Category Archives: project management

NPfIT Cerner go-live at Bristol has “more problems than anticipated”

By Tony Collins

The BBC reports that there are “more problems than anticipated” with a patient-booking system at two Bristol hospitals run by North Bristol NHS Trust.

The trust describes the problems as “teething”.  Consultants say the problems are “potentially dangerous”.

Last month North Bristol went live with the Cerner Millennium system under an NPfIT contract with BT. The Trust says problems are due to software being used incorrectly. They have led to some patients missing their operations and the wrong patients being booked for operations, says the BBC.

Emails from executives at Frenchay and Southmead hospitals, seen by the BBC, said staff should be “vigilant” to check lists were “completely accurate”.

BBC Points West’s health correspondent Matthew Hill said emails sent by consultants to hospital bosses claimed operation lists printed by the system were “complete fiction” and “potentially dangerous”.

One consultant told the BBC he had been put down to operate on patients from a completely different speciality.

The trust said there had been “teething problems” and that there had been “more problems than anticipated”.

In an email to staff the trust said the change of system had been “a very big change” so there was “no surprise” there had been difficulties.

A trust spokesman said there were a series of problems around outpatients and the associated clinics and some of the data moved from old systems had not migrated as planned.

“We need to ensure that we rebuild and recreate the clinics to match what people expect them to be on the ground,” he said.

“In theatres we have had some issues but have absolutely ensured from the outset that clinical safety has been at the top and have ensured any risks and issues have been mitigated.”

Conservative MP Richard Bacon, a member of the Public Accounts Committee, has established through a Parliamentary question that the cost of the North Bristol Cerner implementation is much higher than for a non-NPfIT installation in the same city.

Health Minister Simon Burns told Bacon that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust were £15.2m for deployment and an annual service charge of £2m.

This brought the total cost of the Cerner system over seven years to about £29m, which was more than three times the £8.2m price of a similar deployment outside of the NPfIT at University Hospitals Bristol Foundation Trust.

Comment

Several Cerner implementations under the NPfIT have gone awry but the problems have eventually been resolved. The question is whether patient care and treatment is affected in the meantime. The lack of openness over problems with patient care in the NHS mean that the answer will probably never be known, which underlines the need for better regulation of hospital IT implementations.

Does hospital IT need airline-style safety certification?

CSC to change hands in 2012?

By Tony Collins

Techmarketview analyst Tola Sargeant who has followed the NPfIT closely, and particularly the ups and downs of CSC, says the implications for CSC of the government’s tough stance against the company are “dire”. She adds:

“Indeed, we wouldn’t be at all surprised to see CSC change hands in 2012 as a result”.

Maude gets tough 

Within the Department of Health and CSC in May last year executives were confident a new memorandum of understanding under the NPfIT would be signed.

Now the Government, in the form of the Cabinet Office minister Francis Maude, has declined so far to sign any new deal with CSC. This is the way CSC put it in a filing to the SEC, the US regulators, on 27 December 2011:

“… Since mid-November 2011, the parties [Department of Health, Cabinet Office and CSC) have been engaged in further discussions relating to the MOU [Memorandum of Understanding], which have included discussions regarding a proposed contract amendment with different scope modifications and contract value reductions than those contemplated by the MOU.

“However, CSC recently was informed that neither the MOU nor the contract amendment then under discussion would be approved by the government.

“Notwithstanding the failure to reach agreement, CSC anticipates that the parties will continue discussions in January 2012 regarding proposals advanced by both parties reflecting scope modifications and contract value reductions that differ materially from those contemplated by the MOU.

“As a result of the circumstances described above, CSC has concluded, as of the date of this filing, that it will be required to recognize a material impairment of its net investment in the contract in the third quarter of fiscal year 2012.

“Until CSC and NHS conclude their on-going discussions concerning a possible contract amendment, including any scope modifications and contract value reductions that might be part of any such amendment, the Company is unable to estimate the amount of such impairment.

“However, depending on the terms of such an amendment or if no amendment is concluded, such impairment could be equal to the Company’s net investment in the contract, which, as of November 30, 2011, was approximately £943m ($1.5bn).

“Additional costs could be incurred by CSC depending on the nature of such an amendment, or if no amendment is concluded. The Company is unable to estimate the amount of such additional costs; however, such costs could be material.”

