Category Archives: managing outsourced services

Summary Care Record plods on

Posted on 11/04/2012 | Leave a comment

By Tony Collins

Pulse reports that the Summary Care Record database had 13.1 million records by 22 March 2012, which is around the number the DH had expected for April last year.

It reports that the figures have prompted David Flory, deputy NHS chief executive, to call for ‘rapid further progress’ on the rollout.

In his latest quarterly report on NHS performance, Flory highlighted the SCR as an area for improvement. “Implementation does not meet expectations and rapid further progress is needed,” said Flory. “While performance has improved, the rate of this improvement is beneath the expected trajectory.”

The number of patients with an SCR has almost doubled from around seven million a year ago. Sixteen PCTs have more than 60% of patients with an SCR.

Critical Mass

In February, Kilburn GP and SCR director Gillian Braunold was reported in Pulse to have said the rollout has reached a ‘critical mass’ in some areas. Out-of-hours providers, and those in urgent care and hospitals are viewing about 1,600 records a week.

Braunold said information within the SCR was changing some therapeutic decisions. She also said there was also evidence from areas where end-of-life care plans had been uploaded to care records that more patients were dying in their preferred place.

Nurses at NHS Direct are to have access to care records and the DH is working on plans to replace HealthSpace and enable patients to access their full patient record.

Comment – The devil’s in the detail

It is difficult to put Dr Braunold’s comments into context without published independent evidence of which there is little or nothing that’s recent.

In public, NHS Connecting for Health has never wavered in proclaiming the success of the SCR but it has sought to control authoritative information on the SCR programme.

CfH commissioned an independent UCL report on the NPfIT SCR  “The devil’s in the detail”, but asked researchers to, for example, delete the cost of the SCR programme. CfH also removed passages from official SCR documents it gave the UCL researchers.

The final UCL report , which said in a footnote ” financial data deleted at the request of CFH”,   found that there were inaccuracies in the SCR database. UCL researchers also learned that the SCR database could not be relied on as a single source of truth.

Some CFH staff found the notion of possible ‘disbenefits’ of the SCR difficult to conceptualise, said the UCL report.

There is no doubt that an accurate and well-populated SCR would be useful, especially for out-of-hours doctors. They need to know – at least – what drugs patients are taking and what if any adverse drug reactions they have had.

As the DH tells patients: “Giving healthcare staff access to this (SCR) information can prevent mistakes being made when caring for you in an emergency or when your GP practice is closed.”

But a national database is not the way forward. It is unlikely to be trusted as accurate or up-to-date. It would be better to give patients and clinicians access to locally-held NHS-sourced information. We’ll report more on this separately.

Meanwhile the SCR plods on at a high cost – more than £220m so far. BT, the SCR’s main supplier, will be pleased the programme is continuing, as will those civil servants and consultants who have been involved with the programme for several years. But whether the database is of real value to doctors and patients we don’t know for certain. The DH tends not to publish its independent advice.

Summary Care Record a year behind schedule, DH warns – Pulse

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Posted in Government IT, health, health records, IT projects, IT-related failures, managing change, managing outsourced services, NHS, npfit, openness and transparency, operational issues, Politics

Time for truth on Universal Credit IT

Posted on 03/04/2012 | 5 comments

By Tony Collins

A normally-reliable contact says that the IT project for Universal Credit is in trouble.

A deadline this month to lock-down features in the scheme will not be met, says the contact. This failure will jeopardise the go-live date of October next year for the start of Universal Credit.

The contact also says that the Government will make an announcement on the scheme in September which may refer to a write-off of at least £150m on the IT project. The suggestion is that although the scheme is in trouble officials may be reluctant to impart the whole truth to ministers.

We wonder about the difficulties of agreeing system features when there are so many parties involved in the IT project: HMRC, DWP, local authorities, banks and private sector employers. The contact also says Oracle is having trouble handling functionality.

Officially all is well. The Secretary of State for Work and Pensions, Iain Duncan-Smith, spoke with confidence about the future of the scheme in the House of Commons last week.

That said, he told Parliament on 5 March about the “issues and problems” related to HMRC’s Real-Time Information project which is an essential part of the Universal Credit IT project. He said: 

“HMRC, which is now responsible for this measure, meets me and others in the Department regularly. We have embedded some DWP employees in the HMRC programme; they are locked together. They are, as I understand it, on time, and they are having constant discussions with large and small employers about the issues and the problems, and assessing what needs to be done to make this happen and to make all the changes.

“We must remember that all those firms collect those data anyway; the only question is how they report it back within the monthly cycle. We are on top of that but, obviously, we want to keep our eye on the matter.”

Problems with the IT for Universal Credit – the Government’s leading “agile” software project – may bring a smirk to the faces of those who believe that departments cannot manage agile-based schemes. But agile proponents have long said that Universal Credit is only partially agile – and they have argued that agile should not be mixed with traditional software-writing approaches.

Suppliers on Universal Credit, which include HP, Accenture, IBM,Capgemini and Oracle, are not particularly well known for their love of agile on Government IT projects.

