Category Archives: npfit

£20bn for the NHS? – not spent like this please

Johnathan Lewis, CEO Capita (right) and Simon Stevens, Chief Executive, NHS England (left) at Monday’s Public Accounts Committee.

By Tony Collins

Capita apologies for working “blind” on NHS outsourcing contract – but no humility from NHS England

Capita’s CEO Johnathan Lewis was contrite and authoritative when he appeared before public accounts MPs in the House of Commons on Monday.

He apologised unreservedly for what the committee chairwoman Meg Hillier called “a shambles”, which was Capita’s £330 seven to ten-year contract to run a range of services for GPs, dentists and ophthalmologists, as well as handle invitations and test results for cervical screening.

Capita’s Primary Care Support Services contract began in 2015 and complaints about the service from medical practitioners began to flow months later.

Capita made mistakes, said Lewis who was supported by his colleague Stephen Sharp, who reports directly to Lewis on public sector contracts. One mistake was that Capita tried to save money too soon by folding the work of 47 local NHS offices with 1650 staff into three offices without fully understanding that each office had a different way of working and a different way of delivering NHS services.

[A similar mistake helped to floor the £10bn National Programme for IT in the NHS (NPfIT), where suppliers and Whitehall officials tried unsuccessfully to use computers to standardise working practices and services in hundreds of hospitals before they fully understood the widely-different approaches of each hospital.]

Lewis told the Public Accounts Committee on Monday,

“This was an extremely complex outsourcing of services that I think both parties would recognise were not fully understood when the work was outsourced – the volumes, the scope, the fact that the service was being delivered in different ways across the different regions that became NHS England. At the same time I recognise the pressure NHS England were under to reduce costs and hence the pressure on them to outsource.”

His colleague Stephen Sharp added,

“I think mistakes were made. During the bid stage, NHS England did say there were some inconsistencies and differences within the various operations. But once Capita got into all the offices and looked at it, the inconsistencies and differences were not inconsequential. It was more or less 45 different services being run from 45 different offices, so the closure programme, which we adhered to and carried on with, we maybe should have stopped. We just made the problem worse as we went along.”

Why didn’t you stop the office closures, asked Conservative MP Anne Marie Morris who added that “even the NHS said, ‘We think you need to stop’.”

Sharp replied,

“We were actually working blind for a period of time. It was only once the service had been running under our control for a few months that complaints started to come in and we started to see visibility that there were bigger issues than we thought there were.”

With hindsight he said he would not have closed offices “until we had got the procedures operating on a national basis”. He conceded that if NHS England and Capita had deferred closing offices, the first two years of savings of about £60m would not have been achieved.

Capita’s losses of £140m

Lewis said that Capita had invested £125m in the contract but, given the loss of profit margin, the losses would be closer to £140m. “We will not make money over the life of this contract,” said Lewis.

An MP asked: why not walk away?

Lewis replied, “Because we made a commitment to deliver this service and reputations depend on that commitment. We see the public sector as a segment of our market that helps us achieve a diversified revenue base. It is a segment where we have services and solutions, where we can create value for the taxpayer and that is why it is an attractive segment.”

Capita is now meeting 41 of the 45 KPIs and, though the company is making good progress against the remaining four KPIs, it doesn’t change the fact that “our initial execution on this contract was not good and for that we apologise unreservedly,” said Lewis.

There were failings on the part of NHS England too. Health officials were so anxious to achieve the savings from closing offices and replacing old IT that couldn’t be relied on that they failed to test new national, standardised working practices and services before they asked a supplier to implement this strategy.

The result was that officials at NHS England had no clear idea of how much work they were outsourcing. They left due diligence to Capita; and Capita admitted at the hearing it did not do enough due diligence at the bid stage. If it had understood how much work was involved it would have bid a higher price or not bid at all.

NHS England also failed to involve most of the potential end-users – GPs, dentists and ophthalmologists in the design and planning of new services that would directly affect them such as pensions and payments.

Lewis said.

“There are other stakeholders that have historically not been brought into this process to the extent that they should have been, such as the BMA [British Medical Association] in how we might implement the digitisation of pension payments and the management of its pensions, or the Confederation of Dental Employers with regard to ophthalmic payments.

“We want to bring them into the process in ways that they have not been historically because we think that that will ultimately lead to a more successful roll out of the technology… They rightly have influence over the process. If we are going to roll out a process for digitising the 20,000 paper documents that cover the process by which you get refunded for an ophthalmic prescription today, surely those people need to be involved in the final roll-out and configuration of that solution.”

Absence of humility?

When MPs questioned the top official at NHS England, Simon Stevens, there was little sign of humility, contrition or regret. He left an impression that the same problems could end up being repeated by a different supplier under a different contract. One Conservative MP Bim Afolami found himself “sticking up for Capita”.

Afolami said,

“Do you feel, Mr Stevens, that criticism of this contract is in any way unfair on Capita? The more I hear, the more I feel that Capita has taken the sharp end of this and NHS England, despite slight reputational difficulty, has saved £60 million. To what extent do you feel that you should take more of the blame here and Capita should take less of it?”

Stevens emphasised the £60m savings but made no mention any of the contract’s specific problems such as the thousands of patient records that went missing, dozens of women left off cancer-screening lists, the qualified GPs who were unable to work for months while the system delayed verifying their entitlement to go onto a “National Performers List”, the GPs who ran short of basic supplies or the GPs and ophthalmologists who suffered financial detriment because of delayed payments.

Said Stevens,

“First, let me say that this has clearly been a rocky road, and the National Audit Office accurately described the bumps along the way, which are regrettable. That should not obscure the fact that, notwithstanding the economic pain that Capita has experienced, the contract has saved taxpayers £60 million in lower administrative costs in the National Health Service over the first two years of its life … that £60 million of savings is not to be sniffed at; it is the equivalent of 30,000 operations.”

Comment:

Campaign4Change has repeatedly criticised Capita’s performance on Barnet’s outsourcing contract, in part because Capita and the council have been markedly defensive – thin-skinned.

It was refreshing, therefore, to hear Capita’s newish CEO Jonathan Lewis being openly contrite over highly-visible failings in the NHS contract. He gave the impression to public accounts MPs of being a CEO who is determined to put right the failings for the sake of Capita’s reputation. The cost of correcting the problems seemed a secondary consideration.

With Lewis at the helm, Capita’s share price has continued to rise in recent weeks.

Less impressive at Monday’s hearing was Simon Stevens, NHS England’s chief executive, who seemed to imply that NHS England had done nothing wrong.  It was a reaction we’ve come to expect from top civil servants after an IT-related programme disaster. It’s never the fault of officialdom.

