Category Archives: operational issues

Did Gauke and Couling break free today of DWP “good news” stance on Universal Credit rollout?

By Tony Collins

Two leaders of the Universal Credit rollout, David Gauke and Neil Couling, faced MPs’ questioning this morning on problems with the rollout of Universal Credit.

They were asked, among other things, about excessive delays in payments and payments made on the basis of incorrect data.

Gauke and Couling appeared before the work and pensions committee. There is also a Commons debate today on the Universal Credit rollout.

Gauke, the work and pensions secretary, and civil servant Neil Couling, Director General of Universal Credit, are known to resent criticism of the Universal Credit programme or its rollout.

Couling tweeted last week, in response to academic Jonathan Portas:

But MPs on the work and pensions committee, particularly its chairman Frank Field,  are sensitive to the DWP’s “good news” culture.

Field is reported to have said he suspected that ministers had only pressed ahead with the accelerated rollout of universal credit this month because civil servants at the Department for Work and Pensions had withheld the true scale of the problems.

Field said:

“Given everything we have heard, I was surprised that David Gauke opted to proceed with the accelerated rollout.

“I strongly suspect his decision, together with the failure to tell us anything, reflects a culture at the DWP of those most invested in universal credit not telling anyone, including their ministers, bad news.”

In its 2013 report “Universal Credit Early Progress“, the National Audit Office said,

“Both the Major Projects Authority [now the Infrastructure and Projects Authority] and a supplier-led review in mid-2012 identified problems with staff culture; including a ‘fortress mentality’ within the programme.

“The latter also reported there was a culture of ‘good news’ reporting that limited open discussion of risks and stifled challenge.”

BBC Radio 4’s Today programme heard this morning (18 October 2017) that a Universal Credit claimant who’d been the victim of “mistake after mistake” on his claim had threatened to take his own life and police had been called.

Update:

Gauke and Couling told the work and pensions committee this morning that the rollout may be paused in January 2018 as part of the department’s test and learn philosophy. They called it a “fire-break.  Couling said the rollout was paused in February 2016 for two months and “nobody noticed”.

He added that he was prepared to advise his minister, the Treasury and the prime minister to pause the rollout whenever the “evidence merits”..

Gauke said the advantages of the Universal Credit system were of such a “prize” that there was  cost of slowing down the rollout. “It can transform lives and it’s my determination is to deliver this successfully,” said Gauke.

Gauke and Couling told MPs that the rollout was working successfully. Neither expressed any criticisms of the programme or the rollout; and neither accepted the many criticisms of the committee’s MPs of the programme. At one point, Couling helpfully suggested to the committee some of the questions they “should” have been asking.

Where there were problems it was outside the DWP’s control – because of information supplied, or not supplied, by claimants or employers. The real-time information supplied to DWP by HM Revenue and Customs was only as good as the information provided to HMRC by employers.

Comment:

There’s universal support for the idea of Universal Credit. But there is almost universal criticism of the way it is being rolled out. Critics of the rollout also find it difficult to understand the DWP’s continuing refusal to accept that there are any serious problems.

For decades the DWP and its predecessor the Department of Social Security have been culturally unable to accept criticism of any of their big IT-based projects and programmes, even after a project was aborted.

One DWP director last year used the word “paranoid” when referring to her colleagues and their concerns about leaks of any bad news on the Universal Credit programme.

The DWP routinely declines FOI requests to publish its performance reviews on the Universal Credit programme. This lack of official information on the DWP’s performance leaves officials and ministers free to say that criticism of the programme is subjective or anecdotal.

Stephen Crabb was one of the few politicians who have ever made a difference to the DWP’s closed culture of secrecy and defensiveness. He ordered that internal reports on the risks and progress of the Universal Credit programme be released, against the advice of his civil servants. But Crabb didn’t stay long.

And the “good news” culture has returned, as unremitting as ever. Will any minister or civil servant be able to change the DWP’s “good news” culture?

Probably not.

The DWP’s permanent secretary Robert Devereux is retiring in January 2018, which will open the door to a successor who could try and change the department’s defensive culture.

It’s more likely, however, that Devereux’s replacement will be chosen on the basis that he or she will be a “safe pair of hands” which, in civil service terms, means a staunch defender of the department, its performance, all it is doing and the civil service in general.

However many independent voices call for a brake on the Universal Credit rollout, it seems inevitable that the DWP’s mandarins (and their pliant ministers) will carry on doing whatever they can justify to themselves.

The DWP hasn’t let humility or democratic openness get in the way before. Why would it give in to them now?

 

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Barnet Council claims £31m savings with Capita – and not an auditor in sight.

By Tony Collins

capita

It’s commendable that Barnet Council has published much material on its three-year review of a £322m 10-year outsourcing contract with Capita.

More than a dozen council reports and appendices cover every aspect of the contract.

The quantity of material seems, on the face of it, to answer critics of the outsourcing deal, among them local bloggers, who have pointed to the lack of reliable evidence of the savings achieved. The suspicion is that costs have increased and council services including ICT have deteriorated since Capita took over in 2013.

Now the council has ostensibly proved that the opposite is the case. Barnet’s press release says,

Barnet Council and Capita contract delivers £31m savings

“A review of a contract between Barnet Council and Capita has demonstrated it is delivering significant benefits to the borough with overall savings of £31 million achieved alongside increased resident satisfaction…

“In terms of satisfaction with services provided, the review, showed 76 per cent of residents were satisfied with the outward-facing customer services, up from 52 per cent before the contract was established.

“This increase was even more significant in respect of face to face services, as 96 per cent of residents who engaged with the council in this way said they were satisfied compared with a previous 35 per cent.

“The review also showed that the cost of delivering the bundle of services provided in the contract is now £6m a year less than before the contract was signed and that 90 per cent of the contract’s key performance indicators being met or exceeded.”

The press release quotes two leaders of the council saying how pleased they were with the contract. Capita calls it a “positive review”.