Time for the truth  

The Department for Work and Pensions is refusing to publish any of its reports and assessments on the IT for Universal Credit. The secret reports include:

–   A Project Assessment Review in November 2011

– Universal Credit Delivery Model Assessment Two (McKinsey and Partners)

– Universal Credit end-to-end Technical Review (IBM).

Comment

Officials and ministers speak publicly about the solid progress on Universal Credit IT while refusing to publish their internal reports on progress or otherwise of the scheme.

Past NAO reports have shown that ministers and sometimes senior officials are sometimes kept in the dark when major IT-related projects go wrong. Project steering groups are told what they want to hear. The Programme Board on the NPfIT discussed successes with enthusiasm and hardly mentioned serious problems, judging by minutes of its meetings.

We hope that all is well with Universal Credit IT. The project is, after all,  an advert for innovation in the public sector. If it’s in trouble the truth should come out. Keeping it quiet until September means that suppliers will continue to be paid for several months unnecessarily – perhaps to keep them supportive?

Labour was overly defensive and secretive about its many IT-related failures whereas “openness” is the coalition’s much-favoured word. It’s a pity it has yet to be applied to the Universal Credit IT project.

Secret DWP reports.

Who’ll be responsible if Universal Credit goes wrong?

Banks “unlikely to deliver” Universal Credit

Universal Credit IT plans too optimistic warn MPs.

Universal Credit latest

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Posted in excessive secrecy, Freedom of Information, Government IT, innovation, managing change, managing outsourced services, npfit, openness and transparency, operational issues, Real-Time Information, software development, Universal Credit

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Rights to Provide plans focus on “potential offered by mutual models” to improve services

Posted on 29/03/2012 | 1 comment

By David Bicknell

The Government has detailed how it is developing and implementing Rights to Provide to “empower front line staff across the public sector to take over the services they deliver,” possibly through the creation of new mutuals.

The Government said it has identified local authorities’ services, fire services, probation and adult social care as some of the areas for developing new mutuals. This it says, will be backed by enhanced support available to staff through the Mutuals Information Service and the Mutuals Support Programme.

In announcing an updated discussion paper David Cameron said increasing parental choice in schools, extending personal budgets so people can choose how they spend money on services and increasing the transparency of public service performance and user satisfaction are all part of the next steps to improve public services by opening them up.  The paper updates the Open Public Service (OPS) White Paper published last summer.

Launching the new paper, Cameron said: “Nearly two years on from coming into office, brick by brick, edifice by edifice, we are slowly dismantling the big-state structures we inherited from the last government. We are putting people in control, giving them the choices and chances that they get in almost every other area of life. There is still a way to go and this kind of change will not happen overnight. But no one should doubt my determination to make our public services better, by opening them up.”

Specifically on mutuals, the paper says:

“Alongside the focus on digital delivery, and as a core part of work to reform the Civil Service, Government Commercial Teams are working with individual departments to identify where new commercial models would accelerate reform and improve services. In some cases, this may involve high-quality in-house delivery; in other cases outsourcing may offer best value.

“We are particularly interested in the potential offered by mutual models, including mutual joint ventures, that give employees much greater say in the way their organisation is run, for example the model being considered for MyCSP.

“To ensure that the benefits of mutualisation are available across the wider public sector, we are giving public sector staff new Rights to Provide – empowering employees to form public service mutuals to bid or request to take over the services they deliver. This will empower millions of public sector staff to become their own boss,freeing up untapped entrepreneurial and innovative drive.

“Public service mutuals are now well established in community healthcare, with thousands of public servants working in new mutuals with contracts worth almost £1 billion. We have extended these rights to new areas, including adult social care and NHS trusts, and we are looking to go further, in areas such as youth services, probation services, children’s centres, and fire and rescue services.

“We have been actively working with fledgling mutuals on the ground, for example through the Mystery Shopper service and the Mutuals Information Service; and we are supporting some of the most promising and innovative mutuals to reach the point of investment readiness, through the Mutuals Support Programme – a fund of more than £10 million to contract for support in the form of business and professional services to groups of staff who want to form mutuals or existing mutual organisations in the public sector. A steady stream of applications is developing into a pipeline of projects.”

The Government said all its departments will put in place a Right to Provide to empower employees in public services for which they are responsible to s pin out to create new public service mutuals. Public sector workers who want to formmutuals or co-operatives to deliver public services will be given a Right to Provide.

The Government will look to reflect these commitments in departmental business plans where appropriate.

Information from the Mutuals Information Service will inform departmental policy development, the new paper says.  

It points out that “the Department of Health’s Right to Request is near completion, with 40 services now operating as independent social enterprises and further projects to go live by April 2012. The Right to Provide has generated interest across NHS trusts, foundation trusts and adult social care.

“The Department of Health is already exploring opportunities to support social enterprises and mutuals spinning out from the NHS, social care and adult social work. The status of other government departments is as follows:

• Department for Business, Innovation and Skills (BIS) Further Education – now starting

• Home Office – not yet started

• Ministry of Justice – now starting; commitments will be reflected in the Department’s business plan 

• Department for Work and Pensions – not yet started

•Department for Education Youth Services, and Social Work – now starting

• Department for Education Children’s Centres – not yet started.

