Category Archives: private sector lessons for the public sector

Cancer waits mix-up – how concerned is the Trust?

Posted on 05/07/2012 | 2 comments

By Tony Collins

When a passenger jet crashes, if the airline’s next board meeting barely mentions it, and instead discusses a catering award and a staff survey, those booked on flights with the airline may have cause for concern.

So should patients at Imperial College Healthcare Trust be concerned that the trust has not mentioned in its latest published board papers a blunder that led to the Trust’s losing track, for nearly a year, of hundreds of patients with possible cancer?

The Department of Health requires that patients who go to their GP with symptoms that may indicate cancer are seen by a specialist within a maximum of two weeks.

Records incomplete

But Imperial has lost track of an unknown number of patients who went to their GPs with signs of possible cancer. It has been checking 900 hospital records which it found were incomplete.

For some of the patients the blunder won’t matter:  they will have been called by staff at GP practices, some of whom have systems that track patients under the two-week rule.

But some patients might have slipped through the net and not been alerted by Imperial to their urgent appointments. Imperial has no clear idea how many.

It has asked GP organisations for help in contacting patients, their carers or representatives, to‘ascertain whether the patient has received treatment or still requires treatment’”.

What detail has emerged on the problem has come not from Imperial but from NHS North West London which is a single management team that represents eight PCTs.  NWL  covers St Mary’s Hospital, Paddington, Hammersmith Hospital and Charing Cross Hospital, which are all managed by Imperial.

“Substantial concern”

NWL has what it calls “substantial concern” about the problems at Imperial. In addition to the problem reporting its two-week cancer waits, the Trust is trying to clear a backlog of patients who have waited more than 18 weeks from referral to consultant-led treatment.

“Systematic failings”

NWL executives report that Deloitte has carried out an external audit and “concerns remain about record keeping at Imperial”.  The executives say that “systematic failings” have been identified which will take time to resolve. This issue will be given close attention in the coming year, says NWL.

Patient safety an issue?

NWL also says that a “Clinical Review” is being carried out and a panel is being set up to look at the clinical issues that have arisen at Imperial. “The Director of Nursing confirmed that the clinical review would look at all patients affected by the problems at Imperial …”

In contrast to the concerns about Imperial’s performance among London PCTs, Imperial seems a little surprised that we are even investigating the problems.

“The problems are administrative and nothing to do with IT,” said a spokesperson.

The Trust is right. The problems are nothing to do with IT.  And yet the problems may be everything to do with IT. Appointments for patients with possible cancer have not been entered onto IT systems – and where they have, data has been incorrect, entered into duplicate records, or not followed up to check appointments were kept, or the patient seen for treatment and investigations.

Eye off the ball?

For nearly a year the problem was not spotted, which has left some North West London executives wondering how it could have happened. It is known the Trust has devoted time and attention of senior management to a replacement of existing systems with Cerner, under the National Programme for IT.  Has the Trust taken its eye off the ball while making plans for Cerner?

Some working in the NHS may ask whether it was more important for the Trust to have ensured that appointments for possible cancer were entered correctly onto existing systems, and routines written into software to provide alerts when cancer records were not closed off, or were incomplete.

**

Below are some of the comments of NWL PCTs about Imperial’s problems. Their concerns raise questions about whether the Trust’s processes and administration are stable enough for a transition from existing IT to new systems, which could cause further disruption.

These are some NWL statements in its board papers relating to Imperial:

“It was reported that at Imperial, the calculations of the backlog of referrals had been completed and work is underway to clear the backlog. However Deloitte has carried out an external audit and concerns remain about record keeping at Imperial. Systematic failings have been identified which will take time to resolve. This issue will be given close attention in the coming year.

“A Clinical Review is being carried out and a panel is being set up to look at the clinical issues that have arisen. The Director of Nursing confirmed that the clinical review would look at all patients affected by the problems at Imperial …”

Does NWL always trust what Imperial says?

Jeff Zitron [Chair, NHS NW London, Inner & Outer NWL Sub Clusters] said that the Board needs evidenced assurance that the issues that have arisen at Imperial and North West London Hospitals are being adequately addressed.

**

“Trish Longdon [Vice-chairman, NHS North West London Cluster Board] noted that although the Imperial targets were shown as ‘Green’  this does not reflect the true position. This was agreed and it was noted that they were in fact being treated as if they were Amber.”

“Urgent meeting”

“The Chairman asked for an update on the situation at Imperial College Healthcare Trust which had been the subject of substantial concern at the last INWL Inner North West London NHS] Board meeting. The INWL Board had agreed that an urgent meeting should be held with the Chairman and Chief Executive of Imperial, involving the CCG Chairs, the Tri-Borough Cabinet Members for Health, himself and Anne Rainsberry [Chief Executive North West London Cluster]. This was taking place later that day.”

Clinical harm?

“ Following investigation of Serious Incidents in May 2011, ICHT [Imperial College Healthcare NHS Trust] is unable to provide sufficient assurance of robust data quality in regard to reported performance for 18 weeks RTT [Referral To Treatment], cancer waiting times and the elective waiting list.

The Trust board have approved a reporting break until end of June 2012 which has been agreed by the Cluster in conjunction with NHS London. To ensure due diligence, an independent audit of waiting list management across all specialities has been undertaken and a set of recommendations made.

