Category Archives: consultants

Uupublished plan to throw another £13bn at the NHS’s IT problems?

Posted on 16/10/2018 | 2 comments

By Tony Collins

The Health Service Journal yesterday revealed details of NHS IT investment plans that have been costed at about £12.9bn over the next five years.

The HSJ’s award-winning technology correspondent Ben Heather  says the sums currently involved – which could reduce as proposals are “reined in” – are on a par with the notorious National Programme for IT in the NHS.

He says that officials working on the plan have produced an estimate of between £10.9bn and £12.9bn for the cost of supporting proposals across 15 long-term plan “workstreams” ranging from creating personalised care to improving cancer survival.

The figures form part of the work of the digital and technology workstream for the long term plan, which is being developed by NHS England and NHS Improvement.

“The sum would be on par with the National Programme for IT, the most expensive push to improve IT systems in NHS history and an infamously costly and troubled project. It is likely to reduce substantially, however, as ambitions for the plan are negotiated and reined in over coming weeks.”

The plan is due to be published in late November or early December. The health secretary is known to be a keen advocate of new IT-related investments.

It is likely that a sizeable portion of the new £20bn planned for the NHS – which will be financed partly by tax increases that are due to be announced in the budget later this month – will go on NHS technology.

But the Health Service Journal suggests the investments will be controlled centrally, which may be a bad sign given that one of the major flaws in the failed £13bn NPfIT was that money was controlled centrally rather than by local groups of doctors and nurses.

Comment

On the face of it the current investment proposals bear no resemblance to the NHS IT programme NPfIT which was “dismantled” in 2011.

The NPfIT comprised a handful of specific major projects that were to be implemented nationally under the umbrella of “ruthless standardisation”.

The current proposals look very different. The investments fall into vague categories such as digitalising secondary care, improvements to IT infrastructure, data gathering and analytics.

The proposals have all the appearance of a different way the NHS has found to waste vast sums of public money.

It has never been acknowledged by the Treasury, NHS England or the Department of Health that the NPfIT wasted billions on spending that was invisible to the public, such as numerous consultants, years of globe-trotting by officials, first-class hotels across the world, sponsored conferences and unreported funds for marketing items that included DVDs and board games designed especially to promote the IT programme.

For officials, there’s nothing more exciting than going to work on a £13bn technology programme where money flows more freely than water. It’s no wonder officialdom is lobbying for the money.

No doubt it will be easy for officials to obtain the new billions. At any time in the recent history of the NHS it would have been easy on paper to justify £13bn for new NHS technology. Much of the £13bn could be justified simply enough by submitting plans to HM Treasury to modernise what already exists.

It was easy to justify the NPfIT. Tony Blair approved it at a Downing Street meeting that lasted 40 minutes. Computer Weekly obtained minutes of the Downing Street meeting after various FOI appeals.

But the NHS needs £13bn to be spent wisely on technology. The last thing the NHS needs is for Whitehall officials to be involved. History shows that Whitehall has the reverse Midas touch when it comes to major NHS IT investments. It is local groups of doctors and nurses who know how to spend the money wisely.

If either NHS England or the Department of Health and Social Care is involved in the new proposals for NHS IT investments – and they both are – it’s almost certain the new plans will end up as costly failures.

How would the public feel if they realised that a sizeable portion of their increased taxes for the NHS is almost certainly destined for the dustbin marked “mismanaged Whitehall IT schemes”.

Revealed: Officials’ £13bn funding ask to modernise NHS IT

Another NPfIT scandal in the making?

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Posted in Agile, BT, BT Health, Campaign4Change, Cerner, consultants, Department of Health, excessive secrecy, Freedom of Information, Fujitsu, GDS, Government IT, health records, Institute for Government, IT-enabled projects and waste, IT-related failures, NHS, NHS England, npfit

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Capita’s problems were “preventable” says Royal London

Posted on 06/02/2018 | 3 comments

By Tony Collins

Royal London, a Capita investor, said yesterday it has been “raising concerns about Capita’s weak governance with the firm for a number of years, and voting against many resolutions on director re-elections and pay consistently since 2014.”

Royal London is the UK’s largest mutual life, pensions and investment company. It managed £113bn of funds as of 31 December 2017. It owns a 0.44% stake in Capita.

Ashley Hamilton Claxton, Royal London Asset Mananagement’s Head of Responsible Investment, said in a statement,

“We welcome the honesty and transparency with which Capita’s new CEO has accepted the company’s past failings, and put a plan in place to simplify and improve the business. However, we believe this was preventable and have been privately raising concerns about Capita’s weak governance with the firm for a number of years, and voting against many resolutions on director re-elections and pay consistently since 2014.

“Until recently, Capita’s board flouted one of the basic rules of the corporate governance code, with a small board primarily comprised of management insiders. The result was a board that lacked the independent spirit to rigorously assess whether the company was making the right long-term decisions.

“Our concerns about governance were compounded by the complexity of the underlying business and the company’s acquisition strategy. Capita’s approach to remuneration also left something to be desired, with major losses in 2013 being excluded from the profit figures used to assess the bonuses paid to executives at the firm.

“The sea change in the board over the past 18 months has been welcome and has addressed the key issue of independence. It will be up to the new Chairman and the Board to ensure that Capita does not repeat the mistakes of the past, and that its strategy is fit for purpose during a particularly turbulent time for the outsourcing sector.”

Last week Capita issued a profits warning and announced plans to raise £700m from investors to reduce debts.

With Capita seeking to raise money and cut costs, where will this leave local government customers that are reliant on the supplier to cut the costs of running local services?

Barnet Council has, controversially, contracted out a large chunk of its services to Capita – and also gives the company tens of millions in advance payments in return for a discount on the supplier’s fees.

By becoming a “commissioning council”, Barnet has made itself wholly reliant on Capita, say critics of the outsourcing deal. Among other responsibilities, Capita produced the council’s latest annual accounts – including a financial account of its own services to the council. The accounts were not produced on time which created extra chargeable work for the council’s auditors BDO.

Capita has run into problems on a number of its major outsourcing deals. The National Audit Office is investigating its work on GP support services.

Councillor Barry Rawlings, leader of the Labour group in Barnet, said the profits warning and Capita’s low share price raised questions about how it may respond to further troubles.

He told The Guardian that Capita may be looking to cut back services it supplies.

“Capita handles all of the back office, enforcement, planning, environmental health, trading standards, estates, payroll and so on. Will that be part of their core services? We might be one of the only places they do some things. If they narrow their scope, what is going to happen to these services?

Conservative leader of  Barnet council, Councillor Richard Cornelius, said,  “Capita currently runs approximately 10 per cent of our services by value. They do not run the entire council as some reports have suggested.

“The council regularly reviews the financial status of its major suppliers as part of its contract management and contingency planning arrangements. This is what any responsible local authority would do.”

Capita’s share price has more than halved in the last month – from about 400p to a low on 1 February 2018 of 158p – but today rose by about 10% to 196.

Comment

When an outsourcing giant is looking to cut its costs and raise money to cover debts, how does that square with local government customers that also want to cut costs – which is why they outsourced to Capita?

Outsourcing can make good sense – when for example a global company like BP wants to standardise IT services across the world. It doesn’t always make sense when an organisation wants a service transformation while also cutting costs. Something usually has to give which, perhaps, Barnet Council and its taxpayers are slowly finding out.

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Posted in Barnet Council, Campaign4Change, change management, consultants, local government, managing outsourced services, National Audit Office, outsourcing

Excellent reports on lessons from Universal Credit IT project published today – but who’s listening?

Posted on 06/09/2016 | 5 comments

By Tony Collins

“People burst into tears, so relieved were they that they could tell someone what was happening.”

The Institute for Government has today published one of the most incisive – and revelatory – reports ever produced on a big government IT project.

It concludes that the Universal Credit IT programme may now be in recovery after a disastrous start, but recovery does not mean recovered. Much could yet floor the programme, which is due to be complete in 2022.

The Institute’s main report is written by Nick Timmins, a former Financial Times journalist, who has written many articles on failed publicly-funded IT-based projects.

His invaluable report, “Universal Credit – from disaster to recovery?” – includes interviews with David Pitchford, a key figure in the Universal Credit programme, and Howard Shiplee who led the Universal Credit project.

Timmins also spoke to insiders, including DWP directors, who are not named, and the former secretary of state at the Department for Work and Pensions Iain Duncan Smith and the DWP’s welfare reform minster Lord Freud.

Separately the Institute has published a shorter report “Learning the lessons from Universal Credit” which picks out from Timmins’ findings five “critical” lessons for future government projects. This report, too, is clear and jargon-free.

Much of the information on the Universal Credit IT programme in the Timmins report is new. It gives insights, for instance, into the positions of Universal Credit’s major suppliers HP, IBM, Accenture.

It also unearths what can be seen, in retrospect, to be a series of self-destructive decisions and manoeuvres by the Department for Work and Pensions.

But the main lessons in the report – such as an institutional and political inability to face up to or hear bad news – are not new, which raises the question of whether any of the lessons will be heeded by future government leaders – ministers and civil servants – given that Whitehall departments have been making the same mistakes, or similar ones, for decades?

DWP culture of suppressing any bad news continues

Indeed, even as the reports lament a lack of honesty over discussing or even mentioning problems – a “culture of denial” – Lord Freud, the minister in charge of welfare reform, is endorsing FOI refusals to publish the latest risk registers, project assessment reviews and other Universal Credit reports kept by the Department for Work and Pensions.

More than once Timmins expresses his surprise at the lack of information about the programme that is in the public domain. In the “acknowledgements” section at the back of his report Timmins says,

“Drafts of this study were read at various stages by many of the interviewees, and there remained disputes not just about interpretation but also, from some of them, about facts.

“Some of that might be resolvable by access to the huge welter of documents around Universal Credit that are not in the public domain. But that, by definition, is not possible at this stage.”

Churn of project leaders continues

Timmins and the Institute warn about the “churn” of project leaders, and the need for stable top jobs.

