Category Archives: IT-related failures

Did officials exaggerate death of the NPfIT?

Posted on June 14, 2013 | Leave a comment

By T0ny Collins

In 2011 the Department of Health made a major announcement that implied the NHS IT programme, the NPfIT, was dead when it wasn’t.

The DH’s press release announced an “acceleration of the dismantling of the National Programme for IT, following the conclusions of a new review by the Cabinet Office’s Major Projects Authority”.

It said the Authority had concluded that the NPfIT was “not fit to provide the modern IT services that the NHS needs…” The National media took the press release to mean that the NPfIT was dead.

What the announcement didn’t mention was that at least £1.1bn had still to be spent, largely with CSC, provided that the company successfully completed all the work set out in its revised contracts, and that the projected end-of-life of some centrally-chosen NHS IT systems was 2024.

Some will say: who cares if the DH issues a press release that is misleading. Others may say that in a democracy one should be able to trust institutions of state. If the DH issues an official notice that has the effect of manipulating public perceptions – gives a false impression – can citizens trust the Department’s other official notices?

The press release in question did not say the NPfIT was closing but gave that impression. The announcement distanced the government and the Department of Health from an IT scheme, perhaps the world’s largest non-military IT programme, that was failing. This was the press release:

The government today announced an acceleration of the dismantling of the National Programme for IT.

“The government today announced an acceleration of the dismantling of the National Programme for IT, following the conclusions of a new review by the Cabinet Office’s Major Projects Authority (MPA). The programme was created in 2002 under the last government and the MPA has concluded that it is not fit to provide the modern IT services that the NHS needs…”

The press release was given added weight by those quoted in it. They included the Department of Health, Francis Maude, Minister for the Cabinet Office and Sir David Nicholson, Chief Executive of the NHS.

But the truth about the press release emerged this week at a hearing of the Public Accounts Committee.

Margaret Hodge, chair of the Public Accounts Committee, began a hearing on the NPfIT on Wednesday by asking Sir David Nicholson, the NHS chief, a canny question.

Hodge:  “There was a big announcement back in 2011 that you were closing the NPfIT programme.”

“Yes,” replied Sir David.

“That’s not true,” said Hodge. “It was a PR exercise to say you closed it.”

Nicholson: “It certainly was not a PR exercise.”

Hodge: “What changed?”

Nicholson: “The governance arrangements changed.  So there are separate senior responsible officers for each of the individual programmes [within the NPfIT].”

Hodge: “With the greatest respect, changing governance arrangements is not closing the programme.. .I think the impression you were trying to give was that you were closing the programme. All you were doing was shifting the deckchairs on the Titanic. You were shifting the way you were running it but you were keeping all that expenditure running… The impression given to the public was that you were going to get out of some of these contracts.”

On the basis of the press release the Daily Mail published a front page lead story with this headline:

£12bn NHS computer system is scrapped… and it’s all YOUR money that Labour poured down the drain

On the day of the press release the Daily Telegraph reported that the £11.4bn NHS IT programme was “to be abandoned”.  Similar reports appeared in the trade press.

But this week’s Public Accounts Committee heard that the NPfIT is very much alive:

- the estimated worth of CSC’s contracts under the NPfIT has risen from £3.1bn to £3.8bn at today’s prices.

-  officials expected to pay CSC a further £1.1bn on top of the £1.1bn it has already received, and this payment may include up to £600m for Lorenzo deployments at only 22 trusts. Hodge said: “You are going to spend another half a billion with this rotten company providing a hopeless system” – to which the DH argues that CSC has delivered thousands of (non-Lorenzo) working systems to the NHS which trusts and community health services rely on.

- About £500m of the £1.1bn still set aside for CSC will go on GP systems supplied by CSC’s subcontractor TPP Systmone.

- Further spending on the NPfIT may come as a result of Fujitsu’s legal action against the DH after it left the NPfIT in 2008, which leaves the taxpayer with a potential pay-out of £700m or more. The outcome of a formal arbitration is expected in about six months. The closing arguments are due at the end of this month.

- £31.5m has so far been spent on the DH’s legal costs in the Fujitsu case, mostly with the .law firm DLA Piper.

- DH has agreed a compensation payment to CSC of £100m. In return CSC has released the Department of Health from a contractual commitment for 160 NHS trusts to take the Lorenzo system. The DH has made a further payment to CSC of £10m in recognition of changes to its software which had been requested by the NHS but not formally agreed with CSC.

Comment

It appears there has been no deliberate deception and no deliberate manipulation of public perceptions of the NPfIT. But the fact remains that the DH made a major announcement in 2011 which gave the impression the NPfIT was dead when this was not true.

When a BBC Radio 4 journalist called me this week and we spoke briefly about the NPfIT he said: “I thought it was dead”.

Perhaps the mindset of officials was that the NPfIT was dead because everyone except the suppliers wanted it to be. But because local service provider contracts had to stay in place – the suppliers being much better equipped than the DH to handle any disputes over early termination – large payments to CSC and BT had to continue.

It’s a little like the political row over weapons of mass destruction in Iraq. It’s unlikely Blair lied over the existence of WMD. He probably convinced himself they existed. In a similar act of self-delusion officials appear to have convinced themselves the NPfIT was dead although it wasn’t.

But if we cannot believe a major DH announcement one starts to ask whether any of the department’s major announcements can be believed.

Uncoloured information on the NPfIT has always been hard to come by. So credit is due to the Public Accounts Committee and particularly its MP Richard Bacon for finding out so much about the NPfIT.  All credit to Margaret Hodge for picking up on Bacon’s concerns. Were it not for the committee, with indispensable support from the National Audit Office, the DH would have been a sieve allowing only bits of information it wanted to release to pass through.

The fall-out from the NPfIT will continue for years. We still don’t know, for example, what all the trusts with BT and CSC systems will do when the NPfIT contracts expire in the next three years. The hope is for transparency – and not of the sort characterised by the DH’s announcement in 2011 of the NPfIT’s dismantling.

This post also appears on ComputerworldUK

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Posted in BT, Campaign4Change, CSC, governance, health, health records, IT-related failures, legal disputes, Major Projects Authority, NHS, npfit, project management

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How to cost-justify the NPfIT disaster – forecast benefits a decade away

Posted on June 7, 2013 | 2 Comments

By Tony Collins

To Jeremy Hunt, the Health Secretary, the NPfIT was a failure. In an interview with the FT, reported on 2 June 2013, Hunt said of the NPfIT

“It was a huge disaster . . . It was a project that was so huge in its conception but it got more and more specified and over-specified and in the end became impossible to deliver … But we musn’t let that blind us to the opportunities of technology and I think one of my jobs as health secretary is to say, look, we must learn from that and move on but we must not be scared of technology as a result.”