Other Links

Cabinet Office news release

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Posted in Campaign4Change, managing outsourced services, mutualisation, mutuals, procurement, social economy, social enterprise

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Universal Credit: who’ll be responsible if it goes wrong?

Posted on 27/03/2012 | 1 comment

By Tony Collins

When asked whether Universal Credit will work, be on budget and on time, Ian Watmore, Permanent Secretary, Cabinet Office, gave a deft reply. He told Conservative MP Charlie Elphicke on 13 March 2012:

“From where I sit today, I think all the signs are very positive. I am never going to predict that something is going to be on time and on budget until it is.”

If the plans do not fall into place who, if anyone, will be responsible? In theory it’ll be Iain Duncan Smith, the Secretary of State for Work and Pensions. But as Watmore told the Public Administration Committee, there are several other organisations involved. Although the DWP and HMRC are building the IT systems, the success of Universal Credit also relies on local authorities, which are overseen by the Department for Communities and Local Government.

There are also the Cabinet Office and the Treasury whose officials seek to “ensure that what is going on is appropriate” said Watmore.

If Univeral Credit goes awry all the departments may be able to blame the private sector: the employers that must pass PAYE information to HMRC so that the Revenue’s Real-Time Information element of Universal Credit can work.

David Gauke is the minister responsible for HMRC so would he take some of the blame if Real-Time Information didn’t work, or was not on budget, or was delayed?

Or would the main IT suppliers Accenture and IBM take any of the blame? Highly unlikely, whatever the circumstances.

There is also a dependency on the banks.

But nothing is wrong … is it?

All those putatively responsible for Universal Credit continue to say that all is going well.

Duncan Smith told the House of Commons on 5 March 2012:

“We are making good progress towards the delivery of universal credit in 2013, and I have fortnightly progress meetings with officials and weekly reports from my office. I also chair the universal credit senior sponsorship group, which brings together all Government Departments and agencies that are relevant to the delivery of universal credit.

“Design work is well under way and is being continually tested with staff and claimants, and the development of the necessary IT systems will continue in parallel.”

He said that universal credit will reduce complexity by putting together all the benefits that are relevant to people going back to work – though benefit systems that are not relevant to the coalition’s “Work programme” will not be included in the DWP’s Universal Credit IT consolidation.

To reduce risks Universal Credit will be phased in over four years from October 2013, each stage bringing in a different group of claimants.

But …

Campaign4Change has asked the DWP to publish its various reports on the progress of Universal Credit and it has refused, even under the Freedom of Information Act. It seems the DWP’s secretiveness is partly because all of the risks related to Universal Credit have not been mitigated. We will report more on this in the next few days.

Meanwhile to try and answer the question in our headline: who’ll be responsible if Universal Credit goes wrong? The answer is: the private sector probably. Or rather nobody in the public sector.

Can hundreds of millions be spent on Universal Credit in an agile way?

Universal Credit suppliers Accenture and IBM look to India for skills.

Is Universal Credit a brilliant idea that’s bound to fail?

Universal Credit latest

Universal Credit and the banks.

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Posted in Agile, Campaign4Change, capacity building, change, change management, Freedom of Information, Government IT, IBM, India, IT projects, local government, managing change, managing outsourced services, openness and transparency, outsourcing, oversight, Politics, procurement, project management, public sector, Real-Time Information, reducing cost strategically, risk, Universal Credit

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Is Francis Maude starting to spin – without realising it?

Posted on 16/03/2012 | 6 comments

By Tony Collins

Francis Maude is, perhaps, the most effective Cabinet Office minister in decades.

If the business world divides into two main types of character, black and white, and grey – neither being better or worse than the other –  Maude is black and white.

He wants clarity. He shuns subtlety and complexity. He has no time for civil service sophistry and equivocation, or the coded language of some supplier representatives. He wants cuts in the cost of contracts and doesn’t want to hear long arguments on why things are not that simple. He had deep reservations over doing a new deal with CSC over the NPfIT.

A strength of Maude and his colleagues at the Cabinet Office has been the absence, or at least scarcity, of exaggerated and unsubstantiated statements of efficiency savings, of the sort made repeatedly during Labour’s tenure.

Is that beginning to change?

In the past fortnight Maude has made two major claims that are not based on published evidence.

• Maude said spending on SMEs has risen from 6.5% to 13.7%.  It’s not clear how that figure is calculated. There’s a good analysis of the tenuousness of the claim by Peter Smith of Spend Matters. How much of the increase in SME work is down to unaudited claims by large companies that they are giving their SMEs more work?

• He said that £200m has been cut from Capgemini’s Aspire contract with HMRC. [Aspire also involves Fujitsu and Accenture.] He has received much good publicity for the claim. Said the Telegraph yesterday:

“He [Maude]  announced that ministers had successfully renegotiated one deal on computers and tax systems for HM Revenue and Customs.

He said the new contract, with Capgemini, would save £200 million on the deal previously agreed.”

Last year Mark Hall, deputy CIO at HMRC was reported as saying that the Aspire contract was on course to save more than £1bn. Is the £200m quoted by Maude in many news articles this week new?

And none of the articles mention the total cost of the Aspire contract – so from what is £200m being cut?