But even as the Institute’s reports were being finalised HMRC was losing its much respected chief digital officer Mark Dearnley, who has been in charge of what is arguably the department’s riskiest-ever IT-related programme, to transfer of legacy systems to multiple suppliers as part of the dismantling of the £8bn “Aspire” outourcing venture with Capgemini.

Single biggest cause of Universal Credit’s bad start?

Insiders told Timmins that the fraught start of Universal Credit might have been avoided if Terry Moran had been left as a “star” senior responsible owner of the programme. But Moran was given two jobs and ended up having a breakdown.

In January 2011, as the design and build on Universal Credit started, Terry Moran was given the job of senior responsible owner of the project but a few months later the DWP’s permanent secretary Robert Devereux took the “odd” decision to make Moran chief operating officer for the entire department as well. One director within the DWP told Timmins:

“Terry was a star. A real ‘can do’ civil servant. But he couldn’t say no to the twin posts. And the job was overwhelming.”

The director claimed that Iain Duncan Smith told Moran – a point denied by IDS – that if Universal Credit were to fail that would be a personal humiliation and one he was not prepared to contemplate. “That was very different from the usual ministerial joke that ‘failure is not an option’. The underlying message was that ‘I don’t want bad news’, almost in words of one syllable. And this was in a department whose default mode is not to bring bad news to the top. ‘We will handle ministers’ is the way the department operates…”

According to an insider, “Terry Moran being given the two jobs was against Iain’s instructions. Iain repeatedly asked Robert [Devereux] not to do this and Robert repeatedly gave him assurances that this would be okay” – an account IDS confirms. In September 2012, Moran was to have a breakdown that led to early retirement in March 2013. He recorded later for the mental health charity Time to Talk that “eventually, I took on more and more until the weight of my responsibilities and my ability to discharge them just grew too much for me”.

Timmins was told, “You cannot have someone running the biggest operational part of government [paying out £160bn of benefits a year] and devising Universal Credit. That was simply unsustainable,”

Timmins says in his report, “There remains a view among some former and current DWP civil servants that had that not happened (Moran being given two jobs), the programme would not have hit the trouble it did. ‘Had he been left solely with responsibility for UC [Universal Credit], I and others believe he could have delivered it, notwithstanding the huge challenges of the task,’ one says.”

Reviews of Universal IT “failed”

Timmins makes the point that reviews of Universal Credit by the Major Projects Authority failed to convey in clear enough language that the Universal Credit programme was in deep trouble.

“The [Major Projects Authority] report highlighted a lack of sufficient substantive action on the points raised in the March study. It raised ‘high’ levels of concern about much of the programme – ‘high’ being a lower level of concern than ‘critical’. But according to those who have seen the report, it did not yet say in words of one syllable that the programme was in deep trouble.”

Iain Duncan Smith told Timmins that the the Major Projects review process “failed me” by not warning early enough of fundamental problems. It was the ‘red team’ report that did that, he says, and its contents made grim reading when it landed at the end of July in 2012.

Train crash on the way

The MPA [Cabinet Office’s Major Projects Authority] reviewed the programme in March 2011. “MPA reports are not in the public domain. But it is clear that the first of these flagged up a string of issues that needed to be tackled …

” In June a member of the team developing the new government’s pan-government website – gov.uk – was invited up to Warrington [base for the Universal Credit IT team] to give a presentation on how it was using an agile approach to do that.

“At the end of the presentation, according to one insider, a small number from the audience stayed behind, eyeing each other warily, but all wanting to talk. Most of them were freelancers working for the suppliers. ‘Their message,’ the insider says, ‘was that this was a train crash on the way’ – a message that was duly reported back to the Cabinet Office, but not, apparently, to the DWP and IDS.”

Scared to tell the truth

On another occasion when the Major Projects Authority visited the IT team at Warrington for the purposes of its review, the review team members decided that “to get to the truth they had to make people not scared to tell the truth”. So the MPA “did a lot of one-on-one interviews, assuring people that what they said would not be attributable. And under nearly every stone was chaos.

“People burst into tears, so relieved were they that they could tell someone what was happening.

” There was one young lad from one of the suppliers who said: ‘Just don’t put this thing [Universal Credit] online. I am a public servant at heart. It is a complete security disaster.’

IBM, Accenture and HP

“Among those starting to be worried were the major suppliers – Accenture, HP and IBM. They started writing formal letters to the department.

‘Our message,’ according to one supplier, ‘was: ‘Look, this isn’t working. We’ll go on taking your money. But it isn’t going to work’.’ Stephen Brien [then expert adviser to IDS] says of those letters: ‘I don’t think Iain saw them at that time, and I certainly didn’t see them at the time.”

At one point “serious consideration was given to suing the suppliers but they had written their warning letters and it rapidly became clear that that was not an option”.

Howard Shiplee, former head of the project, told Timmins that he had asked himself ‘how it could be that a very large group of clever people drawn from the DWP IT department with deep experience of the development and operation of their own massive IT systems and leading industry IT suppliers had combined to get the entire process so very wrong? Equally, ‘how could another group of clever people [the GDS team] pass such damning judgement on this earlier work and at the stroke of a pen seek to write off millions of pounds of taxpayers’ money?’

Shiplee commissioned a review from PwC on the work carried out to date and discovered that the major suppliers “were genuinely concerned to have their work done properly, support DWP and recover their reputations”.

In addition, when funding had been blocked at the end of 2012, the suppliers “had not simply downed tools but had carried on development work for almost three months” as they ran down the large teams that had been working on it.

“As a result, they had completed the development for single claimants that was being used in the pathfinder and made considerable progress on claims for couples and families. And their work, the PwC evaluation said, was of good quality.”

On time?

When alarm bells finally started ringing around Whitehall that Universal Credit was in trouble,  IDS found himself under siege. Stephen Brien says IDS was having to battle with the Treasury to keep the funding going for the project. He had to demonstrate that the programme was on time and on budget.

‘The department wanted to support him in that, and didn’t tell him all the things that were going wrong. I found out about some of them, but I didn’t push as hard as I should have. And looking back, the MPA [Major Projects Authority] meetings and the MPA reports were all handled with a siege mentality. We all felt we had to stand shoulder to shoulder defending where we were and not really using them to ask: ‘Are we where we should be?’

‘As a result we were not helping ourselves, and we certainly were not helping others, including the MPA. But we did get to the stage between the end of 2011 and the spring of 2012 where we said: ‘Okay, let’s get a red team in with the time and space to do our own challenge.’”

The DWP’s “caste” system

A new IT team was created in Victoria Street, London – away from Warrington but outside the DWP’s Caxton Street headquarters. It started to take a genuinely agile approach to the new system. One of those involved told Timmins:

“It had all been hampered by this caste system in the department where there is a policy elite, then the operational people, and then the technical people below that.

“And you would say to the operational people: ‘Why have you not been screaming that this will never work?’ And they’d say: ‘Well, we’re being handed this piece of sh** and we are just going to have to make it work with workarounds, to deal with the fact that we don’t want people to starve. So we will have to work out our own processes, which the policy people will never see, and we will find a way to make it work.’

Twin-track approach

IBM, HP and Accenture built what’s now known as the “live” system which enabled Universal Credit to get underway, and claims to be made in jobcentres.

It uses, in part, the traditional “waterfall” approach and has cost hundreds of millions of pounds. In contrast there’s a separate in-house “digital” system that has cost less than £10m and is an “agile” project.

A key issue, Shiplee told Timmins, was that the new digital team “would not even discuss the preceding work done by the DWP and its IT suppliers”. The digital team had, he says, “a messiah-like approach that they were going to rebuild everything from scratch”.

Rather than write everything off, Shiplee wanted ideally to marry the “front-end” apps that the GDS/DWP team in Victoria Street was developing with the work already done. But “entrenched attitudes” made that impossible. The only sensible solution, he decided, was a “twin-track” approach.

“The Cabinet Office remained adamant that the DWP should simply switch to the new digital version – which it had now become clear, by late summer, would take far longer to build than they anticipated – telling the DWP that the problem was that using the original software would mean ‘creating a temporary service, and temporary will become permanent’.

“All of which led to the next big decision, which, to date, has been one of the defining ones. In November 2013, a mighty and fraught meeting of ministers and officials was convened. Pretty much everyone was there. The DWP ministers, Francis Maude (Cabinet Office minister), Oliver Letwin who was Cameron’s policy overlord, Sir Jeremy Heywood, the Cabinet Secretary, Sir Bob Kerslake, the head of the home civil service, plus a clutch of DWP officials including Robert Devereux and Howard Shiplee as the senior responsible owner along with Danny Alexander and Treasury representatives.

“The decision was whether to give up on the original build, or run a twin-track approach: in other words, to extend the use of the original build that was by now being used in just over a dozen offices – what became dubbed the ‘live’ service – before the new, and hopefully much more effective, digital approach was finished and on stream.

“It was a tough and far from pleasant meeting that is etched in the memories of those who were there…

“One of those present who favoured the twin-track approach says: There were voices for writing the whole of the original off. But that would have been too much for Robert Devereux [the DWP’s Permanent Secretary] and IDS.

” So the twin-track approach was settled on – writing a lot of the original IT down rather than simply writing it off. That, in fact, has had some advantages even if technically it was probably the wrong decision…

“It has, however, seen parts of the culture change that Universal Credit involves being rolled out into DWP offices as more have adopted Universal Credit, even if the IT still requires big workarounds.

“More and more offices, for example, have been using the new claimant commitment, which is itself an important part of Universal Credit. So it has been possible to train thousands of staff in that, and get more and more claimants used to it, while also providing feedback for the new build.”

Francis Maude was among those who objected to the twin-track approach, according to leaked minutes of the project oversight board at around this time.

Lord Freud told Timmins,

‘Francis was adamant that we should not go with the live system [that is, the original build]. He wanted to kill it. But we, the DWP, did not believe that the digital system would be ready on anything like the timescales they were talking about then …But I knew that if you killed the live system, you killed Universal Credit…”

In the end the twin-track approach was agreed by a majority. But the development of the ‘agile’ digital service was immediately hampered by a spat over how quickly staff from the GDS were to be withdrawn from the project.

