Category Archives: Campaign4Change

Mutuals: white paper offers public services choice as Cameron tells Civil Service to take more risks

Posted on 12/07/2011 | Leave a comment

It was unfortunate that yesterday’s press conference to launch the Open Public Services White Paper by David Cameron was hijacked by journalists quizzing him on the ongoing News International story.

The event, organised by Reform in Canary Wharf, also featured speakers from big business i.e. the CBI, the consumer organisation Which, and the voluntary sector – “a Coalition in support of the White Paper,” suggested Cameron.

Detailing the public services landscape, Cameron scarcely mentioned mutuals by name, though they do feature significantly in the White Paper itself.

Modernisation of public services, he said, will give people choice and control over the services they use, and end the ‘get what you’re given’ culture.

People will be given more choice to shape the public services they use, putting control in the hands of individuals and neighbourhoods so everyone can benefit from the best public services available.

“I know what our public services can do and how they are the backbone of this country. But I know too that the way they have been run for decades – old-fashioned, top-down, take-what-you’re-given – is just not working for a lot of people.“Ours is a vision of open public services – there will be more freedom, more choice and more local control. Wherever possible we are increasing choice by giving people direct control over the services they use,” said Cameron, who detailed five core principles for modernising public services: choice, decentralisation, diversity, fairness and accountability.

He also made some key points about change and also about risk-taking for those now in the public sector:

“This is the case for change. If we want to compete in the world; if we want to get value for money; and above all if we want the decent, reliable public services that make life better for people, there will be no progress if we stick with the status quo.  What does change look like? It’s about ending the top-down, big government way of running public services,  and bringing in a Big Society approach, releasing the grip of state control and putting power into people’s hands. The old dogma that says ‘Whitehall knows best’ – that is going.”

“We really need to ensure that civil servants and arms length bodies see that there is a clear set of principles to apply: about choice, about diversity, about payment by results, about the role of private and voluntary sectors.

“The biggest challenge for the Civil Service is to try and adapt to this new culture and also a very difficult thing to do, and an easy thing to say, is that actually civil servants will have to take some risks. We all know that in business it is very easy to award the contract to Price Waterhouse. They’ve done it before, they’re an enormous organisation, they won’t fail. I think there’s a similar tendency within the Civil Service. It’s safe to keep it in house and deal with one of the big providers.

“If we really want to see diversity, choice and competition, we have to take some risks and recognise that sometimes there will be a new dynamic social enterprise that has a great way of tackling poverty or drug abuse or helping prisoners go straight, and we do need to take some risks with those organisations and understand that rather like in business, when you have a failure, that that doesn’t mean that the Civil Service has done a disastrous job.

“In business, we try new things in order to do better, and when they don’t work, we sit back and think, ‘How do we do that better next time?’ We do need a sense of creativity and enterprise in our Civil Service which is clearly there….a change of culture, perhaps a different attitude towards innovation and risk and a sense that that will be a good way of driving performance.”

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This what the White Paper says about public service mutuals:

6.14 We are doing much more than just sweeping away regulations. We are giving public sector staff new rights to form new mutuals and bid to take over the services they deliver, empowering millions of public sector staff to become their own bosses. This will free up the often untapped entrepreneurial and innovative drive of public sector professionals.

6.15 Ownership and control, through mutualisation, empower employees to innovate and redesign services around service users and communities, driving up quality. We will not dictate the precise form of these mutuals; rather, this should be driven by what is best for the users of services and by employees as co-owners of the business. Options include wholly employee-led, multi-stakeholder and mutual joint venture models.

6.16 The Government will take steps to identify and overcome the barriers placed in the way of public sector workers who want to exercise these rights.

