity about the poor contractors’ treatment in the NPfIT implementation spread across the UK. Most new contractors became less motivated and unwilling to participate in the replacement of the terminated contracts. With such higher levels of dissatisfaction, it became difficult for NPfIT to get the best contractors to replace the terminated contractors. This affected the faster and successful execution of the project. Combined with the higher level of management rigidity, this rendered the successful project execution almost impossible.
To ensure the success of the NPfIT project, the NHS and the Tony Blair administration were very careful in the decisions for the selection of top managers (Maughan, 2010). They took the decision to select the top management with strong personalities and ambition. With this strong personality, there was a stronger assertion amongst the top managers that since they had already started the project, it would have to succeed irrespective of the circumstances. This created managerial inflexibility and rigidity that affected the execution of the required changes and modifications essential for mitigating the risks of the project’s failure (Darwinist, 2025). Stronger management inflexibilities and rigidities affected the faster change and introduction of the remedial measures in the contingency plan. This affected the management’s agility to deal with some of the emerging eventualities that were affecting the successful project execution. Yet as the NPfIT case depicts how poor contingency planning and even implementation can affect the successful project execution, the other case is reflected in the Babylon Health/NHS Partnership Project.
Case 3: Babylon Health/NHS Partnership Project
Also known as GP at Hand Project, Babylon Health is one of the early digital primary healthcare providers that sought to utilize artificial intelligence and machine learning technologies at the time when no business could imagine doing so. But as it reflects the best case of first-mover advantage businesses. It also reflects how lack of contingency planning to manage and diffuse the unintended consequences of project execution can also cause business failure. Founded by Ali Parsa in the United Kingdom in 2013, Babylon Health created the subscription business model. Under the business model, patients or the general public would be required to register and subscribe on the platform linking with multitudes of healthcare GPs and specialists from different parts of the United Kingdom. Using this subscription platform, the registered users would ask questions or send photos and videos of their healthcare conditions to a team of GPs, nurses and all forms of specialists.
The team of healthcare specialists or even AI chatbots would respond using text messages, the diagnosis reports, prescriptions of the medicines to be taken and potential healthcare specialists that could be consulted. If the text messaging system was not being used, the system could hold video consultation systems where users would hold consultations and receive diagnoses with various specialists. Thereafter, the user would receive the diagnosis report as well as prescriptions of the medicine to use as well as the pharmacies to contact. Using the same Babylon Health app, users could book appointments with the required medical doctors. Using the same platform, if required, the users would access and use various healthcare monitoring tools like home use blood-test kits, activity trackers, fitness questionnaires and lifestyle review kits.
Upon its successful launch, Babylon Health became an instant success in the United Kingdom. It represented a business of its unique kind at the time when the UK population was increasingly becoming concerned about the need to balance healthy lifestyles against the increasingly busy work schedules. Being able to consult and interact with GPs and other essential healthcare specialists from home during weekends, evenings or days off work meant a lot for the UK population that needed to balance work, health and good life. Also, the ease of being able to do all these using their various mobile applications from any location improved Babylon Health’s closer endearing with the UK population.
Without inconveniences and without incurring costs of visits to healthcare facilities, users could easily have some brief understanding of their healthcare problems, the required medications and the healthcare specialists to consult. By the time they visited the healthcare facilities, such brief information improved the knowledge of the kinds of information that they needed to provide to the doctors for such healthcare problems to be resolved. Because Babylon Health’s business model was more responsive to the needs of the UK population, it quickly gained recognition that propelled its growth. The effect is that, by 2014, Babylon Health was already registered with Care Quality Commission, which is the regulator and inspector of the quality of healthcare services in England and Wales. Babylon Health grew. It attracted improved investors’ trust and confidence with the effect that by 2016, Babylon Health attracted $25 million in funding for its digital healthcare operations. It attracted investors like Kinnevik, Hoxton Ventures and Google DeepMind. Babylon Health raised another $550 million in 2019 to develop and improve the artificial intelligence skills for Babylon Health’s software. By 2019, Babylon Health’s subscription had grown to 20 million people and about 5,000 consultations in the United Kingdom.