Why the Cabinet Office has left draft MoU unsigned?

The non-signing of a new deal with CSC is the firmest indication so far that the Cabinet Office is prepared to bring a rigorous, independent scrutiny to big IT projects and contracts.

Though the DH had wanted to sign a new deal with CSC, at least to assure continued support and upgrades to the few NHS trusts that have installed CSC and iSoft’s “Lorenzo” patient records system,  Maude is said to have seen a new deal with CSC as rewarding the company for failings in the past.

Also Cabinet Office officials regarded the terms of a new deal with CSC as unattractive. One Cabinet Office official wrote in a memo dated March 2011 that CSC’s proposals would mean a reduction in Trusts using CSC IT from the original number of 220 Trusts to 80.

 “My view is that, on the face of it, while the additional savings are appealing, the offer is unattractive. This is because the unit price of deployment (per Trust) under offer roughly doubles the cost of each deployment from the original contract.

“Ultimately, we [Cabinet Office] are not convinced the [Department of] Health commercial team are approaching this in the best way.”

It is possible that a new deal for signing was put before Maude – and went unsigned. Had any appeal gone to the Prime Minister David Cameron it is highly likely he would have given his full backing to Maude.

David Cameron’s view?

Cameron may be delighted that at least £2bn remains uncommitted to the NPfIT and could be saved by not signing a new deal with CSC.

Conservative MP Richard Bacon, a member of the Public Accounts Committee who has become an authority on the NPfIT, said of CSC’s warning of write-offs on the Programme:

“It was always a worry that the Department of Health was initially keen to sign a new deal with CSC that would have been poor value. Now it seems the Cabinet Office has done its job as an independent scrutineer and has made sure the interests of taxpayers are protected.

“This shows how important it is for the Cabinet Office to have the final say on big Government IT-based projects.”

What does CSC’s plight mean for the NHS?

NHS trusts have long wanted open competitive tendering and now, to a large extent, they have it. More than a dozen acute trusts are likely to tender for major systems replacements this year which is a big increase on the annual rate for past years.

Some iSoft and Cerner sites may also seek to renew contracts or find replacement systems. CSC, which may be lifted of the burden of meeting high-priced NPfIT commitments, may be a strong competitor in the UK health market.

One problem for NHS trusts will be finding enough strong candidates for their shortlists. They may look to the US market – but end up with products that need anglicising, which will be risky process.

Techmarketview says that what is doom and gloom for CSC is an opportunity for others. Rival suppliers “will be cheered by the prospect of more NHS Trusts procuring systems that CSC should have delivered by now”.

School report on Govt ICT Strategy – a good start

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.

HM Courts Service hides “Libra” IT’s new shortcomings

By Tony Collins

A report published today by the National Audit Office highlights how limitations in Libra, a case management IT system in use across magistrates’ courts, has contributed towards  HM Courts Service’s inability to provide basic financial information to support the accounts.

HM Courts Service claimed a success for the troubled Libra system in 2008 – but the failure of the system was more enduring and deep-rooted than thought. The problems were kept hidden until today’s NAO report because the present and past governments have kept “Gateway” progress reports on IT-based projects confidential.

In an unusual step, the head of the NAO, Amyas Morse, has “disclaimed” his audit opinion on the accounts of the HM Courts Service, largely because of a lack of financial information.

Disclaiming an audit opinion is more serious than qualifying the accounts of a government department or agency. Qualifying the accounts means that Morse has reservations on whether figures presented to the NAO are accurate. Disclaiming an audit opinion means that Morse lacks the basic information on which to give any opinion on the accounts.

MP Richard Bacon, a member of the Public Accounts Committee, says that disclaiming an audit opinion is the “auditor’s nuclear button”.

The NAO report today puts the focus on inadequacies in the “Libra” system which is supplied by Fujitsu and STL, with integration work by Accenture.

Fujitsu originally estimated the cost of Libra, a case management system for magistrates’ courts, at £146m. By March the estimated costs were £447m and were expected to rise further. The Libra project took 16 years to complete.

Problems and cost increases on the Libra system were well known in 2003 when the NAO criticised the management of the project. After that all went quiet until in 2008 when HM Courts Service declared Libra a success.

