Category Archives: public sector

Lessons from an IT disaster

Posted on 23/07/2012 | Leave a comment

By Tony Collins

Only rarely is an independent report on an IT-related disaster published.  So North Bristol NHS Trust deserves credit for publishing a report  by Pricewaterhousecoopers into the problematic go-live of Cerner Millennium in December 2011.  PwC calls the Cerner system a “business-critical patient record system”.

The implementation, says PwC,  resulted in significant continuing  operational difficulty. PwC was asked to review the implementation, identify what went wrong and make recommendations.

What is clear from PWC’s report is that North Bristol NHS Trust repeated the known mistakes of other trusts that had gone live with Cerner Millennium:

–          A lack of independent challenge

–          Not enough testing of the system and new business processes

–          Inadequate contingency arrangements

–          Not enough time for data migration

–          Training systems not the same as those to be used

–          Preparations treated as an IT project, not a change programme.

–          Differences between legacy and Cerner systems not fully understood before go live

–          Staff did not always understand new or changed business processes

In 2007 the National Audit Office reported in detail on the lessons from the go-live of Cerner Millennium at Nuffield Orthopaedic Centre, Oxford in December 2005.

One of those lessons was that the Trust did not learn lessons from earlier NPfIT Cerner Millennium go-lives. This happened again at North Bristol, suggests the PwC report:

“There were not dissimilar Cerner implementations within the Greenfield [other ex-Fujitsu and now BT-managed Cerner Millennium implementations under the NPfIT] systems running a few months before NBT’s [North Bristol Trust] implementation. Similar difficulties were experienced there, but they were more successfully addressed.”

Below are extracts from PwC’s report “Independent review of Cerner Millennium implementation North Bristol NHS Trust”.

“The success of an implementation of this scale, complexity and timing depends on substantial, robust and enduring programme management focusing on:

–          The IT implementation. Incorporating configuration of Cerner Millennium, infrastructure, security, interfaces and testing;

–          The migration of data from the two legacy PAS systems into Cerner Millennium;

–          Change management to engage and train stakeholders, embed change in the organisation and ensure that processes and procedures are aligned to the new system;

–          Continuous communication with users about changes to business processes as a result of the implementation; and

–          Quality control criteria and the association governance to ensure that go-live went ahead in a safe and sustainable manner.

–          The Trust needed stringent programme management with programme and project managers of the highest quality, to ensure that effective governance and project planning procedures were followed.

–          The go-live decision and assurances needed to pass strict criteria with sufficient evidence to provide assurance to the board that all necessary activities were completed prior to go-live.

The implementation in both the wards and the Emergency Department (ED) went well. Staff in ED were well engaged in the project and as a result were fully aware of the changes to their business processes at go live. There were some minor system issues initially but these were resolved quickly and ED was fully operational with Cerner Millennium soon after go live. One of the underlying factors in the success of the deployment to ED was that there was no data migration required as the historical data remains in the old system.

The launch in the wards went as expected; the functionality was tested well and the data was loaded manually, although there now appear to be issues with staff engaging and using the system as intended.

The majority of problems encountered at go live related to the theatre and outpatient clinic builds.

Outpatients had the most disruption immediately after go live. The Trust’s back office team had not finished building the outpatient clinics in Cerner Millennium, so the new and old systems did not mirror each other and data could not successfully migrate. Changes continued to be made to clinics in the old PAS systems, and these were not all reflected in Cerner Millennium.

Ad hoc clinics were used in the old PAS system to allow overbooking to maximise activity. These were not separated from real clinics at go live and migrated to Cerner Millennium as real clinics. The ad hoc clinics in PAS had deliberately abnormal timings so they could be excluded from time-based reports, for example 12:30am and 5:30am. The system generated letters for these ad hoc out- of-hours clinics, and many were sent to patients.

In the old system, clinics for a number of consultants could be pooled to facilitate patients seeing the next available consultant.  All clinics in Cerner Millennium are specific to a consultant and this caused significant confusion to administration staff using the new system.

PAS [the legacy patient administration system] treats “weeks” differently to Cerner Millennium. On migration, weeks were misaligned and the dates for clinics and theatres was incorrect. This created huge confusion as patient notes did not agree with Cerner Millennium , despite exhaustive work before go live to ensure that all patient notes were ready for the clinics that should have been on the system.  This also affected information in letters, with patients advised to attend their appointment on the wrong date.