Now Hunt has a different approach.  “I’m not signing any big contracts from behind [my] desk; I am encouraging hospitals and clinical commissioning groups and GP practices to make their own investments in technology at the grassroots level.”

Hunt’s indictment of the NPfIT has never been accepted by some senior officials at the DH, particularly the outgoing chief executive of the NHS Sir David Nicholson. Indeed the DH is now making strenuous attempts to cost justify the NPfIT, in part by forecasting benefits for aspects of the programme to 2024.

The DH has not published its statement which attempts to cost justify the NPfIT. But the National Audit Office yesterday published its analysis of the unpublished DH statement. The NAO’s analysis “Review of the final benefits statement for programmes previously managed under the National Programme for IT in the NHS” is written for the Public Accounts Committee which meets next week to question officials on the NPfIT. 

A 22 year programme?

When Tony Blair gave the NPfIT a provisional go-ahead at a meeting in Downing Street in 2002, the programme was due to last less than three years. It was due to finish by the time of the general election of 2005. Now the NPfIT  turns out to be a programme lasting up to 22 years.

Yesterday’s NAO report says the end-of-life of the North, Midlands and East of England part of the NPfIT is 2024. Says the NAO

“There is, however, very considerable uncertainty around whether the forecast benefits will be realised, not least because the end-of-life dates for the various systems extend many years into the future, to 2024 in the case of the North, Midlands and East Programme for IT.”

The DH puts the benefits of the NPfIT at £3.7bn to March 2012 – against costs of £7.3bn to March 2012.

Never mind: the DH has estimated the forecast benefits to the end-of-life of the systems at £10.7bn. This is against forecast costs of £9.8bn to the end-of-life of the systems.

The forecast end-of-life dates are between 2016 and 2024. The estimated costs of the NPfIT do not include any settlement with Fujitsu over its £700m claim against NHS Connecting for Health. The forecast costs (and potential benefits) also exclude the patient administration system Lorenzo because of uncertainties over the CSC contract.

The NAO’s auditors raise their eyebrows at forecasting of benefits so far into the future. Says the NAO report

“It is clear there is very considerable uncertainty around the benefits figures reported in the benefits statement. This arises largely because most of the benefits relate to future periods and have not yet been realised. Overall £7bn (65 per cent) of the total estimated benefits are forecast to arise after March 2012, and the proportion varies considerably across the individual programmes depending on their maturity.

“For three programmes, nearly all (98 per cent) of the total estimated benefits were still to be realised at March 2012, and for a fourth programme 86 per cent of benefits remained to be realised.

There are considerable potential risks to the realisation of future benefits, for example systems may not be deployed as planned, meaning that benefits may be realised later than expected or may not be realised at all…”

NPfIT is not dead

The report also reveals that the DH considers the NPfIT to be far from dead. Says the NAO

“From April 2013, the Department [of Health] appointed a full-time senior responsible owner accountable for the delivery of the [the NPfIT] local service provider contracts for care records systems in London, the South and the North, Midlands and East, and for planning and managing the major change programme that will result from these contracts ending.

“The senior responsible owner is supported by a local service provider programme director in the Health and Social Care Information Centre.

“In addition, from April 2013, chief executives of NHS trusts and NHS foundation trusts became responsible for the realisation and reporting of benefits on the ground. They will also be responsible for developing local business cases for the procurement of replacement systems ready for when the local service provider contracts end.”

The NAO has allowed the DH to include as a benefit of the NPfIT parts of the programme that were not included in the original programme such as PACS x-ray systems.

Officials have also assumed as a benefit quicker diagnosis from the Summary Care Record and text reminders using NHSmail which the DH says reduces the number of people who did not attend their appointment by between 30 and 50 per cent.

Comment

One of the most remarkable things about the NPfIT is the way benefits have always been – and still are – referred to in the future tense. Since the NPfIT was announced in 2002, numerous ministerial statements, DH press releases and conference announcements have all referred to what will happen with the NPfIT.

Back in June 2002, the document that launched the NPfIT, Delivering 21st Century IT for the NHS, said:

“We will quickly develop the infrastructure …”

“In 2002/03 we will seek to accelerate the pace of development …

“Phase 1 – April 2003 to December 2005 …Full National Health Record Service implemented, and accessible nationally for out of hours reference.”

In terms of the language used little has changed. Yesterday’s NAO report is evidence that the DH is still saying that the bulk of the benefits will come in future.

Next week (12 June) NHS chief Sir David Nicholson is due to appear before the Public Accounts Committee to answer questions on the NPfIT. One thing is not in doubt: he will not concede that the programme has been a failure.

Neither will he concede that a fraction of the £7.3bn spent on the programme up to March 2012 would have been needed to join up existing health records for the untold benefit of patients, especially those with complex and long-term conditions.

Isn’t it time MPs called the DH to account for living in cloud cuckoo land? Perhaps those at the DH who are still predicting the benefits of the NPfIT into the distant future should be named.

They might just as well have predicted, with no less credibility, that in 2022 the bulk of the NPfIT’s benefits would be delivered by the Flower Fairies.

It is a nonsense that the DH is permitted to waste time on this latest cost justification of the NPfIT. Indeed it is a continued waste of money for chief executives of NHS trusts and NHS foundation trusts to have been made responsible, as of April 2013, for reporting the benefits of the NPfIT.

Jeremy Hunt sums up the NPfIT when he says it has been a huge disaster. It is the UK’s biggest-ever IT disaster. Why does officialdom not accept this?

Instead of wasting more money on delving into the haystack for benefits of the NPfIT, it would be more sensible to allocate money and people to spreading the word within Whitehall and to the wider public sector on the losses of the NPfIT and the lessons that must be learnt to discourage any future administrations from embarking on a multi-billion pound folly.

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Posted in Atos, BT, BT Health, Campaign4Change, change, change management, CSC, e-health, excessive secrecy, Fujitsu, health records, IT projects, IT-related failures, legal disputes, Major Projects Authority, managing change, managing outsourced services, NHS, npfit, public sector, public services, Summary Care Record

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Is Major Projects annual report truly ground-breaking?

