Category Archives: outsourcing

School report on Govt ICT Strategy – a good start

Posted on 21/12/2011 | Leave a comment

By Tony Collins

In a review of progress on the Government’s ICT Strategy after six months, the National Audit Office says that the Cabinet Office has made a “positive and productive start to implementing the Strategy”.

The NAO says that at least 70 people from the public sector have worked on the Strategy in the first six months though the public sector will need “at least another 84 people to deliver projects in the Plan”.

The UK Government’s ICT Strategy is more ambitious than the strategies in the US, Australia, Netherlands and Denmark, because it sets out three main aims:

– reducing waste and project failure

– building a common ICT infrastructure

– using ICT to enable and deliver change

The US Government’s ICT Strategy, in contrast, encompasses plans for a common infrastructure only – and these plans have not produced the expected savings, says the NAO.

In a paragraph that may be little noticed in the report, the NAO says that senior managers in central government have plans to award new ICT contracts (perhaps along the pre-coalition lines) in case the common solutions developed for the ICT Strategy are “not available in time”.

The NAO report also says that “suppliers were cautious about investing in new products and services because of government’s poor progress in implementing previous strategies”.

Of 17 actions in the Strategy that were due by September 2011, seven were delivered on time. Work on most of the other actions is underway and a “small number” are still behind schedule says the NAO.

The NAO calls on government to “broaden the focus to driving business change”.

Some successes of the UK’s ICT Strategy as identified by the NAO:

* The Cabinet Office has set up a small CIO Delivery Board led by the Government CIO Joe Harley to implement the ICT Strategy. The Board’s members include the Corporate IT Director at the DWP, CIOs at the Home Office, MoD, HMRC, Ministry of Justice and Department for Health, together with key officials at the Cabinet Office. The departmental CIOs on the Board are responsible directly to Francis Maude, Minister for the Cabinet Office, for implementing the ICT Strategy in their departments and are accountable to their own minister. No conflicts have arisen

* Senior managers in central government and the ICT industry are willing to align their strategies for ICT with new cross-government solutions and standards but need more detail.

*  Some suppliers have offered help to government to develop its thinking and help accelerate the pace of change in ICT in government.

* The Cabinet Office intended that delivering the Strategy would be resourced from existing budgets. Staff have been redirected from other tasks to work on implementing the Strategy. “We have found collaborative working across departmental boundaries. For example HMRC and the MoD have combined resources to develop a strategy for greener ICT. Teams producing the strategies for cloud computing and common desktops and mobile devices have worked together to reduce the risk of overlap and gaps.

* The BBC has shown the way in managing dozens of suppliers rather than relying on one big company. For BBC’s digital media initiative, the Corporation manages 47 separate suppliers, says the NAO.

* The Cabinet Office intends that departments will buy components of ICT infrastructure from a range of suppliers rather than signing a small number of long-term contracts; and to make sure different systems share data the Cabinet Office is agreeing a set of open technical standards.

* Some of the larger departments have already started to consolidate data centres, though the NAO said that the programme as a whole is moving slowly and no robust business case is yet in place.

* The Cabinet Office is starting to involve SMEs. It has established a baseline of current procurement spending with SMEs – 6.5% of total government spend – and hopes that the amount of work awarded to SMEs will increase to 25%. Government has started talking “directly to SMEs”, says the NAO.

Some problems identified in the NAO report:

* Cloud computing and agile skills are lacking. “Government also lacks key business skills. Although it has ouitsourced ICT systems development and services for many years, our reports have often stated that government is not good at managing commercial relationships and contracts or procurement.”

* Suppliers doubt real change will happen. The NAO says that suppliers doubted whether “government had the appropriate skills to move from using one major supplier to deliver ICT solutions and services, to managing many suppliers of different sizes providing different services”.

* The Government CIO Joe Harley, who promoted collaboration, is leaving in early 2012, as is his deputy Bill McCluggage. The NAO suggests their departures may “adversely affect” new ways of working.

* The NAO interviewed people from departments, agencies and ICT suppliers whose concern was that “short-term financial pressure conflicted with the need for the longer-term reform of public services”.

* The culture change required to implement the Strategy “may be a significant barrier”.

* The Cabinet Office acknowledges that the government does not have a definitive record of ICT spend in central government (which would make it difficult to have a baseline against which cuts could be shown).

* The Cabinet Office has not yet defined how reform and improved efficiency in public services will be measured across central government, as business outcomes against an agreed baseline.

**

Amyas Morse, head of the National Audit Office, said today: ” ICT is going to play an increasingly important role in changing how government works and how services are provided.

“The Government’s ICT Strategy is in its early days and initial signs are good. However, new ways of working are as dependent on developing the skills of people in the public sector as they are on changes to technology and processes; the big challenge is to ensure that the Strategy delivers value in each of these areas.”

NAO report:  Implementing the Government ICT Strategy: six-month review of progress.

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Posted in Campaign4Change, capacity building, change, change management, Cloud, Cloud Computing, collaboration, compliance with spending review, EU procurement, G-Cloud, government, Government IT, Green IT, improving communications, innovation, Lean, managing change, managing outsourced services, open source, operational issues, outsourcing, procurement, project management, public sector, public services, recruitment freeze, reducing cost strategically, reforms, SME, supplier relationships

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CSC criticised again in The Times

Posted on 09/12/2011 | 1 comment

By Tony Collins

The Times has followed up its three pages of coverage of the NPfIT yesterday with an article in which the chair of the Public Accounts Committee, Labour MP Margaret Hodge, criticises one of the programme’s main suppliers CSC.