The success of Babylon Health in the United Kingdom spurred its growth and expansion into the other healthcare markets like the United States, Canada, Rwanda, Cambodia, Hong Kong, Taiwan, Singapore, Malaysia, Indonesia and Vietnam. COVID-19 outbreak found Babylon Health more prepared and thriving as the leading remote provider of primary healthcare. However, problems soon arose from the unintended consequences of its unsafe marketing and promotional approaches. Other challenges arose from the sale of non-MHRA-approved Covid-19 home-based testing kits, poor management of confidential patients’ health data and information. In addition to protracted disputes with the Care Quality Commission, problems also arose from the increasing concerns and criticisms by the UK’s GPs and clinicians.
In the quest to market, promote and improve its market performance, Babylon Health had attempted to overhype its artificial intelligence-supported chatbots to offer better medical diagnostics and advice than human medical doctors. It argued that the AI chatbots that constitute part of its Babylon Diagnostic and Triage System offered better quality medical services than human medical doctors. These claims were aimed at improving sales and Babylon Health’s market performance, However, it seemed condescending to human medical doctors. AI-supported diagnostics can sometimes be more accurate than human doctors. It was such a claim that marked the beginning of the unintended market consequences that it had not planned for.
In response, a number of studies were conducted and the lead study conducted by The Lancet concluded that there was insufficient evidence proving that Babylon Diagnostic and Triage System did better medical diagnostics than human doctors. Instead some studies confirmed that Babylon Diagnostic and Triage System often made errors and mistakes that affected quality while also exposing patients and its several other users to safety issues. When this negative publicity was taken over by some big media houses like the BBC, it caused a lot of reputational damage. During the establishment of Babylon Health, Ali Parsa, the founder had not anticipated nor prepared a contingency plan to deal with such unexpected situations. Combined with some negative experiences of the population when using Babylon Health, these negative accusations marked the beginning of Babylon Health’s troubles. Even if it did not have a contingency plan, the occurrence of COVID-19 could have been a natural opportunity that Babylon Health could have seized to turn around its performance. Unfortunately, that turned out not to be the case. Instead Babylon Health seems to have sealed itself off with the negative publicity as an unethical business entity that engages in medical practices that affect healthcare safety and quality (Adams, 2023).
After Abbott Laboratories developed the Covid-19 antibody home-based testing kit, Babylon Health adopted and started marketing and promoting the kit that had not yet been approved by Medicines and Healthcare products Regulatory Agency (MHRA) as the test kit that used capillary blood or finger-prick. This was a mistake that got noted by Abbott Laboratories that immediately came up to contradict Babylon Health’s position by stating that the kit should not be used for testing blood samples obtained from finger prick. In effect, Medicines and Healthcare products Regulatory Agency came forward to advise the public to ignore any results obtained from testing blood samples from finger-prick. This caused further reputational damage that Babylon Health did not have any known contingency plan for how to deal with and respond to such a challenge.
In the past, Babylon Health had had problems with Care Quality Commission releasing some damaging information about misuse of prescriptions and lack of disclosure of the required information to the relevant GPs of the patients. When the court concurred with the Care Quality Commission to disclose such information, it caused enormous reputational damage. Yet as Babylon Health was still reeling with how to get out of such a situation, another accusation of data breach emerged. Three patients were randomly given access to the recordings of the other patients’ video consultations. Though Babylon Health claimed that this was a mistake, later investigations exposed the vulnerability of Babylon Health’s technology as easily accessible using the Firebase database mistakenly left open.
Even if some people still had some doubts about the accusations against Babylon Health, such results seemed to have confirmed issues of safety, quality and management of the patients’ confidential information. Persistently negative publicity caused reputational damage that affected Babylon Health’s reputation. In turn, this caused declining public trust and confidence in Babylon Health’s services. Combined with declining sales and lack of an effective contingency plan, Babylon Health exited the market by selling its UK operations to eMed Healthcare (Adams, 2023). Maybe as part of its contingency plan, it sold its shares to eMed Healthcare, a US-based healthcare company, and closed its United States operations.
