Another fine NHS IT mess

By Tony Collins

Today the National Audit Office reports on the General Practice Extraction Service, an IT system that allows patient data to be extracted from all GP practices in England.

The report says that Department of Health officials – who were then working for the NHS Information Centre – signed off and paid for a contract even though the system was unfit for use. The original business case for the system grossly underestimated costs.

And the system was developed using the highest-risk approach for new IT – a combination of agile principles and traditional fixed-price contract.

Some of the officials involved appear to be those who worked for NHS Connecting for Health – the organisation responsible for what has become the UK’s biggest IT-related failure, the £10bn National Programme for IT (NPfIT).

As with the NPfIT it is unlikely anyone responsible for the latest failure will be held accountable or suffer any damage to their career.

The NAO says officials made mistakes in the original procurement. “Contract management contributed to losses of public funds, through asset write-offs and settlements with suppliers.” More public money is needed to improve or replace the system.

Labour MP Meg Hillier MP, the new chairman of the Public Accounts Committee, sums up today’s NAO’s report:

“Failed government IT projects have long been an expensive cliché and, sadly for the taxpayer and service user, this is no exception.

“The expected cost of the General Practice Extraction Service ballooned from £14m to £40m, with at least £5.5m wasted on write-offs and delay costs.

“GPES has managed to provide data for just one customer – NHS England – and the data was received 4 years later than originally planned.

“While taxpayers are left picking up the tab for this failure, customers who could benefit, such as research and clinical audit organisations, are waiting around for the system to deliver what they need to improve our health service.”

Some GPs who do not want patient data to be extracted from their systems – they believe it could compromise their bond of confidentiality with patients – may be pleased the extraction system has failed to work properly.

But their concern about patient confidentiality being compromised will not make the failure of the extraction service any more palatable.

The NAO says it only learned of the failure of the extraction system through its financial audit of the Health and Social Care Information Centre. It learned that the system was not working as expected and that HSCIC had agreed to pay additional charges through a settlement with one of the main suppliers, Atos IT Services UK Ltd.

An NHS Connecting for Health legacy?

Work on the GP Extraction Service project began in 2007, first by the NHS Information Centre, and then by the HSCIC.

The NHS Information Centre closed in 2013 and responsibility transferred to the HSCIC which combines the Department of Health’s informatics functions – previously known as NHS Connecting for Health or CFH – and the former NHS Information Centre.

What went wrong 

The original business case said the extraction service would start in 2009-10, but it took until April 2014 for HSCIC to provide the first data extract to a customer.

Meanwhile other potential users of the system have found alternative sources of patient data in the absence of the HSCIC system.

The NAO says that officials changed the procurement strategy and technical design for the GPES extraction systems during the project. “This contributed to GPES being unable to provide the planned number and range of data extracts.”

The NHS Information Centre contracted with Atos to develop a tool to manage data extraction. In March 2013, the Centre accepted delivery of this system from Atos.

But officials at the HSCIC who took over the system on 1 April 2013 found that it had fundamental design flaws and did not work. “The system test did not reflect the complexity of a ‘real life’ data extract and was not comprehensive enough to identify these problems”.

To work in a ‘real life’ situation, the GPES query system needed to communicate accurately with the four separate extraction systems and other systems relying on its data.  The test officials and Atos agreed was less complex. It did not examine extractions from multiple extraction systems at once.

Nor did the test assess the complete process of extracting and then passing GPES data to third-party systems.

Fixed price and agile – a bad combination

Officials began procuring the GPES query tool in April 2009, using a fixed-price contractual model with ‘agile’ parts. The supplier and officials would agree some of the detailed needs in workshops, after they signed the contract.

But the NAO says there was already evidence in central government at this time that the contractual approach – combining agile with a fixed price – was high risk.

The NAO’s report “Shared Services in the Research Councils”reviewed how research councils had created a shared service centre, where a similarly structured IT contract failed.

In the report, Fujitsu and the shared service centre told the NAO that: “the fixed-rate contract awarded by the project proved to be unsuitable when the customers’ requirements were still unclear.”

The court case of De Beers vs. Atos Origin highlighted a similar failure.

To make matters worse officials relied too heavily on contractors for development and procurement expertise.  And 10 project managers were responsible for GPES between 2008 and 2013.

Once health officials and Atos had signed the query tool contract, they found it difficult to agree the detailed requirements. This delayed development, with Atos needing to start development work while some requirements had yet to be agreed. Officials and Atos agreed to remove some minor components. Others were built but never used by HSCIC.

A Department of Health Gateway 4 review in December 2012 found that difficulties with deciding requirements were possibly exacerbated by development being offshore.

They raised concerns about the project management approach:

“The GPET-Q [query tool] delivery is being project managed using a traditional ‘waterfall’ methodology. Given the degree of bespoke development required and the difficulties with translation of requirements during the elaboration parts of R1, the Review Team considers that, with hindsight, it might have been beneficial to have adopted an Agile Project Management approach instead.”

General Practice Extraction Service – an investigation. NAO report. 

Latest healthcare IT disaster is a reminder of how vital government digital transformation is.

 

Pity the 775 users who use this outsourced council system?

By Tony Collins

Adult care systems are a cinderella IT service for councils.

It’s rare for journalists to write about them, for good or ill, perhaps because they help council staff deal with vulnerable adults. Such systems help with payments to care home and hospice providers. They help staff organise facilities for adults with learning disabilities or dementia, and respite care for adults at risk of abuse.

One such system has 775 users in Somerset. It’s a “critical” application according to the county council there.  The Adults Integrated Solution was originally supplied by Northgate. The system became IBM’s responsibility under a 10-year outsourcing and joint venture, Southwest One.