Fury over National Audit Office report

In 2013 the National Audit Office published a report Universal Credit – early progress –  that, for the first time, brought details of the problems on the Universal Credit programme into the public domain. Timmins’ report says that IDS and Lord Freud were furious.

“IDS and, to an only slightly lesser extent, Lord Freud were furious about the NAO report; and thus highly defensive.”

IDS tried to present the findings of the National Audit Office as purely historical.

In November 2014, the NAO reported again on Universal Credit. It once more disclosed something that ministers had not announced – that the timetable had again been put back two years (which raises further questions about why Lord Freud continues to refuse FOI requests that would put into the public domain – and inform MPs – about project problems, risks and delays without waiting for an NAO report to be published)..

Danny Alexander “cut through” bureaucracy

During one period, the Treasury approval of cash became particularly acute. Lord Freud told Timmins:

“We faced double approvals. We had approval about any contract variation from the Cabinet Office and then approvals for the money separately from the Treasury.

“The Government Digital Service got impatient because they wanted to make sure that the department had the ability to build internally rather than going out to Accenture and IBM, who (sic) they hate.

“The approvals were ricocheting between the Cabinet Office and the Treasury and when we were trying to do rapid iteration. That was producing huge delays, which were undermining everything. So in the end Danny Alexander [Lib-dem MP who was chief secretary to the Treasury] said: ‘I will clear this on my own authority.’ And that was crucial. Danny cut through all of that.”

Optimism bias

So-called optimism bias – over-optimism – is “such a common cause of failure in both public and private projects that it seems quite remarkable that it needs restating. But it does – endlessly”.

Timmins says the original Universal Credit white paper – written long before the start of the programme – stated that it would involve “an IT development of moderate scale, which the Department for Work and Pensions and its suppliers are confident of handling within budget and timescale”.

David Pitchford told Timmins,

“One of the greatest adages I have been taught and have learnt over the years in terms of major projects is that hope is not a management tool. Hoping it is all going to come out all right doesn’t cut it with something of this magnitude.

“The importance of having a genuine diagnostic machine that creates recommendations that are mandatory just can’t be overstated. It just changes the whole outcome completely. As opposed to obfuscation and optimism bias being the basis of the reporting framework. It goes to a genuine understanding and knowledge of what is going on and what is going wrong.”

Sir Bob Kerslake, who also identified the ‘good news culture’ of the DWP as being a problem, told Timmins,

“All organisations should have that ability to be very tough about what is and isn’t working. The people at the top have rose-tinted specs. They always do. It goes with the territory.

And unless you are prepared to embrace people saying that ‘really, this is in a bad place’… I can think of points where I have done big projects where it was incredibly important that we delivered the unwelcome news of where we were on that project. But it saved me, and saved my career.”

Recovery?

Timmins makes good arguments for his claim that the Universal Credit programme may be in recovery – but not recovered – and that improvements have been made in governance to allow for decisions to be properly questioned.

But there is no evidence the DWP’s “good news” culture has changed. For instance the DWP says that more than 300,000 people are claiming Universal Credit but the figure has not been audited and it’s unclear whether claimants who have come off the benefit and returned to it – perhaps several times – are being double counted.

Timmins points out the many uncertainties that cloud the future of the Universal Credit programme  – how well the IT will work, whether policy changes will hit the programme, whether enough staff will remain in jobcentres, and whether the DWP will have good relations with local authorities that are key to the delivery of Universal Credit but are under their own stresses and strains with resourcing.

There are also concerns about what changes the Scots and Northern Irish may want under their devolved powers, and the risk that any ‘economic shock’ post the referendum pushes up the volume of claimants with which the DWP has to deal.

 Could Universal Credit fail for non-IT reasons?

Timmins says,

“In seeking to drive people to higher earnings and more independence from the benefits system, there will be more intrusion into and control over the lives of people who are in work than under the current benefits system. And there are those who believe that such an approach – sanctioning people who are already working – will prove to be political dynamite.”

The dire consequences of IT-related failure

It is also worth noting that Universal Credit raises the stakes for the DWP in terms of its payment performance, says Timmins.

“If a tax credit or a Jobseeker’s Allowance payment or any of the others in the group of six go awry, claimants are rarely left penniless in the sense that other payments – for example, Housing Benefit in the case of Jobseeker’s Allowance or tax credits, – continue.

“If a Universal Credit payment fails, then all the support from the state, other than Child Benefit or disability benefits not included within Universal Credit, disappears.”

This happened recently in Scotland when an IT failure left hundreds of families penniless. The DWP’s public response was to describe the failure in Scotland as “small-scale”.

Comment

What a report.

It is easy to see how much work has gone into it. Timmins has coupled his own knowledge of IT-related failure with a thorough investigation into what has gone wrong and what lessons can be learned.

That said it may make no difference. The Institute in its “lessons” report uses phrases such as “government needs to make sure…”. But governments change and new administrations have an abundance – usually a superfluity – of confidence and ambition. They regard learning lessons from the past as putting on brakes or “nay saying”. You have to get with the programme, or quit.

Lessons are always the same

There will always be top-level changes within the DWP. Austerity will always be a factor.  The culture of denial of bad news, over-optimism about what can be achieved by when and how easily it can be achieved, over-expectations of internal capability, over-expectation of what suppliers can deliver, embarking on a huge project without clearly or fully understanding what it will involve, not listening diligently to potential users and ridiculously short timescales are all well-known lessons.

So why do new governments keep repeating them?

When Universal Credit’s successor is started in say 2032, the same mistakes will probably be repeated and the Institute for Government, or its successor, will write another similar report on the lessons to be learned.

When Campaign4Change commented in 2013 that Universal Credit would probably not be delivered before 2020 at the earliest, it was an isolated voice. At the time, the DWP press office – and its ministers – were saying the project was on budget and “on time”.

NPfIT

The National Audit Office has highlighted similar lessons to those in the Timmins report, for example in NAO reports on the NPfIT – the NHS IT programme that was the world’s largest non-military IT scheme until it was dismantled in 2011. It was one of the world’s biggest IT disasters – and none of its lessons was learned on the Universal Credit programme.

The NPfIT had an anti-bad news culture. It did not talk enough to end users. It had ludicrous deadlines and ambitions. The politicians in charge kept changing, as did some of programme leaders. There was little if any effective internal or external challenge. By the time it was dismantled the NPfIT had lost billions.

What the Institute for Government could ask now is, with the emasculation of the Government Digital Service and the absence of a powerful Francis Maude figure, what will stop government departments including the DWP making exactly the mistakes the IfG identifies on big future IT-enabled programmes?

In future somebody needs the power to say that unless there is adequate internal and external challenge this programme must STOP – even if this means contradicting a secretary of state or a permanent secretary who have too much personal and emotional equity in the project to allow it to stop. That “somebody” used to be Francis Maude. Now he has no effective replacement.

Victims

It’s also worth noting in the Timmins report that everyone seems to be a victim, including the ministers. But who are perpetrators? Timmins tries to identify them. IDS does not come out the report smelling of roses. His passion for success proved a good and bad thing.

Whether the direction was forwards or backwards IDS  was the fuel that kept Universal Credit going.  On the other hand his passion made it impossible for civil servants to give him bad news – though Timmins raises questions about whether officials would have imparted bad news to any secretary of state, given the DWP’s culture.

Neither does the DWP’s permanent secretary Robert Devereux emerge particularly well from the report.

How it is possible for things to go so badly wrong with there being nobody to blame? The irony is that the only people to have suffered are the genuine innocents – the middle and senior managers who have most contributed to Universal Credit apparent recovery – people like Terry Moran.

Perhaps the Timmins report should be required reading among all involved in future major projects. Competence cannot be made mandatory. An understanding of the common mistakes can.

Thank you to FOI campaigner Dave Orr for alerting me to the Institute’s Universal Credit reports.

Thanks also to IT projects professional John Slater – @AmateurFOI – who has kept me informed of his FOI requests for Universal Credit IT reports that the DWP habitually refuse. 

Update 18.00 6 September 2016

In a tweet today John Slater ( @AmateurFOI ) makes the important point that he asked the DWP and MPA whether either had held a “lessons learned” exercise in the light of the “reset” of the Universal Credit IT programme. The answer was no.

This perhaps reinforces the impression that the DWP is irredeemably complacent, which is not a good position from which to lead major IT projects in future.

Universal Credit – from disaster to recovery?

Learning the lessons from Universal Credit

 

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Posted in Accenture, Agile, Campaign4Change, capacity building, Capgemini, change management, consultants, culture, DWP, excessive secrecy, FOI, Freedom of Information, Gateway reviews, GDS, Government digital Service, Government IT, HMRC, HP, IBM, Institute for Government, IT-related failures, Legacy ICT, Major Projects Authority, National Audit Office, npfit, project management, PWC, Real-Time Information, supplier relationships, Universal Credit

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NHS “Wachter” digital review is delayed – but does it matter?

Posted on 13/07/2016 | 3 comments

By Tony Collins

The Wachter review of NHS technology was due to be published in June but has been delayed. Would it matter if it were delayed indefinitely?

A “Yes Minister” programme about a new hospital in North London said it all, perhaps. An enthusiastic NHS official shows the minister round a hospital staffed with 500 administrators. It has the latest technology on the wards.

“It’s one of the best run hospitals in the country,” the NHS official tells the minister, adding that it’s up for the Florence Nightingale award for the standards of hygiene.

“But it has no patients,” says the minister.

Another health official tells the minister,

“First of all, you have to sort out the smooth running of the hospital. Having patients around would be no help at all.” They would just be in the way, adds Sir Humphrey.

In the Wachter’s review’s terms of reference (“Making IT work: harnessing the power of health IT to improve care in England“)  there is a final bullet point that refers, obliquely, to a need to consider patients. Could the Wachter terms of reference have been written by a satirist who wanted to show how it was possible to have a review of NHS IT for the benefit of suppliers, clinical administrators and officialdom but not patients?