“ICHT continue to provide shadow reports to NHS NWL during this period with weekly reporting. Some evidence of improved performance management is observed. However this is not yet consistently embedded Trust- wide and clearance of the current backlog of patients is not at sufficient pace to meet the agreed trajectory…

“A clinical review will be undertaken to ensure that patients have not experienced harm due to an elongated wait.”

**

“Anne Rainsberry [Chief Executive North West London Cluster] referred to a range of discussions taking place on Imperial’s performance issues, focussing on the backlog of the Referral to Treatment waiting lists which had resulted in a reporting break being granted.

“Work was concluding at the end of April [2012] to reduce the original backlog of patient cases and enable reporting systems to get back on track in June. A clinical review had also started to determine if any risks to patients had arisen due to the delays. The review findings would be brought back to the Board…

“Anne Rainsberry referred to a meeting she had attended with the Department of Health to review Imperial‟s approach to resolving these issues.”

Big organisational challenge

“Simon Weldon [Director of Commissioning and Performance, North West London Cluster Board] … asked the NWL Board to be aware of the enormity of the organisational challenge facing Imperial and that remedial actions would take time to take effect.”

Imperial responds

Campaign4Change put it to Imperial College Healthcare NHS Trust that there is nothing in its latest published board papers to show the trust is concerned about the problems relating to cancer waits and lost appointments. We said that PCT papers referred to  “substantial concern” but there was nothing similar in Imperial’s latest published papers. We let Imperial know we would be asking the question: how concerned is Imperial about the confusion over cancer waits?

This was the reply of Imperial’s spokeswoman (in full)

“The safety of patients is our absolute priority. Our Trust is taking the issues involved in the current situation very seriously and at all times the well-being of the patients we serve is foremost in our minds.

“We acknowledge that some patients may have been caused additional pain and anxiety associated with a prolonged wait for diagnosis and treatment and worked to address the problem as robustly and quickly as possible.”

Separately, in May 2012, Imperial told us that it was in the process of validating 900 patient records that indicate that a patient might have been waiting longer than two weeks.

At that stage it had closed more than 400 of the 900 records “as the majority indicated that patients have either received or are receiving treatment, or that the patient did not attend their appointment and their GP had advised there was no need for further follow up”.

The spokeswoman said “To date our investigations have found no suggestion that any delay in treatment has caused a patient to come to serious harm.”

She said “This is not an IT issue, but an administrative issue related to the physical input and extraction of data from patient records. It is entirely unrelated to IT systems.”

Comment

It is extraordinary that Imperial is seeking to replace existing systems when it is organisationally in a questionable state. Simon Weldon, Director of Commissioning and Performance, North West London Cluster Board, referred to the “enormity of the organisational challenge facing Imperial”.

Under the NPfIT, a number of implementations of Cerner at several NHS sites have gone badly wrong – and they did not have Imperial’s problems before going live. It would be common sense for Imperial to get its data accurate and its management processes and checks reliably in place before attempting a major switch of IT systems.

Two other things are particularly worrying: Imperial appears not to concede in public it has any major problems, and it appears to separate IT from administration.

Having the best IT in the NHS is of limited value if important parts of the Trust are in a state of administrative disorder.  If data is unreliable, incomplete and inaccurate, and solid processes are not in place to ensure that the correct data is entered into systems when it needs to be entered, and routines are not in place to provide alerts and follow-ups, costly hardware and software may not compensate. Is this an IT issue or not? Does that matter?

We would not like to see a Cerner NPfIT debacle similar to the ones at Barts in London, Royal Free Hampstead, and at hospitals in Oxford, Milton Keynes, Weston-super-Mare, Morecambe Bay, Worthing and Bristol.

But is Imperial particularly concerned? Is it in denial over the seriousness of its problems? Why is it reporting its position at Green when North West London NHS regards its position as Amber? Why do its latest published board papers not mention its problems tracking patients under the two-week rule? Is the Trust so preoccupied with replacing its existing systems with Cerner that it is not doing the basics well?

One specialist in the NHS said: “If the Trust wasn’t spending so much time and effort doing the Cerner deployment then maybe they would have concentrated its scarce resources on performing the  job of managing patients.”

Accountability for failure in the NHS is poor to non-existent. So will Imperial be able to do what it wants regardless?

Troubled Cerner NPfIT go-lives, so far:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

*We acknowledge Pulse which broke the story on Imperial’s cancer wait problems.

GPs asked to contact hundreds of patients who may have missed treatment after hospital’s cancer referrals blunder  – Pulse

London LMCs alert over Imperial cancer waits mix-up – Pulse.

GPs kept in the dark over hospital cancer blunder – Pulse

Other links:

Halt NPfIT Cerner deployments says MP Richard Bacon

Bacon calls for halt on Millennium.

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Posted in Campaign4Change, Cerner, Deloitte, e-health, health, health records, NHS, npfit, openness and transparency, operational issues, oversight, private sector lessons for the public sector, public sector

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Poor IT suppliers to face ban from contracts?

Posted on 28/06/2012 | Leave a comment

By Tony Collins

The Cabinet Office minister Francis Maude is due to meet representatives of suppliers today, including  Accenture BT,Capgemini, Capita, HP, IBM, Interserve, Logica, Serco, and Steria.