At one point, according to Mark Hall, the estimated cost of Aspire rose to £10bn from its original estimate of £2.83bn over 10 years. This means that cost increases on the Aspire contract are measured in billions – which puts the £200m savings figure mentioned by Maude into context.

And have Maude and his team offered Capgemini anything in return for a price cut, such as an improved profit margin? [The contract is on an open-book accounting basis]. This week’s Cabinet Office statement on the £200m cut gives no help here. An HMRC FOI response in 2010 and an NAO report in 2006 show that costs of Aspire are fluid. They change according to internal demand; and pricing arrangements are complex. HMRC has refused FOI requests to publish the contract so how can anyone put the claimed £200m savings into a contractual content?

In 2007 negotiations between HMRC and Capgemini extended the 10-year contract by three years, to June 2017; and there’s an option to extend Aspire  for a further five years to 2022. In return for the contract extension Capgemini has already guaranteed savings of £70m a year and a further £110m a year from 2012. Are these savings in addition to the £200m a year Maude has announced? Or the £1bn savings mentioned by Mark Hall?

The good news is that HMRC’s CIO is Phil Pavitt who is a natural sceptic of big outsourcing deals. If anyone is going to achieve genuine savings on Aspire it is Pavitt. Indeed he has given some details of his negotiations. But the contractual context remains abstruse.

Comment

Doubtless Maude believes the figures he has announced on SMEs and Aspire are correct but without substantiation they will mean little to anyone except the media. Maude, perhaps, needs to trust his own cautious instincts than listen too much to his advisers. Otherwise he’ll begin to sound more like Labour ministers who repeatedly made claims the NAO found difficult to substantiate.

The important and impressive work Maude is doing to cut the costs of running government should not be trivialised and debased by spin. Announcements on what he is doing to cut costs and make government more open are usually helpful. But Maude should the first to differentiate the real – in other words the factually corroborated – from aggrandising and flimsy political claims.

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Posted in Campaign4Change, compliance with spending review, cost avoidance, efficiency savings, Freedom of Information, Government IT, managing change, managing outsourced services, outsourcing, Politics, procurement, public sector, public services, reducing cost strategically, supplier relationships

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Lessons from “stupid” NHS IT scheme – Logica boss

Posted on 13/03/2012 | 1 comment

Some wise words from Andy Green, CE of Logica, on lessons from the NPfIT and other failures

By Tony Collins

Andy Green, CE, Logica

Andy Green, chief executive of Logica, speaking to the BBC’s Evan Davis about the NHS National Programme for IT, NPfIT, said:

“It is a stupid thing for the supply chain to have answered, and it’s a stupid thing for the customer to have asked for.”

Green was speaking on Radio 4’s The Bottom Line about corporate “cock-ups and conspiracies”. Other guests were Phil Smith, chief executive of Cisco UK and Ireland, and entrepreneur Luke Johnson.

Green, who joined Logica as CEO in January 2008, said he was in one of the bidders for the NPfIT when he was at BT.

The plan, he said, had been to put the same system into every hospital but later foundation hospitals were able to opt out of the NPfIT.

“Half way through [the NHS IT programme] foundation hospitals were invented,  and suddenly foundation hospitals did not have to go with what the NHS said at all”.

He added: “There were fundamental errors in the whole procurement process, and then real difficulty in delivering what had been promised.”

Evan Davis said the NHS IT scheme had cost billions, achieved little and had been running for years. He asked Green: “What’s the story?”

Green said some things went well including the supply of a network that connects pharmacies and doctors. But …

“What  had been promised by the supply chain was fantastic software that had not been designed yet that was going to completely revolutionise hospitals and delivering that proved to be horrendous… in the end it is foolish to set out on a programme that is going to take seven years with a fixed procurement up front, which says we all know everything about it …”

Lessons

Green spoke of the need for the supplier to understand exactly what the customer wants and whether it is deliverable before the parties agree to draw up a project specification.

“I think the world is beginning to learn about incrementalism. Let’s do something that we can all see and understand.

“Some of our clients we now work with in common teams – we call it co-management – and only when we have worked out exactly what is going to work in the client, and we can deliver, do we specify it as a project.

“Those things tend to go a lot better. We have got used to the fact that we don’t know everything.”

Luke Johnson

Luke Johnson, who is a former chairman of Channel 4, criticised IT suppliers for not getting it right often enough.  “I have bought quite a lot of projects and been involved as a customer many times… As a customer it is a very scary thing because clearly you are not an expert. Your providers are experts and yet they do not seem to be able to get it right often enough it seems to me, given how much they charge.”

Green said there is a high failure rate in the IT industry. “The client sets out one view at the beginning and then they have to change. The sensible defence to this is the partitioning into smaller items and relationships.

“We bluntly always think of our clients over the long run. You need to know people so that you can sit down and have a decent conversation. Too often when these things start to go wrong everybody runs for the contract. Experienced buyers and sellers do not do that: they run for each other and they talk it through, and they work it out, and they put it back on track.

“It’s value that matters. It’s doing something that really changes Patisserie Valerie’s business. [Luke Johnson is chairman of Patisserie Valerie.] What can you do that would transform that. If you can get that done, then if it over-runs by 20% it probably does not matter.”