The latest in a series of excellent reports on the system’s enduring problems by auditors the South West Audit Partnership goes to Somerset County Council’s Audit Committee today (2 July 2015).

How bad is bad?

The report says the system’s response times have been so poor  that audit trails and logs have been disabled. So how can IBM and the council trace and attribute user activity in the system – particularly one handling sensitive and personal data?

The report says this disabling of the audit trial and logs is “worrying”.

Auditors reported on the system’s weaknesses in their 2012/2013 audit report.  Since then there has been only “limited progress” in implementing recommendations, says today’s report.

On some of their priority recommendations, auditors say they have been unable to obtain documentary evidence to support implementation. They have received verbal assurances – but they remain concerned.

The report says that AIS performance and response times “can still be less than adequate for users’ needs” and IBM is unwilling to develop a service level agreement specifically for the AIS application.

Indeed IBM has refused to give the county council a copy of the AIS contract with Northgate and it was not made available to the South West Audit Partnership for its audit of the system.

This may prompt councillors to ask how the council can properly manage a critical application if it has no control over the system or the outsourcer.

Repeated audit reports on the problems appear to have left matters unresolved.

Below are some of the concerns of the South West Audit Partnership as mentioned in its 2012/2013 audit report. It reports today that it has received only “partial” assurances that these problems have been solved.

Applications could be unavailable a month or more

Said the South West Audit Partnership: “We have identified in previous audit reports that there is no tested IT disaster recovery strategy. This is a strategy that would be put into effect in the event the Somerset County Council data centre was unavailable for any reason. Although a contract has been signed with Adam Continuity, applications could still be unavailable for a month or even more.”

No formally-named business system owner

“As of November 2014, Helen Wakeling (AIS System Owner) has left Somerset County Council. The responsibility of AIS system ownership needs to be reassigned and formalised.”

Payments to care providers not properly checked?

“… there does not appear to be a process to ensure payments are authorised, appropriate, complete and accurate…

 

IBM has no contractual duty to provide a good system

“There is no contractual requirement or service level for Southwest One [IBM] to provide a platform that delivers performance and response time that is acceptable to ASC [Adult Social Care] Operations.”

Data validation?

“Data quality in AIS data is undermined by the lack of robust input validation within the AIS application.

“Client records can be created with a minimum of information. Key personal identifiers such as data of birth, NI number and NHS number do not need to be entered and this both increases the risk of duplicate records and provides less data with which to identify those that have been created…”

Is IBM hiding AIS contract from the council?

“Southwest One currently owns the contract with Northgate and would not provide SWAP with a copy. As a result SWAP [South West Audit Partnership] was not able to evaluate Northgate’s compliance with the terms of the contract including licensing requirements…”

Personal data at risk?

“It was noted that developers have access to the production environment, unmasked live production data is used by developers and vendors for testing purposes and desktops are not locked down.”

Potential for fraud?

“In addition the authorise function, a security feature available in AIS has not been implemented resulting in all authorisations occurring outside of AIS. As a result data loss, potential corruption of data, incorrect and potentially fraudulent use of the application, missed, inappropriate or additional payments, will not be identified and acted upon.”

Corrupt data?

“In spite of a recent security incident that appeared to result in some data corruption, there is no reporting in place or review of user, super user or generic user access for appropriateness.”

Can former staff still log on?

“Terminated users were identified with valid AIS access credentials. Just less than 10% of managers with access were found to be no longer employed. In addition user ids are not disabled after not being used for a period of time.”

Unattended screens?

“The time-out for the application is 1 hour. Although users typically leave the application on and lock the screen when they go out to lunch, this process is inefficient, leaving sessions unavailable for others and insecure, since the user could forget to lock their screen and allow bypass of all security.”

System security?

“We also identified in our capacity management audit that desktop lock-down is not in effect and as a result AIS data can be downloaded and copied to USB flash storage. SWAP recommended data security policies be developed and implemented …”

**

Dave Orr who has followed events at Somerset closely since the county council signed the Southwest One contract in 2007 has written to audit committee councillors about the AIS system.

One of his questions is how the council could have transferred a critical application to IBM without its being protected by any specific service level agreement.

Orr says: “I do not believe that an in-house IT service, with a head of IT in the direct employ of this council, would be allowed to leave these serious shortcomings in performance, audit logging and disaster recovery unaddressed.”

Comment

So much for the claims back in 2007, when the council and IBM formed Southwest One, that the services would be “beyond excellence”.

If this is the worst outsourced system in the UK where does that leave the 775 council users who no doubt are trying to do their best for the vulnerable adults in their community?

Thank you to Dave Orr for providing the information on which this article is based.

Universal Credit at “amber/red” says latest DWP report

By Tony Collins

The Major Projects Authority, which is part of the Cabinet Office’s Efficiency and Reform Group, has today published its annual report on 188 projects including Universal Credit, about which it makes only positive comments.

But the authority’s annual report is, it appears, economical with the actualité. At the same time as the MPA published the report, the Department for Work and Pensions published a spreadsheet with statistics and its own narrative on the state of its major projects including the Universal Credit programme.

The spreadsheet said that the UC programme had an “amber/red” rating – but neither the MPA nor the Department for Work and Pensions has given the MPA’s reasons for the rating.

At the request of permanent secretaries the MPA has agreed not to publish its comments on the traffic light status of certain projects, including Universal Credit. The MPA and the Cabinet Office have agreed to allow officials in each departmental to give their own narrative to explain the traffic light status of their projects.

So the DWP, on its website, gives a summary of the state of its major projects, but its narrative on Universal Credit says nothing about the programme’s problems. Neither is there any of the MPA’s recommendations which related to the “amber/red” rating.

