Washing their hands: Will anyone be held accountable for €150m health fiasco?

JUST when the health services thought that it had finally put a lid on the PPARS controversy, a letter appeared yesterday that again put the Department of Health and the Health Services Executive (HSE) on the back foot.

Three letters have now emerged over three days. The Department of Finance letter, which Fine Gael released on Tuesday, and raised serious concerns about the escalating costs and the massive fees paid to Deloitte and Touche (some of it for work that could have been done in-house) on the PPARS project was bad enough.

But then a letter emerged the following day from the then chief executive of St James's Hospital, who contended that PPARS was putting the management and financial integrity of the hospital at risk, as well as its management's relationship with the staff.

And yesterday, the Department of Finance released another letter it had sent to the Department of Health. It related to FISP, another information and technology system, this one responsible for the financial management of the health services.

After berating Health and the HSE for its botched payroll and personnel system, PPARS, Finance was now making the serious claim that its approach to FISP had heeded none of the mistakes made in relation to PPARS. In other words, the HSE had another 150 million white elephant on its hands.

Yesterday, the HSE took the decision to suspend FISP along with PPARS. It insisted this was being done as a precautionary measure.

The HSE said it had noted Finance's objections but disagreed with it. But after the battering that PPARS has taken this week, it is as plain as a pikestaff that most observers will be lining up with the Department of Finance on this one.

The quick succession of highly-critical and highly-damaging letters has deeply compounded the crisis. Each has raised deeper doubts about the HSE's ambitious technology plans and the biblical sums that have been splurged on them.

There are gnawing and worrying questions about governance, control and responsibility. How were the costs of PPARS allowed to spiral to such zeppelinish proportions with no one shouting stop?

And where does the buck stop? With the HSE? With the Department of Health? Or with Health Minister Mary Harney or her predecessor Micheál Martin?

In briefings yesterday, the HSE defended the flotability of the financial management system, FISP, despite the warning flares of Finance.

The reasons for this, says the HSE, is that FISPit was always under the control of the HSE and not of individual health boards, as it only began in early 2004.

Thus, argues the HSE, there were proper control mechanisms, it was being run by a small and tightly-focused group and its development was being delivered on budget and on time.

Whatever the merits of that argument, it also shows all that PPARS didn't have going for it.

The germ of the idea for PPARS came when the 11 health boards were still in existence, each operating as independent little republics. In its early stages, it was going to be a system for five health board areas and one of the country's leading hospitals, St James's.

As time went on the scope of the project became more ambitious. With the merging of all the health boards on the cards, by 2002, it was extended to cover all 100,000 health service employees in the country.

In addition to payroll functions, it would be a personnel and human relations information system that would be in a position to supply information on rostering and absenteeism as well as employment and recruitment needs.

The costs by that stage had also been revised upwards. From an initial €8.8m it would now cost €100 million. In 2004, management consultancy Gartner said the high costs associated with the project were in line with industry norms, including the very large fees being charged by Deloitte.

But in a key line, Gartner added: "Typically such large scale implementations do not start until the global blueprint and global model is ready. Projects that start too early also never really 'finish'."

That seemed to be the nub of PPARS problems. Started on a small scale, then expanded when the health boards merged, it has never really finished.

The system should have been rolled out by November 2005, yet by yesterday only 40,000 of a potential 100,000 HSE employees (and a further 30,000 associated employees) were covered by it. Nobody seemed to own it. It was only in the summer that it came properly into the ken of the Departments of Health and Finance.

Even then, Finance was complaining that nobody seemed to have taken 'ownership' of the project. It seems that too much autonomy was given, there was a lack of governance, and that nobody questioned a budget vanishing into the stratosphere.

All the change in health structures has made it difficult to pinpoint who should carry the can. When the Comptroller and Auditor General's report on PPARS is made public later this year, many of the questions raised during the nursing charges scandal will crop up again.

In particular, who is going to be found responsible? Will it be a public servant? Or will it be a minister - Ms Harney or her predecessor Micheál Martin?