Luke Johnson: “It depends how much money you’ve got.”

Lowest-price bids

Phil Smith, Cisco

Phil Smith of Cisco said government often has the biggest problems because “they squeeze so much in procurement there is little good value and goodwill left”.He said that on good projects problems are tackled by cooperation but “if every piece of value has been squeezed out before you procure it, your only option is to get something back from it”.

Beware procurement experts

Johnson said if procurement experts take control, and their mantra is to save money, it can often lead to trouble. “I fear that in many aspects of business, it gets down exclusively to price rather than value.

“Quality is out the window. They [procurement experts] can show a saving so they have justified their bonus but the supplier may be rubbish.”

Green said government is in a difficult position when a project starts to go wrong. “You are stuck in a procurement and the poor individual responsible is almost certainly facing a union or a consumer group or a doctor who doesn’t want the thing to happen anyway.”

Evan Davis made the valid point that the costs of projects in the public sector have to be underestimated to get approved. Realistic estimates would be rejected as too costly.

“… The person who is championing this project has to demonstrate to superiors that it is not too expensive. It is only by taking the cheapest bid and starting the thing off that you can sell the project higher up and of course down the line it costs a heck of a lot more.”

Luke Johnson: “We all know in many sectors there are providers that will take things at cost or even less with a view that they will somehow bulk it out and make a margin on the way. They know the client will need variations.

Innovation means taking risks

Luke Johnson: “If you want an innovative society, if you want one that is willing to take risks, to generate new technologies, new jobs, new businesses, then it involves failures and cock-ups.

“I think the British have got vastly better in recent years in accepting that as part of the journey and that is incredibly healthy.”

BBC R4’s The Bottom Line – Cock-ups and conspiracies.

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Posted in Campaign4Change, change management, Government IT, health records, IT projects, IT-related failures, managing change, managing outsourced services, NHS, npfit, operational issues, private sector lessons for the public sector, procurement, project management, supplier relationships

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New child support system has 90,000 requirements – in phase one

Posted on 29/02/2012 | 3 comments

                               A new old-style government IT disaster?

By Tony Collins

While officials in the Cabinet Office offcials try to simplify and cut costs of Government IT, a part of the Department for Work and Pensions has commissioned a system with 90,000 requirements in phase one.

The projected costs of the child maintenance system have risen by 85% and the delivery date has slipped by more than two years.

Even with 90,000 requirements, phase one, which is due to go live in October, excludes 70 requirements that are “deemed critical” says a report published today by the National Audit Office.

The NAO report indicates that the Child Maintenance and Enforcement Commission has commissioned an old-style large IT system using traditional developing techniques and relying on large companies.

G-Cloud and SMEs have not featured in the Commission’s IT strategy – and it abandoned agile techniques last year on its child maintenance project.

The Commission put the cost of its new child maintenance system at £149m in January 2011. Ten months later it put the cost at £275m, an 85% increase. The Commission was unable to give the NAO a full explanation for the difference.

Lessons from past failures not learned?

Today’s NAO report says there is a risk the Commission will repeat mistakes by the Child Support Agency whose IT system and business processes were criticised in several Parliamentary reports. The Commission takes in the work of the Child Support Agency – and indeed runs its own systems and the Child Support Agency’s in parallel.

Officials at the Commission told the NAO they have a good track record of holding back IT releases until they are satisfied they will work.  “Nevertheless, we found that the Commission is at risk of repeating many of the mistakes of 2003,” said the NAO. Those mistakes include over-optimism and a lack of internal expertise to handle suppliers.

Mixing “agile” and “waterfall” doesn’t work

Initially civil servants at the Commission tried to “mix and match” agile and traditional developing techniques – which Agile advocates say should not be attempted.

In 2011 the Commission gave up on agile and “reverted to a more traditional approach to system development” says the NAO report.

The mix and match approach meant there were two distinct routes for specifying requirements and “resulted in duplicated, conflicting and ambiguous specifications”.  The Commission did not have previous experience of using the agile approach.

The Commission’s child maintenance system was due to go live in April 2010 but the delivery date has slipped three times. Phase one is now due to go live in October 2012 and phase two in July next year but the NAO report raises questions about whether the go-lives will happen successfully. The Commission has not planned in its financial estimates for the failure of the system.

The NAO finds that the Commission has struggled to make its requirements for the new system clear. The Commission’s main developer Tata Consulting Services has had protracted discussions over the meaning and implementation of requirements.

The NAO also hints that IT costs may be out of control. It says the Commission may not secure value for money without properly considering alternative options for restructuring and “adequately controlling its IT development …”

These are some of the NAO’s findings:

IT costs could increase further

“The new system is based on ‘commercial off-the-shelf’ products. However, a recent audit by Oracle identified that the performance, maintainability and adaptability of the new system would be key risks. This could increase the cost of supporting the system. The scheme does not yet include plans for the integration with HM Revenue & Customs’ Real Time Information system due to be implemented in 2013, or introducing Universal Credit because of the differing timescales,” says the NAO which adds:

“Achieving the Commission’s plans without further cost increases or delays appears unlikely. The Commission reported to the audit committee in October 2011 on the high risk that the change programme may not deliver phase two functionality within agreed timescales … The Commission did not develop a benefits realisation plan until November 2011.”