There was a further issue in theatres relating to theatre procedure codes. The Trust did not map the old procedure codes to the new to ensure that all the required procedures would be available in Cerner Millennium for the data to migrate successfully. The Trust identified this issue soon after go live and has run a parallel manual process to ensure patients received the correct procedures.

The training provided to staff by the Trust did not equip them to be able to use Cerner Millennium at go live. The training environment did not mirror the system the Trust implemented as certain elements of the system were not complete when the training domain was created. Theatre staff and outpatient appointments could not train on a system with theatre schedules and outpatient clinics built in.

The Trust is now beginning to move out of the crisis and return to normal operations.

Lack of effective quality controls

There was insufficient rigour over the controls criteria and sign off of the gateway reviews.

There was inadequate operational control over the go live process, such as clinic freeze and updates pre-, during, and post go-live. Evidence from the interviews suggests that:

  • There was little challenge to confirm that the gateway criteria had in fact been met.
  • There was no evidence presented to the Cerner Programme Board or the Trust Board to demonstrate that the gateway criteria had been met.
  • There was not enough focus on or monitoring of risks and issues and their impact on go live.
  • The cleansing of old and out-of-date data from the legacy PAS systems was inadequate; as a result, erroneous data became live data in the Cerner system.
  • Data Migration issues were not all resolved and their impact on go live was not considered.
  • The outpatient and theatre builds were neither complete nor accurate, and there were no controls which could have detected this before go live.
  • There were inadequate controls over clinic freeze and clinic changes prior to go live.

Lack of effective programme planning

Programme plans were not rigorously updated as the programme progressed and planning around training, testing and data migration and build was not robust. The Trust failed to recognise this programme as a change programme and did not effectively manage the engagement and feedback from their stakeholders. Evidence from the interviews suggests that:

  • The Trust did not factor contingency into its programme plan to account for changes to the go live date.
  • The Cerner Programme Management Office was not effective because of inadequate resource and programme tools.
  • The Trust had a lack of sufficiently skilled resources for a project on this scale.
  • The Trust’s operational staff were not fully engaged in the Cerner project.
  • The Cerner project was treated as an IT project and not a business change programme.
  • The training was inadequate and did not provide users with the skills they needed to be able to use the system at go live.
  • The testing focused on the functionality of the system and not end-user testing of the outpatient and theatre builds.
  • There was no end-user testing of the final outpatient clinic and theatre builds prior to go live.
  • There was lack of understanding of roles within the wider programme team.
  • External parties offered NBT help and advice. They felt that the advice was not taken and the help was refused.

Lack of effective programme governance

Programme governance processes were not reviewed and updated regularly to ensure that they were adequate and there was inappropriate accountability for key decision making. During the implementation, the Trust established new overarching change management arrangements for the Building our Future programme. Evidence from the interviews suggests that:

  • The Cerner Project team failed to comply with the Trust’s Building our Future governance processes
  • The information presented to the Cerner Programme Board and the Trust board by the Cerner Project team was inadequate for them to make informed decisions;
  • The Cerner Programme Board was not effective; and
  • Significant issues relating to the theatre and outpatient clinic build were not escalated to the Cerner Programme Board or the Trust board.

PwC’s Conclusions

For a programme of this scale and complexity, the management arrangements were not sufficiently extensive or robust. There were many issues with the software and data migration, the training of users and operational go live planning. The Trust Board and the Cerner Programme Board did not plan to have, and did not receive, independent assurance that the state of the programme supported a decision to go-live.

Complex IT implementations are never without risks and issues that need to be managed, even at the point of go live. The scale of the issues in this implementation was not properly understood by those with responsibility, and as a result they were not in a position to make sound decisions.

Many of the problems are associated with poor data and process migration. Staff found that a significant proportion of migrated data was incorrect in the new system, and this had rapid and substantial operational impact which has taken a considerable time to rectify with manual processes. Staff needed to be more directly involved in migration and process testing.

The implementation was manifestly a complex change programme. But IT took the lead, and there was no intelligent customer with sufficient distance from IT to ensure products and progress were properly challenged.