They will be warned that suppliers with poor performance may find it more difficult to secure new work with the Government. The Cabinet Office says that formal information on a supplier’s performance will be available and will be taken into consideration at the start of and during the procurement process (pre-contract).

Maude will tell them that the Government is strengthening its supplier management by monitoring suppliers’ performance for the Crown as a whole.

“I want Whitehall procurement to become as sharp as the best businesses”, says Maude. “Today I will tell companies that we won’t tolerate poor performance and that to work with us you will have to offer the best value for money.”

The suppliers at today’s meeting represent around £15bn worth of central government contract spend.

The representatives will also be:

– asked their reactions on the government’s approach to business over the past two years

– briefed on the expanded Cabinet Office team of negotiators (Crown Representatives) from the private and public sectors. Maude says these negotiators aim to maximise the Government’s bulk buying power to obtain strategic discounts for taxpayers and end the days of lengthy and inflexible contracts.

Spending controls made permanent

Maude is announcing today that cross-Whitehall spending controls will be a permanent way of life. The Government introduced in 2010 temporary controls on spending in areas such as ICT  and consultancy. It claims £3.75bn of cash savings in 2010/11, and efficiency savings for 2011/12, which it says are being audited.

The Cabinet Office says: “By creating an overall picture of where the money is going, the controls allow government to act strategically in a way it never could before. For example, strict controls on ICT expenditure do not just reduce costs but also reveal the software, hardware and services that departments are buying and whether there is a competitive mix of suppliers and software standards across government.”

Maude said: “Our cross-Whitehall controls on spending have made billions of cash savings for the taxpayer – something that has never been done before. That’s why I’m pleased to confirm that our controls will be a permanent feature, helping to change fundamentally the way government operates.”

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Posted in cost reduction, efficiency savings, Government IT, IT-related failures, operational issues, outsourcing, oversight, Politics, private sector lessons for the public sector, procurement, project management, public sector, software quality, supplier relationships

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Why is MoD spending more on IT when its data is poor?

Posted on 28/06/2012 | Leave a comment

By Tony Collins

The Ministry of Defence and the three services have spent many hundreds of millions of pounds on logistics IT systems over the past 20 years, and new IT projects are planned.

But the National Audit Office, in a report published today – Managing the defence investory –  found that logistics data is so unreliable and limited that it has hampered its investigations into stock levels.

“During the course of our study,” says the NAO, “the Department provided data for our analyses from a number of its inventory systems. However, problems in obtaining reliable information have limited the scope of our analysis…”

The NAO does not ask the question of why the MoD is spending money on more IT while data is unreliable and there are gaps in the information collected.

But the NAO does question whether new IT will solve the MoD’s information problems.

“The Department has acknowledged the information and information systems gaps and committed significant funds to system improvements. However these will not address the risk of failure across all of the inventory systems nor resolve the information shortfall.”

MPs on the Public Accounts Committee, who will question defence staff on the NAO report, may wish to ask why the MoD’s is so apparently anxious to hand money to IT suppliers when data is poor and new technology will not plug information gaps.

Comment:

MPs on the Public Accounts Committee found in 2003 (Progress in reducing stocks) that the MoD was buying and storing stock it did not need. Indeed after two major fires at the MoD’s warehouses at Donnington in 1983 and 1988 more than half of the destroyed stock did not need replacing. Not much has changed judging by the NAO’s latest report.

It’s clear that the MoD lacks good management information. Says the NAO in today’s report:

“The summary management and financial information on inventory that is provided to senior staff within Defence Equipment and Support is not sufficient for them to challenge and hold to account the project teams…”

But will throwing money at IT suppliers make much difference? The MoD plans the:

–  Future Logistics Information Services project, which is intended to bring together and replace a number of legacy inventory management systems; and

–  Management of the Joint Deployed Inventory system which will provide the armed services with a common system for the inventory they hold and manage.

But is the  MoD using IT spending as proof of its conviction to improve the quality of data and the management of its inventory?

Managing the defence inventory

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Posted in cost reduction, Defence, Government IT, IT projects, IT-related failures, oversight, private sector lessons for the public sector, project management, public sector, public services, software quality, supplier relationships

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HMRC loses an important voice on its board

Posted on 11/06/2012 | Leave a comment

By Tony Collins

Steve Lamey, who is leaving HM Revenue and Customs as Director General, Benefits and Credits, has worked tirelessly to improve the organisation’s systems and administration; and he has gained a reputation for listening to IT suppliers.

In 2007 he  won a British Software Satisfaction award for his work in promoting collaboration within the business software industry. He joined HMRC in October 2004 as CIO.

He is perceived to be leaving at a time when there are a number of vacancies at the top of HMRC. Accountancylive reported last month there was an “exodus”of senior officials from HMRC, and morale is said to be low.  But a man as influential as Lamey can do only so much.  Anyone who wants to effect major change at  HMRC must move an iceberg with a rowing boat. That said there have been some HMRC IT-related successes.

Was Lamey an unexploded force at HMRC?

But it’s conceivable that Lamey could have achieved more if he had carried on the way he started: by highlighting the need for change.

