Category Archives: open standards

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?

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

By Tony Collins

Were GPs guinea pigs for live testing of the new national NHS e-Referral Service?

Between 2004 and 2010 the Department of Health marked as confidential its lists of problems with national NPfIT systems, in particular Choose and Book.

So the Health and Social Care Information Centre deserves praise for publishing a list of problems when it launched the national “e-Referrals” system on Monday. But that list was 9 pages long.

The launch brought unsurprised groans from GPs who are used to new national systems going live with dozens of known problems.

The e-Referral Service, built on agile “techniques” and based on open source technology, went live early on Monday to replace “Choose and Book” for referring GP patients to hospitals and to other parts of the NHS.

Some GPs found they could not log on.

“As expected – cannot refer anything electronically this morning. Surprise surprise,” said one GP in a comment to “Pulse” on its article headlined “Patient referrals being delayed as GPs unable to access e-Referrals system on launch day.”

A GP practice manager said: “Cannot access in south London. HSCIC debacle…GPs pick up the pieces. Changing something that wasn’t broken.”

Another GP said: “I was proud never to have used Choose and Book once. Looks like this is even better!”

Other GPs said they avoided using technology to refer patients.

“Why delay referral? Just send a letter. (Some of us never stopped).”

Another commented: “I still send paper referrals – no messing, you know it has gone, no time wasted.”

Dr Faisal Bhutta, a GP partner in Manchester, said his practice regularly used Choose and Book but on Monday morning he couldn’t log in. “You can’t make a referral,” he said.

The Health and Social Care Information Centre has apologised for the disruption. A statement on its website says:

“There are a number of known issues, which are currently being resolved. It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks. We have published the list of known issues on our website along with details of how to provide feedback .”

But why did the Centre launch the e-Referral Service with 9 pages of known problems? Was it using GPs as guinea pigs to test the new system?

Comment

The Health and Social Care Information Centre is far more open, less defensive and a better communicator than the Department of Health ever was when its officials were implementing the NPfIT.

But is the HSCIC’s openness a good thing if it’s accompanied by a brazen and arrogant acceptance that IT can be introduced into the NHS without a care whether it works properly or not?

In parts of the NHS, IT works extraordinarily well. Those who design, test, implement and support such systems care deeply about patients. In many hospitals the IT reduces risks and helps to improve the chances of successful outcomes.

But in other parts of the NHS are some technology enthusiasts – at the most senior board level – who seem to believe that all major IT implementations will be flawed and will be improved by user feedback.

The result is that IT that’s inadequately designed, tested and implemented is foisted on doctors and nurses who are expected to get used to “teething” troubles.

This is dangerous thinking and it’s becoming more and more prevalent.

Many poorly-considered implementations of the Cerner Millennium electronic patient record system have gone live in hospitals across England with known problems.

In some cases, poor implementations – rather than any faults with the system itself – have affected the care of patients and might have contributed to unnecessary deaths when records needed urgently were not available, or hospitals lost track of urgent appointments.

A CQC report in March 2015 said IT was a possible factor in the death of a patient because NHS staff were unable to access electronically-held information.

In another incident a coroner criticised a patient administration system for being a factor in the death of three year-old Samuel Starr whose appointment for a vital scan got lost in the system.

Within NHS officialdom is a growing cultural acceptance that somehow a poor IT implementation is different to a faulty x-ray machine that delivers too high a dose of radiation.

NHS officials will always brush off IT problems as teething and irrelevant to the care and safety of patients. Just apologise and say no patient has come to any harm.

So little do IT-related problems matter in the NHS that unaccountable officials at the HSCIC have this week felt sufficiently detached from personal accountability to launch a national system knowing there are dozens of problems with the use of it.

Their attitude seems to be: “We can’t know everything wrong with the system until it’s live. So let’s launch the system and fix the problems as GPs give us their feedback.”

This is a little like the NHS having a template letter of regret to send to relatives and families of patients who die unexpectedly in the care of the NHS. Officials simply fill in the appropriate name and address. The NHS can then fix the problems as and when patients die.