Posted on May 29, 2013 | 2 Comments

By Tony Collins

Francis Maude, the Cabinet Office minister, describes as “nothing short of groundbreaking” a report of the Major Projects Authority which gives the RAG (Rred/Amber/Green) status of more than 100 major projects.

That the report came out late on Friday afternoon as most journalists were preparing to go home, some of them for the whole bank holiday weekend, suggests that the document was a negotiated compromise: it would be published but in such a way as to get minimal publicity.

Indeed the report is a series of compromises. It has the RAG status of projects but not the original text that puts the status into context.

Another compromise: senior civil servants in departments have persuaded Maude to publish the RAG decisions when they are at least six months old.

This enables departmental officials to argue their case in the “narrative” section of the MPA annual report that a red or amber/red decision is out-of-date and that there has been significant improvement since. This is exactly the DWP’s justification for the amber/red status on Universal Credit.

The DWP says in the MPA report: “This rating [amber/red] dates back to September 2012, more than seven months ago. Since then, significant progress has been made in the delivery of Universal Credit. The Pathfinder was successfully launched and we are on course both to expand the Pathfinder in July 2013 and start the progressive national roll-out of Universal Credit in October.”

That the Pathfinder was launched successfully might have nothing to do with Universal Credit’s amber/red status which could be because of uncertainties over how the IT will perform at scale, given the complexities and interdependencies.  The MPA report says nothing about the uncertainties and risks of Universal Credit.

More compromises in the MPA annual report: the Cabinet Office appears to have allowed departments to hide their cost increases on projects such as HMRC’s Real-time Information [RTI] in the vague phrase “Total budgeted whole life costs (including non-government costs).”

The Cabinet Office has also allowed departments to write their own story to accompany the RAG status. So when HMRC writes its story on RTI it says that “costs have increased” but not by how much or why. We know from evidence that HMRC gave to the Public Accounts Committee that RTI costs have risen by “tens of millions of pounds”. There is nothing to indicate this in the MPA annual report.

Another compromise in the MPA annual report: there are no figures to compare the original forecast costs of a project with the projected costs now. There are only the 2012/13 figures compared with whole-life projected costs (including non-government projected spend).

And the MPA report is not comprehensive. It came out on the same day the BBC announced that it was scrapping its Digital Media Initiative which cost the public £98m. The MPA report does not mention the BBC.

The report is more helpful on the G-Cloud initiative, showing how cheap it is – about £500,000. But there is little information on the NHS National Programme for IT [NPfIT] or the Summary Care Record scheme. 

Yet the MPA annual report is ground-breaking. Since Peter Gershon, the then head of the Office of Government Commerce, introduced Gateway reviews of risky IT projects about 12 years ago with RAG decisions, they have remained unpublished, with few exceptions. The Cabinet Office is now publishing the RAG status of major departmental projects for the first time. Maude says

“A tradition of Whitehall secrecy is being overturned. And while previous Governments buried problems under the carpet, we are striving to be more open. By their very nature these works are high risk and innovative.

“They often break new ground and dwarf anything the private sector does in both scale and complexity. They will not always run to plan. Public scrutiny, however uncomfortable, will bring about improvement. Ending the lamentable record of failure to deliver these projects is our priority.”

Comment

The MPA annual report is a breath of fresh air.

Nearly every sentence, nearly every figure, represents compromise. The report reveals that the Universal Credit project was last year given an amber/red status – but it doesn’t say why. Yet the report has the DWP’s defence of the amber/red decision. So the MPA report has the departmental defences of the RAG decisions, without the prosecution evidence. That’s a civil service parody of openness and accountability: Sir Humphrey is allowed to defend himself in public without the case against him being heard.

But it’s still useful to know that Universal Credit is at amber/red.  It implies well into the project’s life that the uncertainties and risks are great. A major project at amber/red at this stage, a few months before go-live, is unlikely to turn green in the short term, if ever.

Congratulations

The Cabinet Office deserves congratulations for winning the fight for publication of the RAG status of each major project. Lord Browne, the government’s lead non-executive director and a member of the Cabinet Office’s Efficiency and Reform group, has said  that billions of pounds of taxpayers’ money is being frittered away because of “worryingly poor” management of government projects.

“Nobody ever stops or intervenes in a poor project soon enough. The temptation is always to ignore or underreport warning signs,” he says.

The management of some large projects – usually not the smaller ones – is so questionable that departments ignore advice to have one senior responsible owner per major project, says the MPA.

The MPA annual report will not stop the disasters. Its information is so limited that it will not even enable the public – armchair auditors – to hold departments to account. Senior civil servants have seen to that.

But the report’s publication is an important development: and it provides evidence of the struggle within Whitehall against openness. Francis Maude and Sir Bob Kerslake, head of the civil service, have had to fight to persuade departmental officials to allow the RAG status of projects to be published. The Guardian’s political editor Patrick Wintour says of the MPA annual report

“Publication led to fierce infighting in Whitehall as government departments disputed the listings and fought to prevent publication.”

Large-scale change

If Maude and Kerslake struggled to get this limited distance, and there is still so much left to reform, will large-scale change ever happen?

Maude and his officials have as comprehensive mandate for change from David Cameron as they could hope for. Yet still the Cabinet Office still seems to have little influence on departments. When it comes to the big decisions, Sir Humphrey and his senior officials hold onto real power. That’s largely because the departments are responsible to Parliament for their financial decisions – not the Cabinet Office.

Maude and his team have won an important battle in publishing the MPA annual report. But the war to bring about major change is still in its very early stages; and there’s a general election in 2015 that could halt Maude’s reform plans altogether.

The Major Projects Authority Annual Report.

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Posted in capacity building, change, change management, DWP, excessive secrecy, Gateway reviews, Government IT, HMRC, IT-related failures, Major Projects Authority, private sector lessons for the public sector, procurement, project management, public sector, public services, Universal Credit

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Report on status of big Gov’t projects to be published at last

Posted on May 9, 2013 | Leave a comment

By Tony Collins

The Telegraph reports that the Cabinet Office’s Major Projects Authority is about to publish its first annual report – and it will reveal the status of schemes that include Universal Credit, says the article.

The Cabinet Office said in 2011 that the MPA’s annual report would be published by the end of December that year. In 2012 Sir Bob Kerslake, head of the civil service, told the Public Accounts Committee’s Conservative MP Richard Bacon that the MPA’s annual report would be published in June 2012.

But senior departmental  civil servants have objected repeatedly to the red-amber-green “traffic light” status of projects being published, which contradicts the wishes of Kerslake and Francis Maude, the Cabinet Office minister.