The review has various mentions of items of additional spending including £9m on ICT and it’s not clear whether the extra sums are taken into account in the savings figures.

Among the review’s suggestions is that the council pay Capita’s annual management fee of £25m up front – a year in advance – instead of every quarter in return for extra savings.

The review also raises the possibility of extending the contract beyond the 10 years in return for additional savings. Capita is “keen” to explore this suggestion (though it could tie the hands of a future council administration).

The review reports were compiled by council officers who reported to a working group of Tory and Labour councillors, under a much-respected Tory chairman. By a small margin, Conservatives run the council.

Lack of independent challenge?

It’s unclear why the council did not commission its audit committee, or auditors, to review the contract. In the past the audit committee has been critical of some aspects of the contract.

For this reason the reports are unlikely to silence critics of Barnet’s outsourcing deal. Council officers compiled the review’s findings, not auditors.

As a result, despite the volume of published written material, there is no evidence that the figures for savings have been independently verified as accurate.

Neither is there independent verification of the methods used by officers for obtaining the figures.

Further, some observers may question the positive tone of the review findings. The “good news” tone may be said to be at odds with the factual neutrality of, say, reports of the National Audit Office.

There are also questions about whether the council is providing enough effective challenge to Capita’s decisions and figures.

At a council committee meeting in November 2016 to discuss the review reports, the most informed challenges to the findings appear to have come not from Barnet councillors but two local bloggers, Mrs Angry and Mr Reasonable, who questioned whether the claimed savings could be more than wiped out by additional spending – including an extra £9m on ICT. They appear to have received no clear answers.

Concerns of some officials

The body of the review reports outline some of the concerns of staff and directors. Mrs Angry quotes some of the concerns from the review reports:

“Transparency of costs, additional charges and project spend were raised as key concerns. It was felt that CSG [Barnet’s Customer and Support Group, for which Capita is responsible] are often reluctant to go above and beyond the requirements of the contract without additional charges.

“Directors reported that the council needs to be more confident that solutions suggested by CSG, particularly for projects and capital spend are best value.

“Concerns were raised that CSG has a disproportionate focus on the delivery of process and KPIs over outcomes, creating a more contractual rather than partnership relationship between CSG and the council. Directors noted that many KPIs are not relevant and their reporting does not reflect actual service performance.”

The Capita contract began in September 2013, under which it provides finance, ICT, HR, Customer Services, Revenues and Benefits, Procurement, Estates and Corporate Programmes.

Comment

On the face of it, Barnet Council’s review of the Capita contract looks comprehensive and impressively detailed.

Looked at closely it’s disappointing – a wasted opportunity.

Had the council wanted the review’s findings to be widely believed, it would have made it uncompromisingly independent, in line with reports by the National Audit Office.

As it is, the review was carried out by council officers who reported to a working group of councillors. The working group comprised Labour as well as Tory councillors but the facts and figures were compiled by officers.

Nearly every page of every Barnet review report has a “good news” feel. There’s an impression that negative findings are played down.

Example:

“It should be noted that the failure to meet the target for KPI 30 related to one quarter only [my italics] and discussions are continuing regarding the application of the above service credit.”

Some negative findings are immediately countered by positive statements:

“CIPFA benchmarking data shows that the cost of the ICT service is slightly above the median, but below upper quartile in terms of the cost of the service as a percentage of organisational running costs.”

Another example of a negative finding immediately countered by a positive one, which may be said to be one hallmark of a non-independent report:

“One key area of concern in terms of overall performance is internal customer satisfaction… Survey results in respect of the financial year 2015/16 were universally poor, with all services failing to meet the target of upper quartile customer satisfaction. As a result, service credits to a total value of £116k have been applied in respect of these KPIs.

“To some extent, a degree of dissatisfaction amongst internal service users is to be expected, given the fact that cost reductions have been achieved to a large extent through increased self-service for both managers and staff, along with more restrictive processes and controls over things like the payment of invoices and the appointment of staff.

“Despite the survey outcomes indicating a low level of satisfaction, the interviews conducted with staff and managers as part of this Review suggest that services are generally considered to be improving.”

Integra ERP financial system a “success” – ?

The review report describes Capita’s introduction of the Integra financial system as “successful”. Elsewhere, however, it says,

“Many users raised issues with the Integra finance system, describing it as clunky and not user-friendly or intuitive.”

Double counting?

There’s no evidence that savings figures have been checked for possible inadvertent double counting on overlapping services. Double counting of savings is regularly found in National Audit Office reports.

“There are no standardised way for departments to evidence the reductions in ongoing expenditure,” said the National Audit Office in a report on Cabinet Office savings in July 2014. “Departments provided poor evidence, and double counting was highly likely as projects reduced staff or estates requirements.”

In a separate report on claimed savings in central government, the National Audit Office quoted the findings of an internal audit …

“A number of errors (instances where the evidence did not support the assertion) were found during our review and total adjusted accordingly … In addition, a number of savings were double counted with other savings categories and these have now been removed…

“We assessed some £200m of other savings as Red because they were double counted due to the same savings having been claimed by different units or, for example, because savings on staff were also claimed through reductions in average case costs.”

Omitted costs?

The omission of relevant costs could skew savings figures. It’s unclear from Barnet’s review reports whether extra spending of millions of pounds on, for example, ICT have been taken into account. Barnet blogger Mr Reasonable, who has a business background, raises the question of whether £65m of additional spending has been taken into account in the savings figures.

Reverse Sir Humphrey phenomenon?

The biggest single flaw in the review reports is that they appear worded to please the councillors who made the decision to outsource – the reverse of the “Sir Humphrey” caricature. The positive tone of Barnet’s reports implies that officers are – naturally – deferring to their political leaders.

In a BBC Radio 4 documentary on Whitehall, former minister Peter Lilley talked about how some officials spend part of their working lives trying to please their political leaders.

“Officials are trying to work out how to interpret and apply policy in line with what the minister’s views on the policy is …. They can only take their minister’s written or spoken word for it and that has a ripple effect on the department far greater than you imagine… Making speeches is the official policy of the department and that creates action.”