He unwittingly made a name for himself in 2005 after a speech he gave to a Government IT conference in which he revealed some of the corporate weaknesses of HMRC, an the organisation he had  joined not long before.

He  probably had not expected  his comments to be reported first in Computer Weekly and then on the front page of the Daily Telegraph.

At that time Lamey was HMRC’s new CIO. He told delegates of some of his discoveries, namely that:

– At least 31 million wrongly addressed letters were being sent out.

– Nearly half of self-assessment tax forms were being incorrectly processed and had to be done again.

–  he had been struck by the out-of-date computer systems. He told the conference: “If I were an information technology historian I would love it. We need to move on from there.”

– his  “biggest, biggest, biggest challenge” was correcting “poor quality data”.

Later a Daily Telegraph article, quoted me as saying “Mr Lamey’s frank assessment of the state of the tax department’s processes and systems is a rare and fresh approach for a senior government official.”

But was Lamey muzzled?

After that article it seems that Lamey was effectively muzzled, at least from making disclosures in public about HMRC’s flaws. Board papers at the time indicated that senior civil servants at HMRC would, in future, have to clear their public speeches in advance. Lamey did not make a similar speech in public again, not to my knowledge at least.

Richard Bacon MP, a member of the Public Accounts Committee, spoke at the time of the apparent attempts by HMRC to silence Lamey.

“It was refreshing to have a senior IT specialist, who is familiar with the business issues, and who is prepared to identify clearly what the scale of the problems is. Unless you’ve got that degree of frankness and candour, I don’t think you’re really going to solve the underlying problems. The alternative is to be in denial, to suggest that the problems don’t exist. It is plain that they do.”

The then Shadow Treasury minister Baroness Noakes, who was formerly a partner at KPMG, said she was concerned that it was already hard for parliament to discover how well HMRC was managing its business.

She said HMRC was “apparently silencing people from telling the truth”. She added “Speaking the truth [in the public sector] in the way you do in the private sector may well not be as acceptable.”

Would Lamey have been even more influential if he had continued – in public – to point to the weaknesses HMRC needed to tackle?

So defensive is HMRC that it considered a positive PR campaign to highlight its strengths after the loss of two CDs which contained the details of 25 million people.

Can an organisation that intuitively discounts and suppresses the negatives while trumpeting the positives ever properly reform itself? Probably not. If you cannot accept you have problems you cannot resolve them. We wonder how HMRC is getting on with its part of the Universal Credit project … its officials say all is well.

Attempts to constrain HMRC directors.

Front page Telegraph article with references to Steve Lamey’s speech

HMRC honcho poached.

Time for truth on Universal Credit

Hungry re-seller bags Steve Lamey.

Whistleblower punished?

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Posted in excessive secrecy, Government IT, HMRC, managing change, openness and transparency, Politics, private sector lessons for the public sector, Real-Time Information, Universal Credit

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The real reason NHS Risk Register is a State secret?

Posted on 16/05/2012 | 2 comments

By Tony Collins

Yesterday  (15 May 2012) the Information Commissioner Christopher Graham issued a finely-crafted report to Parliament on his concerns about the Government’s use of a ministerial veto to stop publication of the Transition Risk Register relating to health service reforms.

Graham’s concern is that the veto represents a new and worrying approach to Freedom of Information.

Graham cannot do anything about the veto but he can warn MPs when he feels the Government has gone too far. This he has done in his report which says that the previous three occasions on which the ministerial veto has been exercised related to the disclosure of Cabinet material under FOIA. Now the Government has applied the veto to information held by the Department of Health.

Says yesterday’s report: “ The Commissioner would wish to record his concern that the exercise of the veto in this case extends its use into other areas of the policy process. It represents a departure from the position adopted in the Statement of Policy and therefore marks a significant step in the Government’s approach to freedom of information.”

The Government’s decision to ban publication of the health service risk register is particularly relevant to IT-related projects. This is because the government uses exactly the same arguments to ban contemporaneous publication of Gateway reviews and other independent assessments of IT-related projects and programmes.

Risk registers and Gateway reviews of IT-enabled change projects are similar. They are designed to identify all the main risks associated with the project or programme and have a red/amber/green system of rating the risks.

The Government’s argues that risk registers (and Gateway reviews) are researched and written in a “safe space” that allows civil servants to give advice and recommendations in a frank way. This candour would be compromised if the civil servants thought their advice would be published, says the Government.

In issuing a veto on the health risk register Andrew Lansley, the Health Secretary said, in essence, that he could not trust civil servants to be entirely honest if they knew their reports would be made public.

Said Lansley:  “If risk registers are routinely or regularly disclosed at highly sensitive times in relation to highly sensitive issues, or there is legitimate concern that they could be, it is highly likely that the form and content will change: to make the content more anodyne; to strip out controversial issues or downplay them; to include argument as to why risks might be worth taking; to water down the RAG [red,amber, green] system.

“They would be drafted as public facing documents designed to manage the public perception of risk; not as frank internal working tools. These consequences (many of them insidious) would be to the detriment of good government.”

Lansley also wanted to ban publication to pre-empt sensational media coverage.  In this he was repeating the arguments made by civil servants under Labour who refused, under the FOI Act, to publish risk registers and Gateway reviews.  Said Lansley “I consider that the form and the frankness of the content of TRR [health service Transition Risk Register] would have been liable to create sensationalised reporting and debate.