One reason for the delay in publishing the MPA annual report is that Maude and Kerslake have been weighing objections to the reporting of the red-amber-green status against the need for departmental cooperation to implement civil service reforms.

From the Telegraph article it appears that Maude has persuaded (or forced) departmental heads to accept the publication of the traffic light status on big and risky projects. The Major Projects Authority reviews IT and other projects costing more than £50m.

The Telegraph says the MPA annual report will reveal Government troubleshooters’ concerns about multi-billion pound projects like the Universal Credit.

The article says the MPA annual report will show that about a third of projects it has reviewed are late or over budget. Says the Telegraph: “Government sources said that the MPA will show that management of big projects has improved significantly since 2010, when two-thirds of programmes were in trouble.

“But the report, expected later this month, will confirm that Whitehall ‘still has a long way to go’ to improve its handling of major projects, a source said.”

The article adds that publication of the annual report “follows a lengthy internal struggle between ministers and civil servants about the disclosure of problems with big Government schemes”.

Some ministers, says the article, are privately concerned that civil servants are bad at managing big, expensive projects but repeatedly cover up their failings and refuse to tell ministers about problems.  Disclosing “candid” assessments about big projects will improve management, ministers believe.

The Telegraph says that a “new publication scheme that will start later this month” will publicly rate each project at red, amber, or green. 

Each central department will be told to publish details of its major projects every six months, including the red-amber-green ratings and the data behind them, says the article.

The Telegraph quotes as a coalition source as saying: “Releasing a candid report about Whitehall’s major projects is a big and brave step for Government…”

Management of big projects better but still generally poor? 

Lord Browne, a lead non-executive in the Cabinet Office and the man appointed to recruit business leaders to Whitehall departmental boards, has criticised the management of major projects as “worryingly poor”.

He said that insufficient attention was given to identifying risks in the planning stage, and that there had been a “consistent failure” to appoint leaders with the right skills and experience.

Browne said the creation of the Major Projects Authority (MPA) in the Cabinet Office in 2011 had improved their delivery, but “nobody ever intervenes in a poor project soon enough” and that warning signs were often ignored or under-reported.

He called for an “ongoing and rigorous review process with real teeth” which would monitor measures of progress and call “time out” on failing projects, allowing them either to be fixed or stopped.

Browne said the government could learn from the private sector, where projects are scrutinised to a “very high standard” before work begins. In line with this, he suggested that the MPA should have a strengthened “stage-gate approval process” to ensure that projects achieve objectives.

He said that projects should not be allowed to begin until a team with the right skills – including a leader who had previously delivered a large, complex project – had been identified.

He also suggested that the MPA nominate leaders and veto unsuitable candidates. He said that expensive projects should “never be seen as a personal development opportunity”.

He advocated using pay, benefits and bonuses to give team members incentives to work on the project “until appropriate milestones are reached”. This, Browne said, had been key to the success of major projects delivered by the private sector.

Departments still sceptical of Maude’s reforms?

Meanwhile the FT has reported that Maude’s attempts to inject commercial acumen into Whitehall by putting leading business figures on departmental boards is failing to live up to its billing, with some departments rarely consulting their external non-executive directors.

The FT says that the Treasury department’s supervisory board met only once in the year to April 2012, according to a report by Insight Public Affairs, a consultancy. The energy department’s board met twice, compared to 15 meetings in the transport department, reflecting the inconsistent involvement of non-executive directors.

John Lehal, managing director of Insight Public Affairs, said the ad hoc manner in which departments held board meetings reflected the need for greater accountability – as underlined by the Treasury’s failure to engage its non-executives.

Comment

At long last the Major Projects Authority, under the straight-talking Australian David  Pitchford, will publish its annual report; and it may contain more detail on major projects than has been published by any government.

As departments fear public embarrassment more than any other sanction, publication of the traffic light status of projects – with the underlying detail – should genuinely discourage the starting of ill-considered projects.

Although the MPA annual report is much delayed Maude has succeeded in getting agreement for it to be published. Provided it contains enough detail to allow the status of projects to be judged by armchair auditors, it should begin to make a real difference.

Telegraph article

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Posted in change management, Gateway reviews, Government IT, IT projects, IT-related failures, Major Projects Authority, openness and transparency, project management, public sector, public services, Real-Time Information, Universal Credit

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Decline of the great British government IT scandal

Posted on May 7, 2013 | 4 Comments

This is a guest post by SA Mathieson, writer of Card declined: how Britain said no to ID cards, three times over .

Whatever happened to the great British government IT scandal?

In the 2000s, such events kept many journalists gainfully employed. Careers were built around the likes of the NHS National Programme for IT and identity cards. But their numbers have fallen away – both the scandals and the journalists – as this government’s programme of austerity reaches even this area of spending.

In seriousness, despite the fact that there are fewer juicy stories, the apparent decline in the number of government IT scandals is clearly a good thing for Britain. But why has it come about; and is it real, or are there problems below the surface?

The Labour government of 1997 to 2010 had a weakness for big IT projects. Some of this stemmed from a creditable wish to modernise the state, but some came from a starry-eyed over-estimation of what IT could do. This may have been generational: its leaders, in particular Tony Blair, liked the sound of IT but had little experience of using it. Mr Blair’s former communications head Alastair Campbell tells a good anecdote about getting a first text message from his former boss after they had left power… sent a word at a time.

Asking too much of IT had serious implications: neither Mr Blair nor a stream of home secretaries ever addressed the serious concerns about the reliability of biometric technology, on which the national identity scheme was heavily dependent, with David Blunkett once telling the Today programme that the scheme would make “the theft of our identity and multiple identities impossible. Not nearly impossible, but impossible”.

Nor did they realise that IT is better at sharing information than securing it – until HM Revenue and Customs lost 25 million people’s personal data on unencrypted discs in the government’s internal mail service in 2007. This over-confidence in technology and security led to other ‘surveillance state’ projects, such as the ContactPoint database of all children and the e-Borders system to monitor all international journeys (the former abolished, the latter only partially implemented with a third of journeys still not covered). 

Mr Blair and his colleagues also ignored what any good technology leader will tell you: that a successful IT project is really about people, organisations and processes. The NHS National Programme for IT did not fail because of IT – parts of it worked fine, and replacement contracts for its N3 broadband network and NHSmail email service are currently being purchased.

The National Programme’s failure came in trying to push individual NHS trusts, which differ enormously, into installing homogenous patient record software.