Another former minister Francis Maude told the BBC he found that too few officials were willing to say anything the minister did not want to hear.

“The way it should work is for civil servants give very candid well informed advice to ministers about what it is ministers want to do – the risks and difficulties,” said Maude. “My experience this time round in government, 20 years on from when I was previously government, is that the civil service was much less ready to do that.

“There were brilliant civil servants who were perfectly ready to tell you things that they thought you might not want to hear but there were too few of them.”

Barnet’s reviewing officers might have been dispassionately independent in reporting their findings and double checking the supplied figures – but who can tell without any expert independent assessment of the review?

The US Sabanes-Oxley Act, which the Bush administration introduced after a series of financial scandals, defines what is meant by an “independent” audit. The Act prohibits auditing by anyone who has been involved in a management function or provided expert services for the organisation being audited.

That would disqualify every Barnet officer from being involved in an independent audit of their own council’s contract with Capita.

The Act also says that the auditor must not have been an employee of the organisation being audited. Again that would disqualify every Barnet officer from an independent audit of their own council’s contract.

Review a waste of time and money?

It would be wrong to imply that the review is a pointless exercise. It identifies what works well and what doesn’t. It will help officers negotiate changes to the contract and to key performance indicators. For example it’s of little value having a KPI to answer phone calls within 60 seconds if the operator is unable to help the caller.

What the review does not provide is proof of the claimed savings. Barnet’s press release announcing savings of £31m is just that – a press release. It does not pretend to be politically neutral.

But without independent evidence of the claimed savings, it’s impossible for the disinterested observer to say that the Capita contract so far has been a success. Neither does evidence exist it has failed.

Capita share price at 10-year low

What is clear is that fixing some of the more serious problems identified in the report, such as obsolescent IT, will not be easy given the conflict between the continuing need for savings and Capita’s pressing need to improve the value of its business for shareholders, against a backdrop of difficulties on a number of its major contracts [Transport for London, Co-op Bank, NHS] and a share price that was yesterday [30 November 2016] at a ten-year low.

The review also raises a wider question: are most of a council’s busy councillors who come to council meetings in their free time equipped to read through and digest a succession of detailed reports on the three-year interim results of a complex outsourcing contract?

If they do glance through them, will they have enough of a close interest in the subject, and a good understanding of it,  to provide effective challenge to council officers and their political leaders?

If nothing else, the Barnet review shows that councillors in general cannot provide proper accountability on an outsourcing contract as complex as Capita’s deal with Barnet.

Either council tax payers have to put their faith in officers, irrespective of the obvious pressure for officialdom to tell its political leaders what they want to hear, or council taxpayers can put their faith in an independent audit.

Barnet Council has not given its residents any choice.

It’s a pity that when it comes to claimed savings of £31m there’s not an auditor in sight.

Barnet declares its contract a success – Barnet and Whetstone Press

Mr Reasonable – important questions on the Capita review

Mrs Angry – who writes compellingly on the council meeting where the review reports were discussed.

Are councillors in Somerset ignoring the wisdom of their auditors?

By Tony Collins

It’s good to see auditors in local government doing their job well  – not accepting verbal assurances and seeking proof that all is well with an outsourced system .

But what if councillors apply a lower standard – and accept verbal assurances without checking them?

A  strong report by the South West Audit Partnership [SWAP] went to councillors at Somerset County Council’s Audit Committee on 2 July 2015. The report was about problems with an outsourced system, the Adults Integrated Solution [AIS].

Although not the original supplier, IBM has provided AIS to Somerset County Council under a 10-year outsourcing contract/joint venture – Southwest One –  that was signed in 2007.

The SWAP report said limited progress has been made in implementing the AIS-related recommendations from its 2012-2013 audit report. It added that:

– AIS performance and response times could be “less than adequate for users’ needs”.

– Southwest One was unwilling to develop a service level agreement specifically for the AIS application.

– “Poor response time has led to the disabling of enhanced audit trails/logs that would make it possible to trace and attribute user activity in the system.” SWAP added that this was “worrying” given that the data involved was “sensitive and personal”.

– SWAP had been refused access to the contract between IBM and Northgate, the original supplier of AIS.

Are verbal assurances worth anything?

Having studied AIS from time to time over 2 years, and spoken to its users, SWAP’s auditors have been reluctant, on some of their concerns, to accept verbal assurances that all is well.

When they have sought documentary evidence to support assurances it hasn’t always been forthcoming.

SWAP said in its latest report:

“Verbal assurances were provided that the ToR for AIS Programme Board had been reviewed and that roles and responsibilities in relation to system ownership had been clarified. However, no evidence was provided to support these assurances.”

Now Somerset’s audit committee has done what its auditors wouldn’t do and has accepted verbal assurances that all is well with AIS.

SWAP’s auditors had expressed a multitude of concerns about AIS. But Somerset’s officers verbally assured audit committee councillors that a single upgrade had solved all the problems.

One officer, in a statement, told Dave Orr, a Somerset resident who campaigns for openness over IBM’s relationship with the council:

“I can confirm that all of the fundamental issues raised through the [SWAP] Audit Report [on AIS] have now been addressed…

“The AIS application is one of the top systems used by local authorities for social care services in the UK. The performance issues referred to in the Audit Report were resolved by a system upgrade.”

Comment:

It’s difficult if not impossible to see how a single upgrade could address all the points SWAP made – such as the lack of a service level agreement to cover AIS or the refusal by IBM to supply a copy of its contract with Northgate.

Whenever auditors produce a hard-hitting report there will be 2 opposing sides: defenders of what’s being criticised and the auditors.

It is up to the auditors to cut through any dissimulation, obfuscation and prevarication to identify what’s going well, what isn’t, and what the uncertainties and risks are.

Auditors would not be doing their job if they always accepted verbal assurances at face value.

But what if auditors are undermined by councillors who readily accept verbal assurances from their officers who wish to defend the suppliers?