103,000 of Commission’s 1.1m cases are handled manually

“Ongoing technical problems have resulted in a large number of cases being removed from the IT system and managed manually. These are known as clerical cases … The Commission has had to operate the ‘old’ and ‘current’ schemes in parallel.  Due to flaws in the IT systems for each scheme, some 100,000 cases have had to be processe:d separately by clerical staff at a cost of £48 million,” says the NAO. It takes 900 contractors to manage the clerical cases.

Comment

Despite numerous NAO reports on failures of Government IT-based projects over the past 30 years the disasters are still happening, with the same mistakes repeated: over-optimism in every aspect of the project including timetables and financial estimates; excessive complexity and over-specification, no sign of cost-consciousness and, worst of all, an apparent indifference to being held accountable for a major failure.

A glance at the monthly outgoings of the Commission (well done to the coalition for requiring departments and agencies to publish contracts over £25,000) show sizeable and regular payments to familiar names among the large suppliers: HP Enterprise Services (formerly EDS), Capgemini, Tata Consultancy Services, BT Global Services and Capita. There is hardly an SME in sight and no sign of imaginative thinking.

Meanwhile some senior officials at the Commission put in monthly expenses for thousands of pounds in travel, accomodation and subsistence for “Commission meetings”. One wonders: to what useful effect?

Officials at the Cabinet Office are trying to change the culture of departments and agencies. They are encouraging departmental heads to do things differently. They advocate the use of  SMEs to show how new ways of working can trounce traditional approaches to projects.

But the Cabinet Office has little influence on the Department of Work and Pensions. Indeed the DWP has lost its impressive chief innovator James Gardner.

We praise the NAO for noting that the Commission risks repeating the IT-related and project management mistakes of the Child Support Agency. But we note with concern that the NAO still puts up with Whitehall’s non-publication of  Gateway reviews, which are independent reports on the progress or otherwise of big and risky IT-based projects.

Would the Commission have been so apparently careless of the risks if it had known that regular Gateway reports on its shortcomings would be published?

How many more government IT-based projects are late, over budget and at risk of failing, their weaknesses hidden by an unwritten agreement between the coalition and civil servants to keep Gateway reviews secret?

NAO report – Child Maintenance and Enforcement Commission: cost reduction

Government repeating child support mistakes – ComputerworldUK

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Posted in Agile, capacity building, change, change management, CIO, Gateway reviews, Government IT, India, IT projects, managing change, managing outsourced services, openness and transparency, operational issues, outsourcing, private sector lessons for the public sector, project management, public sector, public services

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TPP stops gift offers to GPs

Posted on 27/02/2012 | 1 comment

By Tony Collins

IT supplier TPP has stopped offering gifts to GPs while it has talks with NHS Connecting for Health and CSC.

TPP has offered tea at The Ritz, theatre tickets, Marks and Spencer vouchers and chocolates to GPs in return for their hosting demonstrations of its SystmOne  product.

Parts of the NHS have clearly-defined rules on the acceptance of gifts or hospitality, though the rules do not apply to GPs. NHS Sheffield tells its staff:

“All offers of hospitality should be approached with caution. Modest hospitality, for example, a drink and sandwich during a visit or a working lunch is normal and reasonable and does not require approval of a manager. Offers of hospitality relating to theatre evenings, sporting fixtures, or holiday accommodation, or other hospitality must be declined…”

The guidance adds:

“Casual gifts by contractors or others, e.g. at Christmas time, must not be in any way connected with the performance of duties …”

On 30 January 2012 Campaign4Change reported that TPP has offered gifts to tea at The Ritz or two tickets to a West End show to GP leaders in return for helping to organise an event that would give the company a chance to demonstrate its systems.

TPP SystmOne has said in its marketing literature that its systems hold a third of the country’s patient records and have about 100,000 users.

In reply to our questions about TPP’s offers to GPs, the Department of Health said in January that TPP had ceased offering the incentives after a DH intervention.

“We were made aware and asked the supplier about this activity,” said a Department of Health spokesperson. “The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Ten days later Pulse reported that TPP was still offering incentives to GPs. Pulse quoted TPP as saying that it had “momentarily stopped offering the incentives over Christmas but will be resuming during February”.

TPP told Pulse: ‘The incentives were offered only to GPs and practice managers and were completely optional … ‘Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.’

Campaign4Change then questioned whether the DH is powerless to stop TPP offering gifts.

We said that a level playing field for suppliers would mean that all suppliers offered tea at the Ritz or Marks and Spencer vouchers in return for a chance to demo their systems to GPs. Alternatively suppliers could agree that none offers gifts.

Now Pulse has reported that TPP has stopped offering gifts to GP, at least while it has talks with CSC and  NHS  Connecting for Health. TPP is quoted in Pulse as saying:

Obviously TPP would not have begun offering incentives as a thank-you for a GP’s time, if we were not highly confident that we are not doing anything wrong legally or ethically. That remains our position.

However following recent communication with CSC and Connecting for Health we have postponed the sending of marketing material that offers incentives for SystmOne demonstrations, until all parties have agreed a way forward.