The Wachter team will, according to the government,

• Review and articulate the factors impacting the successful adoption of health information systems in secondary and tertiary care in England, drawing relevant comparisons with the US experience;

• Provide a set of recommendations drawing on the key challenges, priorities and opportunities for the health and social care system in England. These recommendations will cover both the high levels features of implementations and the best ways in which to engage clinicians in the adoption and use of such systems.

In making recommendations, the board will consider the following points:

• The experiences of clinicians and Trust leadership teams in the planning, implementation and adoption of digital systems and standards;

• The current capacity and capability of Trusts in understanding and commissioning of health IT systems and workflow/process changes.

• The current experiences of a number of Trusts using different systems and at different points in the adoption lifecycle;

• The impact and potential of digital systems on clinical workflows and on the relationship between patients and their clinicians and carers.

Yes, there’s the mention of “patients” in the final bullet point.

Existing systems?

nhsSome major IT companies have, for decades, lobbied – often successfully – for much more public investment in NHS technology. Arguably that is not the priority, which is to get existing systems to talk to each other – which would be for the direct benefit of patients whose records do not follow them wherever they are looked at or treated within the NHS.

Unless care and treatment is at a single hospital, the chances of medical records following a patient around different sites, even within the same locality, are slim.

Should a joining up of existing systems be the main single objective for NHS IT? One hospital consultant told me several years ago – and his comment is as relevant today –

“My daughter was under treatment from several consultants and I could never get a joined-up picture. I had to maintain a paper record myself just to get a joined-up picture of what was going on with her treatment.”

Typically one patient will have multiple sets of paper records. Within one hospital, different specialities will keep their own notes. Fall over and break your leg and you have a set of orthopaedic notes; have a baby and you will have a totally different set of notes. Those two sets are rarely joined up.

One clinician told me, “I have never heard a coroner say that a patient died because too much information was shared.”

And a technology specialist who has multiple health problems told me,

“I have different doctors in different places not knowing what each other is doing to me.”

As part of wider research into medical records, I asked a hospital consultant in a large city with three major hospitals whether records were shared at least locally.

“You must be joking. We have three acute hospitals. Three community intermediate teams are in the community. Their records are not joined. There is one private hospital provider. If you get admitted to [one] hospital and then get admitted to [another] the next week your electronic records cannot be seen by the first hospital.  Then if you get admitted to the third hospital the week after, again not under any circumstances will your record be able to be viewed.”

Blood tests have to be repeated, as are x-rays; but despite these sorts of stories of a disjointed NHS, senior health officials, in the countless NHS IT reviews there have been over 30 years, will, it seems, still put the simplest ideas last.

It would not cost much – some estimate less than £100m – to provide secure access to existing medical records from wherever they need to be accessed.

No need for a massive investment in new technology. No need for a central patient database, or a central health record. Information can stay at its present location.  Just bring local information together on local servers and provide secure access.

A locum GP said on the Pulse website recently,

“If you are a member of the Armed Forces, your MO can get access to your (EMIS-based) medical record from anywhere in the world. There is no technical reason why the NHS cannot do this. If need be, the patient could be given a password to permit a GP to see another Surgery’s record.”

New appointments

To avoid having patients clog up super-efficient hospitals, Sir Humphrey would have the Wachter review respond to concerns about a lack of joined up care in the NHS by announcing a set of committees and suggesting the Department of Health and NHS England appoint a new set of senior technologists.

Which is just what has happened.

Last week NHS England announced  “key appointments to help transform how the NHS uses technology and information”. [One of the NHS appointments is that of a Director of Digital Experience, which is not a fictional title, incidentally. Ironically it seems to be the most patient-facing of the new jobs.]

Said the announcement,

“The creation of these roles reflects recommendations in the forthcoming review on the future of NHS information systems by Dr Bob Wachter.

“Rather than appoint a single chief information and technology officer, consistent with the Wachter review the NHS is appointing a senior medical leader as NHS Chief Clinical Information Officer supported by an experienced health IT professional as NHS Chief Information Officer.

“The first NHS Chief Clinical Information Officer will be Professor Keith McNeil, a former transplant specialist who has also held many senior roles in healthcare management around the world, including Chief Executive Officer at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust and Chief Executive Officer at the Royal Brisbane and Women’s Hospital in Australia.

“The new NHS Chief Information Officer will be Will Smart, currently Chief Information Officer at the Royal Free London NHS Foundation Trust. Mr Smart has had an extensive career in IT across the NHS and in the private sector.

“The NHS CCIO and NHS CIO post-holders will act on behalf of the whole NHS to provide strategic leadership, also chairing the National Information Board, and acting as commissioning ‘client’ for the relevant programmes being delivered by NHS Digital (previously known as the Health and Social Care Information Centre).

“The roles will be based at NHS England and will report to Matthew Swindells, National Director: Operations and Information, but the post-holders will also be accountable to NHS Improvement, with responsibility for its technology work with NHS providers.

“In addition, Juliet Bauer has been appointed as Director of Digital Experience at NHS England. She will oversee the transformation of the NHS Choices website and the development and adoption of digital technology for patient ‘supported self-management’, including for people living with long term conditions such as diabetes or asthma. Ms Bauer has led delivery of similar technology programmes in many sectors, including leading the move to take Times Newspapers online…”

Surely a first step, instead of arranging new appointments and committees, and finding ways of spending money on new technology, would be to put in place data sharing agreements between hospitals?

A former trust chief executive told me,

“In primary care, GPs will say the record is theirs. Hospital teams will say it is our information and patient representative groups will say it is about patients and it is their nformation. In maternity services there are patient-held records because it is deemed good practice that mums-to-be should be fully knowledgeable and fully participating in what is happening to them.

“Then you get into complications of Data Protection Act. Some people get very sensitive about sharing information across boundaries: social workers and local authority workers. If you are into long-term continuous care you need primary care, hospital care and social care. Without those being connected you may do half a job or even less than that potentially. There are risks you run if you don’t know the full information.”

He added that the Summary Care Record – a central database of every patient’s allergies, medication and any adverse reactions to drugs, was a “waste of time”.

“You need someone selecting information to go into it [the Summary Care Record]so it is liable to omissions and errors. You need an electronic patient record that has everything available but is searchable. You get quickly to what you want to know. That is important for that particular clinical decision.”

Is it the job of civil servants to make the simple sound complicated?

Years ago, a health minister invited me for an informal meeting at the House of Commons to show me, in confidence, a one-page civil service briefing paper on why it was not possible to use the internet for making patient information accessible anywhere.

The minister was incredulous and wanted my view. The civil service paper said that nobody owned the internet so it couldn’t be used for the transfer of patient records.  If something went wrong, nobody could be blamed.

That banks around the world use the internet to provide secure access to individual bank accounts was not mentioned in the paper, nor the existence of the CHAPS network which, by July 2011, had processed one quadrillion (£1,000,000,000,000,000) pounds.

Did the briefing paper show that the civil service was frightened by the apparent simplicity of sharing patient information on a secure internet connection? If nothing else, the paper showed how health service officials will tend, instinctively, to shun the cheapest solutions. Which may help to explain how the (failed) £10n National Programe for IT came into being in 2002.

Jargon

Radiation_warning_symbolNobody will be surprised if the Wachter review team’s report is laden with  jargon about “delays between technology being introduced and a corresponding rise in output”. It may talk of how new technology could reduce the length of stay by 0.1528 of a bed day per patient, saving a typical hospital £1.8m annually or 7,648 bed days.

It may refer to visions, envisioning fundamental change, establishing best practice as the norm, and a need for adaptive change.

Would it not be better if the review team spoke plainly of the need for a patient with a fractured leg not having to carry a CD of his x-ray images to different NHS sites in a carrier bag?

Some may await the Wachter report with a weary apprehension that its delay – even indefinitely – will make not a jot of difference. Perhaps Professor Wachter will surprise them. We live in hope.

Wachter review terms of reference.

Review of IT in the NHS

https://ukcampaign4change.com/2016/02/09/another-npfit-it-scandal-in-the-making/

Hunt announces Wachter review

What can we learn from the US “hospitalist” model?

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Posted in Campaign4Change, change management, CIO, consultants, data sharing, Department of Health, e-health, ERP, health, HSCIC, LPfIT, MoD, National Audit Office, NHS, npfit, open standards, SPfIT, Summary Care Record

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Another public sector IT project disaster – but a useful failure if lessons are disseminated

Posted on 12/07/2016 | 3 comments

By Tony Collins

Comment and analysis

Government Computing reported on 1 July 2016 that the Scottish Police Authority has agreed with Accenture to end their “i6” programme.

It’s a classic public sector IT project disaster. It failed for the usual reasons (see below). What marks it out is the unusual post-failure approach: a limited openness.

Police in Scotland and the Scottish Government plan a review of what went wrong, which is likely to be published.

Usually senior civil and public servants in Whitehall, local government in England and Wales and the NHS rush to shut the blinds when an IT-enabled change project goes awry, which is what has happened recently after failures of the GP Support Services contract with Capita.  [GP magazine Pulse reports that NHS England is to withhold report on primary care support problems until 2017.]

The police in Scotland and the Scottish Parliament are being open but not completely. Their settlement with Accenture remains confidential, but the Scottish Police Authority has published the full business case for i6 and – under FOI – early “Gateway” reviews and “Healthcheck” reports, though with quite a few redactions.

Despite FOI, it’s almost unknown for Whitehall, the NHS or local government in England and Wales, to publish Gateway reviews of big IT projects.

All this means there may be a genuine attempt in Scotland to learn lessons from the failure of the i6 project, and perhaps even let the public sector as a whole benefit from them (if it’s interested),

Due originally to go live last December, and then in the autumn this year, i6 hit problems within months of the start of the contract with Accenture. The contract was signed in June 2013, work started in July and the two sides were reported as being in mediation by August 2013.

Exemplar?

But the programme had followed well-established preparatory routines. One internal report described the procurement approach as an exemplar for the rest of the public sector. Yet it still ended in failure.