A supplier that doesn’t have to provide documentary evidence can say anything in defence of its systems and the quality of service.

Somerset’s councillors are lucky to have auditors as independently-minded as SWAP.

It’s unlikely that SWAP would accept at face value the Somerset officer’s suggestion that because AIS is widely used it’s unlikely to be a poor system.

This would be like Ford saying a particular Mondeo is unlikely to be at fault because thousands of people happily own one.

Every IT installation is different, even if the main software package is widely used. The hardware, network configuration, load on the network, facilities and interfaces installed will render every IT installation unique.

It’s conceivable that every council client of AIS could have a trouble-free service except Somerset.

Are the council’s audit committee councillors gullible to accept verbal assurances about the problems with AIS being solved without requiring proof?

Where does this leave the 775 users of Somerset’s AIS, many of whom may be having to do difficult work in managing vulnerable adults while trying to cope with what may be one of the UK’s worst outsourced systems?

Thank you to Dave Orr for providing information that made this post possible.

Pity the 775 users who use this outsourced council system?

SWAP report on AIS for Somerset County Council’s Audit Committee 2 July 2015

SWAP 2012-2013 audit report on AIS

 

 

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

 

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

After billions spent on NHS IT, a carrier bag to transfer x-ray images

By Tony Collins

After fracturing my angle (slipping on a slope while mowing the lawn) I’ve been surprised how well parts of the NHS work – but not when it comes to the electronic transfer of records and PACS x-ray images from one trust area to another.

The minor injuries unit at one trust wasn’t able to send its PACS images to another trust’s orthopaedic department because it used a different PACS.  [The NHS has spent more than £700m on PACS ]

“Can’t we email the images?” said a senior nurse at the minor injuries unit. In reply the clinician looking at my x-rays gave a look that suggested emailing x-rays was impossible,  perhaps for security and cost reasons. [PACS images are sometimes tens of MBs.]

In the end the minor injuries unit (which within its own sections shared data electronically) had to download my x-rays onto CD for me to take the other trust’s orthopaedic department.  The CD went into a carrier bag.

The next day, at a hospital with an orthopaedic department, after 4-5 hours of waiting in a very busy A&E, I gave a doctor the CD. “I don’t think we can read that,” he said. “We don’t have any computers which take CDs.”

After a long search around a large general hospital the tired doctor eventually found a PC with a CD player. Fortunately the minor injuries unit had downloaded onto the disc a self-executing program to load the x-rays. Success. He gave his view of the fracture.

Even then he didn’t have my notes from the minor injuries unit.

Comment

My care was superb. What was surprising was seeing how things work – or don’t – after the NHS has spent more than £20bn on IT over the past 20 years.

The media is bombarded with press releases about IT innovations in the NHS. From these it’s easy to believe the NHS has the most up-to-date IT in the world. Some trusts do have impressive IT – within that trust.

It’s when records and x-rays need to be transferred outside the trust’s area that the NHS comes unstuck.

As a nurse at my GP’s practice said, “Parts of the NHS are third-world.”

Since 2004 billions has been spent on systems to create shareable electronic patient records.  But it’s not happening.

Within those billions spent on IT in the NHS, couldn’t a little bit of money be set aside for transferring x-rays and patient notes by secure email? That’s the real innovation the NHS needs, at least for the sake of patients.

In the meantime the safest way for x-rays and notes to be transferred from one trust to another is within the patient’s carrier bag.

Jailed and bankrupt because of “unfit” Post Office IT? What now?

By Tony Collins

post office logoThe BBC’s “PM” programme returned to the topic last week of subpostmasters who were stripped of their post office contracts and bankrupted because of theft, fraud and false accounting. Some went to jail.

“Is it possible they were innocent and that a computer system was to blame instead?” asked Eddie Mair, the programme’s presenter.

The BBC has seen a leaked copy of an independent report the Post Office commissioned into its “Horizon” branch office accounting system. An interim version of the report by consultancy Second Sight was released last year.

The leaked report says the system was unfit for purpose in some branches, says the BBC. When Post Office investigators checked out shortfalls they did not look for the root cause of the errors – and instead accused the sub-postmasters of theft or false accounting, says the BBC, quoting from the report.

£1bn Horizon system

More than 11,000 post offices use Fujitsu’s £1bn Horizon system for branch accounting and rarely have problems. At the close of each day, the system balances money coming in from customers and money going out, to banks, energy companies, for tax disc sales and for lottery tickets.

If the system showed there was a shortfall, subpostmasters had few options: make up the deficit themselves, sign off the accounts as correct, or refuse to sign off – which might have meant closing the post office (and upsetting customers) while a financial audit took place.

The BBC PM programme last week re-broadcast its interview in June 2012 with a gently-spoken Welshman, Noel Thomas, who worked for the Post Office for 42 years before he had problems with the Horizon branch accounting system at Gaerwen. When he went to balance the accounts the system kept telling him there was a deficit – a shortfall in the daily takings.

Prison

After speaking to the Post Office helpline several times he believed the matter would be sorted out in time. He signed off the accounts – and the Post Office took him to court for false accounting. He pleaded guilty and went to prison; and he went bankrupt.

In his interview with Eddie Mair, Thomas came across as a man of guileless integrity.

“I had a very busy post office,” said Thomas. “I am not ashamed to tell you I had a very good income of between £20,000 and £30,000 a year. I worked very hard for it: I looked after my customers.”

Mair: What was the first sign of trouble?

“I did have trouble over about 12 months actually. The last six months it went worse. You just couldn’t balance. It was going in the end (into deficit) at the rate of £2,000-£3,000 a week.”

Mair: This wasn’t your own personal books – you weren’t filling in a ledger – this was the computer system?

“This was the computer system. In the end I was convicted on the basis that I false accounted for over £50,000.”

Mair: They thought you’d stolen it?

“Yes. But when it came to the court case they dropped the theft [charge] very very quickly and just went for false accounting.”