The reality is that NHS England was almost as culpable as Capita. NHS England rushed the whole outsourcing exercise – which doomed it from the start. It didn’t listen to critics who warned that primary care support services were too locally diverse and inherently problematic to standardise as part of a national  outsourcing deal.

Instead of first piloting and agreeing with GPs, dentists and ophthalmologists fundamental changes in working practices that would be needed across the country, NHS England went ahead with signing a co-called transformation deal with Capita.

NHS England paid only lip service to engagement with the new system’s end-users in the medical professions. By its own admission Capita, because of its own internal shortcomings, went into the contract blind.

What’s worrying is the way civil servants blithely repeat mistakes of the past and later say they did everything right.

The National Programme for IT in the NHS – NPfIT – failed in part because it was rushed, the implications of “ruthless standardisation” were not fully understood at the outset and there was a lack of proper engagement with potential end-users in hospitals and GP practices. All these same mistakes were made by Capita and NHS England on the Primary Care Support Services contract.

When ordinary human beings become senior civil servants there seems to be a requirement that they lose at a cellular level the facility to express humility and contrition. That loss is replaced by an overly prominent complacency. Whatever goes wrong is not their fault.

Stevens said in essence that NHS England did everything right. Through its unpublished project reviews, the Major Projects Authority – now the Infrastructure and Projects Authority –  endorsed NHS England’ s plans. All the so-called experts gave the outsourcing deal what Stevens called a “thumbs-up”.

It would have been surprising if Stevens had said the public sector was in any way to blame.

At least Capita has learned the lessons. It has a financial interest in doing so.

Ministers can learn from Capita’s candid chief executive

NHS England’s management of Primary Care Support Services contract with Capita – National Audit Office report

Monday’s televised Public Accounts Committee hearing with Capita’s Jonathan Lewis and Simon Stevens of NHS England

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Companies nervous over HMRC customs IT deadline?

By Tony Collins

This Computer Weekly article in 1994 was about the much-delayed customs system CHIEF. Will its CDS replacement that’s being built for the post-Brexit customs regime also be delayed by years?

The Financial Times  reported this week that UK companies are nervous over a deadline next year for the introduction of a new customs system three months before Brexit.

HMRC’s existing customs system CHIEF (Customs Handling of Import Export Freight) copes well with about 100 million transactions a year. It’s expected a £157m replacement system using software from IBM and European Dynamics will have to handle about 255 million transactions and with many more complexities and interdependencies than the existing system.

If the new system fails post-Brexit and CHIEF cannot be adapted to cope, it could be disastrous for companies that import and export freight. A post-Brexit failure could also have a serious impact on the UK economy and the collection of billions of pounds in VAT, according to the National Audit Office.

The FT quoted me on Monday as calling for an independent review of the new customs system by an outside body.

I told the FT of my concern that officials will, at times, tell ministers what they want to hear. Only a fully independent review of the new customs system (as opposed to a comfortable internal review conducted by the Infrastructure and Projects Authority) would stand a chance of revealing whether the new customs system was likely to work on time and whether smaller and medium-sized companies handling freight had been adequately consulted and would be able to integrate the new system into their own technology.

The National Audit Office reported last year that HMRC has a well-established forum for engaging with some stakeholders but has

“significant gaps in its knowledge of important groups. In particular it needs to know more about the number and needs of the smaller and less established traders who might be affected by the customs changes for the first time”.

The National Audit Office said that the new system will need to cope with 180,000 new traders who will use the system for the first time after Brexit, in addition to the 141,000 traders who currently make customs declarations for trade outside the EU.

The introduction in 1994 of CHIEF was labelled a disaster at the time by some traders,  in part because it was designed and developed without their close involvement. CHIEF  was eventually accepted and is now much liked – though it’s 24 years old.

Involve end-users – or risk failure

Lack of involvement of prospective end-users is a common factor in government IT disasters. It happened on the Universal Credit IT programme, which turned out to be a failure in its early years, and on the £10bn National Programme for IT which was dismantled in 2010. Billions of pounds were wasted.

The FT quoted me as saying that the chances of the new customs system CDS [Customs Declaration Service) doing all the things that traders need it to do from day one are almost nil.

The FT quotes one trader as saying,

“HMRC is introducing a massive new programme at what is already a critical time. It would be a complex undertaking at the best of times but proceeding with it at this very moment feels like a high stakes gamble.”

HMRC has been preparing to replace CHIEF with CDS since 2013. Its civil servants say that the use of the SAFe agile methodology when combined with the skills and capabilities of its staff mean that programme risks and issues will be effectively managed.

But, like other government departments, HMRC does not publish its reports on the state of major IT-related projects and programmes. One risk, then,  is that ministers may not know the full truth until a disaster is imminent.

In the meantime ministerial confidence is likely to remain high.

Learning from past mistakes?

HMRC has a mixed record on learning from past failures of big government IT-based projects.  Taking some of the lessons from “Crash”, these are the best  things about the new customs project:

  • It’s designed to be simple to use – a rarity for a government IT system. Last year HMRC reduced the number of system features it plans to implement from 968 to 519. It considered that there were many duplicated and redundant features listed in its programme backlog.
  • The SAFe agile methodology HMRC is using is supposed to help organisations implement large-scale, business-critical systems in the shortest possible time.
  • HMRC is directly managing the technical development and is carrying out this work using its own resources, independent contractors and the resources of its government technology company, RCDTS. Last year it had about 200 people working on the IT programme.

These are the potentially bad things:

  • It’s not HMRC’s fault but it doesn’t know how much work is going to be involved because talks over the post-Brexit customs regime are ongoing.
  • It’s accepted in IT project management that a big bang go-live is not a good idea. The new Customs Declaration Service is due to go live in January 2019, three months before Britain is due to leave the EU. CHIEF system was commissioned from BT in 1989 and its scheduled go-live was delayed by two years. Could CDS be delayed by two years as well? In pre-live trials CHIEF rejected hundreds of test customs declarations for no obvious reason.
  • The new service will use, at its core,  commercially available software (from IBM) to manage customs declarations and software (from European Dynamics) to calculate tariffs. The use of software packages is a good idea – but not if they need large-scale modification.  Tampering with proven packages is a much riskier strategy than developing software from scratch.  The new system will need to integrate with other HMRC systems and a range of third-party systems. It will need to provide information to 85 systems across 26 other government bodies.
  • If a software package works well in another country it almost certainly won’t work when deployed by the UK government. Core software in the new system uses a customs declaration management component that works well in the Netherlands but is not integrated with other systems, as it would be required to do in HMRC, and handles only 14 million declarations each year.
  • The IBM component has been tested in laboratory conditions to cope with 180 million declarations, but the UK may need to process 255 million declarations each year.
  • Testing software in laboratory conditions will give you little idea of whether it will work in the field. This was one of the costly lessons from the NHS IT programme NPfIT.
  • The National Audit Office said in a report last year that HMRC’s contingency plans were under-developed and that there were “significant gaps in staff resources”.