Case 4: NHS 111 IT System
In a bid to improve the quality of healthcare services in England and Wales, the National Health Service created the NHS 111 IT System to offer more efficient and cost-effective online healthcare services. NHS 111 IT System is an algorithm-supported digital triage system that diagnoses health problems without the aid of human medical doctors by asking clients several questions (Pope, MacLellan, Prichard, & Turnbull, 2022). By asking clients several questions, the NHS 111 requires clients to respond to these chronological questions. This enables the digital triage system to discern the nature of the sickness and medical solutions that can be adopted. The digital triage system diagnoses the sicknesses by evaluating and suggesting the medical solutions that the patient can adopt. After the diagnosis, the digital triage system which is the web-based system, prescribes a range of solutions. Such solutions may include emergency department responses using ambulances, urgent treatment centres, GP, pharmacy or any clinics that offer the required healthcare services (Egan, Murar, Lawrence, & Burd, 2020).
NHS 111 seeks to close the gap and distance between the NHS and the UK population by bringing the required healthcare services closer to the population. Using the web-based technology, the NHS 111 enables the general population to access timely healthcare treatment, advice and care at the right time. Given the increasing needs of the population for the NHS’ improvement of quality healthcare services, the fundamental objectives of NHS 111 were to create and provide more accessible healthcare and provide 24/7 healthcare services for emergency and even non-emergency healthcare cases (Morgan & Muskett, 2020). NHS 111’s objectives were to close the gap between the population and healthcare services, while ensuring that patients get the right professional assistance at the right time and place.
In addition to eliminating the uncertainties of where to obtain some healthcare services, NHS 111 uses its artificial intelligence-supported systems to probe and direct clients to the right place. NHS 111 strives to improve patients’ satisfaction with care. It also aims to improve the efficiency of healthcare diagnosis and the direction of people to the right places for treatment. Through such an approach, it reduced the burden on Accident and Emergency Department by directing patients to the other right places like the right GPs or the urgent treatment centres (Iacobucci, 2014).
NHS 111 reduced the costs of healthcare management by eliminating the costs of patients having to travel first to a particular healthcare centre prior to finding the right place that can attend to the healthcare problems being experienced. While accomplishing all these, NHS 111 emerged to be very supportive to various clinicians in the accomplishment of various healthcare activities. In the process of interacting and diagnosing the conditions of different patients, NHS 111 generates, processes and stores a lot of valuable information about each individual patient’s medical condition. As it asks several questions for clients to respond, NHS 111 generates and accumulates a lot of information (Turnbull, Barker, & Fogg, 2025).
When stored, this information would provide valuable insights on where the clinicians or the GPs would start from in the quest to discern the medical solutions that must be adopted. To create and deliver such improved operational values, NHS 111 IT System accomplishes five key functions encompassing call handling support, aid in triage system usage, patients’ direction, integrated clinical advice, and patients’ record and information management. The cycle for the accomplishment of these activities flows from dialing the 111 number which is routed to call handlers supported by the IT system (Dawood, 2024). From there, the triage system commences by asking clients a range of questions which the client is expected to respond to.
Depending on the question, the client is directed to the right area for the required healthcare services. To accomplish these critical core functions, the NHS 111 IT System often consists of components that include telephone and call routing, NHS Pathways (Decision-Support Software), integrated clinical system, DoS (NHS Directory of Services), Patient Record Sharing and the Online NHS 111 Platform. The telephone and call routing system manages a range of integrated regional call centres (Pope et al., 2022). These regional call centres are supported by the advanced telephone system that aids call distribution, queuing, receiving and monitoring.
In some busy geographical places, the system even supports call-backs so that if the lines are all busy, the system calls back clients. NHS Pathways or the Decision Support System is the fulcrum of the NHS 111 that uses algorithms that ask questions for clients to respond to. From there, the pathways direct calls to different paths that may include urgent, risky or routine. The Integrated Clinical System routes clients to a paramedic, a GP, a nurse, a pharmacist or a dentist. It also aids the messaging and sharing of information and data between the patient and the respective healthcare service provider (Egan et al., 2020).
DoS (NHS Directory) is part of the NHS 111 IT System that creates and processes the database and information to direct patients to the nearest health facility. It evaluates the information that the patient is providing against the map and geographical data that it has to discern the nearest area or health facility that the patient must be directed to. This system is integrated with the patient record sharing and management system as well as the NHS 111 Online Platform that consists of the Internet of Things and several interconnected mobile devices.