Implementing such software is difficult enough in one trust – mainly because highly-skilled medical practitioners don’t take kindly to being told what to do, rather than because of insurmountable IT problems – but is still a better bet than trying to impose systems from above.

The present government has learnt that lesson, setting a timescale for electronic patient records’ introduction but leaving trusts to do the work. If some trusts fail to meet this, the result will be local IT scandals rather than a great British one. This is also the level of accident-prone attempts by local government and police forces to outsource IT, such as Somerset’s Southwest One entanglement with IBM.

By downsizing the surveillance state, such as ditching ID cards and stepping back from greatly increased internet monitoring, as well as introducing the likes of Iain Duncan Smith’s Universal Credit in a sensibly incremental fashion,  this government has reduced the likelihood of UK-wide disasters. But while the great British IT scandal has declined, it is not dead. It is just more likely to take place at a local level, away from the national media and political spotlight.

SA Mathieson’s book, Card declined: how Britain said no to ID cards, three times over, reviews the attempts and failures of governments over the last three quarters of a century to introduce identity cards in Britain, focusing on the Identity Cards Act passed in 2006 and repealed in 2010, an issue he covered as a journalist from start to end. It is available as an e-book for £2.99 (PDF  or Kindle and in print for £4.99. 

This article also appears on SA Mathieson’s website.

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Posted in Government IT, IT projects, IT-related failures, NHS, npfit, Universal Credit

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Why isn’t Universal Credit IT a disaster yet?

Posted on April 30, 2013 | 3 Comments

By Tony Collins

voltaireVoltaire said those who walk well-trodden paths tend to throw stones at those who show a new road. 

Iain Duncan Smith has had nothing but criticism in the media for his extreme caution over the go-live yesterday of the innovative Universal Credit scheme. But he told Radio 4’s Today presenter Justin Webb he was learning from the NHS IT scheme and the implementation of tax credits.

[With the NPfIT the Department of Health threw caution to the wind and spent billions on IT work and contracts that were unnecessary. After working tax credits went live the Office of National Statistics estimated that, of the £13.5bn paid out in tax credits in 2004, £1.9bn was in overpayments; and IT-related problems led to delays in issuing payments, which caused hardship for those on low incomes.]

Iain_Duncan_Smith,_June_2007IDS said on R4 Today yesterday:

“What I have introduced here is a deliberate and slower process introduction because I learned from the chaos of tax credits where it collapsed and the chaos of the health department’s changes to their IT systems. I want to do this carefully to make sure we get it right.”

Justin Webb: But your critics say you are not testing the things that could go wrong – children and homeless people are not involved.  When are you going to involve them in a pilot?

IDS: They are all going to be involved as we roll out.

Webb: There will be a pilot that includes those more difficult groups?

IDS: These pilots are to test two things; first of all that the base process works and secondly that all the other issues …

Webb: No homeless people involved in that. The difficult people are not involved?

IDS: What we are doing is testing the basic process. As we roll out from October onwards we then complicate the process and we roll it out in such a way as we are able to bring those people in and ensure that we also test them as we are going through. It’s a perpetual process of rolling out and checking, rolling out and checking. That is the better way to do it. I have done this in the private sector and Lord Freud [work and pensions minister] did this in the banking sector. We have insisted on it because this is the right way to do it. Get it right. Not get it early.

Can IDS be too cautious?

Universal Credit is live on GOV.UK.  To claim it now you need to live in an OL6, OL7, M43 or SK16 postcode, have just become unemployed, fit for work, have no children, not be claiming disability benefits, not have any caring responsibilities, not be homeless or living in temporary accommodation, and have a valid bank account and national insurance number.

But still it’s a test of links between UC  and HMRC’s RTI systems. If the links are working properly the systems should verify that the new UC claimant has recently left PAYE employment. The pilot in Ashton is also a test of the UC payment system and whether the new scheme will encourage claimants to find a job and stay in work longer.

On Sunday, on BBC Radio 5’s Double Take, I praised the Department of Work and Pensions for an ultra-cautious approach in going live with UC.

But IT consultant Brian Wernham, author of Agile Project Management for Government, pointed out to BBC’s World This Weekend that thousands of people will need to claim UC every day from the official start of the scheme in October 2013 to the end of 2017 if the DWP is to complete its UC roll-out within the coalition’s promised schedule.

Yet the limited pilot in Ashton has restricted claimants to about 300 a month. At this rate the roll-out to more than eight million claimants will not be anywhere near complete by the end of 2017.

Comment

The Financial Times quotes Iain Duncan Smith as saying that one million claimants would be receiving universal credit by the end of April 2014.

This is now unlikely if not impossible. Even in October when the UC roll-out begins nationally, it will start with simple cases. By April 2014 it is hard to see that there will be 100,000 people claiming UC, let alone one million. Indeed the most complex cases may be handled outside of the main UC system, possibly manually or on a spreadsheet.

Why should the coalition care if the 2017 deadline is not met? A general election on 7 May 2015 means that UC will become the responsibility of a new government. IDS is then unlikely to be the DWP’s secretary of state. He could argue at that time that he should not be held responsible for any delays in the roll-out. Indeed the Tories could be out of government by then.

So what the coalition says now about UC’s future means little or nothing.

That said, the coalition seems to be learning lessons from past IT-related failures. It deserves praise for its extreme caution over the introduction of UC.

It is not doing everything right: the DWP is refusing to publish any of its expensive consultancy reports on the progress of the UC IT systems. Partly that is because of DWP culture and because shadow ministers are waiting to jump on any putative weakness in the UC scheme. Labour’s shadow work and pensions secretary Liam Byrne said on yesterday’s Today programme that universal credit was “a fine idea that builds on Labour’s tax credits revolution”.

liam byrneHe added: “The truth is the scheme is late, over budget, the IT system appears to be falling apart and even DWP [Department of Work and Pensions] ministers admit they haven’t got a clue what is going on.”

But when Byrne was in government he was an unswerving advocate of the disastrous NPfIT. So can his criticism of the UC project be trusted now?

Despite a generally negative media there are no signs yet that UC is a disaster in the making.  Indeed RTI is working so far, which was the biggest single risk.

Cabinet Office minister Francis Maude is said to remain concerned that UC could prove an electoral disaster, and his concern is good for the UC IT project. It means the coalition will continue to roll out UC with extreme caution.

Such a play-it-safe approach might never have occurred before on a major government IT project. So does it matter that UC  takes years to roll out?

Perhaps the roll-out may continue well beyond 2017 but it’s better to complete a simplification of the benefits system over an extended time than pay claimants the wrong amounts or leave the vulnerable without payment altogether.  