In fact i6 followed the classic script of a traditional public sector IT-based project disaster:

  1. An over-ambitious plan for widespread “integration” – which is one of the most dangerous words in the history of public sector IT-enabled change projects. It seemed a great idea at the time: to save vast sums by bringing together in a single system similar things done in different ways by formerly separate organisations.
  2. A variety of early independent reports that highlighted risks and strengths of the programme but didn’t ask the biggest question of all: could a single national system ever work satisfactorily given the amount of organisational change required – changes that would impose on the system design constant modification as end-users discovered new things they wanted and didn’t want that were in the original design – and changes that would require a large team on the police side to have the time to understand the detail and convey it accurately to Accenture.
  3. An assumption that the supplier would be able to deliver an acceptable system within tight deadlines in a fast-changing environment.
  4. Milestones that were missed amid official denials that the project was in disarray.
  5. An agreement to end the contract that was on the basis of a secret settlement, which brought little or no accountability for the failure. Nobody knows how much has been spent on the project in staff and managerial time, hiring of various consultancies, the commissioning of various reports, and money paid over to the supplier.

What are the lessons?

 

The 10-year programme, which was said to cost between £40m and £60m, was ambitious. It was supposed to replace 135 IT-and paper-based systems across Scotland with a single national integrated system that would be rolled out to all Police Scotland divisions.

A “Gateway review” of the project in March 2013 said the project involved the “largest organisagtional change in the history of Scottish policing”.

The released documents have much praise for the police’s preparatory work on the contract with Accenture. Private consultants were involved as the technical design authority. Deloitte was hired for additional support. There were regular “healthcheck” and Gateway reviews.

Too ambitious?

Bringing together dozens of systems and paper-based processes into a new standardised system that’s supposed to work across a variety of business units, requires – before a single new server is installed – agreement over non-IT changes that are difficult in practice to achieve. It’s mainly a business-change project rather than an IT one.

The business case promised “Full interoperability, of processes and technology, at local and national level.” Was that ever really possible?

The disastrous Raytheon/Home Office e-borders project was a similar classic public sector project failure based on “integration”.  Although it was a much bigger project and far more complex than i6, it followed similar principles: a new national system that would replace a  patchwork of different systems and business processes.

Raytheon could not force change on end-users who did not want change in the way Raytheon envisaged. The Home Office wasted hundreds of millions on the project, according to the National Audit Office which said,

“During the period of the e-borders programme the Department made unrealistic assumptions about programme delivery without recognising the importance of managing a diverse range of stakeholders.

“Delivering the e-borders vision requires that more than 600 air, ferry and rail carriers supply data on people they are bringing in and out of the country, while around 30 government agencies supply data on persons of interest.

“During the e-borders period, the contract made Raytheon responsible for connecting e-borders to these stakeholders’ systems, under the Department’s strategic direction. But carriers and agencies expressed general concerns about the costs and other implications of revising their systems to connect to e-borders, including the interfaces they were expected to use.

“The contract strongly incentivised Raytheon to deliver the roll-out to the agreed schedules but provided less incentive for Raytheon to offer a wider choice of interfaces…Lack of clarity on what was legal under European law further exacerbated the difficult relationships with carriers. These difficulties affected progress in rolling out e-borders from the outset…

“Following the cancellation of the e-borders contract in 2010, the Department [Home Office] took more direct ownership of external relationships instead of working through Raytheon. Transport carriers told us there is now a better understanding of needs and requirements between themselves and the Department.”

The NHS National Programme for IT [NPfIT] was another similar failure, in part because of overly ambitious plans for “integration” – on a scale that could never be imposed on a diverse range of largely autonomous NHS organisations. Some hospitals and GPs did not want a national system that did less than their existing systems. Why would they want to replace their own proven IT with cruder standardised systems for the sake of the common good?

More recently the GP support services contract with Capita has run into serious problems largely because of an overly ambitious objective of replacing fragmented ways of working with a national “common good” system.

A Capita spokesperson said of the new system: ‘NHS England asked Capita to transform what was a locally agreed, fragmented primary care support service, to a national standardised system.”

It’s naïve for politicians and senior public servants to view integration as a public benefit without questioning its necessity in the light of the huge risks.

[Mao Tsedong saw the Great Leap Forward as a public benefit. It was a costly catastrophe, in human and financial terms. ]

Disputes over whether proposals would meet actual needs?

It appears that i6 officials found Accenture’s solutions unconvincing; but it’s likely Accenture found that requirements were growing and shifting, leading to disagreements over varying interpretations of different parts of the contract. Accenture could not compel cooperation by various forces even it wanted to.

It may work elsewhere – but that doesn’t mean it’ll work for you.

This is one of the oldest lessons from countless disaster in the history of the IT industry. It was listed as a key factor in some of the world’s biggest IT disasters in “Crash”.

The business case for i6 says:

“The [Accenture] solution is based on a system delivered to 80,000 officers in the Guardia Civil, Spain’s national police force.

“The procured solution includes software components, software licences, specialist hardware, integration tools and services, business change activities, implementation services, reporting capabilities, data management activities, ongoing support, optional managed service arrangements, additional integration services and other relevant services necessary for the successful implementation of the solution.”

Is it wise to promise huge savings many times greater than projected costs?

Clearly i6 is a political scheme. It’s easy in the public sector to declare at the outset any amount of anticipated savings when it’s clear to everyone that the actual audited savings – or losses – will probably never be announced.

Initial costs were put at £12m, but later revisions put the cost nearer to £46m. More recently costs of £60m have been reported. In 2013, cashable savings to be made by developing i6 were said to be over £61m, with the total cashable and non-cashable savings estimated to be £218m over ten years.

That said, the police appear to have paid over relatively small sums to Accenture, not tens of millions of pounds.

Lessons from past failures have been learned – really?

The Scottish Police Authority gave an unequivocal assurance to its members in June 2013 that i6 will “not suffer the same fate as other high profile large scale IT projects”. This is what the Authority said to its members,

“Delivery Assurance – SPA [Scottish Police Authority] members have sought and been provided with significant assurance that the i6 programme will deliver the intended outcomes and not suffer the same fate as other high profile large scale IT projects.

“The robustness and diligent detail that has gone into the full business case itself provides much of that assurance. Further delivery confidence around i6 comes from a number of sources including:
1. Rigorous Programme Governance.
2. Widespread User Engagement and Robust Requirements Gathering.
3. The creation of a ‘live’ multi-sector i6 Learning Network.
4. The formation of strategic partnership groups.
5. Alignment to the wider Scottish Government Digital Strategy.
6. Active learning from the Audit Scotland Review of Public Sector IT Projects and the Common Performance Management Project (‘Platform’).
7. Significant time and investment in the use of Competitive Dialogue.
8. The formation of a strong and consistent programme team with integrated professional advice & support.
9. Exposure to the full independent OGC Gateway Review Process.
10. An independent Scottish Government Technical Assurance Review.

A growing list of changes.

In February 2016 Accenture said, “This is a very complex project. The complexity of the solution, which has been driven by the client, has increased significantly over the last two years.”

This suggests the scope and specification grew as the many different stakeholders gradually formed a view of what they wanted.

Criticism of the supplier, as if it were the only party responsible or delivering the system.

Police Scotland told members of the Scottish Parliament in February 2016 that Accenture has let the police down.

One question auditors may ask is whether it would have been better for local policing divisions to keep control of their own IT.

Internal reviews too soft, too reassuring?

A technical assurance review in June 2013 gave the i6 project an “amber/green” status.

A secret settlement leaves taxpayers having no clue of how much money has gone down the drain.

The Scottish Police Authority says the settlement is confidential. “The terms of the agreement are commercially confidential. However we can confirm that the settlement results in no financial detriment to the police budget.”

The current police budget may not be affected but how much has already been paid and how much of this is wasted? If no figures are ever given, how can there be proper accountability that could deter a new set of officials making similar mistakes in a future project?

Doomsday Register?

If the public sector kept a published “Doomsday” register of failed projects and programmes and the mistakes made in them, as identified by auditors, the same mistakes would be less likely to be repeated.

Perhaps i6 could be the first entry into a new Doomsday register.

The future’s looking bright (?).

When a project is cancelled, it’s almost inevitable that the consequences will be declared to be minimal; and we’re all left wondering why the project was needed in the first place if the future is so rosy.

Half the story

As things stand,  when a council, police, NHS, or Whitehall project fails and millions of pounds, sometimes tens of millions, even billions, are lost, there’s no incentive for anyone but taxpayers to care – and even then they don’t know half the story.

In the case of i6, once the settlement with Accenture is finalised – with hardly anyone knowing the details – officialdom is free to embark on a similar project in a few years time, with different people involved, and describing it in a different way.

Who cares when the public sector has another IT disaster that follows an age-old script?

**

Project summary

The i6 project was introduced to merge more than 130 different computer and paper systems left in place after eight regional forces were merged to form Police Scotland.

Police Scotland told MSPs in February that they were looking at contingency options because they could not solve scores of faults that had emerged during testing.

Officers involved in the tests said at one point they had found 12 critical errors that made it unusable, and a total of 76 defects that required further work.

Accenture said in February that i6 passed its internal testing but flaws emerged when Police Scotland tested the programme.

**

The Guardian reports on another IT-enabled project problems in Scotland.

“Scottish ministers have already been forced to seek an extension from the European commission after its new £178m farming payments system had to be dramatically scaled back and failed to meet an EU deadline.

“There have been significant delays and cost rises too in a new call-handling and IT system for NHS Scotland’s telephone advice service, NHS 24, which has not yet become operational. Its budget has risen by 55% to nearly £118m, and it is four years late.”

Scottish Police Authority and Accenture terminate i6 contract – Government Computing

 

 

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Posted in Accenture, Campaign4Change, change management, consultants, excessive secrecy, IT-related failures, Police IT, project management, public services, supplier relationships

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Another NPfIT IT scandal in the making?

Posted on 09/02/2016 | 8 comments

By Tony Collins

Jeremy Hunt may have forgotten what he told the FT 2013, as reported in the paper on 2 June 2o13.