In a further shrinking from openness, the MPA and Cabinet Office have agreed with permanent secretaries that the traffic light status of major projects will be published only when they are out of date. So the “amber/red” rating on Universal Credit, although published today, is dated September 2014.

Comment

It is odd in a modern democracy that a large central government department – the DWP – can spend £330m on the IT for a major project and get away with publishing such obviously contradictory information on the scheme.

On the one hand the MPA, the Cabinet Office and the DWP publish only positive comments about progress on the Universal Credit programme.

These are some of the MPA’s comments on Universal Credit:

“Delivery remains on track against plans announced in September 2014. Additionally the Programme has brought forward testing of initiatives from which the programme can learn including the:

• Continued trialling of Universal Support in partnership areas to ensure the right integrated local foundations are in place to support UC expansion.

• Extending In work progression trials to help households increase their earnings once they have found work. • Extending the role of UC Work Coaches to engage with households at their work search interview to assess financial capability.”

Similarly the DWP’s comments in its spreadsheet on the status of its major projects reads like a government press release. Why was one of the government’s major projects – the whole life project costs of UC are estimated at £15.8bn – given an amber/red status?

We don’t know. Except we know that the MPA gives an amber/red rating when it regards a programme as not on track – a programme that needs an assurance and action plan to improve confidence in delivery. Why is the programme not on track? What does the assurance and action plan say? What is the rating today?

So much for open government. Indeed the DWP’s external lawyers are going to an FOI tribunal in London next month as part of a long legal battle to stop four old reports on Universal Credit being published.

Any ministerial announcements about open government in future should, perhaps, take this unedifying FOI episode into account.

Major Projects Authority annual report 2014/2015

Do IDS and Universal Credit deserve such good publicity?

By Tony Collins

Iain DuncanSmith

One of the unwritten conventions in journalism is that is you don’t give bad publicity to a minister who gives you an exclusive interview.

Iain Duncan Smith has given an exclusive interview to the Huffington Post, one of the world’s top-ranking news websites, and it is, perhaps, no surprise that the subsequent headline says:

Iain Duncan Smith Welcomes Record Universal Credit Applications.”

That’s great news. Is the UC programme out of trouble? Are the IT
problems that were imposing artificially low limits on the number and type of claimants – such as incorrect calculations of payments – confined to history?

At one point you could not claim UC as a single person or a couple if you received Jobseeker’s Allowance, Employment and Support Allowance, Income Support, Incapacity Benefit, Severe Disablement Allowance, Disability Living Allowance or Personal Independence Payment.

universal creditYou could not claim if you owned, or partly owned, your home, were homeless, or in supported or temporary accommodation.  You could not claim if you worked but earned more than £330 a month. You could not claim if pregnant,  had disabled, adopted or fostered children.

So are the brakes off now?

The Huffington Post said:

“According to the Department of Work and Pensions (DWP), in May over 3,800 new applications were made a week for the government’s new benefit system.”

That sounds a lot. A record indeed. But a close analysis of the numbers successfully claiming UC shows that since a national roll-out of UC began in February 2015 – amid much good publicity – the increase has been small.

It appears that the UC programme’s costly IT – an investment of £344m by 31 October 2014 (Appendix f) – is still limiting the number of claimants.

dwpThis raises the question of whether the DWP’s publicity machine, with IDS at the helm, has such an influence on the media that it is able to successfully propagate its own message in the face of inconvenient facts.

This was BBC Online’s headline in February 2015: Universal Credit roll-out £600m under budget”

The Sunday Times declared that Universal Credit “is working”. The Telegraph also said that UC is working.

The facts 

The DWP’s plan is for 7 million people to claim UC but the latest figures show that the total number of claimants who had made a successful claim up to 14 May 2015 was 74,120.

This is about 1% of those potentially eligible to claim UC – 25 months after the scheme was launched in April 2013.

Has the number of claimants increased substantially since the national roll-out began in February 2015?

Before the start of the national roll-out about 35,000 people had successfully made a UC claim up to 8 January 2015. There had been an average of 2,325 new claims per week at 96 Jobcentre Plus offices.

Three months after the start of the national roll-out about 74,120 people had successfully claimed UC up to 14 May 2015. There were an average of 3,550 new claims per week at 278 Jobcentre Plus offices.

Rapid pace?

The DWP says on its website:

“Since national roll-out the rate of claims has been increasing at a rapid pace”.

But is this the case?

The number of successful UC claimants has more than doubled since the national roll-out began but the number of Jobcentre Plus offices where UC has launched have nearly tripled in the same period, from 96 in January 2015 to 278 by 14 May 2015.

And the total number of successful claimants remains tiny relative to the potential number of claimants although the DWP says it has expanded eligibility to claim UC from single people to couples and families.

According to the National Audit Office in November 2014, the DWP estimated that around 500,000 claimants would receive Universal Credit by mid‑2016. This target will not be hit at the present rate of successful claimant applications.

Comment

IDS welcomes record numbers of UC applications says the Huffington Post headline.  But almost every week there will be record numbers claiming UC.

That is the nature of a national roll-out:  numbers increase – even by small amounts. The number of applications will continually break records while the roll-out continues during 2015 and 2016.

No doubt IDS and the DWP will continue to seek a succession of media articles on the record number of UC applications. Only this week the DWP announced that UC is rolling out to 10 more jobcentres across England, Scotland and Wales.

Will the media always react complaisantly?

If it does it will be a pity – because MPs may stop asking questions about value for money in the context of the tens,  indeed hundreds, of millions being spent on UC technology with the usual major suppliers.

And if the IT and business change challenges continue to limit the number and type of applications, the total numbers of successful claimants at the end of the national roll-out could be embarrassingly tiny relative to the 7 million potential claimants – not that the DWP’s publicity machine will mind.