It’s surely time that bad practice in NHS IT was eradicated.  Board members need to question more. When necessary directors must challenge the blind positivism of the chief executive.

Some managers can learn much about the culture of care at the hospitals that implement IT successfully.

Patients, nurses and doctors do not exist to tell hospital managers and IT suppliers when electronic records are wrong, incomplete, not available or are somebody else’s record with a similar name.

And GPs do not exist to be guinea pigs for testing and providing feedback on new national systems such as the e-Referral Service.

e-Referral Service “unavailable until further notice”

Hundreds of patients lost in NPfIT systems

Hospital has long-term NPfIT problems

An NPfIT success at Croydon? – Really?

Physicians’ views on electronic patient records

Patient record systems raise some concerns, says report

Electronic health records and safety concerns

HP’s tacit threat to government not to bid for contracts?

By Tony Collins

HP has written to the Treasury  questioning whether it is worthwhile competing for contracts if the Government is no longer interested in doing business with multinationals, says The Independent.

Cabinet Office minister Francis Maude is encouraging departments to spend more with SMEs and be less reliant on a small number of major IT suppliers. He wants departments to avoid signing long-term contracts which lock-in ministers to one major supplier.

The Independent says:

“In a striking case of Goliath accusing David of bullying, the American giants Microsoft and Hewlett Packard have complained that they are being unfairly picked on by the Cabinet Office minister Francis Maude.

“…the Government’s largest IT supplier Hewlett Packard has written to the Treasury to express its concern at plans by Mr Maude to award more Government contracts to smaller suppliers.

“At the same time Microsoft is fighting a rearguard action against the Cabinet Office to protect the million pounds it gets each year from Whitehall by selling popular Office programmes such as Word and Excel.

“Both companies are concerned that they are being singled out by ministers as unpopular and easy targets in their rhetoric about cutting public sector waste…

“Microsoft is attempting to prevent the Government from migrating its own computer systems from those that rely on the multinational to open-source documents that are free to use…

“Both companies look set to be disappointed – at least unless there is a change in Government. Mr Maude is understood to be looking to next year – when a significant number of big IT contracts are up for renewal – to push ahead with the new policy that could significantly denude the profits of IT multinationals.”

A Cabinet Office spokesman said it was unaware of HP’s letter to the Treasury and added: “We value the contribution companies of all sizes make to the UK economy, driving innovation, growth and jobs.”

A spokeswoman for HP told The Independent:  “HP is a proud and long-standing supplier of IT products and services to Her Majesty’s Government and provides vital public services to UK citizens.  We maintain an ongoing dialogue with government about our programme of work.”

A report by the Institute for Government Government Contracting:  Public data, private providers says that HP is the largest supplier to government with earnings in excess of 1.7bn in both 2012 and 2013.

In 2013, 86% (£1.49bn) of HP’s revenue from central government came from a DWP contract to supply infrastructure and systems for DWP and its job centres. “This contract is likely to be the largest single non-defence contract in central government,” says the Institute.

Capgemini, BT and Capita were the next largest suppliers to central government. Capgemini’s work is mainly from HMRC through the “Aspire” contract which is worth about £850m a year.

Departments are more open than they used to be but the Institute found big gaps in the information provided.

These gaps include:

– Contractual transparency –  contracts and contractual terms, including who will bear financial liabilities in the event of failures

– Information about how well contractors perform, allowing a vital assessment of value for money

– Supply chain transparency – information including the proportion of work subcontracted to others, terms of subcontracting (particularly levels of risk transfer), and details on the types of organisation (for example, voluntary and community sector organisations) in the supply chain.

Comment

What concerns Maude and his team is not the existence of major suppliers in central government contracts but the reliance by central departments on long-term contracts that lock-in ministers and lead to costly minor changes.

Nobody wants the major suppliers to stop bidding for contracts. What’s needed is for departments to have the in-house expertise to manage suppliers adroitly, and not to be adroitly managed by their suppliers which seems to be the position at present.

Thank you to openness campaigner Dave Orr for the information he sent me which helped with this article.