Comment

HMRC has an impressive new CIO Jackie Wright but whether she will have the freedom to work within Whitehall’s restrictive practices is uncertain. It seems that the more talented the CIO the more they’re made to feel like outsiders by senior civil servants who haven’t worked in the private sector.  It’s a pity that some of the best CIOs don’t usually last long in Whitehall.

Meanwhile HMRC’s top civil servants and IT specialists seem to be confident that CDS, the new customs system, will work on time.  Their confidence is not reassuring.  Ministers and civil servants publicly and repeatedly expressed confidence that Universal Credit would be fully rolled by the end of 2017. Now it’s running five years late.  The NHS IT programme NPfIT was to have been rolled out by 2015.  By 2010 it was dismantled as hopeless.

With some important exceptions, Whitehall’s track record on IT-related projects is poor – and that’s when what is needed is known. Brexit is still being negotiated. How can anyone build a new bridge when you’re not sure how long it’ll need to be and what the many and varied external stresses will be?

If the new or existing systems cannot cope with customs declarations after Brexit it may not be the fault of HMRC. But that’ll be little comfort for the hundreds of thousands of traders whose businesses rely, in part, on a speedy and efficient customs service.

FT article – UK companies nervous over deadline for new Customs system

A proposed Bill and charter that could change the face of Whitehall IT and save billions

By Tony Collins

A government-commissioned review yesterday backed a Bill that could, if enacted and applied to Whitehall generally, prevent billions of pounds being lost on wasteful projects.

The Public Authority Accountability Bill – known informally as the Hillsborough Law – would establish an offence of intentionally or recklessly misleading the public, media or court proceedings.

It would also impose a legal requirement on public authorities to act with candour, transparency and frankness when things go wrong.

Although the Bill was a reaction, in part, to the cover up by public authorities of their failings in the light of Hillsborough, it could, if enacted, deter public authorities from covering up failings generally – including on major IT programmes.

For decades public authorities have had the freedom – unrestricted by any legislation – to cover up failures and issue misleading statements to the public, Parliament and the media.

In the IT sphere, early problems with the Universal Credit IT programme were kept secret and misleadingly positive statements issued. The National Audit Office later criticised a “good news” culture on the Universal Credit programme.

And still the DWP is fighting to block the disclosure of five project assessment reviews that were carried out on the Universal Credit IT programme between 2012 and 2015.

It could be argued that billions of pounds lost on the NPfIT – the National Programme for IT in the NHS – would have been avoided if the Department of Health had been open and candid at the start of the programme about the programme’s impractically ambitious aims, timescales and budgets.

The Department for Business, Energy and Industrial Strategy is currently keeping secret its progress reports on the £111bn smart meters rollout – which independent experts have said is a failing programme.  The department routinely issues positive statements to the media on the robust state of the programme.

The Public Authority Accountability Bill was drafted by lawyers who had been involved with representing bereaved Hillsborough families. It is aimed mainly at government inquiries, court proceedings and investigations into lapses of public services.

But it would also enshrine into law a duty on public authorities, public servants, officials and others to act within their powers with “transparency, candour and frankness”.

Lawyers who drafted the Bill refer on their website to “institutional defensiveness and a culture of denial” when things go wrong. They say,

“In 2017 we expect public authorities and individuals acting as public servants to be truthful and act with candour. Unfortunately, repeated examples have shown us that this is not generally the case.

“Instead of acting in the public interest by telling the truth, public authorities have tended to according to narrow organisational and individual motives by trying to cover up faults and deny responsibility …”

Backing for the Bill came yesterday from a 117-page report on the Hillsborough disaster by Bishop James Jones. The government commissioned him to produce a report on the experiences of the Hillsborough families so that their “perspective is not lost”.

Jones’ impressive report refers to institutions that “closed ranks, refused to disclose information, used public money to defend its interests and acted in a way that was both intimidating and oppressive”

His report refers to public bodies in general when it points to a “cultural condition” and “mindset” that features an “instinctive prioritisation of the reputation of an organisation over the citizen’s right to expect people to be held to account for their actions”. This, says the report, “represents a barrier to real accountability”.

It adds,

“As a cultural condition, this mindset is not automatically changed, still less dislodged, by changes in policies or processes. What is needed is a change in attitude, culture, heart and mind.”

The report urges leaders of “all public bodies” to make a commitment to cultural change by publicly signing a new charter.

The charter commits public bodies to:

  •  Place the public interest above its own reputation.
  • Approach forms of scrutiny with candour, in an open, honest and transparent way, making full disclosure of relevant documents, material and facts.
  • Learn from the findings of external scrutiny and from past mistakes.
  • Avoid seeking to defend the indefensible or to dismiss or disparage those who may have suffered where the organisation has fallen short.
  • When falling short, apologise straightforwardly and genuinely.
  • Not knowingly mislead the public or the media.

The report says that institutional defensiveness and a culture of denial are “endemic amongst public institutions as has been demonstrated not only by the Hillsborough cover up but countless other examples.”

Stuart Hamilton, son of Roy Hamilton who died at Hillsborough, is quoted in the report as saying,

“Police, officials and civil servants should have a duty of revealing the full facts and not merely selecting some truths to reveal but not others. Not lying or not misleading is simply not good enough. Without this, future disasters cannot be averted and appropriate policies and procedures cannot be developed to protect society.

“Such selective revealing of information also results in the delay of justice to the point where it cannot be served”.

He added,

“I believe that without a change not only in the law but also in the mindset of the public authorities (which a law can encourage) then very little exists to stop the post-event actions happening again.”

IT-enabled projects

Whitehall departments and the Infrastructure and Projects Authority publish their own narratives on the progress on major IT-enabled projects and programmes such as Universal Credit and smart meters.

But their source reports aren’t published.

Early disclosure of failings could have prevented hundreds of millions of pounds being lost on FireControl project, BBC’s Digital Media Initiative, the Home Office Raytheon e-borders and C-Nomis national offender management information projects and the Rural Payments Agency’s CAP delivery programme (which, alone, contributed to EU penalties of about £600m).