There may have been miscommunications in the past about what incentives were offered, when and to whom, but TPP has always been upfront about any promotional incentives that are offered. All parties are now keen to ensure we can agree on ways to advertise and promote our products whilst maintaining our high ethical standards.’

‘In the meantime we will continue to consult with GPs, their staff and any NHS guidelines, in order to gain feedback about the best ways to demonstrate SystmOne to them.

Comment:

Whether or not the talks between TPP, CSC and the Department of Health might have been prompted, in part, by recent publicity over TPP’s offering of gifts, we’re pleased the talks are taking place.

If all IT suppliers to the NHS offered gifts to GPs then some doctors could end up seeing IT demos based in part on the attractiveness of the gifts on offer.

Links:

IT company’s “tea at the Ritz” offer to GPs.

Can officials stop TPP offering gifts to GPs?

Is TPP defying assurance on gifts to GPs? – Pulse

Software firm pulls tea at the Ritz incentives for GPs – Pulse

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Posted in managing outsourced services, NHS, npfit, public sector

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Cerner system “too entrenched to be scrapped”

Posted on 22/02/2012 | 2 comments

By Tony Collins

A report by Deloitte on problematic Cerner installations at some hospitals in Australia calls for the government to appoint a chief medical information officer to oversee computer projects across the State.

The Deloitte report is a reminder that new IT in hospitals can have good – and adverse – safety implications for patients.

Obtained by the Sydney Morning Herald under Australia’s Freedom of Information Act, the Deloitte report is said to accept complaints last year that the system put patients’ health at risk by providing insufficient alerts to clinicians when messages did not reach their destination.  Deloitte found no evidence of harm to patients.

Though the Deloitte report is specific to the Cerner “FirstNet”  system as installed at some emergency departments in New South Wales, the idea of a chief medical information officer is arguably a good one for the UK where the Department of Health’s CIO (currently Katie Davis, interim Managing Director, NHS Informatics) is not responsible for the medical implications of IT go-lives in NHS hospitals.

New systems bypass the sort of regulation that helps protects the public against harm from medical devices. After hospital IT disasters there is no requirement for a genuinely independent investigation, as happens after airline crashes.

The Sydney Morning Herald [SMH] reports Deloitte as saying that the FirstNet system, which was installed to help run emergency departments across New South Wales, is chronically underfunded.

Deloitte was asked to report on the system after some hospital staff last year lost confidence in the software and returned to manual record-keeping.

Despite continuing problems and excessive time spent on data entry, the FirstNet system is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, said Deloitte.

”With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,” said Deloitte as reported by the SMH.

Nurses and doctors had complained that the system increased the amount of time they spent at a screen and reduced contact with patients. But the Deloitte report said more time spent on data entry ”was essential to realise the eventual benefits of an eventual [electronic medical record]”, such as greater accuracy of test results and medicine orders.

Upgrades were improving safety at some hospitals but needed to be across the state.

The government should appoint a chief medical information officer to oversee computing projects across the state, and pay for continuing development and training for FirstNet, said Deloitte.

The Health Minister, Jillian Skinner, said clinicians did not want to scrap FirstNet because they didn’t “want to start anew”.

The list of hospitals that have had serious problems after IT installations is growing, in part because the increasing use of technology in healthcare. Though hospital staff tend to learn in time to manage new systems, the unanswered question is whether patient care and treatment – and potentially their health and safety – should be damaged in an unregulated way until the problems are solved or mitigated.

Below is the UK list where it is known that the installation of new IT has caused serious disruption.  Any effect on individual patients has gone unreported:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

**

Links:

Does Hospital IT need airline-style certification?

Hospital computer system found lacking – Sydney Morning Herald

Jon Patrick’s essay on the effectiveness and impact of Cerner’s FirstNet system in some hospitals in New South Wales.

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Posted in Cerner, health, health records, IT projects, managing change, managing outsourced services, NHS, npfit, operational issues, Politics, public sector

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Can officials stop TPP offering gifts to GPs?

Posted on 10/02/2012 | 3 comments

By Tony Collins

On 13 July 2011 CSC gave this written assurance to NHS Connecting for Health at its headquarters in Leeds.

“CSC can confirm that its subcontractor TPP will no longer be sending out letters to practices offering  gifts in return for organising demonstrations of SystmOne.”

TPP has continued to offer gifts, and the Department of Health is now concerned enough to divulge the letters it has sent to CSC.

It can do little more, for GPs are not bound by NHS rules on the acceptance of gifts.

NHS Connecting for Health became involved after TPP sent out a letter in April 2011 offering tea at The Ritz or two tickets to a West End show of the GP choice.

“All we ask for in return is a short slot at your [local practice manager] meeting so we can demonstrate the benefits of SystmOne,” TPP said. “We’re [sic] a proven system and a real alternative to EMIS and Vision. With a third of the country’s patient records and more than 90,000 users, SystmOne is the leader in hosted clinical systems.

“Following recent success in the London area, TPP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will will also receive afternoon tea at The Ritz or two tickets to a West End show of their choice …Don’t wait around for an alternative that might not arrive – SystmOne is available, right here, right now…”

SystmOne is supplied to the NHS by CSC under the National Programme for IT, at a cost to taxpayers that remains confidential under NPfIT contracts. GPs can also buy the system directly under GP Systems of Choice. Some PCTs are said to be putting pressure on GP practices to replace existing systems with SystmOne.