The IT giants who fear losing the government’s favour

Opening the door to data transparency

 

 

 

Universal Credit: more IT uncertainties

By Tony Collins

Shortly after IDS was in the House of Commons yesterday defending his handling of the Universal Credit project – taking an all is well approach – the National Audit Office issued a report that drew attention to the scheme’s uncertainties, write-offs on IT so far of £41.3m, and the five-year depreciation of a further £91m spend on IT that may not be used after the migration from legacy, or transitional, UC systems to in a new “digital” solution.

The legacy Universal Credit  IT infrastructure is a blend of existing DWP IT and technology adapted to UC.

The DWP had originally expected to depreciate the £91m over 15 years but, suggests the NAO, the legacy Universal Credit IT infrastructure may be of little use after 2017/2018.   

Says the NAO:

“…  the underlying issue [is] that the Department has spent £91.0 million on assets that will only support a limited service for 5 years, with clear consequences for public value.”

On what the NAO report calls the “longer-term programme uncertainties” it says that the “overall cost of developing assets to support Universal Credit is subject to considerable uncertainty”.

It adds:

“The Department acknowledges  … that there is uncertainty over the useful economic life of the existing Universal Credit software pending the development of the alternative digital solution and uncertainty over whether Universal Credit claimants will be able to migrate from the current IT infrastructure to the new digital solution by December 2017.”

The NAO’s report on the DWP’s 2012/2013 accounts also notes the uncertainties with the new digital solution. Says the NAO:

“At this early stage in its development, there are uncertainties over the exact nature of the digital solution, and in particular:

– How it will work;

– When it will be ready;

– How much it will cost; and

– Who will do the work to develop and build it.

A Ministerial Oversight Group has approved a spend of between £25m and £32m on the new digital UC solution up to November 2014. DWP officials and suppliers plan to build a core digital service that will deliver to 100 people by then, after which it will assess the results of that work and consider whether to extend the service to increasing numbers.

The NAO suggests that some of the money spent on the new digital solution may also end up being written off.  Says its report:

“As the Department develops the digital solution, so it will start to recognise some of the costs incurred as assets. Without clear and effective management, in the future the Department may also find it needs to impair some of these new digital assets.”

At a hearing of the Work and Pensions Committee on Monday Iain Duncan Smith depicted the write-off of £40m on UC software code so far as normal for any large organisation in the private or public sector that embarks on a major software-based programme.  IDS said that private sector organisations typically write off a third of the money spent on software on a large project. About £120m has been spent on writing UC software code so far.

Amyas Morse, head of the NAO,refers in his report to the “considerable sums that the Department is proposing to invest in a programme where there are significant levels of technical, cost and timetable uncertainty”.

He adds:

“I reiterate both the conclusion and recommendations from my report in September. The Department has to date not achieved value for the money it has incurred in the development of Universal Credit, and to do so in future it will need to learn the lessons of past failures …”

In a short debate on UC in the House of Commons yesterday Rachel Reeves, Shadow Work and Pensions secretary, suggested Iain Duncan Smith was in denial about being in denial.  She put points to him he did not answer directly.

She said that IDS had told the House of Commons on 5 September 2013 that UC will be delivered in time and on budget. On 14 October IDS made the same claim. Reeves said:

“How on earth can this be on time when in November 2011 he [IDS] said:  ‘All new applications for existing benefits and credits will be entirely phased out by April 2014.’

“We have now learned that this milestone will only be reached in 2016. Will the secretary of state confirm that this is a delay of 2 years? … How can the secretary of state say that Universal Credit will be on budget when even by his own admission £40.1m is being written off on IT [software code]? What budget heading was that under?”

Reeves said IDS also revealed on Monday that another £90m will be written off by 2018. She added:

“ …The underlying problem is surely that the secretary of state has not resolved key policy decisions before spending hundreds of millions of pounds on an IT system… the secretary of state is in denial. Doubtless he’ll deny he is in denial….

IDS replied:

“ I said all along and I repeat: this programme essentially [jeers] is going to be on time. By 2017 some 6.5m people will be on the programme receiving benefits.”

He added that UC will roll out without damaging a single person. “The waste we inherited was the waste of people who didn’t listen, rushed programmes and implementing them badly.”