Comment:

Yesterday’s beautifully-crafted report into the Hillsborough disaster – entitled “The patronising disposition of unaccountable power” – is published on the Gov.uk website.

It has nothing to do with IT-enabled projects and programmes. But, in an unintentional way, it sums up a public sector culture that has afflicted nearly every Whitehall IT-based project failure in the last 25 years.

A culture of denial is not merely prevalent today; it is pervasive. All Whitehall departments keep quiet about reports on their failings. It is “normal” for departments to issue misleadingly positive statements to the media about progress on their programmes.

The statements are not lies. They deploy facts selectively, in a way that covers up failings. That’s the Whitehall culture. That’s what departments are expected to do.

According to Bishop Jones’ Hillsborough report, one senior policeman told bereaved families that he was not obliged to reveal the contents of his reports. He could bury them in his garden if he wished.

It’s the same with government departments. There is no legal duty to keep programme reports, still less any requirement to publish them.

If Bishop Jones’ charter is signed by leaders of public authorities including government departments, and Andy Burnham’s Bill becomes law,  the requirement for candour and transparency could mean that IT programme progress reports are made available routinely.

If this happened – a big if – senior public officials would have to think twice before risking billions of pounds on a scheme that held out the prospect of being fun to work on but which they knew had little chance of success within the proposed timescales, scope and budget.

It’s largely because of in-built secrecy that the impossibly impractical NPfIT was allowed to get underway. Billions of pounds was wasted.

Some may say that the last thing ministers and their permanent secretaries will want is the public, media and MPs being able to scrutinise what is really happening on, say, a new customs IT project to handle imports and exports after Brexit.

But the anger over the poor behaviour of public authorities after Hillsborough means that the Bill has an outside chance of eventually becoming law. Meanwhile public sector leaders could seriously consider signing Jones’ charter.

John Stuart Mill wrote in 1859 (On Liberty and The Subjection of Women) that the “only stimulus which can keep the ability of the [public] body itself up to a high standard is liability to the watchful criticism of equal ability outside the body”.

 

Is Gauke being told the whole truth on Universal Credit’s rollout problems?

By Tony Collins

“It is working,” said Work and Pensions secretary David Gauke in Manchester yesterday. He was referring to a plan to accelerate the rollout of Universal Credit from this month.

“I can confirm that the rollout will continue, and to the planned timetable,” he added.

But are civil servants giving Gauke – and each other – full and unexpurgated briefings on the state of the Universal Credit programme?

Last year, in a high-level DWP document that government lawyers asked a judge not to release for publication, a DWP director referred to

“a lack of candour and honesty throughout the [Universal Credit] programme.”

Senior civil servants were not passing bad news on the state of the Universal Credit IT programme even to each other.

The DWP document was dated several years after Iain Duncan-Smith, the original force behind the introduction of Universal Credit, found his internal DWP briefings on the state of the UC programme so inadequate – a “good news” culture prevailed – that he brought in his own external advisers – what he called his “red team”.

In 2013 the National Audit Office, in a report on Universal Credit, said a “good news” mentality within the DWP prevented problems being discussed.

If problems could not be discussed they could not be addressed.

Last year the Institute for Government, in a report on Universal Credit, said IT employees at the DWP’s Warrington offices burst into tears with relief when at last permitted – by external advisers –  to talk openly about problems on the programme.

The Work and Pensions Committee has questioned why DWP ministers told MPs all was going well with the programme when it was well behind schedule and beset with problems.

The Public Accounts Committee called the DWP “evasive and selective” when it came to passing on information about the state of the Universal Credit programme.

Is there any reason to believe that the “fortress mentality” that the NAO referred to in its report on Universal Credit in 2013 is no longer present?

When David Gauke announced yesterday that he is continuing the rollout of Universal Credit, was he basing his decision on the full facts – or a “good news” version of it as told to him by the DWP?

Comment

David Gauke will have been given the “new minister” treatment when he joined the DWP on 11 June 2017.

“The first thing you’ve got to overcome when you walk through the door is that everybody is being almost far too nice to you,” said one of Gauke’s predecessors, Iain Duncan Smith. He was speaking in 2016 after leaving the DWP.

IDS was much criticised for assuring Parliament all was well with the Universal Credit IT programme when it wasn’t. But maybe he was right to point out that, when he joined the DWP, he found that the “biggest cultural barrier” was getting civil servants to be honest about difficulties.

“The Civil Service, legitimately, see it as their role to deliver on politicians’ policy demands and this can sometimes make them resistant to the idea that they should inform you early of problems,” said IDS.

It was IDS who told BBC’s Radio 4 Today programme in December 2013, that Universal Credit was on track.

“It’s on budget. It’s on budget. Some 6.5million people will be on the system by the end of 2017.”

In fact, fewer than 700,000 people are claiming Universal Credit,  according to the latest DWP statistics.

DWP’s 30 years of a “good news” culture

In the past 30 years, it has been almost unknown for the DWP’s mandarins to concede that they have had serious problems with any of their major IT-based projects and programmes.

Perhaps it’s understandable, then, that Gauke apparently refuses to listen to critics and continues with the accelerated rollout of Universal Credit.

Would he have any idea that the Citizens Advice Bureau, in a carefully-researched report this year, said that some claimants are on the DWP’s “live service” (managed by large IT suppliers) which is “rarely updated” while other claimants are on a separate “full service” – what the CAB calls a “test and learn” system – which is still being designed?

Would Gauke know of the specific concerns of the all-party Work and Pensions Committee which wrote to the DWP earlier this year about Universal Credit decision makers being “overly reliant on information from [HMRC’s] Real-time information” even when there is “compelling evidence” that this data is  incorrect?

Would Gauke have any reason to believe those who refer to regular computer breakdowns and inaccurate and inconsistent data?

In the DWP’s own document that it did not want published, the DWP director said that, internally, “people stopped sharing comments which could be interpreted as criticism of the Programme, even when those comments would be useful as part of something like an MPA [Major Projects Authority] review.”

Many staff believed the official line was ‘everything is fine’. Nobody wanted to be seen to contradict it.

All this suggests that the DWP will carry on much as before, regardless of external criticism.  Individual ministers are accountable but they move on. Their jobs are temporary. It’s the permanent civil service that really matters when it comes to the implementation of Universal Credit.

But mandarins are neither elected nor effectively accountable.

NHS IT programme?

There may be some comparisons between Universal Credit and the NHS IT programme, the £10bn NPfIT.

A plethora of independent organisations and individuals expressed concerns about the NPfIT but minister after minister dismissed criticisms and continued the rollout. The NPfIT was dismantled many years later, in 2011. Billions was wasted.

