By Tony Collins
Last week the National Audit Office reported on the failure of the GP Extraction Service. Health officials had signed off and paid for a contract even though the system was unfit for use.
The officials worked for organisations that have become part of the Health and Social Care Information Centre.
An unapologetic HSCIC issued a statement on its website in response to the Audit Office report. It said, in essence, that the problems with the GP Extraction Service were not the fault of the HSCIC but rather its predecessor organisations (ignoring the fact that many of the officials and contractors from those defunct organisations moved to the HSCIC).
Now it transpires that the HSCIC may have a new IT-related mess on its hands, this time one that is entirely of its own making – the e-Referral Service.
Last month the HSCIC went live with its e-Referral service without testing the system properly. It says it tested for thousands of hours but still the system went live with 9 pages of known problems.
Problems are continuing. Each time in their routine bulletins officials suggest that an upgrade will solve e-Referral’s problems. But each remedial upgrade is followed by another that does not appear to solve the problems.
The system went live on 15 June, replacing Choose and Book which was part of an earlier NHS IT disaster the £10bn National Programme for IT.
Problems more than teething?
Nobody expects a major new IT system to work perfectly first time but regular outages of the NHS e-Referral Service may suggest that it has more than teething problems.
It’s a common factor in IT-based project failures that those responsible have commissioned tests for many hours but with inadequately designed tests that did not always reflect real-world use of the system. They might also have underestimated loads on the available hardware and networks.
This means that after the system goes live it is brought down for regular hardware and software fixes that don’t solve the problems. End-users lose faith in the system – as many GPs did with the Choose and Book system – and a misplaced optimism takes the place of realism in the thinking of managers who don’t want to admit the system may need a fundamental redesign.
On the day the e-Referral Service launched, a Monday, doctors had difficulties logging in. Software “fixes” that day made little difference. By the next day HSCIC’s optimism has set in. Its website said:
“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.”
The “fix” also made little apparent difference. The next day, Wednesday 17 June, the entire system was “unavailable until further notice” said the HSCIC’s website.
By early evening all was apparently well. An HSCIC bulletin said:
“The NHS e-Referrals Service is now available again. We apologise for the disruption caused to users and thank everyone for their patience.”
In fact, by the next day, Thursday 18 June, all was not well. Said another bulletin:
“Yesterday’s outage enabled us to implement a number of improvements and hopefully this is reflected in your user experience today.
“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.”
About 2 weeks later, on 30 June, HSCIC’s officials said there were ongoing problems, because of system performance in provider organisations that were processing referrals.
Was this HSCIC’s way of, again, blaming other organisations – as they did after the NAO report’s on the failure of the GP Extraction Service project? Said a statement on the HSCIC’s website on 30 June 2015:
“Since transition to the NHS e-Referral Service on Monday 15th June, we have unfortunately experienced a number of problems… Although most of the initial problems were related to poor performance of the system, some residual functional and performance issues persist and continue to affect some of our colleagues in their day-to-day working.
“Most of these on-going problems relate to the performance of the system in provider organisations that are processing referrals, though this does of course have a knock-on effect for referrers.
“Please be assured that the team are working to identify root causes and fixes for these issues.”
By last week – 2 July 2015 – HSCIC warned that it will require a “period of planned downtime on the NHS e-Referral Service tonight which is currently scheduled for between 21:00 and 23:00 for some essential maintenance to fix a high priority functional Incident.”
The fix worked – or did it? HSCIC told Government Computing: “An update was applied to the system overnight from Thursday (July 2) into Friday (July 3) which was successful.”
Monday 6 July 2015 4.15pm. HSCIC e-Referral Service bulletin:
“We would like to apologise for the interruption to service between 13:15 and 13:54 today. This was not a planned outage and we are investigating the root cause. If any remedial activity is required we will give notice to all users. Once again please accept our sincere apologies for any inconvenience this caused.”
Why was testing inadequate?
Did senior managers go live without testing how the system would work in the real world, or did they select as test end-users only IT enthusiasts?
Perhaps managers avoided challenging the test system too much in case it gave poor results that could force a redesign.
We probably won’t know what has gone wrong unless the National Audit Office investigates. Even then it could be a year or more before a report is published. A further complicating factor is that the HSCIC itself may not know yet what has gone wrong and may be receiving conflicting reports on the cause or causes of the problems.
An IT failure? – change the organisation’s name
What’s certain is that the NHS has a history of national IT project failures which cause organisational embarrassment that’s soon assuaged by changing the name of the organisation, though the officials and contractors just switch from one to the next.
NHS Connecting for Health, which was largely responsible for the NPfIT disaster, was blended into the Department of Health’s informatics function which was then blended into the HSCIC.
Similarly the NHS Information Centre which was largely responsible for the GP Extraction Service disaster was closed in 2013 and its staff and contractors blended into the HSCIC.
Now, with the e-Referral Service, the HSCIC at least has a potential IT project mess that can be legitimately regarded as its own.
When will a centrally-run national NHS IT-based turn out to be a success? … care.data?
Meanwhile NHS England is looking for a senior responsible owner for e-Referral Service on a salary of up to £98,453.
Usually in central government, SROs do the job as an adjunct to their normal work. It’s unusual for the NHS to employ a full-time project SRO which the NAO will probably welcome as a positive step.
But the job description is vague. NHS England says that the SRO for NHS e-Referrals programme will help with a switch from paper to digital for 100% of referrals in England by March 2018.
“The SRO … will have responsibility for the strategic and operational development of the digital journey, fulfilment of the patient and clinical process and the performance of the service. Plans to achieve the strategy will be underpinned by the delivery of short to medium term objectives, currently commissioned from HSCIC and other third party suppliers.”
Key aspects of this role will be to:-
– Ensure the strategy is formulated, understood by all stakeholders and is delivered utilising all available resources efficiently and effectively.
– Ensure the development and management of plans.
– Ensure appropriate system and processes are in place to enable the uptake and on-going use of digital referrals by GP’s, hospitals, patients and commissioners.
– Proactively manage the key risks and issues associated with ensuring appropriate actions are taken to mitigate or respond.
– Monitor and establish accountability on the overall progress of the strategy to ensure completion within agreed timescales.
– Manage the budgetary implications of activity.
– Avoid the destabilisation of business as usual.
– Manage and actively promote the relationships with key stakeholders.
The job will be fixed-term until 31/03/2017 and interviews will be held in London on the 20th July 2015.
The big challenge will be to avoid the destabilisation of business as usual – a challenge beyond the ability of one person?