The machine will find a new way to sail around the facts. That’s what the DWP’s senior officials seem to believe that government PR staff exist to do.

Universal Credit statistics

Iain Duncan Smith welcome record Universal Credit applications – Huffington Post

DWP’s announcement of the national roll-out of UC

65,000 people claiming Universal Credit

What do Ben Bradshaw, Caroline Flint and Andy Burnham have in common?

By Tony Collins

Ben Bradshaw, Caroline Flint and Andy Burnham have in common in their political past something they probably wouldn’t care to draw attention to as they battle for roles in the Labour leadership.

Few people will remember that Bradshaw, Flint and Burnham were advocates – indeed staunch defenders – of what’s arguably the biggest IT-related failure of all time – the £10bn National Programme for IT [NPfIT.

Perhaps it’s unfair to mention their support for such a massive failure at the time of the leadership election.

A counter argument is that politicians should be held to account at some point for public statements they have made in Parliament in defence of a major project – in this case the largest non-military IT-related programme in the world – that many inside and outside the NHS recognised was fundamentally flawed from its outset in 2003.

Bradshaw, Flint and Burnham did concede in their NPfIT-related statements to the House of Commons that the national programme for IT had its flaws, but still they gave it their strong support and continued to attack the programme’s critics.

The following are examples of statements made by Bradshaw, Flint and Burnham in the House of Commons in support of the NPfIT, which was later abandoned.

Bradshaw, then health minister in charge of the NPfIT,  told the House of Commons in February 2008:

“We accept that there have been delays, not only in the roll-out of summary care records, but in the whole NHS IT programme.

“It is important to put on record that those delays were not because of problems with supply, delivery or systems, but pretty much entirely because we took extra time to consult on and try to address record safety and patient confidentiality, and we were absolutely right to do so…

“The health service is moving from being an organisation with fragmented or incomplete information systems to a position where national systems are integrated, record keeping is digital, patients have unprecedented access to their personal health records and health professionals will have the right information at the right time about the right patient.

“As the Health Committee has recognised in its report, the roll-out of new IT systems will save time and money for the NHS and staff, save lives and improve patient care.”

[Even today, 12 years after the launch of the National Programme for IT, the NHS does not have integrated digital records.]

Caroline Flint, then health minister in charge of the NPfIT,  told the House of Commons on 6 June 2007:

“… it is lamentable that a programme that is focused on the delivery of safer and more efficient health care in the NHS in England has been politicised and attacked for short-term partisan gain when, in fact, it is to the benefit of everyone using the NHS in England that the programme is provided with the necessary resources and support to achieve the aims that Conservative Members have acknowledged that they agree with…

“Owing to delays in some areas of the programme, far from it being overspent, there is an underspend, which is perhaps unique for a large IT programme.

“The contracts that were ably put in place in 2003 mean that committed payments are not made to suppliers until delivery has been accepted 45 days after “go live” by end-users.

“We have made advance payments to a number of suppliers to provide efficient financing mechanisms for their work in progress. However, it should be noted that the financing risk has remained with the suppliers and that guarantees for any advance payments have been made by the suppliers to the Government…

“The national programme for IT in the NHS has successfully transferred the financing and completion risk to its suppliers…”

Andy Burnham, then Health Secretary, told the House of Commons on 7 December 2009:

“He [Andrew Lansley] seems to reject the benefits of a national system across the NHS, but we do not. We believe that there are significant benefits from a national health service having a programme of IT that can link up clinicians across the system. We further believe that it is safer for patients if their records can be accessed across the system…” [which hasn’t happened].

Abandoned NHS IT plan has cost £10bn so far

New national e-Referral Service “unavailable until further notice”

By Tony Collins

The NHS e-Referral Service which launched nationally on Monday was “unavailable until further notice”, the Health and Social Care Information Centre said at 9.30am today.

“Due to issues experienced overnight the NHS e-Referral Service is unavailable until further notice while essential maintenance is performed. If you have local business continuity processes available, we recommend that you consider invoking them,” says the HSCIC on its website.

“We are working hard to resolve these issues as quickly as possible and to keep disruption to a minimum… We apologise for the disruption caused to some users and thank everyone for their patience.”

Late yesterday afternoon the Health and Social Care Information Centre warned GPs and other users of its e-Referral Service that technical problems were continuing.

The difficulties have aggravated cynicism in the GP community about the ability of centrally-based officials to implement national IT systems.

Is it too soon to question whether e-Referrals is the first IT disaster of the new government? There is also the question of whether GPs have been used as guinea pigs to test for problems with the new system.

Until the service went down GPs were in any case unable to log in or were experiencing long delays in arranging referrals. Some reverted to sending letters by post – or always did use the post and avoided the NPfIT Choose and Book system which e-Referral is replacing.

Fewer than 60% of GPs used Choose and Book to hospital appointments for patients.

On its website at 17.30 yesterday the HSCIC said:

“PLEASE PASS THIS ON TO COLLEAGUES WHO USE THE NHS e-REFERRAL SERVICE

“The NHS e-Referral Service has been used by patients and professionals today to complete bookings and referrals comparable with the number on a typical Tuesday but we were continuing to see on-going performance and stability issues after yesterday’s fixes.

“We suspend access to the system at lunchtime today to implement another fix and this improved performance and stability in the afternoon.

“We are continuing to monitor the service and will implement further fixes if required. If users notice any further issues they should log them with their local service desk in the usual way…

“We apologise for the disruption caused to some users and thank everyone for their patience.

Update 14.00 17 June

The Health and Social Care Information Centre said the e-Referral Service was still down.