Based on their civil service briefings, NPfIT ministers had no reason to believe the programme’s critics.

Universal Credit has more support than the NPfIT and the IT is generally welcomed, not shunned. But the Universal Credit rollout is clearly not in a position yet to be speeded up.

Whether Gauke will recognise this before his time is up at the DWP is another matter.

Like IDS, Stephen Crabb and Damian Green – all secretaries of state during the rollout of Universal Credit – Gauke will move on and his successor will get the “new minister” treatment.

And the cycle of ministerial “good news” briefings will continue.

Perhaps the DWP’s senior civil servants believe they’re protecting their secretaries of state.

As the civil servant Bernard Woolley said in “Yes Minister”

“If people don’t know what you’re doing, they don’t know what you’re doing wrong.”

Thank you to David Orr, an ardent campaigner for open government, who alerted me to Universal Credit developments that form part of this article.

What Google looks for when hiring staff … traits Whitehall’s culture abhors?

By Tony Collins

The contrast between what Google looks for when hiring staff and what Whitehall looks for when making some of its top appointments, could give clues as to why many government IT-based projects and programmes fail.

First, the strengths Google looks for.  These were set out yesterday on BBC R4 by Laszlo Bock,  human resources chief at Google for 10 years.

Google was named “Best Company to Work For” more than 30 times around the world and received over 100 awards as a top employer during Bock’s time.

In 2010, he was named “Human Resources Executive of the Year”. Under him, Google changed its clunky, arduous recruitment processes that relied on gimmicks like maths puzzles to those that helped the company grow to about 60,000 employees in less than two decades.

In 2015 he  published his first book, The New York Times bestseller Work Rules!, a practical guide to help people find meaning in work and improve the way they live and lead. He resigned from Google in 2016.

On the BBC  “Analysis” programme on Monday evening – which looked at intelligence and talent and what they mean, if anything, in job interviews –  Bock said the least important attribute Google screens for is whether someone knows about the job they are taking on. Crunching the data on successful hiring led Google instead to look for these characteristics:

  • Humility
  • Conscientiousness
  • A sense of responsibility not to quit until the job is done well
  • Comfort with ambiguity
  • A sense of fun
  • Courage

Why courage?

Bock said,

“It’s about the importance of people being able to raise their voices in organisations. One of the things that happens is, when organisations get large, people stop raising their voices and really bad things happen as a result. That’s where you get whistleblowing, insider trading, all kinds of things.

“Human beings are evolved, biologically, as social, hierarchy-seeking animals. We tend to conform. So courage is important because the really innovative, creative stuff comes from ‘I got this crazy idea’ and the bad problems get flagged by people who are willing to raise their hand and say ‘I don’t think this is a good thing to do’.

“Without that you can’t do great things.”

Comment

It’s too easy to generalise about the hiring and appointment of senior civil servants. But it’s possible to understand a little about the hiring culture within Whitehall’s biggest department, the Department for Work and Pensions.

An insight into DWP culture and thinking can be gleaned from the many Lever arch folders of documents filed by the DWP as part of an FOI case in which it spent several years fighting to stop the release of documents about the Universal Credit IT programme.

The documents include DWP witness statements on the “harm” that would be caused if the IT documents in question were published.

The judge in the case, Chris Ryan, challenged most of the DWP’s arguments.

In one of his rulings, Judge Ryan described the DWP’s claims as:

  • alarming and surprising
  • overstated
  • unconvincing
  • close to fanciful

He said that public confidence in the Universal Credit IT programme had been maintained for some time “on a false basis”; and he raised the possibility that an “unhealthily collegiate relationship had developed” between the DWP and private sector IT suppliers. [Campaign4Change will publish a separate blog post on this ruling in the next few days.]

As well as the insight into DWP culture that one can gain from the FOI case, it’s possible to gauge culture and thinking within Whitehall departments from the talented, free-thinking IT individualists who have joined the top layer of the civil service, quit and returned to the private sector.

It would be invidious to pick out some names as there are so many.

What all this suggests is that Whitehall’s culture appreciates conformity and consensus and shuns boat-rocking.

When top IT professionals who joined HMRC and the DWP spoke publicly at conferences about institutional problems that needed to be tackled, mandarins reacted quickly – and such disclosures were never repeated.

And after a leak to the Guardian about the results of a DWP staff survey of morale on the Universal Credit IT programme, the department launched a formal leak inquiry headed by a senior member of the security services.

At the same time, Universal Credit IT programme documents were no longer emailed but transferred around in taxis.

This bout of nervous introspection (the judge described the DWP’s arguments in the FOI case as “defensive”) when taken together with what else we know, indicate that Whitehall’s culture is insular, distrustful and inimical to open challenge and problem-solving (though there are some within the senior Whitehall ranks who successfully defy that culture).

When Bock talks of conformity being a danger within large organisations he would not have had the DWP in mind – but he aptly describes its culture.

When he speaks about the “importance of people being able to raise their voices in organisations” he was probably unaware of the extent to which Whitehall culture abhors raised voices.

As Bock says, when people don’t raise their voices “really bad things happen as a result”. Perhaps the lack of internal challenge was one reason the NHS IT programme – NPfIT – lost billions of pounds, and the DWP’s Universal Credit programme went badly awry for several years.

When Bock says the “really innovative, creative stuff comes from ‘I got this crazy idea’, he could have been describing the culture of the Government Digital Service. But that refreshing GDS culture is being slowly choked by the conservatism of traditional Whitehall departments.

As Bock says, “the bad problems get flagged by people who are willing to raise their hand and say ‘I don’t think this is a good thing to do’.”  But bad problems are things senior civil servants avoid talking about, even internally. A Disneyland”good news” culture pervades central departments.

A National Audit Office report on the Universal Credit programme referred to a “fortress mentality” within the DWP.

Maybe the consensus-seeking John Manzoni, head of the civil service, and his colleague Sir Jeremy Heywood, Cabinet Secretary, could seek to employ Bock as an adviser on appointments and recruitment.

Bock’s brief? To turn around the senior civil service’s culture of conformity, groupthink, denial, selective use of “good news” facts and a lack of open challenge.

Recognising the destructiveness within a big organisation of having the wrong culture – as Bock does – could be the start of a genuine Whitehall transformation.

BBC R4 “Analysis” on talent, intelligence and recruitment

Laszlo Bock steps down

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

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

 

Inside Universal Credit IT – analysis of document the DWP didn’t want published

dwpBy Tony Collins

Written evidence the Department for Work and Pensions submitted to an FOI tribunal – but did not want published (ever) – reveals that there was an internal “lack of candour and honesty throughout the [Universal Credit IT] Programme and publicly”.