6.17 Public sector employee ownership: the key policies we are already implementing include:

  • Right to Provide – we are giving public sector workers who want to form mutuals or co-operatives to deliver public services a Right to Provide. This will enable public sector workers to form independent, or joint venture based, mutual and co-operative social enterprises. Progress is already being made with a new Right to Provide for NHS staff and opportunities for local authorities to invoke the Right to Challenge;
  • mutual pathfinders – the first wave of employee-led mutual pathfinders was launched in August 2010 with a second wave announced in February 2011. These pathfinders are being mentored by expert organisations as well as leading figures in social enterprise and public service to support their growth and share best practice; the pathfinders will provide critical learning as more employees look to exercise these rights;
  • Mutuals Task Force – Professor Julian Le Grand, one of theUK’s leading thinkers on public service reform, has been appointed to lead a Task Force to push employee ownership across the public sector;
  • Mutuals Support Programme – we will invest at least £10 million in the Mutuals Support Programme, to support some of the most promising and innovative mutuals so that they reach the point of investment readiness. This support will be available from autumn 2011;
  • Enterprise Incubator Unit – this has been set up within the Cabinet Office to provide advice, challenge and resources for public service providers from central government departments and their agencies who want to move from the public sector to the independent sector. The unit will help management teams to restructure themselves and their teams into independent businesses, which may include partners providing finance or expertise, for example through a joint venture;
  • Post Office mutualisation – In May, Co-operativesUK published a report commissioned by the Government on options to transfer Post Office Ltd from government ownership to a mutual run for the public benefit. The Government will carefully consider this report before launching a public consultation later this year; and
  • My Civil Service Pension (MyCSP) – plans have been announced for MyCSP to become the first mutual enterprise to spin out of a central government service. MyCSP administers Civil Service pension schemes for 1.5 million public sector workers. MyCSP’s plans to mutualise, which have the full backing of the Government, will give employees a stake in the new business, alongside government and a private sector partner. The innovative ownership model will be matched by a participative management approach: there has already been a strong turnout in elections for the Employee Partnership Council, through which employees will have a meaningful say in the running of the business.
Enabling new provision

7.7  Creating open public services will require new types of investment in public services: investment of money, inspiration and entrepreneurial effort. The Government will promote the opportunities being created by open public services, tailored to individual sectors. This promotion will aim to support:

  • accessing new forms of external finance – there is an exciting set of opportunities to bring new forms of finance into public services. This includes social investment (e.g. social impact bonds); payment for results on capital improvements (e.g. energy efficiency) and the financing of modernisation programmes (e.g. joint ventures to introduce new technology). Work is under way to develop effective measures of the social impact of investment and to launch the Big Society Bank, which will catalyse the growth of a sustainable social investment market;
  • empowering public sector staff to take control of their own services in new enterprises like mutuals – the creation of mutuals is a critical step in achieving more diversity in public services. However, we recognise that this is a big step to take for both staff and the public body that employs them. We will set out a full range of support available to those who are considering setting up a mutual, in the same way that we seek to stimulate both voluntary and private sector development. This will include a £10 million Mutuals Support Programme to provide support to fledgling mutuals that are being set up to deliver public services by employees leaving the public sector; and
  • actively encouraging new providers, of all sizes and from all sectors, to deliver public services– when we say we want diversity in public services, that is exactly what we mean. We will take active steps to avoid simply switching from one type of monopoly to another. We will launch a positive action programme to improve the awareness of public service opportunities to new providers, especially small and medium-sized enterprises. Many of our policy changes have already opened up attractive new opportunities, for example in the Work Programme and through personal budgets in social care. In addition, we will take positive action on procurement and through regulators to ensure that other opportunities (e.g. in central government procurement) are opened up to new types of provider, be they from the public, private or voluntary sector.

If you want more details, you can access the White Paper here – and the Government has unveiled an Open Public Services website

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Firecontrol shows how much Major Projects Authority is needed

Posted on 07/07/2011 | Leave a comment

When an investigative team from BBC File on 4 went to a business estate near Taunton, they saw an empty “hi-tech fortress” that looked like a NASA control room.

Nobody was working there. Nearly an entire wall of the control room was fitted with 50-inch monitors – 20 of them. They were blank.

That centre – and a further eight purpose-built buildings like it – remain empty because control room software has yet to be installed.

The £469m wasted on the centres and the failed IT project to support them – together called Firecontrol – was the subject yesterday of a hearing of the Public Accounts Committee.

Mistaken recommendation

At the hearing Sir Bob Kerslake, Permanent Secretary, Department for Communities and Local Government, said that officials made a “mistaken” recommendation to go-ahead of a new IT and control centres for fire services.  

Kerslake accepted points made the Committee’s chair Margaret Hodge that officials recommended the go-ahead of the Firecontrol IT project without reliable figures on likely costs, savings or benefits

No finalised business case or project plan 

Also absent when the IT procurement went ahead was a finalised project plan or business case, MPs heard yesterday. The full business case for Firecontrol wasn’t published until June 2007, three years after the start of the IT project. A revised business case was published in 2009, the year before the project was cancelled. 

Rush to buy new systems – as with the NHS IT scheme

The Committee was told that procurement of new systems was underway by May 2004, amid a deep level of ignorance, because officials were in a rush.

It was a similar story on the NPfIT: officials were in a hurry to complete the procurement of new systems. And as with the NPfIT, there was no local buy-in. “Firecontrol was flawed from the outset because it did not have the support of the majority of those essential to its success – its users,” said the NAO.