“The content would also have been inherently highly open to misinterpretation by both the press seeking a headline and/or for political reasons. The likelihood of this occurring is particularly acute where the subject matter is, as with the Transition programme, controversial and the proposals at a highly sensitive stage.”

But the Commissioner did not accept that disclosure of the Transition Risk Register would affect the frankness and candour of future risk registers. The Commissioner also said that a ministerial veto should, by law, be made only in exceptional circumstances.  But the Government has failed to explain why there are exceptional circumstances in this case.  Said the Commissioner:

“The Commissioner does not consider that sufficient reasons have been given as to why this case is considered to be exceptional, particularly in light of the [Information] Tribunal’s decision dismissing the Department’s [Department of Health’s] appeal.

“The Commissioner notes that much of the argument advanced as to why the case is considered to be exceptional merely repeats the arguments previously made to Commissioner and the Tribunal and which were in part dismissed by the Tribunal.”

Graham concludes:

“In light of previous commitments he has made, and the interest shown by past Select Committees in the use of the ministerial veto, the Commissioner intends to lay a report before Parliament under section 49(2) FOIA on each occasion that the veto is exercised. This document fulfils that commitment.

“ Laying this report is an indication of the Commissioner’s concern to ensure that the exercise of the veto does not go unnoticed by Parliament and, it is hoped, will serve to underline the Commissioner’s view that the exercise of the ministerial veto in any future case should be genuinely exceptional…

“The arguments employed by the Department at the Tribunal and by the Secretary of State in explanation of the subsequent veto, both in the Statement of Reasons and in exchanges in the House of Commons around the Ministerial Statement, certainly use the language of ‘exceptional circumstances’ and ‘matter of principle’. But the arguments are deployed in support of what is in fact the direct opposite of the exceptional – a generally less qualified, and therefore more predictable, ‘safe space’.

“As such, the Government’s approach in this matter appears to have most to do with how the law might be changed to apply differently in future. This question falls naturally to consideration by the Justice Committee who have been undertaking post-legislative scrutiny of the Act.”

Comment:

The reason for the veto in the case of the health service risk register has little to do with protecting a safe space for frank discussion.

Civil servants already compile risk registers, Gateway reviews and similar reports on the basis that they may, at some point, be published. Officials are no more likely to be frank if they know their reports will be confidential than more guarded if they know the documents will be published. They will do what their job entails. Their job requires honesty. They will do that job whether or not reports are published.

The real reason for the veto – and the refusal of departments to publish all contemporaneous internal reports on large and complex programmes, particularly those with a large IT element – is that some new schemes within Government operate at a shambolic level.

Any new government, whatever its hue, soon learns to keep secret the fact that such programmes are sometimes characterised by near anarchy.

One outsider to the UK government, Australian David Pitchford, discovered the truth when he became Executive Director of Major Projects within the Efficiency and Reform Group which is part of the Cabinet Office. Pitchford may not have realised his comments would be reported when he told a project management conference in 2010 that “nobody in the UK Government seems to know how many projects they have on the books, nor how much these are likely to cost”.

He found that projects were launched, and continued, without agreed budgets or business cases.  Today, there is better scrutiny of major projects, by the Cabinet Office’s Major Projects Authority. But the MPA is limited in what it can do or scrutinise. Which leaves government in a general mess when it comes to implementing anything new.

Evidence for this mess comes from the National Audit Office. Its auditors tend to investigate departments as a whole more than they do specific projects but when they do the careful reader can see that projects such as the Rural Payments Agency’s Single Payment Scheme (a scant regard for public funds, said the NAO) and the C-NOMIS project for the prison service (kindergarten mistakes, said chair of Public Accounts Committee) were without a structure. Chaos prevailed – and ministers were among the last to know.

Publication of project reports encourages professionalism. Departmental heads can be held to account if Parliament knows what has gone wrong. That’s precisely the reason departmental heads don’t want risk registers and other project reports published. It’s why all internal reports on Universal Credit, the government’s biggest IT-related project, are kept secret in spite of FOI requests.

The ministerial veto in the case of the NHS risk register is the government and civil service colluding in keeping the public and Parliament in ignorance of internal management’s inability to run complex new projects and programmes in a professional way.

Ministers and permanent secretaries don’t especially mind media criticisms that are based on speculation. They don’t want their critics having authoritative internal reports. That’s why the Cabinet agreed the health service veto – and it’s one reason the government has a not-very-hidden aversion to the FOI Act.

The coalition cannot justly claim to cherish open government while it is refusing so many requests under FOI to publish contemporaneous taxpayer-funded reports on its major schemes.

We agree with the Information Commissioner that use of the ministerial veto is a step too far. No number of announcements by the Cabinet Office on open government will gloss over the fact that the coalition is even more secretive about mega-projects than Labour. That’s saying something.

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Posted in Campaign4Change, Freedom of Information, Gateway reviews, Government IT, IT projects, IT-related failures, Major Projects Authority, NHS, operational issues, Politics, private sector lessons for the public sector, project management, public sector, public services, Universal Credit

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Whitehall defies NAO and Cameron on publishing status of big projects

Posted on 02/05/2012 | 1 comment

By Tony Collins

Government action to cut the number of failures of big projects including those with a major ICT component has made a difference, the National Audit Office reports today.

