Health check

Fed up with projects busting their budgets, senior managers failing to take ownership of schemes and poor project management skills, the Department of Health (DoH) has taken action. In a bid to deliver projects more effectively, with more predictable costs and outcomes, it has insisted that all medium- and high-risk construction projects are carried out using the Office of Government Commerce’s Gateway Project Review process.

The concept behind the Gateway initiative is essentially all about bringing in specialists to review schemes where the necessary skills and experience are not available in-house. The review teams highlight risks and issues which, if not addressed, could cause problems, providing a small number of recommendations designed to bring about a more effective delivery of benefits and more accurate predictions of costs and results.

Reviews are carried out at key stages, or ‘gates’, in the life of a project, when it is important to check that everything is in place ready for the next phase (see box, right). Starting with the initial strategic assessment (Gate 0), there are two further gateways before contract award, followed by two gateways looking at implementation. The process finishes with Gate 5: evaluating the project’s benefits.

“It’s all about generating confidence that the project is being managed properly and not creating risk for the commissioning organisation. The Gateway team is not there to say it’s a good scheme or a bad scheme, but to check that you’re doing the right things to make it a success,” says reviewer Bill Headley.

All health sector reviews are carried out by small teams of people chosen for their knowledge and experience, regardless of whether they’ve actually worked in the NHS. They use on-site interviews with a range of staff and stakeholders as one of their main methods of assessment and each review concludes with a short report outlining the team’s findings and how urgently they recommend any changes.

Headley, a qualified architect, is currently project director of the Newcastle Strategic Review, a £300m project consolidating three acute hospitals to provide enhanced services on two sites. It’s a role for which his experience of a Gateway 2 review of another £150m PFI scheme stands him in good stead. Here, his fellow reviewers were a former nurse, now a specialist in service planning, an independent consultant previously employed by an accountant and an ex-Ministry of Defence employee, now an independent consultant with significant experience in risk and procurement.

Headley says that while project directors need to cover many areas in managing major schemes, their strength will normally lie in one discipline, such as estates or finance. The review team can provide a useful breadth of experience, which is where the system pays off.

In this case, the reviewers made a number of recommendations. “We were able to add some value with regard to risk management and to pick up on some nuances of PFI procurement,” Headley explains.

He says the team’s comments focused on ensuring the information was in place to allow the scheme to progress through the gateway: “Our verdict didn’t materially change their direction, it helped them get into the right position to move to the next stage.”