Referring to the failed National Programme for IT [NPfIT] in the NHS he said at that time,

“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.”

He added, “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.”

Now the Department of Health (and perhaps some large IT suppliers) have encouraged Hunt to find £4bn for spending on technology that is (again) of questionable immediate need.

Says Computing, “A significant part of the paperless NHS plans will involve enabling patients to book services and order prescriptions online, as well as giving them the choice of speaking to their doctor online or via a video link.”

The £4bn, if that’s what it will cost, is much less than the cost of the NPfIT. But are millions to be wasted again?

[NPfIT was originally due to cost £2.3bn over three years from 2003 but is expected to cost £9.8bn over 21 years, to 2024.]

Yesterday (8 February 2016) the Department of Health announced a “review of information technology in the NHS”. Announcing it Hunt said.

“Improving the standard of care patients receive even further means embracing technology and moving towards a fully digital and paperless NHS.

NHS staff do incredible work every day and we must give them and patients the most up-to-date technology – this review will tell us where we need to go further.”

The NPfIT was supposed to give the NHS up-to-date technology – but is that what’s needed?

A more immediate need is for any new millions of central funding (for the cost would be in the tens of millions, not billions) to be spent on the seemingly mundane objective of getting existing systems to talk to each other, so that patients can be treated in different parts of the NHS and have their electronic records go with them.

This doesn’t need a new national programme for IT. Some technologists working in the NHS say it would cost no more than £150m, a small sum by NHS IT standards, to allow patient data to reside where it is but be accessed by secure links anywhere, much as secure links work on the web.

But the review’s terms of reference make only a passing reference to the need for interoperability.

Instead the review will have terms of reference that are arguably vague – just as the objectives for the NPfIT were.

The Department of Health has asked the review board, when making recommendations, to consider the following points:

  • The experiences of clinicians and Trust leadership teams in the planning, implementation and adoption of digital systems and standards;
  • The current capacity and capability of Trusts in understanding and commissioning of health IT systems and workflow/process changes.
  • The current experiences of a number of Trusts using different systems and at different points in the adoption lifecycle;
  • The impact and potential of digital systems on clinical workflows and on the relationship between patients and their clinicians and carers.

The head of the review board Professor Wachter will report his recommendations to the secretary of state for health and the National Information Board in June 2016.

Members of the National Advisory Group on health IT in England (the review board) are:

  • Robert Wachter, MD, (Chair) Professor and Interim Chairman, Department of Medicine,University of California, San Francisco
  • Julia Adler-Milstein, PhD, Associate Professor, Schools of Information and of Public Health, University of Michigan
  • David Brailer, MD, PhD, CEO, Health Evolution Partners (current); First U.S. National Coordinator for Health IT (2004-6)
  • Sir David Dalton, CEO, Salford Royal NHS Foundation Trust, UK
  • Dave deBronkart, Patient Advocate, known as “e-Patient Dave”
  • Mary Dixon-Woods, MSc, DPhil, Professor of Medical Sociology, University of Leicester, UK
  • Rollin (Terry) Fairbanks, MD, MS, Director, National Center for Human Factors in Healthcare; Emergency Physician, MedStar Health (U.S.)
  • John Halamka, MD, MS, Chief Information Officer, Beth Israel Deaconess Medical Center; Professor, Harvard Medical School
  • Crispin Hebron, Learning Disability Consultant Nurse, NHS Gloucestershire
  • Tim Kelsey, Advisor to UK Government on Health IT
  • Richard Lilford, PhD, MB, Director, Centre for Applied Health Research and Delivery, University of Warwick, UK
  • Christian Nohr, MSc, PhD, Professor, Aalborg University (Denmark)
  • Aziz Sheikh, MD, MSc, Professor of Primary Care Research and Development, University of Edinburgh
  • Christine Sinsky, MD, Vice-President of Professional Satisfaction, AMA; Primary care internist, Dubuque, Iowa
  • Ann Slee, MSc, MRPharmS, ePrescribing Lead for Integrated Digital Care Record and Digital Medicines Strategy, NHS England
  • Lynda Thomas, CEO, MacMillan Cancer Support, UK
  • Wai Keong Wong, MD, PhD, Consultant Haematologist, University College London Hospitals; Inaugural chair, CCIO Leaders Network Advisory Panel
  • Harpreet Sood, MBBS, MPH, Senior Fellow to the Chair and CEO, NHS England and GP Trainee

Comment

Perhaps egged on by one or two major suppliers in behind-the-scenes lobbying, Hunt has apparently found billions to spend on improving NHS IT.

Nobody doubts that NHS IT needs improving.  But nearly all GPs have impressive systems, as do many hospitals.  But the systems don’t talk to each other.

The missing word  from the review board’s terms of reference is interoperability. True, it’s difficult to achieve. And it’s not politically aggrandizing to find money for making existing systems interoperable.

But at present you can have a blood test at the GP, then a separate blood test at the local hospital and the full results won’t go on your electronic record because the GP and hospital are on different systems with no interoperability between them.

If you’re treated at a specialist hospital for one ailment, and at a different hospital 10 to 20 (or say 100) miles away for something else, it may take weeks for your electronic record to reflect your latest treatment.

Separate NHS sites don’t always know what each other is doing to a patient, unless information is faxed or posted between them.

The fax is still one of the NHS’s main modes of cross-county communication. The DoH wants to be rid of the fax machine but it’s indispensable to the smooth running of the NHS, largely because new and existing systems don’t talk to each other.

The trouble with interoperability – apart from the ugliness of the word – is that it is an unattractive concept to some of the major suppliers, and to DoH executives, because it’s cheap, not leading edge and may involve agreements on data sharing.

Getting agreements on anything is not the DoH’s forte. [Unless it’s an agreement to spend more money on new technology, for the sake of having up-to-date technology.]

Last year I broke my ankle in Sussex and went to stay in the West Midlands at a house with a large ground floor and no need to use stairs. There was no communication between my local GP and the NHS in the West Midlands other than  by phone, post or fax, and even then only a summary of healthcare information went on my electronic record.

I had to carry my x-rays on a CD. Then doctors at my local orthopaedic department in Sussex found it difficult to see the PACS images because the hospital’s PCs didn’t have CD players.

A government employee told me this week of a hospital that gave medication to a patient in the hope she would not have an adverse reaction. The hospital did not have access to the patient’s GP records, and the patient was unsure of the name of the medication she’d previously had an allergic reaction to.

Much of the feedback I have had from those who have enjoyed NHS services is that their care and treatment has been impeded by their electronic records not moving with them across different NHS sites.

Mark Leaning, visiting professor, at University College, London, in a paper for health software supplier EMIS, says the NHS is “not doing very well when it comes to delivering a truly connected health system in 2016. That’s bad for patient outcomes.”

That GPs and their local hospital often cannot communicate electronically  is a disgrace given the billions various governments have spent on NHS IT.  It is on interoperability that any new DoH IT money needs to be spent.

Instead,  it seems huge sums will be wasted on the pie-in-the-sky objective of a paperless NHS by 2020. The review board document released today refers to the “ambition of a paper- free health and care system by 2020”.

What’s the point of a paperless NHS if a kaleidoscope of new or existing systems don’t properly communicate?

Congratulations, incidentally, to GP software suppliers TPP and EMIS. They last year announced direct interoperability between their core clinical systems.

Their SystmOne and EMIS Web systems hold the primary care medical records for most of the UK population.

And this month EMIS announced that it has become the first UK clinical systems provider to implement new open standards for interoperability in the NHS.

It says this will enable clinicians using its systems to securely share data with any third party supplier whose systems comply with a published set of open application programme interfaces.

The Department of Health and ministers need to stop announcing things that will never happen such as a paperless NHS and instead focus their attention – and any new IT money – on initiatives that are not subconsciously aimed at either political or commercial gain.

It would be ideal if they, before announcing any new IT initiative, weighed up diligently whether it is any more important, and any more of a priority, than getting existing systems to talk to each other.

Review of information technology in the NHS

EMIS implements open standards

 

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Posted in Campaign4Change, change management, consultants, culture, Department of Health, Government IT, health, health records, HSCIC, IT-related failures, NHS, npfit, PACS, supplier relationships

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DWP “evasive” and “selective” with information on Universal Credit programme

Posted on 03/02/2016 | 2 comments

By Tony Collins

Has the Department for Work and Pensions put itself, to some extent, beyond the scrutiny  of Parliament on the Universal Credit IT programme?

Today’s report of the Public Accounts Committee Universal Credit progress update was drafted by the National Audit Office. All of the committee’s reports are effectively more strongly-worded NAO reports.

If the Department for Work and Pensions cannot be open with its own auditors – the National Audit Office audits the department’s annual accounts – are the DWP’s most senior officials in the happy position of being accountable to nobody on the Universal Credit IT programme?

The National Audit Office and the committee found the Department for Work and Pensions “selective or even inaccurate” when giving some information to the committee.

In answering some questions, the committee found officials “evasive”.

Today’s PAC report says:

“We remain disappointed by the persistent lack of clarity and evasive responses by the Department to our inquiries, particularly about the extent and impact of delays. The Department’s response to the previous Committee’s recommendations in the February 2015 report Universal Credit: progress update do not convince us that it is committed to improving transparency about the programme’s progress.”

On the basis of the limited information supplied by the DWP to Parliament the committee’s MPs believe that the Universal Credit has stabilised and made progress since the committee first reported on the programme in 2013, but there “remains a long way to go”.

So far the roll-out has largely involved the simplest of cases, and the ineligibility list for potential UC claimants is long.  By 10 December 2015, fewer than 200,000 people were on the DWP’s UC “caseload” list.

The actual number could be far fewer because the exact number recorded by the DWP by 10 December 2015 (175, 505)  does not include people whose claims have terminated because they have become ineligible by for example having capital more than £16,000 or earning more so that their benefits are reduced to zero.

The plan is to have more than seven million on the benefit, and the timetable for completion of the roll-out has stretched from 2017 originally to 2021,  although some independent experts believe the roll-out will not complete before 2023.