Hodge tells The Times she was surprised to learn that CSC was hoping for a revised NHS deal – worth about £2bn – after it failed to deliver fully functional software to any of 166 NHS trusts in England.

CSC has said in a filing to the US Securities and Exchange Commission that, based on events to date, it does not does not anticipate that the NHS will terminate its contract.

CSC gave a series of reasons in its SEC filing why the UK Government may retain CSC and its NPfIT contracts, though it conceded that the outcome of its talks with the Department of Health, is uncertain.

CSC also said it has cured or is in the process of curing the alleged events of default. It asserted that failures and breaches of contract on the part of NHS have caused delays and issues; and it said that if the NHS wrongfully terminated the contract on the basis of alleged material breach, CSC could recover substantial damages.

Hodge told The Times:

“Any private sector company that cares so little about the public interest that they are prepared to extract this kind of money from the public purse should not be given the right to work for the Government again.

“If they are going to take such a private sector attitude to it that they don’t give a toss about the public interest they should be treated like a cowboy builder.”

CSC says it has made a significant investment in developing systems for the NHS and has demonstrated a strong and continuing commitment to improving the quality of healthcare in England. It says it has a demonstrable track record of successful and widescale delivery to NHS within the National Programme and beyond.

The Times also reported that Christine Connelly, the Department of Health’s former CIO,  was bought a £416 first-class train ticket for a visit to a hospital at Morecambe, and was flown to San Francisco and Seattle at a business-class rate costing £8,278.80.

American “cowboys” blamed for NHS fiasco – The Times

CSC confident on £2bn deal says The Times

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Posted in change management, government, Government IT, IT projects, law, legal disputes, managing change, managing outsourced services, NHS, npfit, outsourcing, procurement, project management, reducing cost strategically, supplier relationships

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CSC confident on £2bn NPfIT deal says The Times

Posted on 08/12/2011 | 9 comments

The Times reports today that CSC is confident that the Department of Health will not terminate the supplier’s contracts despite the Government’s pledge to dismantle the national programme.

The paper says that “taxpayers will foot the bill for a further £2bn on a failed NHS IT project even though the Government has already pulled the plug on it”.

It adds that the “American technology company Computer Sciences Corporation (CSC) has boasted to Wall Street that it expects an extension of its contract to provide electronic patient records despite failing to deliver a fully functional version of its software”.

In a series of articles on the NPfIT, The Times suggests that the Government is locked into CSC, at least until 2017.

“The Government’s pledge to dismantle the failed NHS programme to computerise patient records is in tatters because it cannot afford to break its contractual commitments and start a search for alternative suppliers”.

The Times quotes a CSC filing to the US Securities and Exchange Commission in November which says: “Based upon events to date, the Company does not anticipate that the NHS will terminate the contract.”

CSC, the Department of Health and the Cabinet Office are still discussing a memorandum of understanding which may end with the supplier’s cutting £764m from its NPfIT contracts, leaving about £2.1bn in place.

CSC discloses in its SEC filing that the Memorandum of Understanding anticipates that the contract term will be extended one year to June 2017 and that CSC anticipates revenue of £1.5bn to £2bn over the remaining term.

With certain amendments “ the contract remains profitable and the Company would recover its investment,” says CSC in its filing.

But MP Richard Bacon, a member of the Public Accounts Committee, has received Parliamentary replies to his questions on the costs of NPfIT deployments at University Hospitals of Morecambe Bay NHS Foundation Trust and North Bristol NHS Trust which show that the costs of installing and maintaining a system under national programme contracts are more than twice that of systems bought by trusts outside of the NPfIT.

Health Minister Simon Burns said in a reply to Bacon that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust are £15.2m for deployment and an annual service charge of £2m. This brings the total cost of the Cerner system over seven years to about £29m, which is more than three times the £8.2m price of a similar deployment outside of the NPfIT at University Hospitals Bristol Foundation Trust.

At Morecambe Bay, the trust’s costs of being involved with the NPfIT (including the deployment of CSC’s Lorenzo 1.9 system) are £6.2m, according to Burns in his reply to Bacon, whereas the typical internal trust costs of deploying of a non-NPfIT system, excluding the cost of the system itself but including training, project management and additional corporate reporting tools, are about £1m-£2m.

Is the Department of Health locked into CSC?

CSC in its filing to the SEC says that the NHS, when considering its options of maintaining or terminating the contract, will “consider costs and risks that NHS may incur over and above those related to termination fees”.

These include:

– damages and costs that may be payable to CSC

– the cost of initiating and managing a public tender, procedure or procedures to obtain one or more suitable replacement suppliers

– the operational risk of switching suppliers at this stage in the contract with CSC

– the cost of alternative suppliers

– the cost of obtaining exit management services from CSC to ensure an orderly transition to one or more replacement suppliers.

In addition, said CSC in its filing, if the NHS terminated the contract for convenience, possible claims that the Company has against NHS include “claims for compensation due to delays and excess costs caused by NHS or for contractual deployment delay remedies or for costs associated with change.

If the NHS had terminated the entire contract for convenience with immediate effect at September 30, 2011, the termination fee would have been capped at approximately £430m.

CSC would also be entitled by way of termination fee to a sum to compensate for the profit that CSC would have earned over the following 12 months had the contract not been terminated.

CSC recognised in the filing, however, that the signing of a new NPfIT deal was uncertain.

Lorenzo “not right yet”

The Times quotes Dr Simon Eccles, the medical director of Connecting for Health, as saying “Lorenzo has had an extremely painful gestation. Lorenzo may yet be a great success because it is a brilliant bit of software but they haven’t got it right yet.”