Teething troubles on day one of Universal Credit scheme – Guardian

Could HMRC have a major success on its hands? – RTIis working

The vultures circle over Universal Credit IT.

DWP hides the facts on UC IT progress.

Are civil servants misleading IDS over Universal Credit IT progress?

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Posted in Agile, change management, DWP, Government IT, HMRC, innovation, IT-related failures, Major Projects Authority, Universal Credit

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Somerset County Council settles IBM dispute – who wins?

Posted on March 28, 2013 | 5 Comments

By Tony Collins

Somerset County Council has settled a High Court legal dispute with IBM-led Southwest One. It will bring some services back in-house.

The Conservative leader of Somerset council John Osman said, “This agreement will save Somerset residents millions of pounds and will make the contract fit for the future.”

Osman added that the agreement involves settlement of Southwest One fees, which the council had been withholding, for a mutually- agreed sum.

“Most importantly the cancelling of the gainshare agreement will save Somerset County Council residents millions of pounds in the future as those sums can now be kept by the Council,” said Osman.

But as the deal includes payment of an undisclosed sum by the council to Southwest One it is unclear which side is the beneficiary in the dispute. [See Dave Orr comment on this post.]

The council says the settlement will bring benefits for the council including securing “greater strategic control and capacity back with SCC  in terms of Procurement, Property and ICT”.

The agreement also “removes some barriers to ensure successful delivery of our Change Programme – with greater alignment to the operating model, commissioning capacity, service reviews, and technology enablers.”

And the settlement allows officers to focus on improving services rather than on a series of disputes.

Southwest One had issued a writ against the council – what the authority calls a “substantial claim” – and a date for a High Court hearing was set provisionally for November 2013.  Yesterday [March 27 2013] the council agreed to settle the High Court claim, and an unspecified number of other disputes.   

IBM, Somerset County Council, Taunton Deane Borough Council, and Avon and Somerset Police set up Southwest One as a joint venture company in 2007.  IBM  owns 75% of the company.

Somerset’s officers said in a report yesterday:

“Following a series of discussions between the Council and Southwest One we are now in a position to settle the disputes and the Procurement legal proceedings against SCC will cease.

“The agreement includes a settlement payment to SWO which is substantially lower than the claim against SCC and releases payments to SWO that were held by SCC as part of the dispute.”

Somerset County Council will take back several services and about 100 people who had been seconded to Southwest One. The council says that taking back staff and services will “reduce the potential for further disputes and align those services much closer to the operating model the Council has adopted”.

Services returning to SCC include:

• Strategic and Operational Procurement
• Property Services
• Estates Management
• ICT Strategic Management including some web management posts
• Some business support posts for the above functions

The council says there will be little change in day to day activities and no changes to locations of staff. Somerset’s staff will have their secondments terminated and revert to the council’s terms and conditions.

The High Court action was because of a disagreement  about the quality of Southwest One’s procurement service and what payments Southwest One was entitled to as a result of savings made through the joint venture.

Secrecy

Whereas a High Court hearing would have been open to the public, the sum paid by Somerset to IBM as part of the settlement,  and the risks of bringing staff and services back in-house, are being kept confidential because of what the council calls “commercial sensitivity”.

Risks

Some of the settlement’s main risks for the council are listed in yesterday’s report:

• The confidential nature of the discussions held to secure an agreement has
meant that full consultation with a wide range of officers and partners has not
been possible.
• The transfers of staff and functions will take place during the new financial
year. The proposed transfers create some risk due to SAP changes required.
• There will be some risks in the hand-over of programmes of work.
• Despite all efforts to mitigate risks to services, it is possible that some
disruption may occur. Transition workshops are planned to identify and preempt such instances, which significantly reduces the risk.
• Implications for partners have also been estimated. It is possible that partners
may take a different view of the implications for them.

Blame

Osman blamed the previous Liberal Democrat administration for the problems which he said were owing to the way the contract was worded, the actions of the previous Lib Dem administration transferring services to Southwest One that should never have transferred and the failure to clarify the savings sharing element of the agreement. Osman said this was the “equivalent of the Lib Dems writing a blank cheque”.

The 10-year joint venture, which started in 2007, will continue. 

Comment:

As the terms of the settlement and the risks associated with transferring staff and services back in-house are being kept secret nobody outside an inner circle of the council can know how bad the joint venture and the dispute have been for Somerset council’s taxpayers.

If anything is clear it is that IBM held the dominant legal hand all along. It issued a High Court claim, and now it has received a payment from the council.

It seems to be a feature of big council outsourcing deals and joint ventures that councillors are easily swayed by promises of enormous savings, often upfront savings, and are not too concerned about the risk of things going wrong because they won’t be in office when or if any mud hits the fan.

Yesterday Cornwall Council’s Interim CEO, along with the Chairman of Cornwall Partnership Foundation Trust and the Director of Finance at Peninsula Community Health signed a contract for a joint venture with BT.

As Andrew Wallis, an independent councillor in Cornwall, says

“Lets hope the Council does not regret this day.”

The Southwest One joint venture was flawed joint venture from the time a rushed contract riddled with literals was signed in the early hours of a Saturday morning in 2007.  For years afterwards, Somerset Council has been trying to dig itself out of a hole. It is now near the surface – except that yesterday’s council report says there is a potential for further disputes. 

Will other councils learn from Somerset’s experiences? Cornwall’s deal shows that any learning will be very limited.

And the secrecy that tends to go with big outsourcing deals and joint ventures means that a small group of councillors can sign joint ventures and outsourcing contracts without proper accountability  - and can settle any legal disputes later without accountability, and indeed with impunity.

Whenever a  major supplier offers a council large upfront savings from an outsourcing deal or a joint venture why would the authority’s inner circle of councillors say no?

Thank you to campaigning Somerset resident and former county council employee Dave Orr who provided the links and information that made this post possible.

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Posted in Campaign4Change, IBM, IT projects, IT-related failures, law, legal disputes, local government, managing change, managing outsourced services, outsourcing, public-private partnerships, SAP, supplier relationships

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Francis Maude –“unacceptable” civil service practices

Posted on March 21, 2013 | Leave a comment

By Tony Collins

Francis Maude laments civil service inaction over a cabinet committee mandate for centralising procurement. It “corrodes trust in the system”.

Gus O’Donnell, the former head of the civil service,  confronted Francis Maude, the Cabinet Office minister in charge of civil service reform, on BBC R4’s In Defence of Bureaucracy last week.