Local fire services were under no statutory duty to use the regional control centres. As with the NPfIT, central government officials thought they could persuade local services to use the centres. They failed.

Firecontrol has lost a minimum of £469m, according to the NAO. The Department cancelled the scheme in December 2010 because of continued uncertainties. The coalition has approved a new project due to cost about £84m – which prompted MPs to ask yesterday why the original scheme could not have been done much cheaper.

What about the officials who made the flawed recommendation to go ahead?

Margaret Hodge, chair of the committee, asked Kerslake why his department did not seek a “ministerial direction” before embarking on a project that was so flawed. Ministerial directions are issued by departments’ most senior civil servants when they disagree with their minister’s decision so strongly that they refuse to be accountable for it.

Kerslake replied that no ministerial direction was issued because it was officials who were recommending the project’s go-ahead.

Said Kerslake: 

“I don’t think it came to that [Ministerial Direction] because the view of officials was to recommend, with some of issues identified as concerns, that the scheme went ahead. This was not a case where a Direction would have applied because the recommendation from officials, as I understand it, was to go ahead with the scheme.”

MPs heard that Kerslake was a non-executive director at the department when the decision was taken to go ahead with Firecontrol. Didn’t he object to the scheme’s approval?

Kerslake said he raised concerns to the board about the large scale of the investment compared to the problem. “The concern I had at the time, whether fire and rescue services were willing to take on this technology, were all points that were discussed. The view of the officials on balance at the time was that the benefits of doing the scheme outweighed the risks and costs.”

Kerslake said that as a non-executive he was on the board in an advisory role.

Conservative MP Richard Bacon, a long-standing member of the committee, asked Kerslake if his scepticism as a non-executive was recorded.

“It was clearly part of the discussion. I have not gone back and checked every note of the meetings.”

Comment:

MP Richard Bacon suggested yesterday that the only accountability for the failure of the project was Sir Robert Kerslake’s having an uncomfortable two hours before the Public Accounts Committee.

As for his officials, the only accountability for the waste of £469m was to sit in seats behind him, periodically passing him notes. An observer at the hearing said public seats in the committee room “seemed to be packed full of advisers passing notes to the four people hauled before the committee”.

It’s a civil service tradition that officials are not generally held responsible for recommendations because the final decision on major projects is taken by the department’s minister; yet ministers will tend to know only what they are told by department’s civil servants. 

If the officials are incompetent in drawing up their recommendations, they may be incompetent in the briefings they give their ministers.

Even so it would be a brave minister who rejected the recommendation of permanent and supposedly expert staff.

That’s why the coalition’s setting up of the Cabinet Office’s Major Projects Authority is such a good move: it will challenge departmental complacency and over-confidence in its own abilities and decisions. 

Cabinet Office Francis Maude announced on 31 March 2011 that “from today all major projects will be scrutinised by the new Major Projects Authority”. 

Most importantly it has powers from the Prime Minister to oversee and direct the effective management of all large-scale projects. Though there are still uncertainties among Cabinet Office officials about the extent to which the Major Projects Authority can intervene in major projects, it has an enforceable mandate from Cameron to scrutinise proposals for major projects; and the Authority is run by the redoubtable Australian David Pitchford who reports to the Cabinet Office’s Chief Operating Officer Ian Watmore whose brief includes making efficiency savings.

With the Major Projects Authority central government has the chance to stop flawed projects such as Firecontrol going ahead. Yesterday’s PAC hearing showed how badly the Authority is needed as an independent challenge. The existence of the Authority is one of the most important developments in government IT for decades – provided it makes effective use of the PM’s mandate. 

Firecontrol chiefs list reasons for project’s collapse.

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Posted in Campaign4Change, npfit, public sector, public services, supplier relationships, Uncategorized

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Would-be mutuals must overcome fear of failure and embrace risk

Posted on 07/07/2011 | Leave a comment

By David Bicknell

A lack of confidence and fear of failure must be overcome if the government’s goal of seeing employee-led mutuals take off is to be achieved.

The government believes that by 2015, one in six public servants could be involved in mutuals. The problem is giving them the confidence to use their undoubted knowledge of public service delivery and take advantage of the flexibility that running your own business brings, as opposed to the frustrations of years of a ‘can’t do’ approach that meekly says ‘..but we’ve always done it this way.”