In an editorial on its NPfIT investigations, The Times said that government IT failures have in common the fact that “we don’t really know who was to blame”. It says:

“Nobody took responsibility and nobody apologised. It is perhaps too much to hope that there will not be more disasters. But if there are, someone must carry the can.”

NPfIT to be dismantled – brick by brick

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Posted in Campaign4Change, change management, Government IT, IT projects, legal disputes, managing outsourced services, NHS, npfit, outsourcing, procurement, public sector, public services, reducing cost strategically, supplier relationships

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Why hospital IT needs airline safety culture

Posted on 29/11/2011 | 2 comments

By Tony Collins

Earlier this month the pilots of a Boeing 787 “Dreamliner” carrying 249 passengers aborted a landing at Okayama airport in Japan when the wheels failed to deploy automatically. The pilots circled and deployed the landing gear manually.

A year ago pilots of an Airbus A380, the world’s largest passenger plane, made an emergency landing at Singapore on landing gear that they deployed using gravity, the so-called “gravity drop emergency extension system”.

In both emergencies the contingencies worked.  The planes landed safely and nobody was hurt.

Five years earlier, during tests, part of the landing gear on a pre-operational A380 failed initially to drop down using gravity.

The Teflon solution

The problem was solved, thanks in part to the use of Teflon paint (see below). Eventually the A380 was certified to carry 853 passengers.

Those who fly sometimes owe their lives to the proven and certified backup arrangements on civil aircraft. Compare this safety culture to the improvised and sometimes improvident way some health IT systems are tested and deployed.

Routinely hospital boards order the installation of information systems without proven backup arrangements and certification. Absent in health IT are the mandatory standards that underpin air safety.

When an airliner crashes investigators launch a formal inquiry and publish their findings. Improvements usually follow, if they haven’t already, which is one reason flying is so safe today.

Shutters come down when health IT fails 

When health IT implementations go wrong the effect on patients is unknown. Barts and The London NHS Trust, the Royal Free Hampstead, the Nuffield Orthopaedic Centre, Barnet and Chase Farm Hospitals NHS Trust and other trusts had failed go-lives of NPfIT patient administration systems. They have not published reports on the consequences of the incidents, and have no statutory duty to do so.

Instead of improvements triggered by a public report there may, in health IT, be an instinctive and systemic cover-up, which is within the law. Why would hospitals own up to the seriousness of any incidents brought about by IT-related confusion or chaos? And under the advice of their lawyers suppliers are unlikely to own up to weaknesses in their systems after pervasive problems.

Supplier “hold harmless” clauses

Indeed a “hold harmless” clause is said to be common in contracts between electronic health record companies and healthcare provider organisations. This clause helps to shift liability to the users of EHRs in that users are liable for adverse patient consequences that result from the use of clinical software, even if the software contains errors.

That said the supplier’s software will have been configured locally; and it’s those modifications that might have caused or contributed to incidents.

Done well, health IT implementations can improve the care and safety of patients. But after the go-live of a patient administration system Barts and The London NHS Trust lost track of thousands of patient appointments and had no idea how many were in breach of the 18-week limit for treatment after being referred by a GP. There were also delays in appointments for cancer checks.

At the Royal Free Hampstead staff found they had to cope with system crashes, delays in booking patient appointments, data missing in records and extra costs.

And an independent study of the Summary Care Records scheme by Trisha Greehalgh and her team found that electronic records can omit allergies and potentially dangerous reactions to certain combinations of drugs. Her report also found that the SCR database:

–  Omitted some medications

–  Listed ‘current’ medication the patient was not taking

–  Included indicated allergies or adverse reactions which the patient probably did not have

Electronic health records can also record wrong dosages of drugs, or the wrong drugs, or fail to provide an alert when clinical staff have come to wrongly rely on such an alert.

A study in 2005 found that Computerized Physician Order Entry systems, which were widely viewed as a way of reducing prescribing errors, could lead to double the correct doses being prescribed.

One problem of health IT in hospitals is that computer systems are introduced alongside paper where neither one nor the other is a single source of truth. This could cause mistakes analogous to the ones made in early air crashes which were caused not by technology alone but pilots not fully understanding how the systems worked and not recognising the signs and effects of systems failing to work as intended.

In air crashes the lessons are learned the hard way. In health IT the lessons from failed implementations will be learned by committed professionals. But what when a hospital boss is overly ambitious, is bowled over by unproven technology and is cajoled into a premature go-live?

In 2011, indeed in the past few months, headlines in the trade press have continued to flow when a hospital’s patient information system goes live, or when a trust reaches a critical mass of Summary Care Record uploads of patient records (although some of the SCR records may or not be accurate, and may or may not be correctly updated).

What we won’t see are headlines on any serious or even tragic consequences of the implementations. A BBC File on 4 documentary this month explained how hospital mistakes are unlikely to be exposed by coroners or inquests.

So hospital board chief executives can order new and large-scale IT systems without the fear of any tragic failure of those implementations being exposed, investigated and publicly reported on. The risk lies with the patient. Certification and regulation of health IT systems would reduce that risk.

Should health IT systems be tested as well as the A380’s landing gear? – those tests in detail

Qantas Flight 32 was carrying 466 passengers when an engine exploded. The Airbus A380 made an emergency landing at Singapore Changi Airport on 4 November 2010. The failure was the first of its kind for the four-engined A380.

Shrapnel from the exploding engine punctured part of the wing and damaged some of the systems, equipment and controls. Pilots deployed the landing gear manually, using gravity  – and it worked well. Despite many technical problems the plane landed safely.

Five years earlier, tests of a manual deployment of the A380’s landing gear failed initially. It happened in a test hangar, more than a year before the A380 received regulatory approval to carry 853 passengers.