It’s the first authoritative confirmation by the DWP that it has not always been open and honest when dealing with the media on the state of the Universal Credit IT programme.

FOI tribunal grants request to publish DWP's written submission

FOI tribunal grants request to publish DWP’s written submission

According to the DWP submission, senior officials on the Programme became so concerned about leaks that a former member of the security services was brought in to lead an investigation. DWP staff and managers were the subjects of “detailed interviews”. Employee emails were “reviewed”, as were employee access rights to shared electronic areas.

Staff became “paranoid” about accidentally leaving information on a printer. Some of the high-security measures appear still to be in place.

Unpublished until now, the DWP’s written legal submission referred, in part, to the effects on employees of leak investigations.

The submission was among the DWP’s written evidence to an FOI Tribunal in February 2016.

The Government Legal Service argued that the DWP’s written evidence was for the purposes of the tribunal only. It should not be published or passed to an MP.

The Legal Service went further: it questioned the right of an FOI Tribunal to decide on whether the submission could be published. Even so a judge has ruled that the DWP’s written evidence to the tribunal can be published.

Excerpts from the submission are here.

Analysis and Comment

The DWP’s submission gives a unique glimpse into day-to-day life and corporate sensitivities at or near the top of the Universal credit IT programme.

It reveals the lengths to which senior officials were willing to go to stop any authoritative “bad news” on the Universal Credit IT programme leaking out. Media speculation DWP’s senior officials do not seem to mind. What appears to concern them is the disclosure of any credible internal information on how things are progressing on Universal Credit IT.

Confidential

Despite multiple requests from IT suppliers, former government CIOs and MPs, for Whitehall to publish its progress reports on big IT-based change programmes (some examples below), all central departments keep them confidential.

That sensitivity has little to do with protecting personal data.

It’s likely that reviews of projects are kept confidential largely because they could otherwise expose incompetence, mistakes, poor decisions, risks that are likely to materialise, large sums that have been wasted or, worst of all, a project that should have been cancelled long ago and possibly re-started, but which has been kept going in its original form because nobody wanted to own up to failure.

Ian watmore front cover How to fix government IROn this last point, former government CIO and permanent secretary Ian Watmore spoke to MPs in 2009 about how to fix government IT. He said,

“An innovative organisation tries a lot of things and sometimes things do not work. I think one of the valid criticisms in the past has been when things have not worked, government has carried on trying to make them work well beyond the point at which they should have been stopped.”

Individual accountability for failure?

Oblivious to MPs’ requests to publish IT progress reports, the DWP routinely refuses FOI requests to publish IT progress reports, even when they are several years old, even though by then officials and ministers involved will probably have moved on. Individual accountability for failure therefore continues to be non-existent.

Knowing this, MPs on two House of Commons select committees, Public Accounts and Work and Pensions, have called for the publication of reports such as “Gateway” reviews.

This campaign for more openness on government IT projects has lasted nearly three decades. And still Whitehall never publishes any contemporaneous progress reports on big IT programmes.

It took an FOI campaigner and IT projects professional John Slater [@AmateurFOI] three years of legal proceedings to persuade the DWP to release some old reports on the Universal Credit IT programme (a risk register, milestone schedule and issues log). And he had the support of the Information Commissioner’s legal team.

universal creditWhen the DWP reluctantly released the 2012 reports in 2016 – and only after an informal request by the then DWP secretary of state Stephen Crabb – pundits were surprised at how prosaic the documents were.

Yet we now know, thanks to the DWP’s submission, the lengths to which officials will go to stop such documents leaking out.

Understandable?

Some at the DWP are likely to see the submission as explaining some of understandable measures any government department would take to protect sensitive information on its largest project, Universal Credit. The DWP is the government largest department. It runs some of the world’s biggest IT systems. It possesses personal information on nearly everyone in Britain. It has to make the protection of its information a top priority.

Others will see the submission as proof that the DWP will do all it can to honour a decades-old Whitehall habit of keeping bad news to itself.

Need for openness

It’s generally accepted that success in running big IT-enabled change programmes requires openness – with staff and managers, and with external organisations and agencies.

IT-based change schemes are about solving problems. An introspective “good news only” culture may help to explain why the DWP has a poor record of managing big and successful IT-based projects and programmes. The last time officials attempted a major modernisation of benefit systems in the 1990s – called Operational Strategy – the costs rose from £713m to £2.6bn and the intended objective of joining up the IT as part of a “whole person” concept, did not happen.

Programme papers“watermarked”

The DWP’s power, mandate and funding come courtesy of the public. So do officials, in return, have the right to keep hidden mistakes and flawed IT strategies that may lead to a poor use – or wastage – of hundreds of millions of pounds, or billions?

The DWP’s submission reveals that recommendations from its assurance reports (low-level reports on the state of the IT programme including risks and problems) were not circulated and a register was kept of who had received them.

Concern over leaks

The submission said that surveys on staff morale ceased after concerns about leaks. IT programme papers were no longer sent electronically and were delivered by hand. Those that were sent were “double-enveloped” and any that needed to be retained were “signed back in”. For added security, Universal Credit programme papers were watermarked.

When a former member of the security services was brought in to conduct a leaks investigation, staff and mangers were invited by the DWP’s most senior civil servant to “speak to the independent investigator if they had any information”. This suggests that staff were expected to inform on any suspect colleagues.

People “stopped sharing comments which could be interpreted as criticism of the [Universal Credit IT] Programme,” said the submission. “People became suspicious of their colleagues – even those they worked closely with.

“There was a lack of trust and people were very careful about being honest with their colleagues…

“People felt they could no longer share things with colleagues that might have an honest assessment of difficulties or any negative criticism – many staff believed the official line was, ‘everything is fine’.

“People, even now, struggle to trust colleagues with sensitive information and are still fearful that anything that is sent out via email will be misused.

“For all governance meetings, all documents are sent out as password protected, with official security markings included, whether or not they contain sensitive information.”

“Defensive”

dwpLines to take with the media were added to a “Rolling Brief”, an internal update document, that was circulated to senior leaders of the Universal Credit IT programme, the DWP press office and special advisors.

These “lines to take” were a “defensive approach to media requests”. They emphasised the “positive in terms of progress with the Programme without acknowledging the issues identified in the leaked stories”.

This positive approach to briefing and media management “led to a lack of candour and honesty through the Programme and publically …”

How the DWP’s legal submission came about is explained in this separate post.

Were there leaks of particularly sensitive information?