Since the NHS is an integrated system, it supports the interoperability of several interlinked subsystems linking up with the GPs, doctors, nurses, pharmacists, emergency services, dentists and community healthcare consultants (Morgan & Muskett, 2020). These services are combined with several inbuilt data analytics services that aid the seamless acquisition, analysis and interpretation of various forms of data to understand the patterns in data and the improvement of healthcare services that can be adopted.
However, even if the NHS 111 IT System Project was a success, problems still arose to cause the escalation of its implementation costs to even £50 million. Problems arose from lack of a contingency plan predicting that NHS Pathways’ over-usage would become a problem and from constant system outages and failures (Iacobucci, 2014). These challenges were exacerbated by the emerging disintegrated NHS systems, management and procurement problems, poor workforce training and development, data and privacy management issues, as well as structural and design flaws.
Over-dependence on NHS Pathways was found to pose risks that affect patients’ safety as well as the efficiency of the accomplishment of the activities in other departments. Because of how the algorithm for Pathways works, any description of the health problem which is perceived as serious is directed to the Accident and Emergency Department. When asked questions, it is often essential that patients do not use descriptions that imply the seriousness of their conditions. Otherwise, the algorithms will pick up such language and use it to determine the level of the sickness’ seriousness. In that process, the triage algorithms used in Pathways are criticized as extremely strict, rigid and inflexible to the extent that any slight misuse of words that can be interpreted to imply the sickness is quite serious (Turnbull et al., 2025). This leads to the direction of the health case to the Accident and Emergency Department. As a result, most cases were referred to the Accident and Emergency Department, thereby over-flooding the A&E Department even with cases that should have been referred to the other departments.
Yet as the A&E Department is flooded with cases that should have been referred to the other departments, it also causes the misdirection of patients to physicians, GPs and clinicians that should not necessarily be consulted and engaged. The persistence of these errors and the consequences caused prompted most critics to start questioning the value of NHS 111 IT System (Dawood, 2024). It was also from such increasing errors of the system that questions came to be posed about the efficiency and efficacy of total reliance on artificial intelligence and machine learning in medical diagnosis. Some of the cases are depicted in the instances where a caller’s description of a mild chest tightness arising from stress and anxiety is often considered by the triage algorithm as a cardiac arrest case. This guides the patient to the cardiac department only for the staff to discover on physical assessment that the case belongs to another department. During the planning and implementation of the NHS 111 IT System Project, an effective contingency plan had not been put in place to enhance the NHS’ effective response to such a problem (Pope et al., 2022).
If problems are not arising from such challenges, risks could arise from sudden cyber-attacks that cause complete system failure. System failure can cause the complete disruption of the NHS 111 IT System’s operations. This was evident in 2022 when Advanced, the Information Technology provider in the United Kingdom, was hit by a cyber-attack to disrupt normal NHS 111 IT System operations for some days. The problem was that the implementation of the NHS 111 IT System was not accompanied by an effective contingency plan avoiding risks of depending on just a single IT service provider. The contingency plan also did not anticipate and put in place the strategies for constantly improving and upgrading its IT infrastructure (Egan et al., 2020). It also did not put in place the measures for dealing with risks of cybersecurity.
In the process of over-expanding across the United Kingdom and increasing the types of healthcare services that it deals with, the NHS 111 IT System also became disintegrated. Disintegration affected the interoperability as well as the effective linkage and coordination of different activities within the NHS 111 IT System. With time, it became apparent that not all GPs, pharmacies, treatment centres and ambulance services were connected to the NHS 111 IT System. Because of the increasing amorphousness of the system, some critical information like the available ambulance services was also not linked and integrated with the NHS 111 IT System (Morgan & Muskett, 2020). Besides that, problems also arose from poor governance and procurement that outsourced call centre handling services to multitudes of service providers. This fragmented the system to affect the standardization of service quality as well as the procedures for accomplishing different things.
For purposes of keeping internal business secrets, most of the systems being used by different call centre service providers were also not compatible with each other. Yet as all these problems arose, the implementation of NHS 111 IT System had also not been accompanied by the design of a contingency plan that could be used in such situations (Iacobucci, 2014). Combined with poor skills and competencies for using and managing such a complex system, all these undermined the successful implementation of the project. Even after improvement initiatives have been introduced by introducing video-consultation systems as well as AI-based improvements, not much has been achieved. The effect was that the NHS spent over £50 million, but still the NHS 111 IT System failed to work and achieve the desired strategic goals and objectives.