Mair: You went to jail?

“Yes… I was lucky. I only had eight days. Time went very very quickly.”

Mair: But I am guessing for you that was not really the problem, the passing of time. You’d been branded a criminal?

“Yes. That’s what got me you see.”

Mair: The Post Office still says it is confident about this computer system. It is still happy with it.

“It would say [that], wouldn’t it?”

Mair: As for you, are you confident you didn’t make a lot of mistakes?

“Yes. I can say I didn’t make mistakes. I can say with my hand on my heart I didn’t take the money.”

Mair: What effect has this had on you?

“A big effect, because I was declared bankrupt. The Post Office are paying my pension but they took my private pensions away.”

Mair: What would you like to happen?

“Not for me myself but for (other subpostmasters and mistresses). It has ruined their lives hasn’t it? If you pilfer off the Royal Mail you need to be punished –”

Mair: But Noel if you are correct – and obviously the Post Office has a different view of this – if you are right then you have been made bankrupt, you have lost almost everything –

“Yes.”

You have been to jail –

“Yes.”

Over a computer mistake –

“Yes.”

Mair: What do you want from them?

“That we can get justice for everybody.”

Criminals or faulty systems?

Thomas had given up trying to prove his innocence when he received a phone call from retired senior probation officer Roch Garrard who said the same thing had happened to his local postmistress in Hampshire.

In time Thomas found that dozens of middle-aged, middle-class subpostmasters and mistresses who had never put a foot wrong were being branded criminals.

“It didn’t make sense to me so I started to contact some of them and said to them ‘this is what happened to our postmistress, what happened to you’ and the stories were all so similar that I thought there must be something wrong,” he said.

Now, more than 150 sub-postmasters say they were wrongly prosecuted, or made to repay money, because of the system. The Post Office remains defensive. Its public statements express little sympathy. It is, though, in secret talks with the subpostmasters over possible compensation. But can money ever put right injustices that have ruined lives?

New Second Sight report

BBC reporter Dan Johnson said the latest report explains exactly was going on with the Post Office computer system. “The thrust of this report is that it was faults in that computer system as well as communication problems, and issues around training that led to these mistakes. It wasn’t dishonesty,” said Johnson.

The report said training was not good enough for those without IT skills and power failures and communication issues made things worse. Helpline staff gave conflicting advice or said problems would sort themselves out.

Second Sight found in its research on Horizon that bugs were  not unknown. It said in its interim report that “some combinations of events can trigger situations where problems occur”.

A tearful Sarah Burgess Boyd, from Newcastle-upon-Tyne told the BBC she lost her life savings in repaying an incorrect shortfall. She said of the Post Office, “I just don’t know of another business that would conduct themselves in such a callous and inhumane manner.”

The Post Office said the leaking of the report was “unhelpful”. In a statement, the Post Office told the BBC:

“Although we will not comment on the contents of any confidential documents, after two years of investigation it remains the case that there is absolutely no evidence of any systemic issues with the computer system which is used by over 78,000 people across our 11,500 branches and which successfully processes over six million transactions every day.”

The Post Office is in mediation with some of the affected subpostmasters, in part because of campaigning for justice by MPs, particularly North East Hampshire MP James Arbuthnot.

Also leading the campaign is the Justice for Subpostmasters Alliance, which was set up to “raise awareness of the problems around the Post Office Horizon system which for many years Post Office Limited has denied exist”.

Despite the mediation, the relationship between the accused subpostmasters and the Post Office remains strained. Alan Bates, a former subpostmaster in Wales who founded the Justice for Subpostmasters Alliance, continues to submit FOI requests to the Post Office, the latest being August 2014. The Post Office tends to refuse his requests or gives him unsympathetic replies.

In one of his FOI appeals, Bates tells the Post Office that the concern is not about the millions of successful weekly and monthly financial reconciliations that take place but the “numerous unsuccessful reconciliations that take place that Post Office refuses to even consider may occur”. Post Office management “seems blind to such possibilities”.

He told BBC Wales in 2012:

“One of the big problems with Horizon is the inability to fully examine all the data you have put in the system. You were not allowed to interrogate it. They restricted the access. I refused to be held liable for a system that I and my staff were unable to access to check.”

Under the FOI Act, Bates asked the Post Office last month for the total amount in value and number of all “transaction correction” invoices and credit notes issued to post offices in the latest accounts period; and he asked in April 2014

“Has Post Office ever been made aware of faults within the software of their Horizon System that would have impacted in any way on the accuracy of the accounts of any post office?”

The Post Office did not say. Its reply was that the question was not specific enough.

Ministers have been unsympathetic to the accused subpostmasters –  although the campaign to clear the names of the accused has come mostly from Conservative MPs. Minister Jo Swinson told the House of Commons last year that the number of subpostmasters who’d complained about the Horizon system was “tiny, tiny”.

The National Federation of SubPostmasters has also been unsympathetic and has backed the Post Office. The Federation said: “We continue to have complete confidence in the Horizon system, which carries out hundreds of millions of transactions every week at 11,500 Post Office outlets across the country.

“The NFSP has seen no evidence to suggest that Horizon has been at fault and we believe it to be robust.”

Contract Law

Bhavisha Parekh, a case handler at Contact Law, was approached in 2009 by a sub-postmaster whose accounts had been audited that morning – and they’d found a loss of £7,000.

Parekh writes on the Contract Law website:

“The client had found this loss when doing her daily accounts a week earlier and asked the Post Office auditors to assist her and investigate the matter to locate the loss and rectify the accounts.

“Post Office accounts consist of cash, stamps, and postal orders as well as anything else they trade in; everything is given a financial value. The client’s loss was not of cash and all her transactions were showing to be completed correctly.

“However, upon the auditor’s confirmation of the loss she was charged with theft from the Post Office and given notice of being given a statutory demand for the £7,000.

“The client was in tears over the phone as she felt she had been wrongly charged; the client had run the Post Office for many years without fault and had become a pillar of the community.