Meanwhile the DWP appears to be controlling carefully the information it gives to Parliament on progress. The committee accuses the DWP in today’s report of making it difficult for Parliament and taxpayers to hold the department to account. Says the report,

“The programme’s lack of clear and specific milestones creates uncertainty for claimants, advisers, and local authorities, and makes it difficult for Parliament and taxpayers to hold the Department to account.”

These are more excerpts from the report:

“In February 2015 the previous Committee of Public Accounts published Universal Credit: progress update … The Department accepted the Committee’s recommendations.

“However, we felt that the Department’s responses were rather weak and lacked specifics, and we were not convinced that it is committed to ensuring there is real clarity on this important programme’s progress.

“As a result, we recalled both the Department and HM Treasury to discuss a number of issues that concerned us, particularly around the business case, the continuing risks of delay, and the lack of transparency and clear milestones.

“Recommendation: The Department should set out clearly how it is tracking the costs of continuing delays, and who is responsible for ensuring benefits are maximised.

“The Department does not publish accessible information about plans and milestones and we are concerned by the lack of detail in the public domain about its expected progress.

“For proper accountability, this information should be published so that the Committee, the National Audit Office and the general public can be clear about progress…

“… the Department did not acknowledge that the slower roll-out affects two other milestones, because it delays the date when existing claimants start to be moved onto Universal Credit and reduces the number of Universal Credit claimants at the end of 2019.

“The flexible adaptation of milestones to circumstances is sensible, but the Department should be open about when this occurs and what the effects are. Instead, the Department’s continued lack of transparency makes it very difficult for us and the public to understand precisely how its plans are shifting.

“Claimants need to know more than just their benefits will change ‘soon’; local authorities need time to prepare additional support; and advisers need to be able to help people that come to them with concerns…

“Recommendation: By May 2016, the Department should set out and report publicly against a wider set of clearly stated milestones, based on ones it currently uses as internal measures, including plans for different claimant groups, local authority areas and for the development and use of new systems. We have set out the areas we expect these milestones to cover in an appendix to this report…

“The Department was selective or even inaccurate when highlighting the findings of its evaluation to us.”

The DWP has two IT projects to deliver UC, one based on its existing major suppliers delivering systems that integrate the simplest of new claims with legacy IT.

The other and more promising solution is a far cheaper “digital service” that is based on agile principles and is, in effect, entirely new IT that could eventually replace legacy systems. It is on trial in a small number of jobcentres.

The DWP’s slowly slowly approach to roll-out means it is reluctant to publish milestones, and it has reached only an early stage of the business case. The final business case is not expected before 2017 and could be later.

The committee has asked the DWP to be more transparent over the business case. It wants detail on:

  • Projected spending, including both investment and running costs for:
  • Live service (split between ‘staff and non staff costs’ and ‘external supplier costs’)
  • Digital service (split between ‘staff and non staff costs’ and ‘external supplier costs’)
  • Rest of programme (split between ‘staff and non staff costs’ and ‘External supplier costs’)
  • Net benefits realised versus forecasts.

Meanwhile the DWP’s response to those who criticise the slow roll-out is to give impressive statistics on the number of jobcentres now processing UC claims, without acknowledging that nearly all of them are processing only the simplest of claims.

Comment

To whom is the DWP accountable on the Universal Credit IT programme? To judge from today’s report it is not the all-party Public Accounts Committee or its own auditors the National Audit Office.

No government has been willing to force Whitehall departments to be properly accountable for their major IT-enabled projects or programmes. Sir Humphrey remains in control.

The last government with Francis Maude at the helm at the Cabinet Office came close to introducing real reforms (his campaign began too forcefully but settled into a good strategy of pragmatic compromise) but his departure has meant that open government and greater accountability for central departments have drifted into the shadows.

The DWP is not only beyond the ability of Parliament to hold it accountable it is spending undisclosed of public money sums on an FOI case to stop three ageing reports on the Universal Credit IT programme being published. The reports are nearly four years old.

Would that senior officials at the DWP could begin to understand a connection between openness and Lincoln’s famous phrase “government of the people, by the people, for the people”.

Public Accounts Committee report Universal Credit, progress update

DWP gives out “selective” information on welfare reform even to its auditors (a similar story in 2015)

Department for Work and Pensions “evasive” – Civil Service World (This article is aimed at its readers who are mostly civil servants. It is likely it will find favour with senior DWP IT staff who will probably mostly agree with the Public Accounts Committee’s view that the DWP hierarchy is, perhaps because of culture, evasive and selective with the information it gives to Parliament and the public.)

 

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Posted in Accenture, Agile, Campaign4Change, consultants, contractors, DWP, excessive secrecy, FOI, Freedom of Information, Fujitsu, Gateway reviews, Government digital Service, Government IT, HP, IBM, Institute for Government, IT projects, Legacy ICT, Major Projects Authority, National Audit Office, Universal Credit

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FOI hearing today on DWP’s refusal to publish Universal Credit reports

Posted on 15/07/2015 | 7 comments

By Tony Collins

External lawyers acting for the Department for Work and Pensions are due to appear before an FOI Upper Tribunal judge in London today to argue why four reports on Universal Credit should not be published.

It’s the latest step in a costly legal battle that has lasted two years so far.

A first-tier FOI tribunal judge in 2014 ordered the four reports to be published. The DWP asked for permission to appeal that decision and lost its case.  The DWP then asked an Upper Tribunal for permission to appeal and lost that case as well.

Then it asked a different Upper Tribunal judge for permission to appeal .  As a result, a 1 day hearing is taking place today.

The case takes in evidence from the DWP, the Information Commissioner, John Slater who requested 3 of the reports in question and me. Slater requested in 2012 a Universal Credit risks register, milestone schedule and issues register (which set out problems that had materialised with the Universal Credit programme).  I requested a project assessment review carried out in 2011 on the Universal Credit programme by the Cabinet Office’s Major Projects Authority.

The DWP has refused to publish the four reports – and millions of pounds worth of other similar reports.

Today the DWP will argue that the judge in an earlier Upper FOI Tribunal did not fully consider the “chilling effect” that disclosure of the reports would have on the behaviours of civil servants or consultants who helped to write the reports in question.

In essence the DWP’s lawyers are asking the judge to accept the arguments put forward against disclosure by Sarah Cox, the DWP’s main witness in the case. Cox is a former programme assurance director for Universal Credit.

Cox submitted 49 pages of evidence – plus secret evidence during a closed hearing – on why the UC reports should not be published.  She said that civil servants must be able to think the unthinkable and record the outcome of these thoughts without hesitation or fear of disclosure.

If contributors feared the reports would be routinely disclosed the documents could become “bland records” prepared with half an eye to how they would be received in the public domain.

She said the danger of damage to the public interest cannot be overstated.

Disclosure could adversely affect management of the Universal Credit programme – and “failure of proper programme management may be catastrophic”.

Emphasising the importance of effective management of risk, she referred to the banking system prior to the credit crunch and the stability of the Bank of England in that period.

“Inappropriate or premature disclosure of the information in the risk registers or the issues registers could lead to those failures occurring in government risk management with broader parallels for other project management tools.”

She then referred to “disaster myopia” – a phenomenon she said was well established in cognitive psychology.  It referred to “an underestimation of the likelihood of low frequency but high risk damage risks”.

She added: “This can result in a lack of appropriate mitigating actions, increasing the likelihood of the risk becoming an issue. In this case fear of disclosure and misinterpretation can exacerbate this myopia, leading to the toning down of the direct and forceful language used to describe risks, or worse, risks not being identified at all”.

If civil servants or consultants writing reports on projects were to downplay the risks because of a fear of disclosure, problems may be overlooked, solutions not found, or not found promptly. “Such an outcome would be seriously detrimental to the delivery of major projects.”

Cox’s evidence could appear to some to suggest the DWP was preoccupied with its image, and the image of the Universal Credit programme, in the media, and among MPs and the public. She said routine disclosure of such reports as those in question “will distract civil servants from their tasks at a crucial point in the process of programme management.

“Instead of concentrating on implementing the changes, they will be required to address stakeholder, press or wider public concerns which have been provoked by the premature disclosure of material.”

It would be unhelpful if “attention is focused on clarifying positions with stakeholders and addressing the concerns of media, opposition and interest groups in order to correct the often misleading impression created by premature disclosure”.

This issue is “magnified in a programme with as many delivery partners as Universal Credit, covering both central and local government, with implications for all territories in the UK”.

That is because of the “implications of issues for different partners are often slightly different, so that each partner may need to be given a slightly different, and tailored, response”.

This concern should not be understated, she said.

“From my experience of high profile matters which emerge with little warning, I can say that ministers and senior officials are likely to be forced to clear their diaries, cancelling planned meetings, events and other important engagements, to attend rapidly-convened meetings to discuss the handling of the premature disclosure.

“Officials in the relevant policy areas (and lawyers as appropriate) would need to set aside other essential and pressing work to prepare briefings on the likely impact of disclosure and options for next steps. ‘Lines to take’ and a stakeholder and media-handling strategy would need to be discussed, agreed and signed off by ministers.

“Ministers could also be called to respond to urgent questions tabled in Parliament, especially where the disclosure  is made in respect of a high-profile policy area. The media might press for interviews with ministers and/or senior officials, which require careful preparation…”

But, as the Information Commissioner has pointed out, disclosure of the documents under FOI is not the same as a leak to the media.

And the reports in question are now four years old and so massive media interest is unlikely. Any media interest could be managed by DWP press officers without distracting project managers.

Cox said disclosure could harm rather than assist public debate.

“Material that requires civil servants to think the unthinkable, or to consider unusual or highly unlikely events, using intentionally vivid and forceful language, at a single point in time, potentially pre-dating attempts to mitigate the position could easily distort the public perception of the real or likely situation and encourage sensationalist rather than responsible and balanced reporting.”

She said that officials may have to release further information to counteract any misunderstandings (from a misreading of the disclosed reports). But the “world of media” may ignore this further information.