There were not dissimilar Cerner implementations within the Greenfield running a few months before NBT implementation. Similar difficulties were experienced there, but they were more successfully addressed.”

PwC recommends that:

–  the Trust “stop and take stock”. It says  “The Trust needs to take stock of its position and develop a coherent and detailed plan for the remainder of the recovery stage. The Trust then needs to ensure that effective cross programme planning and governance arrangements are enforced for all current projects, especially those under the Building Our Future programme.”

PwC also recommends that the Trust carry out a:

–  Governance review

– Capability/capacity review

– Cross programme plan review

– Operational assessment

– Review of process and controls

– Review of information requirement

– Technical resilience/infrastructure review

– Review of access controls

Comment:

To me the PwC report throws up at least six points:

1) Are NPfIT go-lives more political than pragmatic?

In the 1990s Barclays Bank went live with new systems for all its branches. During the night (I was invited to watch the go-live at head office) the most striking element was a check list that asked questions on progress so far. The answers determined whether the go-live would happen. The check-list was completed repeatedly – seemingly endlessly – during the night.

Many  different types of mishaps could have stopped the go-live.  None did.  Go-lives of Cerner Millennium are different. They seem unstoppable, whatever the circumstances, whatever the problems.  There was nothing political about the Barclays go-live. But NPfIT go-lives are intensely political.

Would North Bristol’s board have accepted with equanimity a last-minute cancellation, especially after go-lives had been postponed at least twice before?

2)  Are NHS boards too focused on “good news” to oversee an NPfIT go live?

North Bristol NHS Trust deserves praise for publishing the PwC report.  But it’s not the whole story.  The report says little about any potentially serious impact on patients. Also it mentions (almost in passing) that the Trust board discussed in November 2011 the readiness of Cerner Millennium to go live. That discussion was probably positive because Millennium went live a month later. But there is no mention of that discussion in the Trust’s board papers for November 2011.

Why did the Trust discuss its readiness to go live in secret? And why did it keep secret its November 2011 report on its readiness to go live?

If North Bristol, like so many NHS trusts, is congenitally beset with a good news culture at board level, can the full truth ever be properly discussed?

3) Isn’t it time Cerner lessons were learnt?

After seven years of Cerner implementations in the NHS, several of them notorious failures, isn’t it time Trusts learnt the lessons?

4)  What’s the current position?

PwC’s report is succinct and professional. It’s also diplomatically-worded. There is little in the report that points to how the Trust is coping with the operational difficulties. Indeed it suggests the Trust is returning to normal. “The Trust is now beginning to move out of the crisis and return to normal operations,” says the PwC report. But that is, in essence, what the Trust has been saying publicly since January 2012.  PwC says nothing about whether the safety of patients has been jeopardized by the go-live.

5) Where were the Trust’s Audit Committee – and internal auditors?

Every NHS Trust has an audit committee and internal auditors to warn about things that are going wrong, or may go wrong. It appears that they were out to lunch when it came to North Bristol’s Cerner Millennium project and its consequences.  The Audit Committee seems hardly to have mentioned the project. Should North Bristol’s board hold the Audit Committee and internal auditors to account?

6) Is the Trust board to blame?

Perhaps rightly PwC does not seek to apportion blame. But did the Trust board ask the right questions often enough?  The tacit criticism in the PwC report is of the IT department and layers of management below board level. But is that criticism misdirected? If the board’s culture of encouraging good news – of “bring me solutions not problems” –  has not changed, perhaps little or nothing will have been learned from North Bristol’s IT-related disaster.

PWC report Independent review of Cerner Millennium implementation North Bristol NHS Trust.

Lessons from Nuffield Orthopaedic’s Cerner Millennium implementation in 2005.

North Bristol apologises over Cerner go-live.

New hospital system caused chaos.

MP asks why two Cerner systems cost vastly different prices.

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Posted in Campaign4Change, culture, e-health, Gateway reviews, governance, Government IT, health, health records, IT projects, IT-related failures, NHS, npfit, openness and transparency, operational issues, project management, public sector, public services

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All change for police IT – again?

