i The Guy's Hospital Phase III project cost £115 million more than the original estimate of £35.5 million and was delivered over three years late. It is a disgrace that the original estimate was so inadequate, and was approved by both the Department of Health and the Treasury quickly, even though both had strong reservations about it;
ii The unrealistic initial cost estimates may have enabled Guy's to secure a place in the queue for scarce NHS capital investment at the expense of other schemes. We expect the NHS Executive to ensure that priorities for capital allocation are based on realistic cost estimates;
iii A key factor in the cost overruns and delays was that during the course of the project there were four changes of client body with overall responsibility, six different project sponsors, and five changes in project manager. While we recognise that the NHS was undergoing considerable change during this period, the failure to ensure consistent project oversight and management was indefensible. We note the NHS Executive's assurance that they are now seized of the importance of the sponsorship role and the need to ensure continuity of personnel, and indeed had intervened in recent cases to keep project sponsors in post;
vi Accountability for such projects has been sharpened since 1994, with the issue of the Capital Investment Manual, and the designation of trust chief executives as accountable officers with a direct line of accountability to the NHS Chief Executive. However, we are disturbed that no one associated with this major failure of cost control and project management has been identified or disciplined;