The story of the landing gear tests is told by Channel 4 as part of a well-made documentary, “Giant of the Skies” on the construction and assembly of the A380.  Against a backdrop of delays and a budget overspend, Airbus engineers must show that if power is lost the wheels will come down on their own, using gravity.

The film shows an Airbus A380 suspended in a hangar while the undercarriage test gets underway. The undercarriage doors open under their own weight and a few seconds later the locks that hold up the outer wheels release. Two massive outer sets of four wheels each fall down through a 90-degree arc. Something goes wrong.  At about 45 degrees, one of the Michelin tyres catches on an undercarriage door which looks as if it has not opened as fully as it would have if powered electrically. Only after 16 seconds does the jammed wheel set slip free. Engineers watching the test look mortified.

Simon Sanders, head of landing gear design at Airbus, tells Channel 4: “We need to understand and find a solution.”

An engineer smeared some grease (Aeroshell 70022 from Shell, Houston) on a guide ramp where the A380’s wheels are supposed to push the door open in an emergency loss of power. This worked and the test was successful: the left-side outer landing gear doors opened under their own weight; a few seconds later the wheels fell down, also under their own weight, and this time the tyre that had jammed earlier hit the grease on the door and slid down without any delay. But a permanent solution was needed.

A month later Airbus repeated the undercarriage “gravity” test. Sanders told Channel 4: “We have applied a layer of Teflon paint which is similar to the Teflon coasting you have on non-stick flying pans. This will reduce the friction when we do the free-fall [of the undercarriage]. We are now going to perform the test to demonstrate that with this low-friction Teflon coating we have solved the problem.”

This time the A380’s chief test pilot Gérard Desbois was watching. If the wheels got struck again Desbois could refuse to accept the aircraft for its first test flight, which would mean a further delay.

The loss-of-power test began. The outer landing gear doors opened … the wheels fell down under their own weight … and jammed again. This time they freed themselves quicker than before. After some hesitation Desbois accepted the aircraft on the basis that if power were lost and the left outer landing wheels took a little longer to come down than the right outer set this would not be a problem.  The gravity free-fall backup system was further refined before the A380 went into service.

The importance of the tests was shown in 2010 when an exploding Rolls-Royce Trent 900 engine on an Airbus A380,  Qantas Flight 32 from Singapore to Sydney, caused damage to various aircraft systems including the landing gear computer which stopped working.  The pilots had to deploy the landing gear manually. The official incident report shows that all of the A380’s 22 wheels deployed fully under the gravity extension backup arrangements.

If a hospital board had been overseeing the A380’s tests back in 2005, would directors have taken the view that the test was very nearly successful, so the undercarriage could be left to prove itself in service?

For the test engineers at Airbus, safety was not a matter of choice but of regulation and certification. It is a pity that the deployment of health IT, which can affect the safety of patients, is not a matter of regulation or certification.

Links:

Oxford University Hospitals NHS Trust postpones major IT go-live.

Giant of the Skies – Channel 4 documentary on manufacture and testing of the Airbus A380

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Posted in Campaign4Change, change, change management, health, law, managing change, managing outsourced services, NHS, npfit, operational issues, outsourcing, private sector lessons for the public sector, risk, supplier relationships

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Making the case for “tilting the table” for mutuals

Posted on 11/11/2011 | Leave a comment

By David Bicknell

A recent get-together organised by Stepping Out discussed the landscape for mutuals and asked what needs to happen to get the mutuals show on the road.

The discussions are summed up in this well argued blog by Craig Dearden-Phillips.

A few paragraphs caught my eye:

“The general view in the room is that financial weakness – in the form of small balance sheets – is a disadvantage facing spin-outs tendering for contracts. There appears to be a truth that when tenders come up, this sector struggles to show the financial ‘leg’ necessary to get nervous public sector commissioners into bed. Instead they bee-line for safer-looking super-providers. Some would argue that social enterprises should be ‘gifted’ public assets in the form of property to address the balance sheet issue.

“Therefore, to what extent Government should ’tilt the table’ and if so how was one of the talking-points. There is a natural reluctance in many quarters of too much government intervention in markets of any sort. ‘Best is best’ is a common watchword in the world of public procurement. How to behave in markets is also a big question for spin-out organisations. Are they best, in the longer term, to partner up or even fold-in larger healthcare groups in order to gain efficiencies and achieve long-term stability? Or is this too much of a compromise that would water down their raison d’etre as socially focused organisations?

“This one of the unresolved questions facing spin-outs in this sector, particularly as they come up head to head with organisations whose chief competencies lie not in actual service delivery but the winning and fulfilment of contracts, often with third party deliverers.”

The blog makes some good points and appears to sum up the key issues facing mutuals.  To deliver any sense of a future for spin-out mutuals, the question is not whether to tilt the table, but how and when.

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Posted in change, mutualisation, mutuals, outsourcing, procurement, public sector, public services, Uncategorized

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Without commissioning reforms, no mutuals within five years, only outsourcing companies

Posted on 07/11/2011 | Leave a comment

By David Bicknell

The government has been put on notice to find ways of making life easier for mutuals – or suffer the consequences.

As Public Finance reports, Patrick Burns, a member of the Cabinet Office Mutuals Taskforce, has warned that without changes in the way outsourcing contracts are awarded, spun-off mutuals could fail within five years.

Burns said: ‘If you don’t do something with the commissioning environment, then in five or ten years time you will not be dealing with mutuals, you will be dealing with [outsourcing companies] Serco, Capita and Virgin. Not that they are bad companies, but it’s not the point.’