In its report “Assurance for major projects”  the NAO is largely supportive of actions by the Government, , the Cabinet Office’s Major Projects Authority and the Treasury in setting up reviews of major high-risk projects, including ICT-based programmes, to ensure that if they are failing they are put back on track or cancelled.

The NAO says the Government’s decision to “dismantle” the NPfIT was taken after the project was assessed by the Major Projects Authority.

But the report also shows how civil servants have managed to defy a mandate from the Prime Minister, and a separate NAO recommendation in 2010, for information on the status of big ICT and other high-risk projects to be published.

Says the NAO report

“The ambition to publish project information, as part of the government’s transparency agenda, has not been met.

“Our 2010 report recommended that the government should publicly report project status. We consider that public reporting of project information is key to providing greater accountability for projects and improving project outcomes… Regular transparent reporting of performance which highlights successes and non-compliance would also help to build an enduring assurance system.”

Separately in the report the NAO says

“There has been a lack of progress on transparency.  The [Cabinet Office’s Major Projects] Authority has not yet met its commitment to publish project information in line with government’s transparency agenda. The Authority cannot deliver this objective on its own. Senior level discussions are ongoing, between Cabinet Office, HM Treasury and departments, on the arrangements for public reporting.”

Should ministers intevene to force publication?

But the NAO report does not raise the question of why ministers have not intervened to force civil servants to publish the status information on high-risk projects.

Campaign4Changehas argued that publishing status reports on big ICT projects and programmes would be the most effective single action any government could take to reduce the number of failures. (see “Comment” below)

Prime Minister’s 2011 mandate

The NAO’s 2010 recommendation for status information on major projects to be published was backed by a mandate from the Prime Minister in January 2011 which included the undertaking to “require publication of project information consistent with the Coalition’s transparency agenda”.

The House of Commons’ Public Accounts Committee has recommended that departments publish information on the state of their major IT-based projects and programmes; and the Information Commissioner has rejected civil service arguments for not publishing such information.

In addition Francis Maude, the Cabinet Office minister, said, when in opposition, that the Conservatives, if they gained power,  would publish “Gateway” review reports soon after they are completed.  Gateway reports are similar to the assurance reviews carried out for the Major Projects Authority.

Yet none of this has happened.

The “rebel” civil servants

How is it that a group of civil servants who are opposed to publishing information on the status of large risky projects can defy the Prime Minister, Francis Maude, the National Audit Office, and the all-party Public Accounts Committee? Those recalcitrant civil servants argue that assurance reviewers would not tell the whole truth if they knew their assessments would be made public.

But how do we know they tell the whole truth when the reports are kept confidential? The Information Commissioner has pointed out in the past that civil servants have a public duty to be candid and honest. If they are not because their reports are to be published, they are failing in their public duty.

Today’s NAO report says there are differences of opinion among civil servants over whether to publish status information on projects.

Says the NAO

“There has been some support for greater transparency from departments who believe that tracking and publishing major milestones could create helpful tension in the system.

“However, concerns have been raised that increased transparency could limit the value of assurance, as it could inhibit assurance reviewers and project staff holding full and frank discussions.

“Some senior project staff also have concerns that public reporting could have a negative commercial impact, and would prefer delayed rather than real-time public reporting.”

The Cabinet Office told Campaign4Change in 2010 and 2011 that instead of publishing status reports on each major project, it will publish an annual report on the state of its programmes.

But that hasn’t happened either.

Says the NAO:

“As well as the objective to publish project information, the [Major Projects] Authority has not yet met its objective to publish an annual report on government’s major projects.

“The Authority initially expected to publish an annual report in December 2011 but is now expecting the report to be published in May or June 2012. The format of the annual report, and the information it will contain, has yet to be decided.”

Comment:

Many times over the last 20 years I have said that publishing status reports on major IT-based projects and programmes would be the most effective single action any government could take to deter departments from going ahead with overly ambitious schemes that are doomed to fail. If, against good sense, impractical schemes are approved, publishing status information will make all the difference.

Permanent secretaries will not lose sleep over a failing project, but they will not want information on it published – which is why that information should be published.

Publishing status information would give civil servants a good reason to tackle weaknesses as they developed.  Permanent secretaries may not mind losing public money on a failing project or programme. They will always fear embarrassment, however.

Who is really in control of Whitehall – civil servants or No 10? David Cameron’s office has issued a mandate that requires status information on projects to be published. The NAO has issued a similar recommendation. How long can the civil service hold out against the political will?

Links:

NAO report – Assurance for major projects

Firecontrol – same mistakes repeated on other projects

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Posted in cost reduction, culture, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, IT projects, IT-related failures, Major Projects Authority, openness and transparency, operational issues, private sector lessons for the public sector, project management, public sector

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Cerner project over budget by 100 times amount of local heart monitor donations

Posted on 25/04/2012 | Leave a comment

By Tony Collins

When the Lord Mayor of Bristol presented a cheque for £20,000 to buy 10 cardiac monitors for local hospitals he could not have known that NHS officials were quietly spending more than 100 times that amount on an over-budget Cerner project.