Three months after TPP’s “tea at The Ritz” letter, on 6 July 2011, NHS Connecting for Health’s Programme Director, GP IT, wrote to CSC.

Dear Sirs

GPSoC [GP Systems of Choice] Marketing Activity by Subcontractor (TPP)

It has come to the attention of the Authority [Connecting for Health/Department of Health] that TPP have been sending letters to practices which include offers of gifts in return for organising meetings of practice managers  during which SystmOne would be demonstrated. The gifts on offer include tea at The Ritz, two tickets to a West End show and £50 of Marks and Spencer vouchers.

The activities being carried out by TPP state that they are in relation to the provision of SystmOne through GP Systems of Choice. As the Supplier of SystmOne under the Framework Agreement, the Authority requests that CSC review these activities and provides a response to the Authority, by no later than 13 July, to advise whether TPP, as their subcontractor, will be continuing with such activity.”

CSC’s Primary Care Product Executive replied on 13 July:

“CSC was not aware of such activities being undertaken by TPP and immediately entered into dialogue with TPP.

CSC can confirm that its subcontractor TPP will not be sending out letters to practices offering gifts in return for organising demonstrations of SystmOne.”

In December 2011 Campaign4Change learned that TPP was offering £25 Marks and Spencer vouchers to GPs in return for a “short slot at your meeting so we can talk to you and demonstrate the benefits of SystmOne”. By that time TPP put the number of its users at more than 100,000.

We asked the Department of Health in December 2011 whether it approved of TPP’s incentives. It replied:

“We were made aware and asked the supplier about this activity. The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Then we learned of a TPP offer of Hotel Chocolat chocolates.

“Happy Christmas and a Happy New Year from TPP.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration…”

This month, February 2012, TPP sent out this message:

TPP sponsorship for your practice meeting

“TPP are looking to sponsor your practice manager meeting! We’ll provide lunch and refreshments for all of your attendees. As a thank-you, the organiser of the meeting will also receive £25 Marks and Spencer vouchers! All we ask for in return is a short slot at your meeting so we can talk to your attendees and demonstrate the benefits of SystmOne to those practices not yet using it. Anyone that books a SystmOne demonstration on the day of the meeting will also recieve £25 Marks and Spencer vouchers!

“You already know all the great reasons to move to SystmOne, why not share them with other practices in your area? The more practices that move to SystmOne, the more benefits you’ll see.

“To arrange sponsorship for your next meeting and take advantage of this great offer, just contact us on the number below or reply to this email.”

We asked DH why it had suggested that the gift offers had ceased when they hadn’t. Its reply:

“The Department contacted CSC (as the GPSoC supplier) about this activity by their subcontractor TPP. CSC confirmed that TPP would cease offering gifts to GPs in return for organising demonstrations of SystmOne. We have contacted CSC about TPP’s position which is not in line with the assurances previously provided.”

We also asked the DH why it was concerned about the gifts. It did not reply directly but sent us copies of the letter it had sent to CSC, and CSC’s reply.

Is the DH powerless to stop TPP offering gifts?

TPP told Pulse this week:  “We momentarily stopped offering the incentives over Christmas but will be resuming during February … The incentives were offered only to GPs and practice managers and were completely optional.

“Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.”

CSC has made no comment.

Pulse reports that the GP Systems of Choice framework agreement prohibits software providers from offering gifts to any servant of the authority or a PCT. The ban does not include GPs because they do not sign the framework. Suppliers can offer gifts to GPs without breaching the framework agreement says Pulse.

It quotes Dr Charlie Stuart-Buttle, a former chair of the EMIS user group and a GP in Tonbridge, Kent, as saying the incentives were an unacceptable way of going about things. It also quotes Dr Trefor Roscoe, a GP in Sheffield and former medical IT consultant, as saying the incentives were not a problem as long as the GPs felt the system in question was worth demonstrating in the first place.

Comment

Some will say that GPs are bombarded with offers of freebies from drug companies. So why does it matter if an IT company offers gifts?

Another argument is that drugs are different. GPs can stop offering drugs that become too expensive. They cannot simply stop using a GP system. It’s a big decision for any GP practice to choose a new system even with subsidies from the Department of Health under GP Systems of Choice GPs, while the GPSoC framework lasts. Any new GP system is likely to be a long-term commitment because of the disruption of changing.

GPs should surely choose their IT supplier on the basis of the facts and after shortlisting suppliers.

We dislike the expression “level playing field” but if applied here it would mean that GPs chose new systems only after demos at which all shortlisted suppliers offered tea at the Ritz or Marks and Spencer vouchers to certain GPs.

Alternatively the suppliers could agree that none offers gifts.

IT company’s tea at The Ritz offer to GPs.

Pulse article on TPP incentives

Are PCTs putting GPs under pressure to switch to SystmOne?

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Posted in change, Government IT, health, health records, managing outsourced services, NHS, npfit, outsourcing, Politics, procurement, supplier relationships

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