Insights from these healthcare project failures raise a lot of managerial implications for the contemporary managers.
Managerial Implications
Contingency planning influences the successful project implementation. It improves the preparedness of project managers to diagnose and respond to the unfolding dynamics. However, from Stewart’s (2025) study on the “Common Pitfalls of Contingency Planning”, problems arise from the tendency of project managers to underestimate the scope and risks’ effects during project planning. Such a finding echoes the insights explaining NPfIT failure. When hostile public opinions started arising to create situations that affected the NPfIT project implementation, NHS did not have a contingency plan on how to deal with such eventualities. To ensure the successful implementation of the project, the implementers of the NPfIT project did not anticipate that poor contractors’ management and motivation would emerge as one of the limitations affecting the successful NPfIT project’s implementation. During the contracting stages, the management dictated every term of the contracts to the contractors. The contractors were not consulted about the terms of the contract. Instead the contractors were engaged to do as instructed by management. Some of the contract terms required the contractors to complete all the work upfront before demanding payment.
Some terms required some contractors to bear some risks. Because most of the contractors were scampering to be part of this mega contract, most of them accepted and signed the contracts. But along the way as the NPfIT project was being criticized for other reasons, most of the contractors were also experiencing difficulties in completing the allocated project tasks (UK Parliament, 2013). Because of unfair contractual terms and conditions, they had used all the money and even borrowed funds for the accomplishment of various project activities (Maughan, 2010). Now that they had come halfway and the management was unwilling to give some advance payments and get the work done, it became difficult for them to go ahead with the accomplishment of the required project activities. The effect is that most of the contracted or subcontracted project activities were not executed and completed within the scheduled time. However, without the contingency plan for managing such a situation, it became difficult for NHS to discern how to deal with such a situation. By the time NHS realized that the NPfIT project was going to fail, the cost of the project’s implementation had shifted from just £6 billion to £9.8 billion (Takian & Cornford, 2012). Such a finding accentuates findings from literature that revealed that contingency planning can be affected by mismanagement of the contingency fund, poor communication, failure to update and upgrade the contingency plan and over-reliance on a single scenario as the basis for the development of the contingency plan.
Stewart explains that problems often arise from the tendencies of managers to underestimate the impact of the identified risks. During risk analysis, identification and modelling, mistakes can be made for the management to assume that though the risks will occur, they will not be quite serious. This can lead to the putting in place of a contingency plan which is not adequate for dealing with the emerging disruptions. It can also cause under-preparations that affect the preparedness of the project implementation organisation to respond to the unfolding threats and dynamics.
How capital investment can improve patient outcomes at Birmingham’s New Midland Metropolitan Hospital. Laura Broster, Director of Communications and Involvement and Rachel Barlow, Managing Director for the Midland Metropolitan University Hospital explain the new facilities and ambitions including new maternity suites, green spaces and wellbeing, community
In terms of Carillion’s contingent planning, it assumed that with its years of experience and expertise, all would go well. If any disruptions occurred, it assumed that the disruptions would just be minor ones that could easily be mitigated (Matchwell, 2018). Even if Carillion failed, the Trusts, NHS, Cabinet Office and the Department of Health and Social Care assumed that the construction of the two hospitals would still continue. For PFI companies, they assumed that if Carillion failed, the project execution would still continue as new contractors were searched for. In that process, the engaged PFI companies often prepared themselves to take over in case Carillion failed. These predictions turned into realities when Carillion collapsed and got liquidated in 2018 just two years after starting the construction of the Midland Metropolitan Hospital in 2016 (Schouten, 2017). Even if the construction of the Midland Metropolitan Hospital was supposed to be completed in October 2018, Carillion’s disagreement with its subcontractor Aecom’s over the design of the plumbing, mechanical and electrical systems as well as how the flow of IT, gas, water and electricity would fit into the designated space delayed the project. That explains why in most of the cases, the project implementation organisations fail to diagnose and respond to certain risks. This is not because they did not foresee the risks, but because they foresaw the risks and underestimated them. This affected the preparations of management to ensure the risks are thwarted before occurrence.