Now the NAO’s Morse says:

“Because of limitations in the underlying systems, HM Courts Service has not been able to provide me with proper accounting records relating to the collection of fines, confiscation orders and penalties. I have therefore disclaimed my audit opinion on its Trust Statement accounts.”

In a statement the NAO criticises the Libra system directly:

“Today’s report highlights how limitations in Libra, the case management IT system in use across magistrates’ courts, and similar systems have contributed towards  HM Courts Service’s inability to provide information at an individual transactions level to support the accounts.”

The NAO says that the Ministry of Justice plans to investigate further the functionality of Libra to determine whether it is possible to provide evidence to support accruals-based financial reporting.

Says the NAO:

“In particular, the Ministry and HMCTS [HM Courts and Tribunals Service] believe that it may be possible to obtain evidence over fines and confiscation orders if a suitable report is run shortly after the month end.

“ However, the Ministry and HMCTS have informed me that they may not be able to address these fundamental issues until Libra is significantly enhanced or replaced with a new case management and accounting system. The timing of this enhancement or replacement is currently uncertain. However, the Ministry have committed to ensuring that any replacement for Libra includes accounting functionality to enable financial reporting.”

MP Richard Bacon, who has followed the Libra project for many years, says:

“This is a disgraceful position for the Courts Service to have reached.  It is true that the Libra computer system is both expensive and useless but we have known this for many years (Cost of Courts’ IT system triples) and public bodies still have a duty to keep proper records.

“We are now looking at a possible £1.4 billion loss in uncollected fines and penalties partly because of the longstanding shambles that passes for record-keeping in the courts service.

“For centuries, people have kept accurate records and accounts using pen and paper. This could still be done now if needed and if there were sufficient will to do it.”

Margaret Hodge MP, Chair of the Committee of Public Accounts, said:

“It is really worrying that HM Courts and Tribunals Service can’t produce basic financial records.  HM Courts Service is responsible for collecting fines and penalties, but we can’t tell if this money is accounted for properly.

“The Comptroller and Auditor General has taken the rare step of disclaiming his audit opinion – the Committee will be looking for HM Courts and Tribunals Service to improve.”

Comment:

It is astonishing that HM Courts Service has been able to continue in operation without MPs having idea until today that the costly Libra computer system was unable to provide basic financial information.

Parliament was kept in the dark about Libra’s new shortcomings because “Gateway” review reports in IT-based projects and programmes are kept confidential. It is a pity for taxpayers and accountability on major projects that ministers are surrendering to the wishes of civil servants who want Gateway reports kept confidential.

NAO report on Courts Service.

CSC criticised again in The Times

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

Strewth! Managing public sector IT projects is also a challenge Down Under

By David Bicknell

A critical report by the Ombudsman in the Australian state of Victoria has meant that taxpayers will have to bear an additional A$1.44bn of costs because of mismanaged IT projects.

The Victorian Ombudsman George Brouwer looked at 10 major IT projects which suffered cost overruns under the Labour government, including the public transport ticketing system myki.

Mr Brouwer found each that project failed to meet user expectations, was delivered late and overran on cost.

The original budget for the projects was $1.3 billion but new estimates suggest the costs have more than doubled.

The report found the two largest projects, myki and the hospital IT system HealthSMART, would need almost $600 million more than originally planned, while Victoria Police spent $5 9 million on a Link crime database  over four years before it was cancelled. VicRoads spent $52 million on a licensing system RandL, which had not yet made it past the design phase.

The Ombudsman’s Report says:

“In Victoria over the last few years, in our respective roles as Auditor-General and Ombudsman, we have tabled in Parliament a number of reports relating to ICT-enabled projects. These reports have identified significant shortcomings in the public sector’s management of such projects and have included numerous recommendations about how such management can be improved.

“Despite these reports, we see little sign of lessons learnt in the public sector. The evidence to date is that the public sector is not managing ICT-enabled projects effectively, as demonstrated by the current difficulties that Victoria is facing in this area and the increasingly adverse public comment about major ICT-enabled projects. A new and more disciplined approach is required if the government is to avoid being faced with continuing cost overruns and failures to deliver.”

You can read the Ombudsman’s report here