As a number of speakers at the Civil Service event – including Peter Marsh, vice-chair of the Mutuals Task Force, My CSP head Phil Bartlett, and Mitie’s chief executive Ruby McGregor-Smith – suggested, those within the public sector, and especially the Civil Service – do have the ability to overcome their fears of failure, and indeed, as it emerged from one mutuals seminar, their worries about competing against the private sector or their discomfort about having some ‘conflict of interest’ within the wider public sector about using their knowledge to set up a mutual. As was pointed out, using that knowledge and embracing the flexibility of running your own (employee-owned) ship, is just what the Cabinet Office wants them to do.

More on Civil Service Live to follow. In the meantime, the Guardian is carrying an excellent piece on fear of failure and the acceptance of risks in mutuals.

You can read it at http://www.guardian.co.uk/social-enterprise-network/2011/jul/06/fear-failure-public-service-mutuals

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Mutuals bring relief after the public sector moratorium

Posted on 05/07/2011 | Leave a comment

The public sector landscape is likely to be dominated by mutuals in the future.  In this guest blog, John Pendlebury-Green and John Jones of Landseer Partners discuss the outlook for service providers in this mutualised world and argue that their approach must be both innovative and flexible.

Last year was a difficult one for service providers to the public sector given the moratorium and general economic slow-down.  Despite a relatively slow start 2011 is looking significantly brighter for existing and new entrant market players.  The Government’s plans to achieve cost savings, develop mutual organisations, and use SMEs and the third sector to develop new ways of delivering services, are moving rapidly from theory to reality.  So, with the white paper on Open Public Services due out in July, now is the right time for both large and SME service providers to look at themselves and work out how they should be playing in this new world.

We wrote about the concept of mutualisation in early 2010. It has taken the Government longer to get to this point than we expected but the number and variety of public sector organisations looking at mutualisation in one form or another is impressive. The opportunities are starting to appear: from Camden Council looking at how all of its services can be delivered to Cleveland Fire Service receiving approval to finalise a business plan and a structure to establish an employee-owned mutual.   In central government the announcement that My Civil Service Pension is going to be placed into a mutual joint venture is the first major “spin out” of a central government service giving employees the opportunity to take a stake in their business.

So with Francis Maude now talking about an expectation of up to a million public sector workers being in mutual organisations by 2015, the scale of the government’s ambition for mutualisation is clear.  With these types of numbers being talked about it makes it obvious that a one-size-fits-all approach by service providers is doomed to fail.

Our view is that service providers, including possible new entrants, will need to invest time and money now by discussing with existing and new clients the art of the possible: what can be achieved in setting up mutual organisations in order to deliver jointly and successfully services that will provide the right outcomes to the customers of the mutual.

This is most likely to be in the form of working with the public sector organisation to help define the vision and outline structure, and identify the stakeholders – from users to the Cabinet Office – who need to agree the idea.  Then the service provider is ideally positioned, given its private sector experience, to help develop the business plan.  The plan needs to cover the services to be provided, the market opportunity to provide additional services and the resourcing and finances needed to make the new business work.

How this works in practice will be closely examined and no doubt later mutuals will learn from any mistakes in setting up the initial ones.  So the success of the pathfinder mutuals and high-profile examples such as My Civil Service Pension will examined very carefully.   It is clear that how the successful private sector service provider and any third sector organisations become part of these new entities, and how the governance, structure and profit share will work, will set the tone for subsequent mutuals.

Now at mid-year in 2011 it is still early days for new ways of working with the public sector.  If events to date have not spurred service providers to action the July white paper should certainly do this. Either this, or the significant number of re-tenders now coming onto the market, should provide some welcome relief compared to the slow down in 2010.

For more details, read the white paper or visit Landseer Partners’ website

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Engaging with the disengaged on sustainability

Posted on 05/07/2011 | Leave a comment

By David Bicknell

Sustainability has made it onto the business agenda of most large organisations. Admittedly some organisations treat the sustainability reality more seriously than others:  some will use it as a competitive enabler, or to beef up their brand identity. Others will use it as a means of cutting costs: i.e. ‘talk green, mean lean.’

Whatever their commitment, there are precious few organisations that have not had some discussions about either sustainability in their supply chain, or their corporate social responsibility, or  how they can engage with their customers on green issues.

Sometimes, however, ‘engaging’ is easier said than done. Preaching to the converted is fine – but it’s the unconverted that need to be enlightened. This was the subject of a recent event in Reading hosted by Clarkslegal and organised and moderated by C8 Consulting.

The attendees included Connect Reading, Kyocera Mita, Global Cool Foundation, Locus, Reading Borough Council, Ennismore Partners, The FD Centre, Integral, Jacobs Engineering, Reading Football Club, Graft Thames Valley, CBS Business Interiors, Thames Water and the Campaign4Change.