Posted on 18/07/2012 | 4 comments

By Tony Collins

Police IT is supposed to have undergone a transformation over the past 13 years, thanks in part to a Home Office national police IT programme called NSPIS – for which Securicor Information Systems was awarded contracts worth more than £140m.

NSPIS contracts awarded in 1999 included:

– Case preparation: acquisition and delivery of forms, photographs, police reports, statements and other materials required in court for trying cases.

– Custody: booking in, tracking and monitoring of individuals held in police cells.

– Command and control: coordination and management of police operations.

– Crime: analysis of case histories and crime statistics.

With some reluctance, dozens of police forces took NSPIS systems with mixed success. The national transformation did not happen, though large sums were spent. NSPIS [National Strategy for Police Information Systems] was followed by another national IT-led transformation programme ISIS [Information Systems Improvement Strategy].

Now the government plans another police IT-led transformation. It is setting up a new company to improve police IT [as if the last so-called transformation programmes had not existed].

In a joint statement, the Home Office and the Association of Police Authorities say the new company will give strategic ICT advice to forces and procure, implement and manage ICT solutions for forces.

The company will “help police forces to improve their information technology and get better value for money from contracts”.

The police ICT company Ltd is now owned by the Association of Police Authorities and the Home Office but will be handed over to police and crime commissioners following elections in November.

In setting up the company Nick Herbert, the policing minister, says

“While some police IT is good, such as the new Police National Database, much of it is not.  There are 2,000 systems between the 43 forces of England and Wales, and individual forces have not always driven the most effective deals.

“We need a new, more collaborative approach and greater accountability, utilising expertise in IT procurement and freeing police officers to focus on fighting crime.

“By harnessing the purchasing power of police forces, the new company will be able to drive down costs, save taxpayers’ money, and help to improve police and potentially wider criminal justice IT systems in future.”

Chairman of the Association of Police Authorities Councillor Mark Burns-Williamson says that when the new company is handed over to police and crime commissioners “we want it to be fit for purpose and efficient in delivering IT tasks”.

The aim of the new company, says the Home Office and the Association of Police Authorities, is to “free chief officers from in-depth involvement in ICT management and enable greater innovation so officers have access to new technology to save time and ensure better value for the taxpayer”.

Police IT in a poor state?

UKAuthority.com reports that Tom Winsor, the new chief inspector of police, is “staggered” at the ineffectiveness of police IT.

Giving evidence to MPs he said

“I was staggered when I did my field work, in the police pay review, at just how low-tech the technology of the police is in volume crime and so on. It is extraordinary. They have computer screens that resemble those that we saw in the early 1980s. I mentioned the police officers doing their own two-finger typing and so on.

“It is the most extraordinarily archaic system. I think it is part of HMIC‘s role to expose inefficiency – and that surely is massively inefficient.”

Winsor said he had watched police officers standing in a queue for up to four hours at a time to book in a suspect. The private sector would not tolerate such delays, and would quickly change the system, he said.

Comment

With 43 forces buying their own IT it seemed sensible for the Home Office to try and introduce national systems.  As Neil Howell, the then IT Director at Hampshire Police Authority, said in March 2006, there was “political pressure to take up some systems – e.g. NSPIS Case and Custody ” but some national systems did not “match current level of functionality or requirements …”

In the NHS, several national IT-led transformation programmes preceded the NPfIT, but nobody in power wanted to know about the past when NPfIT was launched in 2003.

An extraordinary effort – and money – went into NSPIS  but police forces resented being told what to buy and in general were happy with own IT choices. Many were particularly happy with NSPIS rival systems from Canadian company Niche.

Perhaps the Home Office should accept that, apart from natural national systems such as the  Police National Database, Automated Numberplate Recognition, and the “Impact” intelligence sharing system, police IT is too complicated to be done nationally.

Mandating rarely works

Mandation rarely if ever works in the public sector. The Home Office and its agents cannot tell 43 autonomous police forces what technology to buy and implement.  Public bodies can, and do, circumvent mandation, sometimes by simply ignoring it, as National Audit Office reports point out.

The Department of Health  tried to tell trusts what to buy under the NPfIT and that didn’t work. Like police forces NHS trusts are largely autonomous.

Governments don’t have memories when it comes to failed IT-led transformation programmes. It may be good for civil servants and suppliers to learn new skills and experiment with IT on recycled transformation programmes.