“She felt victimised, as when trying to resolve this problem with the Post Office she had asked them to audit her branch and now she was being charged with theft.

“That day I gave the client details of a firm local to her (solicitors) to assist her with this matter. A few weeks later when calling the client to get feedback on the outcome of her case, she explained that she had had been investigated by the Post Office but they had not found anything to show she had taken the money.

“When auditing her branch the final accounts showed a loss; however, the auditors were unable to trace where this loss occurred. After further investigation and having a forensic accountant look into the matter, there were still no answers as to where this loss had occurred.

“This seemed pretty strange; the client in the meantime was told she could not work in the Post Office or even enter the building so she was left without an income and fear of being criminally prosecuted.

“However, after a month or so the Post Office wrote to her to state they had dropped the charges. She would however not be able to commence work as a sub-postmaster, and no explanation of the matter was given.

“Since speaking to this client I was approached by two more former sub-postmasters with the same case. However, they have not been as ‘lucky’ as my initial client – one was dismissed as a sub-postmaster and asked to repay this ‘lost’ amount, and the other was charged with theft and imprisoned for 18 months as well as ordered to pay a sum of £75,000.

“In all three cases the Post Office and their trained auditors have been unable to locate what this loss is; further they have not been able to trace any money into the postmasters’ accounts. Apart from there actually being a loss, there has been no evidence of any theft ever taking place.

“I have only spoken to three sub-postmasters; however this is happening at an increasing scale all over England. Computer experts are now stating that the ‘Horizon’ software the Postmasters use is flawed and so showing these losses.

“Potentially, due to this computer error, many sub-postmasters have lost their jobs, been imprisoned, and left traumatised by the Post Office’s actions.”

Comment

The Post Office deserves credit for investigating some of the complaints (after years of pressure from MPs) and it is said to have settled some of the less serious cases. But five years since the accumulation of problems came to light the convictions against subpostmasters remain. Computer Weekly highlighted the plight of subpostmasters in 2009.

Second Sight’s latest report will add to concern that lives were ruined because unexplained deficits on the Post Office’s Horizon system were not thoroughly investigated – and the root cause established – before the Post Office ticked the legal box to prosecute.

There is scope for systems to go wrong when there are multiple interfaces, occasional power failures and faults in networks and communications equipment. The Post Office’s Horizon system has multiple interfaces; and in any case no IT system is perfect. That Horizon works well for tens of thousands of subpostmasters is no guarantee it will work well for all.

Telling the family of someone struck by lightning that millions of people are not struck by lightning every year is extraordinarily insensitive. What’s the point of the Post Office’s continuing to insist that most subpostmasters have no problem with Horizon? Clearly there are no system-wide issues but nobody is saying there are – and why would those sent to prison, made bankrupt or deprived of their livelihoods care if IT issues were systemic or not? They say it happened to them.

Nobody in the general population would believe that 150 or more subpostmasters were dishonest.

Who would put the integrity of a computer system above the integrity of 150 subpostmasters?

The Post Office, as the prosecuting authority, could argue it is only doing its job in protecting its money and the investments of taxpayers. But in doing their jobs Post Office managers seem to be behaving more like machines than humans. They prosecuted for false accounting because they could.

They could, because sub-postmasters, when confronted by a deficit they didn’t understand, signed off accounts after being told by the IT helpdesk that the problems would probably clear in time. Strictly speaking, signing off accounts as correct when they are  known to be incorrect is false accounting. But was it something the Post Office should have prosecuted, given the mounting complaints about the accuracy of the system’s deficit figures?

Still the Post Office is refusing to answer subpostmaster’s questions. Its managers know they have the legal and contractual upper hand; and as owners of the system they possess the facts. What they do not have is the moral upper ground: they lost any claim to neutrality when they took subpostmasters to be dishonest before properly investigating the potential for shortcomings of the system.

It will be damaging to justice and the reputations of the subpostmasters if the Post Office continues to conform to the stereotype of a large organisation that, once it has denied liability for anything, refuses repeatedly to alter its position, whatever the facts.

As individuals, Post Office managers are probably understanding. As an institution the Post Office appears hostile to those whose lives have been ruined. It seems content to allow the cry for justice to stretch out for years, while it remains defensive and unsympathetic.

Shadow business minister Ian Murray asked in the House of Commons last year:

What processes will be put in place to compensate sub-postmasters and former sub-postmasters who have been disadvantaged, fined, lost their businesses, homes or even jailed, as a result of the problems with the Horizon system?

Wronged subpostmasters deserve far more in compensation than the sums originally in dispute. Is the Post Office institutionally capable of righting egregious wrongs?

Are disaffected subpostmasters having to sign gagging orders?

Second Sight interim report

Subpostmasters tell their story

Justice for Subpostmasters Alliance

 

Another DWP leader quits – is Universal Credit IT really working?

By Tony Collins

As the head of the Universal Credit programme, Howard Shiplee, returns to work after being off sick with bronchitis, news emerges that the DWP is to lose its IT head Andy Nelson whose responsibilities include Universal Credit.

The highly regarded Nelson is to leave this summer after little more than a year as the DWP’s CIO.

The DWP’s press office – which for more than a year had a brief to tell journalists that Universal Credit was on time and to budget – is saying that Nelson’s brief was the whole of the DWP’s IT. The implication is that Nelson had little to do with Universal Credit.

But Nelson’s brief specifically included Universal Credit. At the weekend IDS told the BBC’s Sunday Politics that the IT for Universal Credit is working. If that were so, wouldn’t Nelson want to be associated with such a high-profile success?

The FT, in an article in February on Shiplee’s sick leave, pointed out that Terry Moran, the civil servant in charge of universal credit at its inception, retired from the department last year after an extended period of sick leave.

Hilary Reynolds, a department civil servant who was appointed programme director in November 2012, moved to another role four months later. She in turn had taken over from Malcolm Whitehouse, who had stepped down from the programme around the same time as Moran.