A charity, the Frenchay Cardiac Support Group, raised the £20,000 through a shop and fund-raising events. It was 100th the amount  of the overspent element on a project to install an NPfIT Cerner patient administration system at the North Bristol NHS Trust.

Officials at NHS Connecting for Health and the Trust may consider it unfair of Campaign4Change to compare a charity donation with the unplanned extra costs of an IT-enabled change programme. But whereas North Bristol is accountable to local patients and fund-raisers for the £20,000 donation, it has no duty to explain to its patients (or anyone) how or why it has spent £5m on a Cerner project that was expected to cost the Trust about £3m.

The figures are buried deep in the Trust’s latest board papers. There has been no discussion of the overspend during the public part of the Board’s March meeting. Nor was it mentioned on the Board’s agenda for the meeting.

What the Trust says

The Trust declined our invitation to explain the overspend saying that it has commissioned a review of the Cerner project by PWC. Its statement to us said:

“North Bristol NHS Trust has commissioned an independent review into the issues surrounding the implementation of its new electronic patient record system. This will be carried out by PricewaterhouseCoopers LLP.  The outcome of the review will be published in due course.  We do not feel it is appropriate to comment further until the conclusion of the review, which is expected to take several weeks.”

The Trust’s papers say that the majority of capital spending in January and February was on the Cerner project. The anticipated spending on the project will be more than £5m which would see the Trust considerably overspent because of the difficulties encountered, say the papers.

The same Board papers put the Trust’s IM&T overspending at about £2.3m. This is on top of the hundreds of millions of pounds that NHS Connecting for Health is paying BT to install Cerner at sites in the south of England, including north Bristol.

Comment:

NHS Trusts across London and the south of England are expected to install new Cerner systems in the coming years. London is in the midst of a major procurement, as is the south. If the disruption is as serious as in some earlier implementations thousands of patients will be affected. So what?

At North Bristol the NPfIT implementation of Cerner has gone seriously awry. Besides the duplication of medical records, disruption to appointments, and, for the first time, the missing of a two-week wait target for cancer patients, there have been at least 16 clinical incidents; and the Trust’s papers say there has been a “significant increase in DNA [Did Not Attend an appointment] rates since the implementation of Cerner”.

Time heals?

Does it matter? It will all settle down in time say NHS officials.

Indeed some in the NHS and the scientific community in general have a view that taking known risks are part and parcel of achieving Progress. If lives are lost pushing back frontiers of knowledge it is for the greater good. Hence the justification for risks taken in launches of the Space Shuttle and building new designs of bridges, tunnels and aircraft.

The greater good

It’s a philosophy not lost on officials at NHS Connecting for Health. Go-lives of electronic patient record systems will be disruptive and may even affect the care and treatment of patients. But it’s for the greater good and the damage won’t last too long. Besides, if the health of any individual patients is affected, this will be supposition: no official evidence will exist.

So should patients fear the implementation of new hospital-wide systems? It’s a little like the early flights of commercial aircraft. Most flights will go without incident but now and again a passenger jet will crash.

One difference between aircraft crashes and hospital IT implementations is that crashes are usually investigated by law, and lessons applied by regulatory authorities to make flying safer. The NHS has no duty to investigate or apply lessons from its IT-related mistakes. Which is one reason that the lessons from the Cerner implementation at Nuffield Orthopedic Centre in Oxford in 2005 have still not been learned. For example there were important differences in the way the Nuffield’s staff and doctors worked, and the way the system was designed to work.

Who would want to fly in an aircraft that hasn’t been certified as safe? So should patients experience an NHS that has uncertified patient record systems?

In aircraft crashes deaths are obvious. There is often a clear cause and effect. In the NHS there is no certification of IT systems. A hospital can go live with whatever systems it wants, whatever the effect on patients. Indeed the reporting of any damage to patients is down to the Trusts. That’s a clear conflict of interest – like relying on the builders of a supertanker to report the effects on wildlife and fish of an oil spillage.

It’s time for a change.

It’s time for the NHS – and the Department of Health and particularly NHS Connecting for Health – to get professional about hospital-wide IT implementations.

It’s time for regulation and certification, minimum standards of safety and independent reporting of disasters.

Links:

Does Hospital IT need airline-style certification?

Halt NPfIT Cerner projects says MP

NPfIT Cerner installation at Bristol as “more problems than anticipated”

Why is North Bristol Cerner project so expensive?

An ongoing IT crisis case study – North Bristol NHS Trust

Lessons from Cerner go-live at Nuffield in 2005.

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Posted in Campaign4Change, Government IT, managing change, managing outsourced services, NHS, npfit, openness and transparency, operational issues, oversight, Politics, private sector lessons for the public sector

Should Francis Maude say “no” to so many projects?

Posted on 23/03/2012 | Leave a comment

By Tony Collins

When Jack Straw was Secretary of State for Justice and Lord Chancellor, he told MPs on the Constitutional Affairs Committee in 2007 that when he abandoned projects there was a fuss at first and soon nobody noticed the project did not exist.

“There is always the option to abandon things. I did that in the Foreign Office with much complaint that the world might end.