One of the key topics discussed was the need to find a way of making sustainability desirable. As Global Cool put it, ‘Climate change doesn’t have an awareness problem. But it does have a marketing problem. Almost everyone is aware of the climate issue, but only a minority are changing their lifestyles to reduce carbon. Remember the old adage, “If what you’re doing isn’t working, do something else.”

Companies sell products which are fabulously profitable. But they do it not by talking about profitability, but by showing how cool and desirable the product is. The same must go for sustainability. That means not talking simply about sustainability – because most people aren’t interested – but showing how lifestyles and products which happen to be sustainable, are in the ‘customer’s’ interests.

Another issue discussed is the challenge of getting SMEs engaged on sustainability. The problem is that in today’s economic climate, most SMEs are running around just trying to keep their businesses afloat. Sustainability – or ‘green’ – just doesn’t register. Even the various loans, grants etc available pass them by, because in many cases, they have to spend to get matching grants ‘to save’.

The idea was mooted that maybe SMEs might have more clout – and more interest in what they could save off their energy bills – if they had a bigger voice. One large voice composed of a million smaller voices carries more clout than one single voice. It’s the difference between a choir and a chorister. Perhaps this model for SMEs demands more exploration. For the moment, however, the sustainability – and potentially lower cost – message is being drowned out by the ‘bigger drumbeat’ for the SME –  of customer retention and acquisition – and survival.

More thoughts on this subject to follow.

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Posted in Campaign4Change, Climate Change, greentech, sustainability

Parliamentary Committee to discuss the role of mutuals this week

Posted on 04/07/2011 | Leave a comment

By David Bicknell

Parliament will discuss the prospects for mutuals at a meeting of the House of Commons Public Administration Select Committee tomorrow morning.

The session, the Committee’s fifth instalment of its Big Society Inquiry, will focus on the Government’s intention to diversify the provision of public services by opening them up to charities, social enterprises, mutuals and the private sector. The Committee will hear from representatives of the voluntary sector and the TUC, Professor Julian Le Grand and Ed Mayo from the Cabinet Office Mutuals Taskforce, and Shona Nichols from business process outsourcing company Capita.

The Committee’s questioning is likely to cover

  • obstacles to voluntary sector organisations delivering public services;
  • the work of the Government’s Mutuals Taskforce in driving forward employee ownership of public services; and
  • the role of the private sector in the Big Society.

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12 good reasons to mutualise

Posted on 01/07/2011 | 1 comment

By David Bicknell

There are 12 good reasons to mutualise, according to City law firm Field Fisher Waterhouse (FFW)

FFW has advised on the restructuring of NHS Hull’s community health services to became an example of how public services could be transferred to an employee led social enterprise, City Health Care Partnership CIC.

12 months into the project, says FFW, City Health Care Partnership CIC is enjoying the benefits of becoming a social enterprise which demonstrates that the drivers for social enterprise and public service mutualisation are as valid as ever.

These benefits, FFW says, include:

  1. Improved staff motivation
  2. Improved customer (i.e. patient) satisfaction
  3. Leaner and more efficient structures
  4. More responsive services
  5. Real teamwork
  6. Opportunities to grow the business
  7. Strengthened connection to the community
  8. Flexibility and agility
  9. Less red tape – ability to introduce better ways of
    working, more quickly
  10. Greater sense of inclusiveness and participation
  11. Control of destiny
  12. Ability to contribute to the wider needs of target
    communities

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Could a new mutuals model work for trading standards?

Posted on 30/06/2011 | Leave a comment

By David Bicknell

A mutuals-like model for trading standards has been proposed by Consumer Focus, the statutory consumer champion, which in a paper, discusses the future of trading standards in light of spending cuts, the Government’s new empowerment strategy and changing consumer power.

The paper, ‘Hard times or our mutual friend’, by Paul Connolly,  is an excellent read and argues that the Trading Standards community should engage with another Government agenda:  mutualisation.

It says:

“Cabinet Office Minister Francis Maude wants to see mutuals widely adopted. He suggests within 10 years they will become ‘one of the major types of organisation providing excellent public services’ in a redistribution of power and ownership comparable with 1980s reforms.

“His reasoning is clear. First, he wants to continue the process of public service reform by ensuring direct ‘in-house’ delivery continues to be ‘contested’. In the past this primarily meant outsourcing. Plainly under this administration private providers will continue to feature in service delivery. However, the Government has indicated it wants a more diversified range of providers, including more small and medium enterprises (SMEs).