Departures of top DWP people may be one of the few outward signs of the true state of UC IT until the next government reviews the programme and perhaps announces the results.

Open?

On the BBC’s Sunday Politics programme on 9 March 2014 IDS suggested he is being entirely open about the Universal Credit programme – he invited the media and come and see where it is being rolled out. But the DWP keeps hidden its internal reports on the actual state of the programme.  The Information Tribunal is currently weighing up whether the DWP should be ordered to publish one of its internal reports on the Universal Credit project.

IDS on BBC’s Sunday Politics

Below is a partial transcript of IDS’s interview with presenter Andrew Neil on the Universal Credit project. IDS refers incorrectly to write-offs of £28bn on IT programmes by the last government,  and he gives some seemingly contradictory answers.  If the government needs a spokesman to argue that day is night and night is day, IDS is probably the man.

Andrew Neil (presenter) Why has so much been written off on UC although it has barely been introduced?

IDS: “It’s a £2bn project and in the private sector IT programmes write off 30%-40% regularly because that’s the nature. The point I want to make here is that UC is already rolling out. The IT is working. We are improving as we go along. You keep your eye on the bits that don’t work and you make sure they don’t create a problem for the programme.

“The £40m that was written off was to do with security IT. I took the decision over a year and half ago. That is the standard write down – the amortisation of costs over a period. The existing legacy systems were written down in cost terms years ago in the accounts but they continue to work right now.

“We are doing pathfinders and learning a lot about it but I am not going this again like the last government did which is big bang launches and then you have problems like they had with the health IT and it crashes. You do it phase by phase, you learn what you have to do and you make the changes, then you continue to get the rest of it out.

“The key point is that it is rolling out and I invite anybody from the media etc to come and look at where it is being rolled out …”

Neil: You say it [Universal Credit] is being rolled out but nobody notices. You were predicting that one million people would be on universal credit by April and now it’s March and there are only 3,200 are on it.

IDS: “I am not bandying figures around but it is 6,000 and rising. I changed the way we were rolling out over a year ago. Under the advice I brought in from outside – he said: you are better off Pathfinding this out, making sure you learn the lessons, roll it out slower and you gain momentum later on.

“On the timetables for the roll-out we are pretty clear. It is going to rollout in the timescales originally set [completion by October 2017] but the scale of that rollout … so what we are going to do is roll it out in the North West,  recognise how it works properly, and then you roll it out region by region.

“There are lot of variations and variables in this process but if you do it that way you won’t end up with the kind of debacle the last government had in the health service and many others where they wrote off something in the order of £28 billion pounds of IT programmes. We won’t be doing that. There is £38bn of net benefits so it is worth getting it right.”

Neil: When will UC be universal – when will it cover the whole country?

IDS: “By 2016 everybody who is claiming a benefit will be claiming universal credit.

Neil: But not everybody will be getting it by then.

IDS: “Because there are some who are on sickness benefits and they will take longer to bring on because it is a little more problematic, and a bit more difficult because many of them have no work expectations. For those who are on tax credits and job seekers allowance they will be making claims on universal credit and many are already doing that now. There are over already 200,000 people around the country who are on parts of universal credit now.”

Neil: When will everybody be on UC?

IDS: “We said they would be on UC by 2018.”

Are you on track for that?

“Yes we are. 2016 is when everybody claiming this benefit will be on. Then you have to bring on those who have been on a long time on other benefits. UC is a big and important reform. It is not an IT reform. IT is only the automation. The important point is that it will be a massive cultural change.   The change is dramatic. You can get a jobseeker to take a small part-time job immediately while they are looking for work. That improves their likelihood of getting longer work and it means flexibility for business.”

Comment

The DWP says it needs a “safe space” to discuss the progress of its projects without the glare of publicity. That’s one reason it refuses to publish any of the reviews it has commissioned on UC. But the hiding of these reports, which have cost taxpayers hundreds of thousands of pounds, means that IDS can go on TV and say almost whatever he likes about progress on the Universal Credit project, without fear of authoritative contradiction.

Why does the Cabinet Office allow the DWP and other departments to keep secret their internal reports on the progress or otherwise of their IT-based projects and programmes? Probably because the Cabinet Office’s minister Francis Maude doesn’t want to be too intrusive.

So we’ll be left guessing on the state of big IT-enabled programmes until the scheme’s defects are too great to be hidden or the NAO publishes a report. Will the former that be the fate of Universal Credit IT?

Andy Nelson quits as DWP CIO

Coroner criticises hospital’s new IT after boy’s death

By Tony Collins

Avon coroner Maria Voisin said yesterday that a new booking system at the Royal United Bath was responsible for three year-old Samuel Starr not being seen and given timely treatment.

It’s rare for a coroner to criticise a hospital’s new IT in direct terms. It is also rare for evidence to emerge of a link between the introduction of new hospital IT and harm to a patient.

Since patient administration systems began to be installed as part of the National Programme for IT in 2005, the disruption arising from go-lives has led to thousands of patient appointments being delayed at a number of trusts. Usually  trusts contend that no patients have suffered serious harm as a result.

Yesterday at the coroners court near Bristol, the coroner Voisin said: “Due to the failure of the hospital outpatients booking system, there was a five-month delay in Samuel being seen and receiving treatment. Samuel’s heart was disadvantaged and he died following urgent surgery.”

Catherine Holley, Samuel’s mother, said her first warning of Cerner implementation problems came in June 2012, about three months before her son’s death, when the RUH cardiologist’s post clinic letter said:

“I apologised to the parents that I should have seen him in January of this year, but I am afraid a few patients have fallen foul of the Millennium changeover and I suspect this is the case here”.

The RUH installed the Cerner Millennium system at the end of July 2011. After the go-live the trust’s board reports, and a post-implementation review of the system by Pwc in February 2012, raised no serious concerns.

One of Pwc’s main criticisms of the system was the lack of clinical engagement – a common problem with NPfIT deployments.