Dame Anne Begg, chair of the Work and Pensions Committee, said that IDS promised UC would be digital by default. “It isn’t,” she said.

“He promised that all new claims would be on UC by May 2014. They won’t…  So why should anyone believe him when he says that delivery of UC is now on track?”

IDS replied: “The proof of this will be as we roll it out…”

Comment

IDS is doing what he has to do: defend the UC project at all costs; and the NAO is doing what it needs to do: highlight the uncertainties and wasted spending.  If IDS admits to his doubts and concerns the opposition will jump on him. At least he is not being kept in the dark any longer by his senior civil servants.  He has his own reliable information – via Howard Shiplee – and from the NAO.  In 2011 he commissioned his own independent “red team” review which led to the pilot Pathfinder projects.

But the uncertainties highlighted by the NAO’s report today could be said to tacitly confirm that the transfer of all relevant claimants to UC project is unlikely to be complete before 2019/2020 at the earliest.  That’s probably not something anyone in government could own up to before the 2015 general election.

And even his advisers may not tell IDS that big government IT projects can be defined by the exceptions. IDS told MPs yesterday that Pathfinder projects indicated that 90% of people are claiming universal credit online and 78% are confident about their ability to budget with monthly payments. That’s 10% who don’t claim online and 22% who may not be able to manage with monthly payments. Will the high number of exceptions prove a show-stopper?

There’s a long way to go before officials and ministers can have confidence in UC IT. But, unlike the NPfIT which had little support in the NHS, most of those involved in the UC project want it work. That could make all the difference. 

Will Universal Credit be complete by 2020?

By Tony Collins

Comment

Much of what Iain Duncan Smith said at the Work and Pensions Committee yesterday made sense. In essence the DWP’s plan is to delay putting most of the  claimants onto the Universal Credit system until the technology is proven to work.

But there is little evidence it will work at scale, handling reliably and accurately millions of claimants and complex cases. It emerged yesterday that the DWP has still not yet agreed with suppliers a specification for the UC systems, and the latest business case has yet to be approved. How can anyone say on the basis of the limited work so far that the technology will work?

And Howard Shiplee,  Director General of Universal Credit, made the point yesterday that the technology is only part of the story. For UC to work there have to be changes in culture, operational procedures within the DWP and the retraining of tens of thousands of staff.

IDS is doing what various sets of ministers and officials did during the distended failure of the NHS’s £11bn computer programme, the National Programme for IT [NPfIT]: in assuring Parliament all was well they always used the future tense. The programme “will” give everyone in England an electronic patient record. But nothing was delivered that provided evidence the promises would be fulfilled. It took a new government to admit the NPfIT was a failure.

UC differs from the NPfIT in a crucial way. The NPfIT did not need to work. It was conceived at the top without support from the NHS. Many hospitals didn’t want centrally-bought IT foisted on them. The NPfIT was wanted, in the main, by a small number of politicians, officials and big suppliers. UC is needed and wanted. Simplifying the horrifying complex benefit systems has all-party support. Shiplee is right when he says UC has to work. But he didn’t yesterday commit himself to a timeframe.

The last major benefits computerisation project – called “Operational Strategy” – took about 10 years to finish. It did not achieve the promised financial benefits and benefit systems were not combined as originally intended but, in the end, the technology worked well for its time.

If UC does work there’s every reason to believe it will be in a similar timeframe to Operational Strategy: about 10 years. But could IDS keep his job while saying UC will be fully delivered in 2020 or beyond? I doubt it.

Francis Maude –“unacceptable” civil service practices

By Tony Collins

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

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

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

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

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

Indeed Maude said,

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

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

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

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

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

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

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

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

Massive duplication

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

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

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

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

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

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

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

Comment

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

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

O’Donnell said

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

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

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

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

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

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

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

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

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

Big IT suppliers and their Whitehall “hostages”

By Tony Collins

Mark Thompson is a senior lecturer in information systems at Cambridge Judge Business School, ICT futures advisor to the Cabinet Office and strategy director at consultancy Methods.