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Fiddling savings on shared services? Officialdom in need of reform

Posted on 21/10/2011 | 3 comments

 By TonyCollins

An NAO report today suggests that some officials are fiddling projected savings figures from a shared services deal involving seven research councils.

It all began so well. A Fujitsu press release in 2008 said:

“UK Research Councils to implement shared services with Fujitsu. £40 million project will generate cost and efficiency savings across the organisations.”

An executive who representedFujitsu Services’ was quoted in the press release as saying at the time:

“Fujitsu is consistently proving that it can deliver effective shared services infrastructures and is playing a vital role in driving forward the transformational government agenda through shared services.

“Organisations that adopt a shared services approach can experience genuine economies of scale and reduction in costs which can be essential in their drive for continuous improvement.

Twenty-one months later Fujitsu and Research Councils UK parted company. The 10-year shared services contract began in August 2007. It was terminated by mutual consent in November 2009.

A revealing report, which is published today by the National Audit Office, shows how, despite the best intentions by the Cabinet Office to improve the management of IT-related projects and programmes, and decades of mistakes to learn from, some officials in departments are still making it up as they go along.

The worrying thing in the NAO report is not only what happened in the past – few will be surprised that the NAO report characterises the shared services deal as lacking professionalism. What’s worrying is officialdom’s more recent disregard for the truth when claiming savings for its shared services arrangements.

The NAO’s report”Shared Services in the Research Councils” suggests that officials manipulated – some could say fiddled – projected savings figures.

The NAO also found that officials awarded a £46m shared services contract to Fujitsu which came second in the bid evaluation. Exactly how the contract came to be awarded will be investigated soon by MPs on the Public Accounts Committee.

Origins of shared services contract  

In 2004 a review led by the Government adviser Peter Gershon suggested that the public sector should save money by sharing support services such as IT, HR and finance. In 2006 officials at the Department of Trade and Industry (now the Department for Business, Innovation and Skills) encouraged their colleagues at seven research councils to set up a shared service centre, which they did.

The UK Research Councils is an important organisation. In 2009/10 it spent £3.7bn, mostly on giving research grants to universities, the European Space Agency and other organisations. Its biggest recipient of grants is the Medical Research Council.

Fujitsu contract

Public servants appointed Fujitsu in August 2007 to put in place the ICT systems to underpin the shared service centre in a ten-year contract worth £46m. Fujitsu came second in the initial bid evaluations.

The NAO said that the bidding process produced a shortlist of three companies including Fujitsu. Said the NAO:

“The initial weightings applied by the [bid] panel had placed Fujitsu second: although the bid had scored well on quality, it was 19 per cent more expensive than the cheapest bid.”

An independent review commissioned by the project board backed the evaluations which put Fujitsu second. But the bid panel and the project board had concerns about the evaluation. The supplier chosen in the evaluation – which the NAO refuses to name – did not score well on quality requirements.

It appears that the bid panel and the project board preferred Fujitsu.

Mathematical error

Then officials happened to spot a mathematical error in the bid scoring. The corrected scoring left Fujitsu on top, as the new preferred bidder.

Said the NAO:

“… a mathematical error was identified by a member of the project team that changed the order of the preferred suppliers, leaving Fujitsu as the front runner

“The [bid] panel reconvened to discuss this but, rather than re-performing in full the quantitative and qualitative analysis and submitting this to independent review, it decided to appoint Fujitsu on the basis of a vote.

“In September 2007 the gateway review team concluded that the incident had weakened the value of the overall process and had left the project at risk of challenge.”

User requirements unclear

Full delivery was due in September 2008 but the project team and Fujitsu “quickly encountered difficulties, resulting in contract termination by mutual consent in November 2009”.

The NAO said there was “miscommunication between the parties about expectations and deliverables, primarily because design requirements had not been sufficiently defined before the contract started”.

Fujitsu consequently missed agreed milestones. “Fujitsu and the Centre told us that the fixed-rate contract awarded by the project proved to be unsuitable when the customers’ requirements were still unclear.”

Officials paid Fujitsu a total of £31.9 million, of which £546,000 related to termination costs. Despite the payments to Fujitsu, parts of the system were withdrawn and rebuilt in-house.

Overspend on Fujitsu contract

The NAO found there were “significant overspends on design and build activities and the contract with Fujitsu.”

At least £13m wasted on Fujitsu deal

Said the NAO:

“Had the Fujitsu contract worked as planned, we estimate that the additional £13.2m design and build costs … would not have been needed. In addition the project management overspend of £9.1m would have been lower, as, after termination of the Fujitsu contract, a significant overhead in managing contractors was incurred by the project.”

Fujitsu out – Oracle in

The breakdown in relations with Fujitsu led to the appointment of Oracle as supplier of the grants element of the project. “The contract with Oracle suggested that lessons had been learnt by the project following its experience with Fujitsu, with greater effort given to specifying the design upfront,” said the NAO.

Did officials know what they were doing?

In deciding how to share services the research councils came up with six options including setting up a centre run jointly by the councils or joining with another public sector agency such as one supplying the NHS.

But two of the options including the NHS one were dropped without proper analysis, said the NAO. The remaining four options were each given a score of one to three, against seven criteria. “The scores appear to be purely judgemental with no quantified analysis,” said the NAO.

Even if the six options had been properly appraised, the evaluation would have failed because it did not include a “do-minimum” option as recommended by HM Treasury.

“Overall, the quality of options appraisal was poor,” said the NAO.

Fiddling the figures?

 The NAO found that:

–         Initial estimates were of zero projected procurement savings from shared services. But by the time the first draft of the business case had been written the projected savings had soared to £693.9m.