“HSCIC are completing the final stage of testing a number of fixes to the NHS e-Referrals Service. It is hoped that the service will be available again later today. A further update will be issued at 15:00 today.”

Update 18.00 17 June

Said the HSCIC:

“The NHS e-Referrals Service is now available again. We apologise for the disruption caused to users and thank everyone for their patience.

Update 15.00 18 June – ongoing problems

“Yesterday’s outage enabled us to  implement a number of improvements and hopefully this is reflected in your user experience today,” said HSCIC’s website.

“This morning users reported that there were ongoing performance issues so work has now taken place to implement changes to the configuration to the NHS e-Referral Service hardware and we are currently monitoring closely to see if this resolved the issue.”

Why was NHS e-Referral service launched with 9 pages of known problems?

By Tony Collins

Were GPs guinea pigs for live testing of the new national NHS e-Referral Service?

Between 2004 and 2010 the Department of Health marked as confidential its lists of problems with national NPfIT systems, in particular Choose and Book.

So the Health and Social Care Information Centre deserves praise for publishing a list of problems when it launched the national “e-Referrals” system on Monday. But that list was 9 pages long.

The launch brought unsurprised groans from GPs who are used to new national systems going live with dozens of known problems.

The e-Referral Service, built on agile “techniques” and based on open source technology, went live early on Monday to replace “Choose and Book” for referring GP patients to hospitals and to other parts of the NHS.

Some GPs found they could not log on.

“As expected – cannot refer anything electronically this morning. Surprise surprise,” said one GP in a comment to “Pulse” on its article headlined “Patient referrals being delayed as GPs unable to access e-Referrals system on launch day.”

A GP practice manager said: “Cannot access in south London. HSCIC debacle…GPs pick up the pieces. Changing something that wasn’t broken.”

Another GP said: “I was proud never to have used Choose and Book once. Looks like this is even better!”

Other GPs said they avoided using technology to refer patients.

“Why delay referral? Just send a letter. (Some of us never stopped).”

Another commented: “I still send paper referrals – no messing, you know it has gone, no time wasted.”

Dr Faisal Bhutta, a GP partner in Manchester, said his practice regularly used Choose and Book but on Monday morning he couldn’t log in. “You can’t make a referral,” he said.

The Health and Social Care Information Centre has apologised for the disruption. A statement on its website says:

“There are a number of known issues, which are currently being resolved. It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks. We have published the list of known issues on our website along with details of how to provide feedback .”

But why did the Centre launch the e-Referral Service with 9 pages of known problems? Was it using GPs as guinea pigs to test the new system?

Comment

The Health and Social Care Information Centre is far more open, less defensive and a better communicator than the Department of Health ever was when its officials were implementing the NPfIT.

But is the HSCIC’s openness a good thing if it’s accompanied by a brazen and arrogant acceptance that IT can be introduced into the NHS without a care whether it works properly or not?

In parts of the NHS, IT works extraordinarily well. Those who design, test, implement and support such systems care deeply about patients. In many hospitals the IT reduces risks and helps to improve the chances of successful outcomes.

But in other parts of the NHS are some technology enthusiasts – at the most senior board level – who seem to believe that all major IT implementations will be flawed and will be improved by user feedback.

The result is that IT that’s inadequately designed, tested and implemented is foisted on doctors and nurses who are expected to get used to “teething” troubles.

This is dangerous thinking and it’s becoming more and more prevalent.

Many poorly-considered implementations of the Cerner Millennium electronic patient record system have gone live in hospitals across England with known problems.

In some cases, poor implementations – rather than any faults with the system itself – have affected the care of patients and might have contributed to unnecessary deaths when records needed urgently were not available, or hospitals lost track of urgent appointments.

A CQC report in March 2015 said IT was a possible factor in the death of a patient because NHS staff were unable to access electronically-held information.

In another incident a coroner criticised a patient administration system for being a factor in the death of three year-old Samuel Starr whose appointment for a vital scan got lost in the system.

Within NHS officialdom is a growing cultural acceptance that somehow a poor IT implementation is different to a faulty x-ray machine that delivers too high a dose of radiation.

NHS officials will always brush off IT problems as teething and irrelevant to the care and safety of patients. Just apologise and say no patient has come to any harm.

So little do IT-related problems matter in the NHS that unaccountable officials at the HSCIC have this week felt sufficiently detached from personal accountability to launch a national system knowing there are dozens of problems with the use of it.

Their attitude seems to be: “We can’t know everything wrong with the system until it’s live. So let’s launch the system and fix the problems as GPs give us their feedback.”

This is a little like the NHS having a template letter of regret to send to relatives and families of patients who die unexpectedly in the care of the NHS. Officials simply fill in the appropriate name and address. The NHS can then fix the problems as and when patients die.

It’s surely time that bad practice in NHS IT was eradicated.  Board members need to question more. When necessary directors must challenge the blind positivism of the chief executive.

Some managers can learn much about the culture of care at the hospitals that implement IT successfully.

Patients, nurses and doctors do not exist to tell hospital managers and IT suppliers when electronic records are wrong, incomplete, not available or are somebody else’s record with a similar name.

And GPs do not exist to be guinea pigs for testing and providing feedback on new national systems such as the e-Referral Service.

e-Referral Service “unavailable until further notice”

Hundreds of patients lost in NPfIT systems

Hospital has long-term NPfIT problems

An NPfIT success at Croydon? – Really?

Physicians’ views on electronic patient records

Patient record systems raise some concerns, says report

Electronic health records and safety concerns

Sensible advice on planning an end to 10-year outsourcing deal

By Tony Collins

Dave Orr used to work in IT at Somerset County Council. Since retiring in 2011 he has, among other things, watched closely the undoing of Southwest One, IBM’s 10-year outsourcing/joint venture deal with the county council, Taunton Deane Borough Council and Avon and Somerset Police.