“What happened was that we saved a lot of money and no one ever noticed the fact that that scheme did not exist…it is very frustrating that so many people, including the private sector, are taken in by snake oil salesmen from IT contractor who are not necessarily very competent and make a lot of money out of these things. I am pretty intolerant of this.”

Andrew Tyrie (Conservative): Do you suggest that the public sector has been taken in by snake oil salesmen?

Straw: I am saying that we are all taken in. There are plenty of disastrous IT examples in the private sector, BP and Sainsbury being two of them.

Tyrie: I was looking at the public sector.

Straw:

“I was looking at both. I think we all face problems whereby unless we are total IT experts there is a danger of being taken in by snake oil salesmen… It is a real problem and it is one that is inherent in IT; it is not just a problem for the public sector.

“The difficulty is that in the case of the public sector it is taxpayers’ money, not shareholders’ or customers’ money, and the mistakes are much more visible, but plenty of companies in the private sector have similar problems.”

Comment:

Should the Cabinet Office Francis Maude say “no” to so many projects? Clearly he’s doing the right thing if Straw’s remarks are anything go by. Would a  private sector board that has to watch every penny launch costly IT-related projects that weren’t really needed?

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Posted in Campaign4Change, cost avoidance, efficiency savings, Government IT, IT projects, IT-related failures, private sector lessons for the public sector, project management, public sector, reducing cost strategically, supplier relationships

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Francis Maude reforms by saying “no” – a “massive” number of times

Posted on 23/03/2012 | 1 comment

By Tony Collins

Cabinet Office minister Francis Maude has intervened to reject departmental projects a “massive” number of times says Ian Watmore, Cabinet Office permanent secretary and former Government CIO.

Evidence Ian Watmore gave to the Public Administration Committee last week suggests that the Cabinet Office’s saying “no” repeatedly to departmental projects has changed behaviours within the civil service.

Watmore, the Cabinet Office’s permanent secretary, told Tory MP Charlie Elphicke, that Francis Maude and his officials now have the power to challenge departments’ civil servants who try and ignore Cabinet Office recommendations.

“In the past, those controls did not exist so they [officials in departments and agencies] could ignore us if they wanted to and carry on as before,” said Watmore. “Under the new regime, they cannot do that because in the end, if they ignore the recommendations that we come to, then they have to seek approval for the expenditure they were going to make on their projects and Francis Maude would, in his own words, happily say ‘no’ in such situations, and say ‘no’ again until people actually came to the table and changed what they were doing.”

Elphicke: Has he done so to date?

Watmore: Yes, an absolutely massive number of times.

Changing behaviour

Since departments have found it harder to get the Cabinet Office to endorse their projects, departmental officials are now “bringing their plans to us much earlier in the timeframe because they do not want us saying ‘no’ when it is well advanced”,  said Watmore.

“So we are getting into a dialogue with them early on about what the best way of doing something is. When we have agreed on the best way of doing something, when it comes back for approval, it gets nodded through and that is working much more effectively.”

Watmore added that the Cabinet Office’s controls will become redundant over time “because people will behave the right way”. He said: “Like the Carlsberg complaints department was the analogy I had in my head; it exists but it is never used.. At the moment we use it a lot because, left to their own devices, people would do things that were suboptimal when you look at it from across Government.

“Francis Maude is in a position to say, ‘No, you are not doing that. You are going to do it this way and reuse somebody else’s system or somebody else’s way of doing things’. He is very hands-on and vigorous at doing that.

Comment:

Watmore’s evidence confirms that Maude remains the mainspring of change in the way government works. Without Maude the unreasonably costly status quo would prevail.  He may be in danger of spinning. But how many ministers like to say “no”? He is invaluable for that reason alone.

What will happen when Maude is promoted, stands aside or retires?  The minister who likes to say “yes”  will earn the respect of some of his civil servants. The refreshing thing about Maude is that he is happy to take his plaudits from taxpayers, not officialdom.

Watmore’s evidence to the Public Administration Committee, 13 March 2012.

Institute for Government open letter on civil service reforms – the problems and opportunities.

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Posted in Campaign4Change, CIO, compliance with spending review, efficiency savings, Government IT, IT projects, managing change, private sector lessons for the public sector, procurement, project management, reducing cost strategically

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Osborne’s Budget speech may provide update on Coalition’s mutuals plans

Posted on 19/03/2012 | 1 comment

By David Bicknell

Will Wednesday’s Budget bring further news on the Coalition’s plans and prospects for public sector mutuals?

Yesterday’s Independent believes it might. An article by Business Editor James Ashton suggests that Chancellor George Osborne  is likely to “talk up the progress made in Whitehall reforms” in his Budget statement.

It argues that “thousands of civil servants will be transferred into the private sector under a blueprint to shake up Whitehall that will be unveiled next month.”

Ashton suggests that new recommendations on spin-outs are due to be outlined  in a report by Stephen Kelly, the Cabinet Office’s Crown Commercial Representative.

The report is expected to say that “there are numerous government operations that could be potentially commercialised, either through forging partnerships with outside firms or seeking capital injections.”

Related Link

Stephen Kelly – the man at the coal face of the Big Society

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Posted in Campaign4Change, mutualisation, mutuals, private sector, private sector lessons for the public sector, public sector, public services

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