–         When this project board queried this figure the research councils’ internal audit service scaled down the figure to £403.7m – but this included £159.3m of savings that internal audit had concluded were not soundly based.

–         Since the shared services centre began officials have recorded procurement savings of £35.2m against the business case and while of these are valid savings some are not. The NAO investigated 19 high-value savings that represented 40% of savings recorded to the end of 2010 and found that 35% “should not be claimed against the project investment”.

–         The research councils have been “unable to provide paperwork to substantiate the claimed saving”.

–         Savings claimed were indistinguishable from normal business practice such as disputing costs claimed by a supplier.

–         Clear evidence exists that the budget holder had no intention or need to pay the higher price against which the saving was calculated

–         Last month the research councils claimed that savings were £28m higher than they had reported previously owing to errors in the original numbers. But the NAO found that the councils were unable to reconcile fully the two sets of numbers; had not used a single method for calculating benefits or tracked these effectively; and had not included £7m of spending incurred by the councils. “Overall, this review has highlighted that Councils have not put in place proper processes to track benefits and forecast future operational savings,” said the NAO.

–         Further, investments needed to deliver projected savings have not been included in calculations.

–         Double counting. A revised target for projected procurement savings procurement “includes elements of double counting …”

Other NAO findings:

–        Four Gateway review reports of progress on setting up the shared services centre, including a review which put the project at “red – immediate action needed”, were not fully followed up. 

–         There was no evidence of intervention by the Department for Business, Innovation and Skills when it became clear the shared services project was likely to overspend.

–         The shared services centre has begun to match the pre-shared services payment performance of the research councils but a high number of invoices was on hold at the end of July 2011 because of problems with the end-to-end processes. About 5,900 invoices were on hold, awaiting payment, in July 2011, which was 21 per cent of all invoices due to be paid in that month. The reason for the delay was being investigated.

–         Despite the shared services arrangements, some research council staff were at times running parallel systems, or managing their businesses without adequate data.

–         In July 2011 the shared services centre had 53 key performance targets to meet but was only able to measure activity against 37 of them and of these met only 13..

–         Five of the seven research councils did not file annual accounts on time in 2011 in part because functions in the finance ICT system were not delivered by the project.

Some good news

Said the NAO:

“The grants function and its associated ICT system developed by the project has allowed the Councils to replace older systems that were increasingly at risk of failing. This is of critical importance, given that the processing of research grant applications lies at the heart of what the Councils do. The single grants system has the potential to make it easier for the Councils to collectively modify their processes in the future…”

Comment

The commendably thorough NAO investigation has shown once again how badly departments and their satellites are in need of independent Cabinet Office oversight when it comes to major IT-related projects. In that respect thank goodness for the Cabinet Office’s Major Projects Authority. But how much influence can it really have? How much influence is it having?

This NAO report suggests that some officials are fiddling the figures without a care for professional accounting practices. Double counting, not including full costs in projected savings calculations, not having paperwork to support figures and other such administrative misdemeanours indicates that some officials are making up savings figures as they go along.

What is to be done when some departments and their agencies are not to be trusted in managing major projects?

NAO report on shared services at seven research councils

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Posted in Campaign4Change, change, change management, collaboration, Government IT, improving communications, legal disputes, managing change, openness and transparency, outsourcing, private sector lessons for the public sector, procurement, public sector, public services, reforms, research, Uncategorized

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Summary Care Record – an NPfIT success?

Posted on 17/10/2011 | 2 comments

By Tony Collins

Last month the Department of Health briefed the Daily Mail on plans to dismantle the National Programme for IT.  The result was a front page  lead article in the Mail, under the headline:

£12bn NHS computer system is scrapped… and it’s all YOUR money that Labour poured down the drain.

The article said:

“The Coalition will today announce it is putting a halt to years of scandalous waste of taxpayers’ money on a system that never worked.  It will cut its losses and ‘urgently’ dismantle the National Programme for IT…”

Now the DH has briefed the Telegraph on the success of  Summary Care Records, the national database run by BT under its NPfIT Spine contract.

So the Telegraph has given good coverage to the summary care records scheme.

By its selective briefings the DH has achieved prominent coverage in the national press for dismantling a failing £12bn NHS IT programme, and for modernising the NHS by successfully creating summary care records (under an IT programme that is being dismantled).

The DH’s officials know that the national press will usually give priority to off-the-record briefings by representatives of departments, especially if the briefing is in advance of the issuing of a press release. The Telegraph’s article was in advance of the DH’s publication of this press release.

Prominent in the Telegraph’s coverage was Simon Burns, the NPfIT minister, who in May 2011 spoke on BBC R4’s Today programme of the “fantastic” NPfIT systems [which are based on Cerner Millennium] at the Royal Free Hampstead NHS Trust.

Last week in his praise of summary care records in the Telegraph Burns quoted various medical organisations as supporting the scheme. Taken together the Telegraph articles depict the Summary Care Records scheme as a success – an important part of patient care and treatment.  Said Burns :

“Patient charities have seized on the Summary Care Record; a new type of national, electronic record containing key medical information, as a way of making sure the NHS knows what it needs to about their condition.

“Some of these groups have told us how this can sometimes be a real struggle. Asthma patients being asked to repeat their medical history when they are struggling to breathe. The patient with lung disease carrying around a wash bag with ‘Please make sure I take this medication’ written on it when they are admitted to hospital. Or even the terminally ill patient who ends up dying in hospital because their wish to die at home wasn’t shared with an out–of–hours doctor.

“Patient groups are recognising that one of the easiest and most effective ways of giving these patients a stronger voice is to use the record to tell the NHS the most crucial information about their condition.