The irreconcilable differences between O’Donnell and Maude were obvious and may be a sign of how difficult it will be for the minister to make lasting and deep cuts in IT-based spending, simplify overly complex processes, and reduce duplication.

O’Donnell spoke of the virtues of the civil service that have served the country for more than a century, particularly its impartiality.  But Maude said the “value of impartiality can sometimes turn into indifference”.

O’Donnell said: “We need to be proud and passionate about the public sector ethos…” and confronted Maude for saying things about the civil service “that are not always totally positive”.

francis-maude.jpgIndeed Maude said,

“Most of the civil servants I deal with are terrific, work hard and do really good work.  It is not universal.”

O’Donnell then confronted Maude for saying that ministers in this and previous government have too often found that decisions they have made don’t get implemented. Is that the fault of ministers or civil servants, asked O’Donnell.

“I’d be astonished if it’s ministers,” said Maude who added,

“ I had a meeting the other day around this table …  where a decision was made by a cabinet committee, more than a year ago, on the centralising of procurement. It had happened to a very minimal extent.

“If there is a problem with it, that can be flagged up and tell us. Just to go away and not do it is unacceptable … it is protection of the system. This is the speaking truth unto power thing. What is unacceptable is not to challenge a ministerial position but then not to implement it. That is what corrodes trust in the system.”

About £230bn a year – nearly a third of everything government spends – is on public sector procurement.  In 2010, Nigel Smith, then CEO of the Office of Government Commerce, spoke to the “Smartgov” conference about the need for major reform in the way government buys things.

He spoke of the need for re-useable software, open source if possible, and said that suppliers regularly use fragmentation within government to maximise profits. “This has got to change,” says Smith.

He said there were 44,000 buying organisations in the public sector which buy “roughly the same things, or similar things, in basic commodity categories” such as IT and office supplies.

Massive duplication

He spoke of “massive duplication”, high tendering costs on suppliers, and a loss of value due to a lack of true aggregation. He said suppliers had little forward look of opportunities to tender and offer innovative solutions for required outcomes.

“Contract management with supplier relationship management is inconsistent, with too little attention paid to continuous improvement and benefits capture within contract.

“The opportunity to improve outcomes and efficiency gains should not be constrained by contract terms and innovations should not stop at the point of contract signature.

“If we miss this opportunity [to reform] we need shooting.”

So it is clear procurement [and much else] needs reforming. But in the R4 broadcast last week (which unfortunately is no longer available) O’Donnell portrays a civil service that is almost as good as it gets.

He speaks of its permanence in contrast to transient ministers. His broadcast attacks the US system of government in which public service leaders change every time there is a new government.  The suggestion is that the US system is like a ship that veers crazily from side to side, as one set of idealogues take the captain’s wheel from another. O’Donnell implies that in the UK civil service stability lasts for decades, even centuries.

The virtues he most admires in the UK civil service are what he calls the 4 “Ps” – Pace, Passion, Professionalism and Pride.  His broadcast speaks of the UK civil service as a responsible, effective, continual and reliable form of administration.  

Comment

O’Donnell’s most striking criticism of Maude’s intended reforms of central government goes to the heart of what Maude is trying to do: change what is happening in departments.

When, in the broadcast, Maude suggested that civil servants were not challenging ministerial decisions and were not implementing them either, O’Donnell replied that Maude was “overstating the issue”. But O’Donnell went much further and added a comment that implied Maude should leave departments alone.

O’Donnell said

“These sorts of problems mainly arise when ministers at the centre of government want to impose their will on secretaries of state who want to be left alone to run their departments as they see fit.”

Is O’Donnell giving permanent secretaries and departmental ministers his support if they continue to snub Cabinet Office reforms?

It is hardly surprising Maude is a bundle of frustrations. Central government administration cannot be reformed if departments have the autonomy to refuse to implement decisions of a cabinet committee.

It is ironic that cabinet committee decisions are binding on the entire Cabinet – but not, it seems, on departments.

Perhaps the gap between political and civil service leaders at the centre, and senior civil servants in departments, is as irreconcilable as ever. Today’s UK civil service is more than ever “Yes Minister” without the jokes.  Should this be the dysfunctional basis for coalition reforms of central government?

Perhaps this explains why Maude is trying to implement open standards, make government procurement friendly to SMEs and encourage the use of G-Cloud while the Department for Work and Pensions and the Foreign and Commonwealth Office are  agreeing new mega-contracts,  with the same handful of monolithic suppliers.

Sir Jeremy Heywood, the current Cabinet Secretary,  is perhaps a little more Maude-friendly than O’Donnell when he says in the R4 broadcast,

“There are lots of things we need to do better. Too many projects that we undertake are delayed, are over budget and don’t deliver on all the benefits that were promised. We are not as digital as the most effective private sector organisations are. We have been slow to embrace the digital revolution.”

Fine words. But if a cabinet committee’s decision on centralising procurement has little effect, how is Sir Jeremy going to convert his words into action? Or Francis Maude’s?

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Posted in Campaign4Change, Cloud, Cloud Computing, collaboration, compliance with spending review, cost reduction, EU procurement, G-Cloud, governance, government, Government digital Service, Government IT, IT-related failures, open source, open standards, Politics, procurement, project management, reducing cost strategically, SME, supplier relationships, US Government

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Cornwall Council rushes to sign BT outsourcing deal before elections

Posted on March 8, 2013 | 2 Comments

By Tony Collins

Cornwall council logoCornwall Council was a model of local democracy in the way it challenged and then rejected a large-scale outsourcing plan. Now it has gone to the other extreme.

Amid extraordinary secrecy the Council’s cabinet is rushing through plans to sign a smaller outsourcing contract with BT – a deal that will include IT – before the May council elections.

Councillors who have been given details are not allowed to discuss them. No figures are being given on the costs to the council, or the possible savings. The Council’s cabinet is not releasing information on the risks.

Councillors are being treated like children, says ThisisCornwall. Documents with details of the BT outsourcing plans have to be handed back by councillors, and cabinet papers are being printed individually with members’ names as a watermark, on every page, to guard against copying and to help identify any whistleblowers.

The council’s Single Issue Panel has a timetable for the IT outsourcing plan.

- Recommendation to Cabinet to approve release of ITT – 27 February 2013

- Evaluation of bid – March 2013

- If contract awarded, commencement of implementation work – April 2013

- Staff transfer date – July 2013

The SIP report emphasises that the timetable for signing a deal is tight. “Evidence received is that there is little room for slippage in the timetable, but that potential award of contract is achievable by the end of March 2013… It is expected that a contract could be ready to be issued as part of the ITT [invitation to tender] pack by early in the week commencing 4 March 2013.”