It appears not. The so-called leaks revealed imperfections in the running of the Universal Credit programme; but there was no personal information involved. Officials were concerned about the perceived leak of a Starting Gate Review to the Telegraph (although the DWP had officially lodged the review with the House of Commons library).

The DWP also mentioned in its statement a leak to the Guardian of the results of an internal “Pulse” survey of staff morale – although it’s unclear why the survey wasn’t published officially given its apparent absence of sensitive commercial, personal, corporate or governmental information.

NPfIT

The greater the openness in external communications, the less likely a natural scepticism of new ways of working will manifest in a distrust of the IT programme as a whole.

The NHS’s National Programme for IT (NPfIT) – then the UK’s biggest IT programme costing about £10bn – was dismantled in 2011 after eight fraught years. One reason it was a disaster was the deep distrust of the NPfIT among clinicians, hospital technologists, IT managers, GPs and nurses. They had listened with growing scepticism to Whitehall’s oft-repeated “good news” announcements.

Ex-Government CIO wanted more openness on IT projects

When MPs have asked the DWP why it does not publish reports on the progress of IT-enabled projects, it has cited “commercial confidentiality”.

But in 2009, Ian Watmore (the former Government CIO) said in answer to a question by Public Account Committee MP Richard Bacon that he’d endorse the publication of Gateway reviews, which are independent assessments of the achievements, inadequacies, risks, progress and challenges on risky IT-based programmes.

“I am with you in that I would prefer Gateway reviews to be published because of the experience we had with capability reviews (published reports on a department’s performance). We had the same debate (as with Gateway reviews) and we published them. It caused furore for a few weeks but then it became a normal part of the furniture,” said Watmore.

Capability reviews are no longer published. The only “regular” reports of Whitehall progress with big IT programmes are the Infrastructure and Projects Authority’s annual reports. But these do not include Gateway reviews or other reports on IT projects and programmes. The DWP and other departments publish only their own interpretations of project reviews.

In the DWP’s latest published summary of progress on the Universal Credit IT programme, dated July 2016, the focus is on good news only.

But this creates a mystery. The Infrastructure and Projects Authority gave the Universal Credit programme an “amber” rating in its annual report which was published this month. But neither the DWP nor the Authority has explained why the programme wasn’t rated amber/green or green.

MPs and even IT suppliers want openness on IT projects

Work and Pensions Committee front coverIn 2004 HP, the DWP’s main IT supplier, told a Work and Pensions Committee inquiry entitled “Making IT work for DWP customers” in 2004 that “within sensible commercial parameters, transparency should be maintained to the greatest possible extent on highly complex programmes such as those undertaken by the DWP”.

The Work and Pensions Committee spent seven months investigating IT in the DWP and published a 240-page volume of oral and written in July 2004. On the matter of publishing “Gateway” reviews on the progress or otherwise of big IT projects, the Committee concluded,

“We found it refreshing that major IT suppliers should be content for the [Gateway] reviews to be published. We welcome this approach. It struck us as very odd that of all stakeholders, DWP should be the one which clings most enthusiastically to commercial confidentiality to justify non-disclosure of crucial information, even to Parliament.”

The Committee called for Gateway reviews to be published. That was 12 years ago – and it hasn’t happened.

Four years later the Committee found that the 19 most significant DWP IT projects were over-budget or late.

DWP headline late and over budget

In 2006 the National Audit Office reported on Whitehall’s general lack of openness in a report entitled “Delivering successful IT-enabled business change”.

The report said,

“The Public Accounts Committee has emphasised frequently the need for greater transparency and accountability in departments’ performance in managing their programmes and projects and, in particular, that the result of OGC Gateway Reviews should be published.”

But today, DWP officials seem as preoccupied as ever with concealing bad news on their big IT programmes including Universal Credit.

The costs of concealment

The DWP has had important DWP project successes, notably pension credits, which was listed by the National Audit Office as one of 24 positive case studies.

But the DWP has also wasted tens of millions of pounds on failed IT projects.

Projects with names such as “Camelot” [Computerisation and Mechanisation of Local Office Tasks] and Assist [Analytical Services Statistical Information System) were cancelled with losses of millions of pounds. More recently the DWP has run into problems on several big projects.

“Abysmal”

On 3 November 2014 the then chairman of the Public Accounts Committee Margaret Hodge spoke on Radio 4’s Analysis of the DWP’s ‘abysmal’ management of IT contracts.”

1984

As long ago as 1984, the House of Commons Public Accounts Committee called for the civil service to be more open about its progress on major computer projects.

Today there are questions about whether the Universal Credit IT will succeed. Hundreds of millions has already been spent. Yet, as mentioned earlier, current information on the progress of the DWP’s IT programmes remains a state secret.

It’s possible that progress on the Universal Credit IT programme has been boosted by the irregular (but thorough) scrutiny by the National Audit Office. That said, as soon as NAO reports on Universal Credit are published, ministers and senior officials who have seen copies in advance routinely dismiss any criticisms as retrospective and out-of-date.

Does it matter if the DWP is paranoid about leaks?

A paper published in 2009 looks at how damaging it can be for good government when bureaucracies lack internal challenge and seek to impose on officials a “good news” agenda, where criticism is effectively prohibited.

The paper quoted the then Soviet statesman Mikhail Gorbachev as saying, in a small meeting with leading Soviet intellectuals,

“The restructuring is progressing with great difficulty. We have no opposition party. How then can we control ourselves? Only through criticism and self-criticism. Most important: through glasnost.”

Non-democratic regimes fear a free flow of information because it could threaten political survival. In Russia there was consideration of partial media freedom to give incentives to bureaucrats who would otherwise have no challenge, and no reason to serve the state well, or avoid mistakes.

The Chernobyl nuclear disaster, which occurred on April 26, 1986, was not acknowledged by Soviet officials for two days, and only then after news had spread across the Western media.

The paper argued that a lack of criticism could keep a less democratic government in power. But it can lead to a complacency and incompetence in implementing policy that even a censored media cannot succeed in hiding.

As one observer noted after Chernobyl (Methvin in National Review, Dec. 4, 1987),

“There surely must be days—maybe the morning after Chernobyl—when Gorbachev wishes he could buy a Kremlin equivalent of the Washington Post and find out what is going on in his socialist wonderland.”

Red team

Iain DuncanSmithA lack of reliable information on the state of the Universal Credit IT programme prompted the then secretary of state Iain Duncan Smith to set up his own “red team” review.