“The record contains information about medications, allergies and bad reactions to drugs and is mainly being used by outof–hours GPs to provide safer care where no other information is available…

“Patients can speak to their GP about adding extra information that they want the NHS to know about them in an emergency to their record. The Muscular Dystrophy Campaign has urged their patients to do just this as the first group to recognise the potential of the Summary Care Record. Mencap, AsthmaUK, DiabetesUKand the British Lung Foundation are also raising awareness among patients about how the Summary Care Record can be used to improve and personalise the care they receive.

“Some seriously ill patients have added information about their end of life wishes to their record, helping to ensure that their wishes, typically to die at home, are respected.

“This is because information about their wishes can be shared with everyone, including, most critically, outof–hours doctors and paramedics, involved in their care.

“Some patients have voluntarily added ‘do not resuscitate’ requests to their records, which would be cross–checked against other sources of information at the point of care. Families and carers report that this has saved them and their loved ones much needless distress…”

The Telegraph noted that about 8.8 million people – a fifth of the total number of patients in England – have summary care electronic records. All 33.5 million NHS patients in England are being offered the opportunity of having the service, said the newspaper which added that only a “few” people have opted out. [About 1.2% have opted out, which is about double the rate of opt-outs in the early stages of the SCR programme.]

Comment:

When he meets his Parliamentary colleagues Simon Burns does not like to hear criticism of the NPfIT. He is earning a reputation as the NPfIT’s most senior press officer, which may seem odd given that the programme is supposedly being dismantled.

But Burns’ enthusiasm for the NPfIT is not odd.  He is reflecting the views of his officials, as have all Labour NPfIT ministers:  Caroline Flint, Ben Bradshaw and Mike O’Brien were in the line of Labour NPfIT ministers who gave similar speeches in praise of the national programme.

That Burns is following suit raises the question of why he is drawing a minister’s salary when he is being simply the public face of officialdom, not an independent voice, not a sceptical challenge for the department.

Burns and his Labour predecessors make the mistake of praising an NPfIT project because it is a good idea in principle. Their statements ignore how the scheme is working in practice.

The NPfIT’s projects are based on good ideas: it is a good idea having an accurate, regularly-updated electronic health record that any clinician treating you can view. But the evidence so far is that the SCR has inaccuracies and important omissions. Researchers from UCL found that the SCR  could not be relied on by clinicians as a single source of truth; and it was unclear who was responsible or accountable for errors and omissions, or keeping the records up to date .

Should an impractical scheme be justified on the basis that it would be a good thing if it worked?

The organisations Burns cites as supporting the summary care record scheme are actually supporting the underlying reasons for the scheme. They are neutral or silent, and perhaps unaware, of how the scheme is working, and not working, in practice.

That has always been the way. The NPfIT has been repeatedly justified on the basis of what it could do. Since they launched it in 2002, ministers and officials at the DH and NHS Connecting for Health have spoken about the programme’s benefits in the future tense. The SCR “will” be able to …

Hence, six years into the SCR,  the headline of the DH’s latest press release on the scheme is still in the future tense:

Summary Care Record to benefit millions of patients with long term conditions, say patient groups

Burns says in the press release that the SCR has the “potential” to transform the experience of healthcare for millions of patients with long term conditions and for their families and carers.

Caroline Stevens, Interim Chief Operating Officer at the British Lung Foundation says in the same press release that the SCR “will” bring many benefits for patients.

And Nic Bungay, Director of Campaigns, Care and Support at the Muscular Dystrophy Campaign says in the press release that his organisation sees the great “potential” for Summary Care Records…”

Summary Care Records – the underlying problems 

Shouldn’t the SCR, hundreds of millions of pounds having been spent, be transforming healthcare now? The evidence so far is that the SCR scheme is of limited use and might have problems that run too deep to overcome.

Trisha Greenhalgh and a team of researchers at UCL carried out an in-depth study of the SCR with funding from NHS Connecting for Health though CfH did not always  extend the hand of friendship to the team.

Greenhalgh showed a conference of Graphnet healthcare users at Bletchley Park code-breaking centre last year how the SCR scheme was entangled in a web of political, clinical, technical, commercial and personal considerations.

Quite how political the scheme had become and how defensive officials at the DH had been over Greenhalgh’s study can be seen in her presentation to Graphnet users which included her comment that:

“All stakeholders [in the UCL report] except Connecting for Health wrote and congratulated us on the final report.”

CfH had sent Greenhalgh 94 pages of queries on her team’s draft report, to which they replied with 100 pages of point-by-point answers. The final report, “The Devil’s in the Detail“, was accepted by peer review – though it later transpired, as a result of UCL investigations, that one of the anonymous peer reviewers was in fact working for Connecting for Health.

These were some of the Greenhalgh team’s findings:

– There was low take-up of the SCR by hospital clinicians for various reasons: the database was not always available for technical reasons, such as a loss of N3 broadband connection; and clinicians did not always have a smartcard, were worried about triggering an alert on the system, were not motivated to use it, or might have been unable to find a patient on the “spine”.  The  SCR was used more widely by out-of-hours doctors and walk-in centres.

– GP practices had systems that were never likely to be compliant with the Summary Care Record central system.

– The SCR helped when a record existed and the patient had trouble communicating.

– The SCR helped when a record existed and the patient was unable to say what multiple medications they were using.

–  There were tensions between setting a high standard for GPs to upload records or lowering standards of data quality to encourage more GP practices to join the scheme.

–  Front-line staff didn’t like asking patients for consent to view the SCR at the point of care. This consent model was unworkable, inappropriate or stressful.

–  There was no direct evidence of safer care but the SCR may reduce some rare medication errors.

– There was no clear evidence that consultations were quicker.