The SIP report concedes that the plan is “fast moving”.

In the past, the SIP group of councillors has been open and challenging in its reports on the council’s plans with BT (and CSC before the company withdrew from negotiations). Now the SIP’s latest report is vague and unchallenging. The risks are referred to in the report as a tick-box exercise. Entire paragraphs in the SIP report appear to have little meaning.

“Risk log and programme timelines are reviewed and updated on a regular basis… 

“The Council and health partners have been working on and have reached agreement on their positions in relation to commercial aspects in the contract and their expectations have been part of the dialogue with BT.”

“Previous concerns of the Panel relating to the area of new jobs have been addressed with BT in contract discussions and contract clauses have been revised to reflect this…”

It is also unclear from the SIP report why the council is outsourcing at all, only perhaps a hint that the deal will be value for money.

“The contract will be fully evaluated by the Head of Finance and her team to ensure value for money once the final bid is received. No savings have been assumed for 2013/14 budgetary purposes, although there are assumptions of savings for the indicative figures for future years,” says the SIP report.

Comment

It is a pity that Cornwall Council’s cabinet is rushing to sign a deal for which it won’t be accountable if things go wrong. In a few weeks a new council will be voted in and, if the outsourcing deal with BT ends up in a dispute or litigation, the new council will simply blame the old, as happened when Somerset County Council’s joint venture deal with IBM, Southwest One, went into dispute.

In essence, with the local elections only two months away, Cornwall Council’s cabinet has a freedom to make whatever decision it likes with impunity; and it appears to be taking that freedom to an extreme, almost to the point of sounding, in the latest SIP report, as if the council is an arms-length marketing agent of BT.

Cornwall Council’s cabinet has a mandate from the full council to move to a contract with BT. The full council has voted to “support” a deal. But that vote was a mandate to negotiate, not to sign anything BT wants to sign.

Openness has gone out of the window and BT, it seems, is no longer being rigorously  challenged – by Cornwall’s cabinet, the full council, the public or the media.

How exactly can BT guarantee jobs and make savings? We don’t know. The Cabinet isn’t saying, and its members are doing all they can to stop councillors saying.

Are BT’s promises reliant on the fact that IT is subject to constant and sometimes costly change – often unforeseen change – and that is bound to continue, at least in the form of supporting changing legislation and reorganisations?

Unforeseen changes could add unforeseen costs which the council may have to pay because IT is at the heart of business continuity.  In any dispute with the council  – and BT knows its way around the world of contested contracts – the company would have the upper hand because of its experience with litigation and the fact that the council would need undisrupted IT at a time of change and could not afford, without risk, to take the service back in-house.

We have seen how normality broke down at Mid Staffs NHS Foundation Trust amid a lack of openness and excessive defensiveness;  and we have seen, in Somerset County Council’s joint venture with IBM, Southwest One, what can happen when a contract signing is rushed.

Cornwall Council’s cabinet is doing both. It is rushing to sign a contract; and it is rushing to sign it amid excessive secrecy.

Surely Cornwall Council can do better than slip into the shadows to sign a deal with BT before the council elections in May?  If it is such a good deal, the new council will want to sign it. A new council should have the chance to do so.

For Cornwall Council to outsource now what is arguably its single most important internal resource – IT – is bad for local democracy: it is snub to anyone who holds true the idea that local councillors are accountable to local people.

Thank you to campaigner Dave Orr who drew my attention to information that made this post possible.

* Cornwall Council, by the way, has one of the best local authority websites I have seen.  If the website is a reflection of the imagination and efficiency of its IT department, Cornwall Council should be selling its IT skills to BT for a small fortune – not giving staff away.

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Posted in BT, Campaign4Change, change management, excessive secrecy, IBM, IT-related failures, legal disputes, local democracy, local government, managing outsourced services, openness and transparency, operational issues, private sector lessons for the public sector, procurement, project management, public sector, public services, public-private partnerships

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Shouldn’t David Nicholson stay?

Posted on March 6, 2013 | 3 Comments

By Tony Collins

Sir David Nicholson seems to have a glass half-full view of life as the Chief Executive of the NHS. Perhaps unfairly there are calls for him to resign over the deaths at Mid Staffordshire NHS Foundation Trust.  He says he did not know what was happening there.

But he was wrong to suggest the problems at Mid-Staffs were not systemic. Fourteen hospitals are being investigated for unusually high death rates.

Nicholson was also wrong in 2007 when he gave a reassuring briefing to the then prime minister Tony Blair on the state of the National Programme for IT. The paper on which his briefing was based was supposed to have been a secret but it was mistakenly put on the web then removed. I kept a copy.

It showed a bar chart that implied that the main elements of the NPfIT were complete.  It said that,

“ … much of the programme is complete with software delivered to time and to budget”.

That wasn’t correct then, or today – which is six years later. The main element of the NPfIT, a national electronic health record, does not exist. Arguably the NPfIT is one of the worst IT-related disasters of all time – and Sir David Nicholson remains its official Senior Responsible Owner. He has defended the NPfIT even after coalition ministers criticised it.

He also personally rejected a call by 23 academics in 2006 for an independent review of the NPfIT. When I was in his company a few years ago he said (politely) that he would not put the idea of an independent review to his ministers.

So why shouldn’t he go? The resignation of one man over pervasive cultural problems within the NHS could be an irrelevance, a harmful distraction. It could imply that the NHS is cured of the pervasive cultural problems highlighted by Francis in his report on Mid Staffs.

Perhaps Nicholson should stay because he is a reminder that the health service’s senior management doesn’t really change however many times new governments impose reorganisations. Particularly at trust board level directors keep the same principles of defensiveness and denial when things go wrong. Nicholson, perhaps, should remain as a symbol of what is wrong with the NHS.

If he resigned, his successor would most likely be appointed by a panel that would be attracted to the virtues Nicholson displayed at his interviews for the job of NHS Chief Executive. In other words Nicholson may be replaced by someone very similar – someone who would, at heart, defend the NHS, and particularly the Department of Health, against whinging outsiders including politicians, the media and patients.

Does a Mid Staffs culture still pervade the NHS?

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Posted in Campaign4Change, culture, e-health, excessive secrecy, health, health records, IT-related failures, NHS, npfit, openness and transparency