From FOI answers, reading council papers and meetings with councillors and officials he has learned a great deal about what works and what doesn’t in a large outsourcing deal.

For nearly four years after the creation of Southwest One in 2007  he saw events from the inside, as an employee of the county council.

Now that Southwest One is approaching its natural end in 2017 and Taunton Deane councillors are considering “succession planning”,  Orr has sent them his advisory paper.

These are some of the points Orr made to Taunton Deane’s councillors:

– It’ll cost more to unravel the contract with IBM than council officers say.

“From previous freedom of information disclosures, it cost this Council around half a million pounds to get into this controversial contract with IBM back in 2007 and I believe that it will cost at least that, to get out of the contract and implement the succession option,” says Orr.

“The current project budget request before you tonight for £47,000 is clearly a “starter for 10” and you can expect further costs, including a significant write down on the remaining book value of SAP.

“Back in 2005, the councils [Somerset County Council and Taunton Deane Borough Council] decided from the outset that a large outsource of so-
called “back office” services in a joint venture was “the right answer”; the next two and a half years were spent working backwards from that answer to try and make a viable Business Case.

“Please do not make that fundamental mistake again. Please do not rush into a preferred option early on in Phase One, without making sure that you have a clear view of what sort of Council and what services you will be delivering in future.

“This state is currently referred to by officers as the ‘New Operating Model’.

“If you don’t know what sort of Council you want to be, then how will you know what sort of IT you will need to support this Council? Or what option is best for delivering the IT needed?

– Don’t leave key decisions to council officers

“It is for you as councillors to lead and guide the officers, not for an early  preferred option to lead you.

“Clearly, the original Southwest One business case was flawed, as no-one  modelled for static or falling budgets; the ridiculous claims by IBM of £192m of
procurement savings were never ever there – good times or bad.

“All that shows is that predicting the complex and fast changing real world in a fixed written contract for 10 years is next to impossible.”

The end of IBM’s joint venture?

Separately Orr points out that Southwest One’s partners are now running three separate procurement exercises to determine what will happen at the end of contract. The three organisations undertake to simply “inform each other” of progress.

Orr says it makes sense for Avon and Somerset Police to go its own way when the Southwest One contract ends – although it shares a SAP system configured for use by the three organisations – but it would be a wasted expense for Somerset County Council and Taunton Deane to have separate procurements as they will share offices in future.

Excessive secrecy?

Orr also makes the point that councillors who take part in discussions on succession planning will be legally bound to secrecy.

But would excessive secrecy give a licence to a small group of officers and councillors to act almost as they want, incompetently, or in ignorance of the full facts?

Somerset County Council concedes that the 3,000-page Southwest One contract, which was signed in 2007, and was replete with literals because it was signed in a rush, has proved difficult to implement.

Will the same mistakes be made again, even though the council has produced several “lessons learned” reports?

The forthcoming discussions will involve IBM so secrecy will be a dominant issue.

But some of the discussions are deemed so secret that officers need not consult councillors on every important matter – which means that even those councillors who are bound by legal non-disclosure agreements may be excluded from some decisions.

Officers will tell councillors what’s happening only when officers decide that councillors should be consulted. Officers say they’ll consult councillors “when required”.  It will be up to officers to decide what “when required” means.

In discussions with possible outsourcers what if one council officer favours a company for reasons that aren’t clear?  Who among the lay councillors will stop mistakes being made if they don’t know everything that’s going on?

Campaign4Change has previously quoted the late Lord Chief Justice Lord Bingham on openness but it’s worth requoting:

“… Modern democratic government means government of the people by the people for the people.

“But there can be no government by the people if they are ignorant of the issues to be resolved, the arguments for and against different solutions and the facts underlying those arguments.

“The business of government is not an activity about which only those professionally engaged are entitled to receive information and express opinions.

“It is, or should be, a participatory process. But there can be no assurance that government is carried out for the people unless the facts are made known, the issues publicly ventilated.

“Sometimes, inevitably, those involved in the conduct of government, as in any other walk of life, are guilty of error, incompetence, misbehaviour, dereliction of duty, even dishonesty and malpractice.

“Those concerned may very strongly wish that the facts relating to such matters are not made public.

“Publicity may reflect discredit on them or their predecessors. It may embarrass the authorities. It may impede the process of administration. Experience however shows, in this country and elsewhere, that publicity is a powerful disinfectant.

“Where abuses are exposed, they can be remedied. Even where abuses have already been remedied, the public may be entitled to know that they occurred.

FOI exempt

Somerset’s officers have warned councillors that discussions over succession planning will be exempt from the FOI Act to “protect commercial interests”.

Says Somerset:

“Members on the [Joint Members Advisory] Panel should not disclose to any person outside the Panel any information which falls within the above definition. Much of the information provided to the Panel will fall into this definition. Therefore, it is anticipated that all information will be kept confidential, unless it is specifically agreed that the information can be shared.”

Any sharing of information will need the agreement of named council officers.

Comment

Sensible advice from Dave Orr.

Leaving officers to decide what to tell councillors, hiding away discussions behind locked doors, forcing some councillors to sign confidentiality agreements, and trusting supplier assurances that outsourcing deals don’t really go wrong – it’s all made up by the media – are factors that make outsourcing failure almost inevitable.

And it’s undemocratic for a cabal of officers and councillors to treat one of the council’s most important decisions as a private matter.