– Costly changes to supplier contracts were needed to take in requirements that were not fully appreciated at the outset of the programme.

– The scheme was far more complex than had been debated in public. Its success depended on radical changes to systems, protocols, budget allocations, organisational culture and ways of working. And these could not be simply standardised because nearly every health site was different.

So what’s the answer?

The SCR is an excellent idea in principle. Every out-of-hours doctor should know each patient’s most recent medical history, current medications and any adverse drug reactions.

But this could be provided locally – by local schemes that have local buy-in and for which there is accountability and responsibility locally. It can be argued that the Summary Care Record, as a national database, was never going to work. Who is responsible for the mistakes in records? Who cares if it is never widely used? Who cares if records are regularly updated or not? Why should GPs care about a national database? They care about their own systems.

It appears therefore that the SCR has benefited, in the main, the central bureaucracy and its largest IT supplier BT.  The SCR national database has kept power, influence and spending control at the centre, emasculating to some extent the control of GPs over their patient records.

The central bureaucracy continues to justify the scheme with statistics on how many records have been created without mentioning how little the records are looked at, how little the information is trusted, and how pervasive are the errors and omissions.

BT and DH officials will be delighted to read Simon Burns’ commentary in the Telegraph on the SCR. But isn’t it time IT-based schemes were unshackled from politics? DH press releases on the success of local IT schemes would be few and far between. But why should £235m – the last estimated cost of the SCR – be spent so that ministers can make speeches and be quoted in press releases?

.

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Posted in Campaign4Change, change management, collaboration, Government IT, managing change, NHS, npfit, openness and transparency, outsourcing, public sector, public services, reforms, Uncategorized

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NPfIT – criminal incompetence says The Times

Posted on 05/10/2011 | 2 comments

By Tony Collins

In an editorial not everyone would have seen, The Times said the history of the NPfIT was “one of criminal incompetence and irresponsibility”.

The main leader in The Times on 23 September had the headline “Connecting to Nowhere”.

It said:

“The comically misnamed Connecting for Health will continue to honour its contracts with big companies and to swallow taxpayers’ money for some time to come: up to £11bn on current estimates. The figure demonstrates the truly egregious scale of the previous Government’s incompetence on this issue: this vast sum seems to have been committed irrevocably, even though the project has never achieved its objectives.

“The story is a dismal catalogue of naivity, ambition and spinelessness. NHS managers and officials …were [not] brave enough to question the direction of travel at crucial moments when IBM and Lockheed pulled out of the project early on. Whitehall was sold a grand vision by consultants, software and technology companies charging grandiose fees. It signed contracts that appear to have been impossible to break when the promised land did not appear. Yet no one seems responsible. No one has been sacked. Most of the officials involved have long moved on…

“There have been spectacular failures in the private sector too. But businesses, with tighter controls on spending, tend to halt things earlier if they are going wrong. Many prefer off-the-shelf systems such as SAP or Oracle, which are tried and tested. They know that it is cheaper to adapt their processes, not the software.

“This newspaper is in favour of serious investment in technology, which could play an important part in economic growth. The NHS debacle has done enormous damage to this country’s reputation for expertise in IT systems. The lessons for the future are clear. Governments must hire people who can make informed and responsible procurement decisions. Patients, in every way, are going to end up paying the price.”

A separate article in The Times 0f 23 September included comments by Campaign4Change whose spokesman said that if the Department of Health continues to spend money on NPfIT suppliers it will probably get poor value for money.

Comment:

Compare the remarks in The Times with those of David Nicholson, Chief Executive of the NHS and Senior Responsible Owner of the NPfIT who refused to agree to a request by 23 academics to have an independent review of the scheme. Nicholson could not contain his enthusiasm for the NPfIT when he told the Public Accounts Committee on 23 May 2011:

 “We spent about 20% of that resource [the £11.4bn projected total spend on the NPfIT] on the acute sector. The other 80% is providing services that literally mean life and death to patients today, and have done for the last period.

“So the Spine, and all those things, provides really, really important services for our patients. If you are going to talk about the totality of the [NPfIT] system … you have to accept that 80% of that programme has been delivered.”

It’s difficult to accept Nicholson’s figures. But even if we do, we’d have to say that the 20% that hasn’t been delivered was the main reason for the NPfIT: a national electronic health record which hasn’t materialised and isn’t likely to in the near future.

The contrasting comments of The Times and Nicholson’s are a reminder that the civil service hierarchy at the Department of Health operates in a world of its own, unanswerable to anyone, not even the Cabinet Office or Downing Street.

Can the Department of Health be trusted to oversee health informatics when it has such close relationships with major IT companies and consultants? While Katie Davis is in charge of health informatics there is at least an independent voice at the DH. But as an interim head of IT how long will she last? The DH has a history of not being keen on independent voices.

Nicholson: still positive after all these years.

NPfIT goes PfffT.

Beyond NPfIT.

Surge in tenders for non-NPfIT systems.

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CSC optimistic on new NPfIT deal – officials less so

Posted on 24/08/2011 | 1 comment

By Tony Collins

CSC is due to meet officials from the Cabinet Office next month to discuss a possible new deal over the company’s £3bn worth of NHS IT contracts. Proposals from the Cabinet Office’s Efficiency and Reform Group have gone to the Department of Health and Downing Street for approval.

Nobody seems to know yet what the ERG has proposed but CSC remains confident that a new NPfIT deal will be signed that is good for the supplier’s finances and for the NHS.  Not all Whitehall officials share CSC’s confidence, however.

A new deal may be signed – but perhaps without the exclusive arrangements in the original contracts and the NHS commitments to place a minimum amount of business with the company.

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