“Further, creating mutual structures can contest services, while empowering staff and short circuiting the public/private antagonism.

“Indeed, workforce empowerment is key. Mutualisation and outsourcing to SMEs, cooperatives and charities, are both connected with Big Society thinking. Government wishes to divest itself of direct responsibility for state delivery, but to do so in ways which spread associated commercial opportunities to those who have not benefited previously.

“This includes giving opportunities to existing public sector staff. Indeed, enthusiasts for mutuals believe workforce energies can be harnessed to support reform. Frontline staff understand their services, but are often inhibited from innovating by constraining bureaucracy.

“Decoupling mutuals from bureaucracies and giving staff stakes that link productivity to personal rewards encourage entrepreneurship and improve standards.

“Mutuals are not a ‘fluffy’ option. They are run as businesses. But the staff engagement model of mutuals, where rewards are linked to innovation, service improvement and productivity gains, means there is a real prospect of harmonising the interests of service producers and the individuals and communities they serve.

“There are many challenges associated with mutualisation. Is the largest public sector retrenchment in history the ideal moment to encourage people to risk a semi-commercialised model of delivery? Should staff downsizing precede or follow mutual incorporation? And how on current trends will the numbers mutualising substantiate Maude’s claims of an importance comparable with privatisation?

“The 12 pilots on the Cabinet Office website are pretty small, niche services, mostly in the health and social care arenas. Small and mutualisation might be perceived as a natural match, but there’s nothing to stop a whole agency, hospital, or local authority mutualising, John Lewis-style, or a series of small thematically-linked mutuals being incorporated under a franchising umbrella, like the Co-Op. Whatever, a substantial increase in adopters will be needed to match Maude’s ambitions. That will mean lots of services taking a risk. The danger for this intriguing agenda – which has attracted interest across the political spectrum – is that it doesn’t fly because volunteers are few.

“Nevertheless, Government continues to signal its intent in this area. Mutualisation is being strongly encouraged in areas of health, such as community care. The Public Services (Social Enterprise and Social Value) Bill is intended to put wind in the sails of mutualisation, while the Localism Bill calls for staff-managed approaches to be among the options considered in re engineering local services.

“The Trading Standards profession could do Francis Maude and themselves a favour by ‘going mutual’. Under the leadership of the Trading Standards Institute (TSI) – itself already in effect a social enterprise – and the Trading Standards Policy Forum, with possible input from Local Better Regulation Office (LBRO), one of two approaches could be adopted: a national super-mutual, covering England initially, but evolving to the devolved contexts following suitable negotiations, could be formed.

“It would be a single incorporated body. It would have a national head office. It would co-ordinate the use of any resources it received from central Government (the implied new BIS monies for instance) to address complex, nationwide and international threats. It would oversee and co-ordinate the delivery activities of suitably located regional, sub-regional and local offices.

“The mutual’s services would be purchased by local and central Government to meet statutory Trading Standards obligations.

“A second option, perhaps more realistic given that some Local Authority Trading Standards Services (LATSS) partnerships have already incorporated as businesses, would be for TSI and the other players to create a mutuals confederation. This would be a franchise support hub for a national network of local mutuals, each created as and when individual LATSS departments chose to incorporate. The hub would again attract funding for national projects and but would also co-ordinate the activities of the network, providing mechanisms for collaboration between local mutuals, and new sub-regional and regional structures, where appropriate.”

It is intriguing to see the mutual model being considered in this way. I hope for those considering creating mutuals, that the Consumer Focus trading standards paper might offer some useful ideas. It’s certainly worth a read – and we’d be interested in your comments.

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NHS IT supplier “corrects” Health CIO’s statements

Posted on 30/06/2011 | 3 comments

An IT supplier to the NHS has written to MPs to “correct” statements made by Health CIO Christine Connelly.

The implications of the supplier’s corrections are that Conservative MP Richard Bacon might have been right all along:  that the Department of Health may be paying BT as much as £200m more than necessary to install the “RiO” patient record system at 25 trusts in the south of England.

The corrections by CSE Healthcare Systems – supplier of RiO – call into question some of the Department of Health’s justifications for the high costs of NPfIT versions of RiO.

RiO is an electronic patient record system that is supplied to mental health trusts and community service organisations. Trusts can buy directly from CSE Healthcare or via its partner BT Global Services which is the local service provider to London under the National Programme for IT.

Through the NPfIT, BT is installing RiO at 25 trusts in the south of England under a £224.3m NPfIT deal – £8.9m per site, compared with £500,000 to £1.5m per site if supplied to the NHS directly by CSE outside of the national programme.