Any councillor whose authority is considering a major outsourcing deal may, perhaps, wish to think about all the councillors and officers who have waved enthusiastically from the open window of their train carriage as they headed unknowingly on a track ending at a precipice – councillors and officers from:

– Bedfordshire County Council which paid £7.7m to terminate an unsatisfactory £250m 12-year outsourcing deal prematurely. The then leader of the council, said the decision to end the partnership was to “improve quality and performance”.

– Suffolk County Council which looked to become a “light” organisation and outsource a lot of its duties but found it “simply did not work” according to then leader Mark Bee.

– Sandwell Council which left its planned 15-year partnership with BT, called Transform Sandwell, nine years early. Councillors were unhappy with the service.

– Liverpool Council which said last year it would save £30m over 3 years by ending its outsourcing/joint venture Liverpool Direct with BT.

– Birmingham City Council which plans to end  its £1bn outsourcing deal with Capita early and has taken a 500-strong contact centre back in-house.

– Cornwall Council, which is only 2 years into a 10-year outsourcing contract with BT, and says the supplier has not met key performance indicators, and not delivered on jobs promises.

Southwest One – the complete story

Somerset starts planning for life after Southwest One

Why some US companies are giving up on outsourcing (Forbes)

Lessons from Indiana’s outsourcing deal with IBM

Is HMRC spending enough for help to replace £10.4bn Aspire contract?

By Tony Collins

Government Computing reports that HM Revenue and Customs is seeking a partner for a two-year contract, worth £5m to £20m, to help the department replace the Aspire deal which expires in 2017.

HMRC is leading the way for central government by seeking to move away from a 13-year monopolistic IT supply contract, Aspire, which is expected to cost £10.4bn up to 2017.

Aspire’s main supplier is Capgemini.  Fujitsu and Accenture are the main subcontractors.

HMRC says it wants its IT services to be designed around taxpayers rather than its own operations. Its plan is to give every UK taxpayer a personalised digital tax account – built on agile principles – that allows interactions in real-time.

This will require major changes in its IT,  new organisational skills and changes to existing jobs.

HMRC’s officials want to comply with the government’s policy of ending large technology contracts in favour of smaller and shorter ones.

Now the department is advertising for a partner to help prepare for the end of the Aspire contract. The partner will need to help bring about a “culture and people transformation”.

The contract will be worth £5m to £20m, the closing date for bids is 6 July, and the contract start date is 1 September.  A “supplier event” will be held next week.

But is £5m to £20m enough for HMRC to spend on help to replace a £10.4bn contract?

This is the HMRC advert:

“HMRC/CDIO [Chief Digital Information Officer, Mark Dearnley] needs an injection of strategic-level experience and capacity to support people and culture transformation.
“The successful Partner must have experience of managing large post-merger work force integrations, and the significant people and cultural issues that arise. HMRC will require the supplier to provide strategic input to the planning of this activity and for support for senior line managers in delivering it.
“HMRC/CDIO needs an injection of strategic level experience and capacity to help manage the exit from a large scale outsourced arrangement that has been in place for 20+ years.
“HMRC is dependent on its IT services to collect £505bn in tax and to administer £43bn in benefits each year. The successful supplier must have proven experience of working in a multi-supplier environment, working with internal and external legal teams and suppliers and must have a proven track record of understanding large IT business operations.
“HMRC/CDIO needs an injection of strategic level experience and capacity to help HMRC Process Re-engineer and ‘Lean’ its IT operation. HMRC/CDIO requires a Programme Management Office (PMO) to undertake the management aspects of the programme.
“It is envisaged that the Lead Transformation Partner will provide leadership of the PMO and work alongside HMRC employees. The leadership must have significant experience of working in large, dynamic, multi-faceted programmes working in organisations that are of national/international scale and importance including major transformation…”

Replacing Aspire with smaller short-term contracts will require a transfer of more than 2,000 Capgemini staff to possibly a variety of SMEs or other companies, as well as big changes in HMRC’s ageing technologies.

It would be much easier for HMRC’s executives to replace Aspire with another long-term costly contract with a major supplier but officials are committed to fundamental change.

The need for change was set out by the National Audit Office in a report “Managing and replacing the Aspire contract”  in 2014. The NAO found that Capgemini has, in general,  kept the tax systems running fairly well and successfully delivered a plethora of projects. But at a cost.

The NAO report said Aspire was “holding back innovation” in HMRC’s business operations”.

Aspire had made it difficult for HMRC to “get direction or control of its ICT; there was little flexibility to get things done with the right supplier quickly or make greater use of cross-government shared infrastructure and services”. And exclusivity clauses “prevented competition and stifled new ideas”.

Capgemini and Fujitsu made a combined profit of £1.2bn, more than double the £500m envisaged in the original business plan. Profit margins averaged 16 per cent to March 2014, also higher than the original 2004 plan.

HMRC was “overly dependent on the technical capability of the Aspire suppliers”. The NAO also found that HMRC competed only 14 contracts outside Aspire, worth £22m, or 3 per cent of Aspire’s cost.

Although generally pleased with Capgemini,  HMRC raised with Capgemini, during a contract renegotiation, several claimed contract breaches for the supplier’s performance and overall responsiveness.

When benchmarking the price of Aspire services and projects on several occasions, HMRC has found that it has often “paid above-market rates”.

HMRC did not consider that its Fujitsu-run data centres were value for money.

Comment

HMRC deserves credit for seeking to replace Aspire with smaller, short-term contracts. But is it possible that HMRC is spending far too little on help with making the switch?

HMRC doesn’t have a reputation for caution when it comes to IT-related spending.  The total cost of Aspire is expected to rise to £10.4bn by 2017 from an original expected spend of £4.1bn. [The £10.4bn includes an extra £2.3bn for a 3-year contract extension.]

Therefore a spend of £5m to £20m for help to replace Aspire seems ridiculously low given the risks of getting it wrong, the complexities, the number of staff changes involved, the changes in IT architecture, and the legal, commercial and technical capabilities required.