Lawyers for the Information Commissioner, in their submission to today’s hearing, will argue that an earlier tribunal had not found any existence of a “chilling effect” in this case. The tribunal had not been persuaded by what the DWP had said.

The earlier tribunal had not dismissed all of the DWP’s concerns as entirely without merit. It accepted that disclosure of the documents in question “may not be a painless process for the DWP” and that there “may be some prejudice to the conduct of government of one or more of the kinds asserted by the DWP”. The tribunal was simply unpersuaded by the extent of those prejudices.

The Commissioner’s lawyers will say the earlier tribunal gave due weight to the evidence of Ms Cox but it was not obliged to agree with her.

There was no observable chilling effect from disclosures in the past where a chilling effect had been envisaged. The DWP had not provided any evidence that a chilling effect existed.

Indeed a Starting Gate Review on the Universal Credit project had been published (by Campaign4Change) after the DWP refused to release the document under FOI. The DWP had refused to publish the Starting Gate Review because of the chilling effect it would have on the contributors to such reports.

But there was no chilling effect in consequence of publication of the Starting Gate review, say the Information Commissioner’s lawyers.

The incident “illustrates that it is perfectly within the bounds of reason to be sceptical about the DWP’s assertions about the chilling effect and the like,” says the Information Commissioner’s submission to today’s hearing.

On Ms Cox’s point that disclosure of the reports in question would change behaviours of civil servants and consultants compiling the documents, the earlier tribunal had concluded that the public was entitled to expect from senior officials – and no doubt generally gets – a large measure of courage, frankness and independence in their assessments of risk and provision of advice.

The Information  Commissioner’s lawyers will today ask the judge to dismiss the DWP’s appeal.

Comment

The DWP’s evidence suggests that the reports in question today are critical to the effective delivery of Universal Credit. The reality is that excessive secrecy can make bureaucracies complacent and, in the the DWP’s case, somewhat chaotic.

When Campaign4Change asked the DWP under FOI for two Universal Credit reports – an end to end technical review carried out by IBM at a cost of £49,240 and a “delivery model assessment phases one and two” carried by McKinsey and Partners at a cost of £350,000 – the DWP mistakenly denied that the reports existed.

When we provided evidence the reports did exist the DWP said eventually that it had found them.  The DWP said in essence that the documents had been held so securely nobody knew until searching for them that they existed.

So much for the DWP’s argument that such reports are critical to the effective management of major projects.

And when Campaign4Change asked the DWP, under FOI, to supply a project assessment review report on the Universal Credit programme, officials mistakenly supplied an incorrect version of the report (a draft) to an FOI tribunal.  Officials later apologised for their mistake.

National Audit Office reports on Universal Credit do little to portray the DWP as a professional, competent and well-managed organisation.

Which all suggests that excessive secrecy within the DWP has made officials complacent and disorganised.

Continued excessive secrecy within the department could reinforce a suspicion, justified or not, that the department may not be in a strong position to run a programme as large and complex as Universal Credit.

 

 

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Posted in change management, consultants, contractors, DWP, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, HMRC, Major Projects Authority, National Audit Office, procurement, project management, public sector, Real-Time Information, Universal Credit

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Yet another NHS IT mess?

Posted on 09/07/2015 | Leave a comment

By Tony Collins

Last week the National Audit Office reported on the failure of the GP Extraction Service. Health officials  had signed off and paid for a contract even though the system was unfit for use.

The officials worked for organisations that have become part of the Health and Social Care Information Centre.

An unapologetic HSCIC issued a statement on its website in response to the Audit Office report. It said, in essence, that the problems with the GP Extraction Service were not the fault of the HSCIC but rather its predecessor organisations (ignoring the fact that many of the officials and contractors from those defunct organisations moved to the HSCIC).

Now it transpires that the HSCIC may have a new IT-related mess on its hands, this time one that is entirely of its own making – the e-Referral Service.

Last month the HSCIC went live with its e-Referral service without testing the system properly. It says it tested for thousands of hours but still the system went live with 9 pages of known problems.

Problems are continuing. Each time in their routine bulletins officials suggest that an upgrade will solve e-Referral’s problems. But each remedial upgrade is followed by another that does not appear to solve the problems.

The system went live on 15 June, replacing Choose and Book which was part of an earlier NHS IT disaster the £10bn National Programme for IT.

Problems more than teething?

Nobody expects a major new IT system to work perfectly first time but regular outages of the NHS e-Referral Service may suggest that it has more than teething problems.

It’s a common factor in IT-based project failures that those responsible have commissioned tests for many hours but with inadequately designed tests that did not always reflect real-world use of the system. They might also have underestimated loads on the available hardware and networks.

This means that after the system goes live it is brought down for regular hardware and software fixes that don’t solve the problems.  End-users lose faith in the system – as many GPs did with the Choose and Book system – and a misplaced optimism takes the place of realism in the thinking of managers who don’t want to admit the system may need a fundamental redesign.

On the day the e-Referral Service launched, a Monday, doctors had difficulties logging in. Software “fixes” that day made little difference. By the next day HSCIC’s optimism has set in. Its website said:

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

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

The “fix” also made little apparent difference. The next day, Wednesday 17 June, the entire system was “unavailable until further notice” said the HSCIC’s website.

By early evening all was apparently well. An HSCIC bulletin said:

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

In fact, by the next day, Thursday 18 June, all was not well. Said another bulletin:

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

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

About 2 weeks later, on 30 June, HSCIC’s officials said there were ongoing problems, because of system performance in provider organisations that were processing referrals.

Was this HSCIC’s way of, again, blaming other organisations – as they did after the NAO report’s on the failure of the GP Extraction Service project? Said a statement on the HSCIC’s website on 30 June 2015:

“Since transition to the NHS e-Referral Service on Monday 15th June, we have unfortunately experienced a number of problems… Although most of the initial problems were related to poor performance of the system, some residual functional and performance issues persist and continue to affect some of our colleagues in their day-to-day working.

“Most of these on-going problems relate to the performance of the system in provider organisations that are processing referrals, though this does of course have a knock-on effect for referrers.

“Please be assured that the team are working to identify root causes and fixes for these issues.”

By last week – 2 July 2015 – HSCIC warned that it will require a “period of planned downtime on the NHS e-Referral Service tonight which is currently scheduled for between 21:00 and 23:00 for some essential maintenance to fix a high priority functional Incident.”

The fix worked – or did it? HSCIC told Government Computing: “An update was applied to the system overnight from Thursday (July 2) into Friday (July 3) which was successful.”

But …

Monday 6 July 2015 4.15pm. HSCIC e-Referral Service bulletin:

“We would like to apologise for the interruption to service between 13:15 and 13:54 today.  This was not a planned outage and we are investigating the root cause.  If any remedial activity is required we will give notice to all users. Once again please accept our sincere apologies for any inconvenience this caused.”

Why was testing inadequate?

Did senior managers go live without testing how the system would work in the real world, or did they select as test end-users only IT enthusiasts?

Perhaps managers avoided challenging the test system too much in case it gave poor results that could force a redesign.

We probably won’t know what has gone wrong unless the National Audit Office investigates. Even then it could be a year or more before a report is published. A further complicating factor is that the HSCIC itself may not know yet what has gone wrong and may be receiving conflicting reports on the cause or causes of the problems.

An IT failure? – change the organisation’s name

What’s certain is that the NHS has a history of national IT project failures which cause organisational embarrassment that’s soon assuaged by changing the name of the organisation, though the officials and contractors just switch from one to the next.

NHS Connecting for Health, which was largely responsible for the NPfIT disaster, was blended into the Department of Health’s informatics function which was then blended into the HSCIC.

Similarly the NHS Information Centre which was largely responsible for the GP Extraction Service disaster was closed in 2013 and its staff and contractors blended into the HSCIC.

Now, with the e-Referral Service, the HSCIC at least has a potential IT project mess that can be legitimately regarded as its own.

When will a centrally-run national NHS IT-based turn out to be a success? … care.data?

New SRO

Meanwhile NHS England is looking for a senior responsible owner for e-Referral Service on a salary of up to £98,453.

Usually in central government, SROs do the job as an adjunct to their normal work. It’s unusual for the NHS to employ a full-time project SRO which the NAO will probably welcome as a positive step.

But the job description is vague. NHS England says that the SRO for NHS e-Referrals programme will help with a switch from paper to digital for 100% of referrals in England by March 2018.

“The SRO … will have responsibility for the strategic and operational development of the digital journey, fulfilment of the patient and clinical process and the performance of the service. Plans to achieve the strategy will be underpinned by the delivery of short to medium term objectives, currently commissioned from HSCIC and other third party suppliers.”

Key aspects of this role will be to:-

– Ensure the strategy is formulated, understood by all stakeholders and is delivered utilising all available resources efficiently and effectively.

– Ensure the development and management of plans.

– Ensure appropriate system and processes are in place to enable the uptake and on-going use of digital referrals by GP’s, hospitals, patients and commissioners.

– Proactively manage the key risks and issues associated with ensuring appropriate actions are taken to mitigate or respond.

– Monitor and establish accountability on the overall progress of the strategy to ensure completion within agreed timescales.

– Manage the budgetary implications of activity.

– Avoid the destabilisation of business as usual.

– Manage and actively promote the relationships with key stakeholders.

The job will be fixed-term until 31/03/2017 and interviews will be held in London on the 20th July 2015.

The big challenge will be to avoid the destabilisation of business as usual – a challenge beyond the ability of one person?

Government Computing. 

Another fine NHS IT mess

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

National e-Referral Service unavailable until further notice

 

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Posted in Agile, Campaign4Change, consultants, e-health, e-Referral Service, Government IT, HSCIC, IT-related failures, National Audit Office, NHS, npfit, operational issues

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

Posted on 04/06/2015 | 7 comments

By Tony Collins

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

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

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

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

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

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

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

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

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

This is the HMRC advert:

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

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

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

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

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

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

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

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

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

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

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

Comment

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

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

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

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

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

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

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

Government Computing article

 

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