At a hearing of the Public Accounts Committee on 23 May 2011, Conservative MP Richard Bacon asked Connelly to explain why RiO costs so much more when it is supplied by BT.

Connelly told the Committee that the Department of Health had investigated the RiO costs at Bradford District Care Trust, which is a mental health trust.

Bradford bought RiO outside the NPfIT, using the ASCC framework contract, which enables trusts to buy systems directly from suppliers without going through NPfIT local service providers.

The total cost of RiO at Bradford was £1.3m, which Connelly said was for a 59‑month contract.

She told MPs:

“So the comparison: in terms of the services that we provide, there are a whole set of services that are not within that £1.3m that are inside the Local Service Provider contract.

“Earlier somebody said, ‘Well, doesn’t everybody have disaster recovery.’  Well, actually, no, and at this Trust only 25% availability is provided in their local arrangements, which are not included in these costs.

“So we have a cost in terms of the BT LSP in the South for the same period, which includes the hardware, the support, the disaster recovery at 100%, the Spine connectivity, all of which are not supplied inside this Bradford system.

“If we looked at those costs through BT’s cost profile, it would be valued at £2.5m.”

Bacon pointed out that £2.5m was still much less than £8.9m being charged by BT. He wanted the difference explained.

Connelly said:

“So first there is the period. So we need to take a look at the average period that you would expect to be there, because we pay a one‑off deployment charge and then we pay a monthly charge.  So in terms of the figure that you quote, it is generally for about a four-year period, and the figure we quote is generally for about a six-year period, sometimes a little more.  I think what we get is 24/7 support.

“We get full disaster recovery.  I think it is fine to say, “Oh, anybody has that.”  The cost of full disaster recovery is significant, when you look at the costs that BT have; we invited an external auditor to go look at the cost build-up, and they have audited these costs.  We looked at BT’s profit margin, and they have taken a significant reduction in their profit margin between the original contract and the contract that we have today…”

To which Bacon replied:  “But it is not the taxpayer’s fault if BT has unbelievably high costs.”

Bacon said that one reason the costs are so high is that CSE cannot talk directly to NHS trusts and must go through BT.  “That is the problem with this structure,” said Bacon. “It is like having you over here, and the customer over there, and an enormous thicket, a forest of lawyers, in between.”

Connelly replied that a change to the programme means that suppliers of RiO are now on site “talking to Trusts themselves”.  In London and the South, for RiO, a new user group brings together all the Trusts. Cerner, the supplier of NPfIT patient administration systems in London and the south of England, also deals directly with trusts rather than through BT, said Connelly.

Taking issue with Connelly’s comments about Bradford, this was CSE’s written statement to the Public Accounts Committee:

“During the evidence presented by Ms Christine Connelly, one of our contracts for RiO,  Bradford Mental Health Trust was referenced.

“Ms Connelly’s statement was that Bradford is receiving a lower standard of service than provided by BT in London and hence the lower price charged by CSE Healthcare Systems to Bradford.

“CSE Healthcare Systems wishes to correct the evidence given.

• Ms Connelly stated that the service is NOT 24*7 hours – the service is a 24*7 service.

• Ms Connelly stated that Disaster Recovery (DR) was NOT included in the service – a DR service is included.

• There was no mention of Facilities Management – we provide remote Facilities Management

• The service contract is for five years – not four years as stated.

• Ms Connelly implied that the system only had 25% availability – our records demonstrate that this is not true; the system is architected to achieve an availability of over 99%.”

**

Another NHS IT supplier Maracis has provided evidence that RiO costs several times more under the NPfIT than outside the programme, for similar levels of service, disaster recovery, availability and support periods.

On its website CSE Healthcare says its system is compliant with the NPfIT data “spine” and supports established standards for interoperability such as HL7 and XML.

The Public Accounts Committee is finalising a report on the NPfIT detailed care record systems. Its findings will be based on its questioning of Connelly and other witnesses, written evidence from CSE and others, and a report of the National Audit Office in May.

Connelly, who is Director General of Informatics, has announced she is leaving at the end of this month, after three years. She is being replaced in the interim by Katie Davis, who is from the Cabinet Office.

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MP questions why IT costs at two nearby hospital trusts are vastly different for similar systems

Posted on 28/06/2011 | 4 comments

By Tony Collins

A Conservative MP has asked the NHS Chief Executive Sir David Nicholson to explain why an NHS trust is deploying a centrally-chosen Cerner patient record system at more than twice the cost of a similar but non-NPfIT system at a nearby Foundation trust.