Last month he said in a Guardian comment that central government departments are “increasingly being held hostage by a handful of huge, often overseas, suppliers of customised all-or-nothing IT systems”.

Some senior officials are happy to be held captive.

“Unfortunately, hostage and hostage taker have become closely aligned in Stockholm-syndrome fashion.

“Many people in the public sector now design, procure, manage and evaluate these IT systems and ignore the exploitative nature of the relationship,” said Thompson.

The Stockholm syndrome is a psychological phenomenon in which hostages bond with their captors, sometimes to the point of defending them.

This month the Foreign and Commonwealth Office issued  a pre-tender notice for Oracle ERP systems. Worth between £250m and £750m, the framework will be open to all central government departments, arms length bodies and agencies and will replace the current “Prism” contract with Capgemini.  

It’s an old-style centralised framework that, says Chris Chant, former Executive Director at the Cabinet Office who was its head of G-Cloud, will have Oracle popping champagne corks. 

“This is a 1993 answer to a 2013 problem,” he told Computer Weekly.

In the same vein, Georgina O’Toole at Techmarketview says that central departments are staying with big Oracle ERP systems.   

She said the framework “appears to support departments continuing to run Oracle or, indeed, choosing to move to Oracle”. This is “surprising as when the Shared Services strategy was published in December, the Cabinet Office continued to highlight the cost of running Oracle ERP…”

She said the framework sends a  message that the Cabinet Office has had to accept that some departments and agencies are not going to move away from Oracle or SAP.

“The best the Cabinet Office can do is ensure they are getting the best deal. There’s no doubt there will be plenty of SIs looking to protect their existing relationships by getting a place on the FCO framework.”

G-Cloud and open standards?

Is the FCO framework another sign that the Cabinet Office, in trying to cut the high costs of central government IT, cannot break the bond – the willing hostage-captive relationship –  between big suppliers and central departments?

The framework appears to bypass G-Cloud in which departments are not tied to a particular company. It also appears to cock a snook at the idea of replacing  proprietary with open systems.

Mark Thompson said in his Guardian comment: 

– Administrative IT systems, which cost 1% of GDP, have become a byword for complexity, opacity, expense and poor delivery.

– Departments can break free from the straitjackets of their existing systems and begin to procure technology in smaller, standardised building blocks, creating demand for standard components across government. This will provide opportunities for less expensive SMEs and stimulate the local economy.

– Open, interoperable platforms for government IT will help avoid the mass duplication of proprietary processes and systems across departments that currently waste billions.

–  A negative reaction to the government’s open standards policy from some monopolistic suppliers is not surprising.

Comment

It seems that Oracle and the FCO have convinced each other that the new framework represents change.  But, as Chris Chant says, it is more of the same.

If there is an exit door from captivity the big suppliers are ushering senior officials in departments towards it saying politely “you first” and the officials are equally deferential saying “no – you first”. In the end they agree to stay where they are.

Will Thompson’s comments make any difference?

Some top officials in central departments – highly respected individuals – will dismiss Thompson’s criticisms of government IT because they believe the civil service and its experienced suppliers are doing a good job: they are keeping systems of labyrinthine complexity running unnoticeably smoothly for the millions of people who rely on government IT.

Those officials don’t want to mess too much with existing systems and big IT contracts in case government systems start to become unreliable which, they argue, could badly affect millions of people.

These same officials will advocate reform of systems of lesser importance such as those involving government websites; and they will champion agile and IT-related reforms that don’t affect them or their big IT contracts.

In a sense they are right. But they ignore the fact that government IT costs much too much. They may also exaggerate the extent to which government IT works well. Indeed they are too quick to dismiss criticisms of government IT including those made by the National Audit Office.

In numerous reports the NAO has drawn attention to weaknesses such as the lack of reliable management information and unacceptable levels of fraud and internal error in the big departments. The NAO has qualified the accounts of the two biggest non-military IT spending departments, the DWP and HMRC.

Ostensible reformers are barriers to genuine change.  They need to be replaced with fresh-thinking civil servants who recognise the impossibility of living with mega IT contracts.

Mark Thompson’s Guardian article.