That move was not known about at the time. Indeed in December 2012 – at a point when the DWP was issuing public statements on the success of the Universal Credit Programme – the scheme was actually in trouble. The DWP’s legal submission said,

“In summary we concluded (just before Christmas 2012) that the IT system that had been developed for the launch of UC [Universal Credit] had significant problems.”

One wonders whether DWP civil servants kept Duncan Smith in the dark because they themselves had not been fully informed about what was going on, or because they thought the minister was best protected from knowing what was going on, deniability being one key Whitehall objective.

But in the absence of reliable internal information a political leader can lose touch completely, said the paper on press freedom.

“On December 21, 1989, after days of local and seemingly limited unrest in the province of Timi¸ Ceausescu called for a grandiose meeting at the central square of Bucharest, apparently to rally the crowds in support of his leadership. In a stunning development, the meeting degenerated into anarchy, and Ceausescu and his wife had to flee the presidential palace, only to be executed by a firing squad two days later.”

Wrong assumptions

Many times, after the IT media has published articles on big government IT-based project failures, TV and radio journalists have asked to what extent the secretary of state was responsible and why he hadn’t acted to stop millions of pounds being wasted.

But why do broadcast journalists assume ministers control their departments? It is usually more likely that ministers know little about the real risks of failure until it is too late to act decisively.

Lord Bach, a minister at DEFRA, told a House of Commons inquiry in 2007 into the failure of the IT-based Single Payment Scheme that he was aware of the risks but still officials told him that systems would work as planned and farmers would receive payments on time. They didn’t. Chaos ensued.

Said Lord Bach,

“I do think that, at the end of the day, some of the advice that I received from the RPA [Rural Payments Agency] was over-optimistic.”

Lord WhittyAnother DEFRA minister at the time Lord Whitty, who was also party in charge of the Single Payment Scheme, told the same inquiry,

“Perhaps I ought also to say that this was the point at which I felt the advice I was getting was most misleading, and I have used the term ‘misleading’ publicly but I would perhaps prefer to rephrase that in the NAO terms …”

Even the impressive Stephen Crabb – who has now quit as DWP secretary of state – didn’t stand much of chance of challenging his officials. The department’s contracts, IT and other affairs, are so complex and complicated – there are bookcases full of rules and regulations on welfare benefits – that any new ministers soon find themselves overwhelmed with information and complexity.

They will soon realise they are wholly dependent on their officials; and it is the officials who decide what to tell the minister about internal mistakes and bad decisions. Civil servants would argue that ministers cannot be told everything or they would be swamped.

But the paper on press freedom said that in order to induce high effort within a bureacucracy, the leader needs “verifiable information on the bureaucrats’ performance”.

The paper made a fascinating argument that the more complacent the bureaucracy, the more aggressively it would control information. Some oil-rich countries, said the paper, have less media freedom than those with scarcer resources.

“Consistent with our theory, [some] non-democratic countries … have vast resources and poor growth performance, while the Asian tigers (South Korea, Taiwan, Hong Kong, and Singapore), while predominantly non-democratic in the 1970s and 1980s, have high growth rates and scarce natural resource.”

In an apparent opening up of information, the government in China passed a law along the lines of the U.S. Freedom of Information Act (“China Sets Out to Cut Secrecy, but Laws Leave Big Loopholes,” New York Times, Apr. 25, 2007). But was this law self-serving? It, and the launch of local elections, provided the central government with relatively reliable information on the performance of provincial bosses.

These stories from less democratic countries may be relevant in Britain because politicians here, including secretaries of state, seem to be the last to know when a big IT-based programme is becoming a disaster.

Bad news

Whtehall’s preoccupation with “good news only” goes well beyond the DWP.

T auditors Arthur D Little, in a forensic analysis of the delays, cost over-runs and problems on the development of a huge air traffic control IT project for National Air Traffic Services, whose parent was then the Civil Aviation Authority, which was part of the Department for Transport, referred to an “unwillingness to face up to and discuss bad news”.

Ministers helpless to force openness on unwilling officials?

Francis Maude came to the Cabinet Office with a reforming zeal and a sophisticated agenda for forcing through more openness, but the effects of his efforts began to evaporate as soon as he left office. Even when he was at the height of his power and influence, he was unable to persuade civil servants to publish Gateway reviews, although he’d said when in opposition that he intended to publish them.

His negotiations ended with central departments agreeing to publish only the “traffic light” status of big projects – but only after a minimum delay of at least six months. In practice the delay is usually a year or more.

Brexit

Brexit campaigners argue that the EC is undemocratic, that decisions are taken in Brussels in secret by unelected bureaucrats. But the EC is at least subject to the scrutiny, sometimes the competing scrutiny, of 29 countries.

Arguably Whitehall’s departments are also run by unelected bureaucrats who are not subject to any effective scrutiny other than inspections from time to time of the National Audit Office.

Yes Minister parodied Sir Humphrey’s firm grip on what the public should and should not be told. Usually his recommendation was that the information should be misleadingly reassuring. This was close enough to reality to be funny. And yet close enough to reality to be serious as well. It revealed a fundamental flaw in democracy.

Nowhere is that flaw more clearly highlighted than in the DWP’s legal submission. Is it any surprise that the DWP did not want the submission published?

If officials had the choice, would they publish any information that they did not control on any of their IT projects and programmes?

That’s where the indispensable work of the National Audit Office comes into the picture – but it alone, even with the help of the Public Accounts Committee, cannot plug the gaping hole in democracy that the DWP’s submission exposes.

These are some thoughts I am left with after reading the legal submission in the light of the DWP’s record on the management of IT-based projects …

  • Press freedom and the free flow of information cannot be controlled in a liberal democracy. But does Whitehall have its own subtle – and not so subtle – ways and means?
  • In light of the DWP’s track record, the public and the media are entitled to distrust whatever ministers and officials say publicly about their own performance on IT-related programmes, including Universal Credit.
  • More worryingly, would the DWP’s hierarchy care a jot if the media and public didn’t believe what the department said publicly about progress on big projects such as Universal Credit?
  • Is the DWP’s unofficial motto: Better to tell a beautiful lie than an ugly truth?
  • AL Kennedy mentioned the “botched” Universal Credit programme  when she gave a “point of view” on Radio 4 last week. Not referring specifically to Universal Credit she said facts can be massaged but nature can’t be fooled. A girder that won’t hold someone’s weight is likely to fail however many PR-dominated assurance reports have gone before. “Facts are uncompromising and occasionally grim. I wish they weren’t. Avoiding them puts us all at increased risk,” she said.

 Excerpts from the DWP submission

Some Twitter comments on this post:

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

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?

Another NPfIT IT scandal in the making?

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

 

Yet another NHS IT mess?

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