The risks are worth taking, for HMRC to regain full control over ICT and performance of its operations.

If all goes wrong with the replacement of Aspire, costs will continue to spiral. The Aspire contract lets both parties extend it by agreement for up to eight years. HMRC says it does not intend to extend Aspire further. But an overrun could force HMRC to negotiate an extension.

As the NAO has said, an extension would not be value for money, since there would continue to be no competitive pressure.

Campaign4Change has never before accused a government department of allocating too little for IT-related change. There’s always a first time.

Government Computing article

 

Does Barnet know if it’s saving money with Capita?

By Tony Collins

Are council outsourcing contracts becoming so unfathomably complex that officials and leading councillors have no real idea whether they’re saving money?

A Somerset County Council report on the lessons learnt from its troubled outsourcing/joint venture deal with IBM emphasized the importance  of “not making  contracts overly complicated”.

The report said:

” Both the provider [IBM] and the Council would agree that the contract is incredibly complicated. A contract with over 3,000 pages was drawn up back in 2007 which was considered necessary at the time given the range of services and the partnership and contractual arrangements created…

“The sheer size and complexity of this contract has proven difficult to manage.”

For years there have been arguments in Somerset over whether the council has saved or spent more as a result of the relationship with IBM.  The absence of audited figures means nobody knows for certain.

It seems to be the same at Barnet. An absence of audited figures – the council does not have to produce them for an outsourcing contract – means that nobody knows for certain if Capita is costing or saving money.

It’s likely that councillors who supported the outsourcing to Capita, and critics of the deal, will never agree on whether local residents are better or worse off.

Now a Barnet resident and respected blogger Mr Reasonable, who studies the accounts of the local council as part of his efforts to be more open and accountable, has offered £250 to charity if the Tory leader Richard Cornelius provides evidence of how Capita is making savings as promised.

Mr Reasonable made the offer on 24 May 2015 and has heard nothing. His request to Barnet was followed up by Aditya Chakrabortty, senior economics commentator at the Guardian. The council didn’t reply within his deadline. Says Chakrabortty:

“If you want to see the world of outsourcing at its most illogical, spend a bit of time with detail-hunters like Mr Reasonable.

“He tells me about phoning his local library to see if a children’s book was in stock. The call was of course routed to a Capita call centre in Coventry, where staff spent ages unable to help before connecting him back to the librarians just down the road. By his calculations, for that wasted call Capita would charge Barnet £8.

“Outsourcing is full of these invented costs, which is how the privateers make their billions.

“Mr Reasonable can tell you about how Barnet now pays £800 for a day’s training in how to take minutes, or £14,628 for just two months of occupational health assessments. In both cases these are services that would previously have been provided in-house for minimal cost…

“These examples would be comic, if they didn’t cost blameless taxpayers so much money…”

Commercial confidentiality

Mr Reasonable says all the commercially sensitive elements of Barnet’s contracts with Capita are redacted and there are “numerous clauses relating to incentives and penalties which would have made publishing a single payments schedule almost impossible”.

It’s also impossible he says to know what Capita has billed for or not.

“I have asked repeatedly to see the evidence of precisely what we are paying for and a detailed explanation of why the payments are so high. Whilst a few promises of evidence were made when the previous COO was in place, none actually materialised.”

Open day?

He adds:

“If Barnet Council is serious about openness then why not host an open day where they go through the contract in detail so that we can understand exactly what we are paying for?

“I would have thought it would have made sense for Capita to get involved with this, to work through the contract with interested citizens and to demonstrate clearly how much money they are saving.

“So I hereby throw down a challenge to the Chief Executive Mr Travers, to Richard Cornelius and to Capita – host an open day, bring bloggers and critics in and show them what you are doing, how the contract is working in reality what money is being paid to whom and how much is really being saved – evidence is essential.

“Indeed a few Conservative councillors might want to come along as well seeing as they voted for this contract. I know some of them privately had serious concerns about the contract but were worried about making those views public.

“And to put my money where my mouth is, I will donate £250 to a charity of Richard Cornelius’ choice if he makes this contract open day happen.”

Comment 

Outsourcing deals should be signed on the basis of pure pragmatism, never because of an ideology.

Barnet’s deal with Capita (and Somerset’s) was signed for largely ideological reasons. Somerset wanted to “go beyond excellence” and Barnet’s ruling councillors want to be immortalised by establishing a new frontier for local government – a “commissioning council” whereby all services are bought in.

It might have been cheaper for Barnet’s residents if the council had given its ruling councillors immortality by building statutes of them in the council’s grounds.

Will council officers have enough time or understanding of the nuances of the contract, with its maze of incentives and penalties,  to know whether they are saving money or not?

In any case how accurate were the pre-outsourcing baseline figures and assumptions on which to make a comparison between what services were costing then, and what they are costing now?

There is no equivalent in local government of the National Audit Office, no organisation that will audit a local government outsourcing deal and publish the results.

This means councillors can say what they like in public about the success of a deal without fear of authoritative contradiction. Their critics can only speculate on what is really happening while they try to shine a light at the dense fog that is commercial confidentiality.

It appears that more and more councils are seriously considering large-scale outsourcing, perhaps on the basis that they can promise guaranteed savings without anyone being able to hold them to account on whether genuine savings materialise.

The first we’ll know anything is awry is when a council report, years into a contract, reveals some of the difficulties and says a resolution is being discussed with the supplier; and it’s another year or two before the contract is terminated at considerable extra cost to the council – and nobody is in post from the time of the original contract to be held accountable.

Is this really the shape of local government outsourcing to come?

Mr Reas0nable