To therefore avoid future failures like the costly failures of healthcare projects like e-referrals, NPfIT, Babylon Health, Care.Data and Carillion Projects that have cost the UK taxpayers billions, the recommendations below imply that there are a lot of managerial implications that the contemporary healthcare project managers must consider emulating and implementing. From the overall findings of this study, it is recommended that NHS must consider adopting the Framework for Healthcare Project Contingency Planning that requires the NHS to consider using the processes encompassing:
Critical Situational Diagnosis
Crisis Profiling and Impact Modelling
Establishment of Contingency Fund
Agile Crisis Response
Continuous Analysis and Improvement
Details of how NHS can go about applying these measures are elucidated as follows.
Critical Situational Diagnosis
Critical situational analysis is essential for healthcare project managers at NHS to discern the plan that must be put in place to respond to any eventualities. Critical situational analysis enhances a critical evaluation of the organization and the unfolding ecosystem dynamics. This enables the healthcare project managers at NHS to assess the current organizational strengths vis-à-vis weaknesses to discern the improvement initiatives that can be adopted. Such analysis enables management to evaluate how the organization is quite vulnerable if a crisis occurs. Even if some of the crises are unpredictable, a critical situational analysis shall improve NHS’ capabilities to prepare to respond to the unfolding dynamics. During that process, NHS must also do forecasting and analysis to discern the likely future changes that may pose threats to the successful execution of various healthcare projects. Using the increasingly more advanced artificial intelligence and machine learning technologies, NHS must be capable of forecasting the future disruptive trends. NHS can also improve its capabilities to read, sense and respond to the unfolding disruptive trends. After a critical situational analysis, NHS must be able to do crisis profiling and impact modelling.
Crisis Profiling and Impact Modeling
Crisis profiling and impact modeling is one of the strategies that NHS can use to evaluate and understand the most threatening and less threatening risks. Some risks may seem more threatening, but they may never turn out to be threatening upon occurring. In contrast, the other risks that may seem not threatening may turn out to be more threatening upon occurrence. But still crisis profiling and impact modeling will enable NHS to discern the kinds of crises that may most likely unfold and the impacts of such risks. Evaluation of the potential impacts of the identified risks shall enable the NHS to identify the potential risks and their impacts. This will enable the NHS to put in place the necessary strategies to respond if the crisis unfolds. It improves the preparedness of the NHS. However, no matter the kinds of the identified and profiled risks, NHS must ensure that it is constantly prepared to respond to any forms of crisis.
Establishment of Contingent Fund
After understanding the nature of the crisis that may affect the successful implementation of the available healthcare projects, the establishment of the appropriate contingent fund is essential for enhancing the successful project execution. When a crisis occurs like it was in the cases of Carillion, Care-Data, NPfIT and e-referrals, NHS will require adequate financial resources, technology and clear management structures to respond to any of the emerging disruptive dynamics. Hence, the purpose of the contingency plan is to prepare NHS to put in place the required resources to respond to any eventualities that may affect the successful project execution. Once the contingency plan and the required fund are available, NHS should prepare to use a more proactive strategic process to respond to the unfolding crisis.
Agile Crisis Response
Agility is quite essential for enabling NHS to identify and thwart the devastating effects of a crisis before it becomes quite devastating. The value of agile response is depicted in the fact that failure to act fast and quickly affected the mitigation of the crisis that affected the faster completion of the Royal Liverpool Hospital and Midland Metropolitan Hospital. In the execution of various healthcare projects, NHS shall need to evaluate and ensure that it acts with the requisite agility if a crisis occurs. Using a proactive approach, NHS should be able to evaluate and respond to the unfolding dynamics before they become serious for the project managers to handle the emerging damages. However, as the contingency plan is being used to respond to any of the emerging dynamics, NHS will also need to continuously analyse and improve the efficacy of its contingency plan.
Continuous Analysis and Improvement
Continuous analysis and improvement are essential for improving the effectiveness of the contingency plan. As the contingency plan is being used for responding to the crisis, it may not contain the plans, strategies and tactical plans that effectively respond to the crisis. Hence, NHS must continuously analyse, modify and improve its contingency plan to respond to the unfolding disruptive dynamics. Such modifications improve the effectiveness of the contingency plan to respond to and mitigate risks or crises that may affect the successful implementation of the required healthcare projects.
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