Some excerpts from Pwc’s report:

“Given the issues and delays there is a still a good deal of uncertainty about whether the planned benefits can be realised. It is therefore important that there is a concerted effort to focus on driving out these benefits, early in 2012.”

“The go live itself did have some issues, but most of those interviewed felt that, relative to other Cerner Millennium implementations, it had gone well. Since the go-live the Trust has been working hard to address the issues, and to help users use the system more effectively…”

“There are a number of issues which arose during the audit which, although not directly covered within the audit objectives, are important in ensuring that the trust realises all the potential benefits from the Cerner Millennium implementation. These are as follows:

“There is a need for greater clinical engagement to ensure that clinicians are using the system in the most effective way – the Trust operates a Clinical Engagement Group which meets on a monthly basis.

“However feedback from a number of interviewees is that this meeting isn’t as productive as it might be and that the Trust needs to think of other ways to improve clinical engagement.”

Pwc said that the trust needed a clinical lead for Cerner Millennium who would focus on key clinical priorities and “sell” the benefits of Millennium to other clinicians. The trust also needed a CIO who would be responsible for IM&T, the Business Intelligence Unit, the Care Records Service team, Records Management, and managing the end of a [local service provider] contract with BT in 2015.

Pwc said the risks included:

  • The end of the contract with BT in 2015
  • Recent issues with BT delivery, with several significant outages of service
  • The issues with clinical engagement.

None of the trust reports – or Pwc’s review –  mentioned any adverse impact of the new system’s implementation on patients.

In 2011, several months after the go-live, the RUH’s “Insight” magazine quoted the Chief Executive James Scott as suggesting the go-live had been a success.

“Thanks to everyone for their hard work and patience during the switchover period,” Scott is quoted as saying. “It has been a major project for the RUH (and our partners BT and Cerner are describing it as the smoothest deployment yet), but we now have the foundation in place to meet the future needs of the Trust and the NHS.”

Care plan?

Catherine Holley expected Samuel to go onto a care plan after he had successful heart surgery at the age of nine months, in 2010. But it proved difficult to arrange an appointment for a scan on the new Cerner Millennium system installed at Royal United Hospital, Bath.

When the scan was eventually carried out Samuel’s heart had deteriorated and he died in September 2012 after an operation that was more complicated than expected.

This week’s three-day inquest at Flax Bourton Coroners Court heard that although Samuel’s medical records had been created on Millennium, no appointments were transferred across.

Speaking after the inquest, Samuel’s parents said they believe the system at Bath failed their son and that mistakes were made.

“It was devastating to hear evidence that an improperly implemented computer appointments system and a series of human errors resulted in the death of our son,”said Paul Starr’s Samuel’s father.

“We accept that mistakes happen but we believe that leaving a child unmonitored for as long as Samuel was, with so many opportunities to attend to him, goes beyond a simple error.

“Our three year old son had a complex cardiac condition and had been scheduled for regular cardiac reviews. In fact he was not properly assessed or nearly 21 months because of further delays.”

A Freedom of Information request revealed that there were 63 missed paediatric cardiac appointments as a result of problems arising from the Cerner implementation – some of which took nearly two years to discover.

Comment

It’s unlikely to have been the Cerner system itself at fault but an  implementation that involved several organisations including the Southern Programme for IT, a branch of the dismantled National Programme for IT.  As such nobody is likely to held responsible for what the coroner called a “failure” of the IT system.

Then again blaming an individual would be pointless.  Learning lessons – the right ones, and not just technical ones – is the objective. It may make a world of difference if those in charge of major go-lives in hospitals acknowledged that delayed appointments, or difficulties arranging them, and a disrupted administration, can harm patients – or worse.

IT in the NHS is seen as an integral part of hospital care when the technology, clinicians, nurses, administrators and other users are working in alignment. But when the IT is not working well, it is seen as something techie which has little or nothing to do with patient care and treatment.

Samuel Starr’s inquest draws attention to the fact that the difference between a good and bad IT implementation in a large hospital can be the difference between life and death.

But hospital deployments of patient administration systems have been going wrong with remarkable regularity for many years.  Isn’t it time to learn the right lessons?   

Hospital group wins $106m settlement in Cerner dispute

By Tony Collins

 A US health organisation Trinity Medical Centre has won a $106m settlement in  a legal dispute with Cerner, which is one the main suppliers of patient record systems to NHS trusts in London and the south.

Under the NPfIT BT has installed Cerner at trusts that include the Royal Free, London, Barnet and Chase Farm Hospitals NHS Trust, Weston Area Health NHS Trust, Barts Health NHS Trust, North Bristol NHS Trust and more recently at Croydon Health Services NHS Trust.

The Wall St Journal says a clinical patient accounting program Trinity bought from Cerner in 2008 was defective and didn’t deliver the promised benefits, which Cerner disputed. Trinity sought about $240m in damages; Cerner estimated $4m.

The companies agreed to submit the dispute to arbitration which began in October 2013.

Cerner said it “strongly disagrees” with the award and believes the claim was based on unique circumstances. It called the award the only material judgment against Cerner in its 34-year history.

US lawyer Michael Dagley says his firm won a $106m settlement for North Dakota-based Trinity Medical Centre in an arbitration case against Cerner.

The firm says that Trinity alleged in 2012 that patient accounting software and other services purchased from Cerner were defective, producing thousands of billing errors.

“We think it’s tremendously significant because it represents the first major victory that we’re aware of by a health care provider against a software vendor,” Dagley said in a statement.

“Providers are under pressure to automate and vendors are under pressure to offer integrated products. Providers want one vendor for all their IT needs, so the vendors have this incentive to deliver software to the market as quickly as possible, and that can lead to products being introduced that are immature and defective, which in health care, can cause tremendous damage.”

Last year Cerner said it believed the chance of a material loss related to the matter was remote and it had 147 hospitals and 735 clinics using the patient accounting program.

Despite the settlement Cerner’s share price has held up well.

Trinity Medical Centre is a non-profit organisation with about 2,700 employees.