University Hospitals Bristol NHS Foundation Trust is deploying the Medway system from System C  (now owned by McKesson] at a reported cost of £8.2m over seven years. The acute trust is one of the largest in the country.

With support for less than five years, the nearby North Bristol NHS trust is taking the Cerner Millennium patient record system under the NPfIT at a cost of £21m from BT – and the go-live date in June has slipped to July.

Now Richard Bacon, a member of the Public Accounts Committee, has written to Sir David Nicholson asking for an explanation of why the two trusts are paying vastly different amounts for systems that do similar things. Bacon has also asked Nicholson whether he believes the higher sum is value for money.

The average cost of BT Cerner go-lives under  the NPfIT is £28.3m according to the National Audit Office.

Bacon’s letter is part of evidence which suggests that continuing NPfIT contracts is costing hundreds of millions of pounds more than necessary.

The coalition government, despite its plan to cut public sector IT costs, may spend a further £3bn to 4.bn with the NPfIT’s two major suppliers, BT and CSC, though the Cabinet Office’s Major Projects Authority is reviewing CSC’s £2.9bn worth of contracts.

Bacon’s letter also questions advance payments to CSC, and whether a recent hearing of the Public Accounts Committee was told the full truth.

An unwavering defender of the NPfIT, Nicholson is likely to defend the cost of the North Bristol implementation, and the advance payments to CSC. On costs, he will argue that North Bristol’s systems have better resilience than at non-NPfIT sites.

If that were true – and there is no evidence it is – the extra costs of having a “hot”, or real-time standby data centre, may not justify a doubling of a rival’s prices. 

This is Bacon’s letter to Sir David Nicholson:

Chief Executive, National Health Service, Department of Health, Richmond House, London SW1A 2NS

27 June 2011

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I am writing following the hearing of the Public Accounts Committee on Monday 23 May 2011, to follow up on two important issues that were raised during your evidence:

ADVANCE PAYMENTS TO SUPPLIERS

In your supplementary memorandum to the PAC following the hearing you gave a total of advance payments made up to 31 March 2011, in respect of all contracts over the whole period of the Programme, of £2,532m of which suppliers have retained £1,328m. You also identified a further £119 million of advance payments to be earned or refunded.  Since the memorandum was received by the PAC, it has been reported that the NHS made an advance payment of £200 million to CSC in April 2011.

I should be most grateful if you would let me know the answers to the following questions:

Is this report accurate?

Why was this payment was not reported to the PAC, either during the hearing or in the subsequent memorandum?

What was the justification for this payment and what value does it represent to the NHS?

What will happen in respect of this payment if a new memorandum of understanding is not in fact signed with CSC?

I would also be grateful if you would comment on the CSC filing with the US Security and Exchange Commission, which states that in the opinion of the company, if the NHS were to terminate the current contract “for convenience” it would owe fees totalling less than the $1 billion asset value CSC now has on its books for the contract.  

How is this consistent with the claim at the PAC  hearing by Ms Connelly that the cost of terminating the CSC deal could “potentially leave us exposed to a higher cost than if we completed as it stands today”?

2. THE COST OF DEPLOYING CERNER MILLENNIUM AT NORTH BRISTOL

Second, I would be grateful if you could comment on the cost of deploying Cerner Millennium at North Bristol, reported in your memorandum as £21 million, including service for 56 months, and on the current expected go-live date.  Specifically:

Can you explain why the delivery date agreed with BT at the contract “reset” was 4th June 2011?

Why it was then revised to 2nd July 2011?

And why it now appears that there is no agreed delivery date at all?

Can you also give your best comparison of the cost of deploying the Cerner Millennium system at North Bristol, with the cost to University Hospitals Bristol of deploying the System C Healthcare Medway system outside the National Programme?  It would appear from media reports that this latter contract includes deployment of functionality including PAS, Accident and Emergency, maternity, theatres, clinical data collection, and a data warehouse and reporting system, as well as integration of third party and current Trust applications.  According to the National Audit Office, the average cost for each new site under the BT South contract is £28.3 million, but the cost of the Medway system to UHB has been reported as £8.2 million over seven years. (http://www.guardian.co.uk/healthcare-network/2011/may/19/university-hospitals-bristol-foundation-trust-awards-e-patient-contract)   What is the justification for this apparent difference?

As the Senior Responsible Owner for the National Programme, can you give your explicit undertaking that the North Bristol contract represents value for money for taxpayers?

I look forward to receiving your reply.

With many thanks

Yours sincerely

Richard Bacon

MP for South Norfolk, Member of the Public Accounts Committee

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