But should suppliers learn at the expense of taxpayers? And should new ministers and civil servants keep launching new and exciting IT-led transformation programmes that fail as miserably as the last – giving excuses for a replacement set of ministers and civil servants to renew the cycle?

The Department of Health has finally learnt that what’s needed before the launch of any major  IT-led initiative is a frank appraisal of what has gone wrong in the past, and what can be learnt.  The DH achieves this in the “Impact Assessment” section of its latest IT strategy.  It’s not beyond the wit of police forces, the Home Office and the Association of Police Authorities to follow the DH’s example.

Unless they do, perhaps David Pitchford’s Major Projects Authority at the Cabinet Office should think twice before allowing large sums to be spent on new police IT.

Joint statement of Home Office and Association of Police Authorities

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Posted in outsourcing, Politics, private sector lessons for the public sector, procurement, project management, public sector, public services, public-private partnerships, reducing cost strategically

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All change at the DH, CfH and on NPfIT – or not?

Posted on 11/07/2012 | Leave a comment

By Tony Collins

Katie Davis is to leave as interim Managing Director of NHS Informatics, says eHealth Insider which has seen an internal memo.

.The memo indicates that Davis “intends to focus on being a full-time mother to her two children”.

She joined the Department of Health on 1 July 2011, on loan from the Cabinet Office where she was Executive Director, Operational Excellence, in the Efficiency and Reform Group.

Before that she was Executive Director of Strategy at the Identity and Passport Service in the Home Office.

The memo indicates that the director responsible for the day-to-day delivery of NHS programmes and services, Tim Donohoe, will take-over Davis’ role until NHS Connecting for Health shuts down at the end of March 2013.

CfH’s national projects look set to move to the NHS Commissioning Board in Leeds, while its delivery functions will move to the Health and Social Care Information Centre.

Davis had told eHeath Insider that her priorities included concluding a piece of unfinished business on the NPfIT – the future of the [CSC] local service provider deal for the North, Midlands and East.

Comment:

Davis has been a strong independent voice at the Department of Health. Partly under her influence buying decisions have passed to NHS trusts without penalties being paid by the NHS to NPfIT local service provider CSC.

It is a little worrying, though, that high-level responsibility for the rump of the NPfIT – CSC’s contracts, Choose and Book, the Spine, Summary Care Record and other centrally-managed projects and programmes – may fall to David Nicholson, Chief Executive of the NHS.

Labour appointed Nicholson in 2006 with a brief that included making a success of the NPfIT. He has been the NPfIT’s strongest advocate.

Indeed a confidential briefing paper from the Department of Health to the then PM Tony Blair in 2007 on the progress of the NPfIT said:

“… much of the programme is complete with software delivered to time and to budget.”

It is difficult to see the NPfIT being completely dismantled under David Nicholson. It’s probable that CfH will be shut down in name but recreated in other parts of the NHS, while the NPfIT programmes and projects run down very slowly.  It’s even conceivable that CSC’s and BT’s local service provider contracts will be extended before they are due to expire in 2015/16.

A comment on eHealth Insider says:

“My understanding is that NPfIT is leaving us with a legacy of ancient PAS systems barely fit for purpose which cost a fortune to operate and which will transfer to a massive service charge once national contracts end. That’s if you don’t count the most expensive PACS system in the universe. And I wonder what Lorenzo cost?”

It’s hard to argue with that. Meanwhile the costly NPfIT go-lives are due to continue, at Imperial College Healthcare NHS Trust, for example.

End game for Davis and CfH announced.

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Posted in Campaign4Change, change management, health records, IT-related failures, managing outsourced services, NHS, npfit, public sector, public services, reducing cost strategically

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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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Civil service reform plan – real change or a tweak?

Posted on 19/06/2012 | Leave a comment

By Tony Collins

The civil service reform plan is to be published this afternoon, at 3.30pm.  The Cabinet Office minister  Francis Maude and Sir Bob Kerslake, the head of the civil service, write about it in today’s Daily Telegraph.

They say that the plan will help deliver a civil service culture that is “pacier, more innovative, less hierarchical and focused on outcomes not process”. They write:

“We also need sharper accountability, in particular from permanent secretaries and those leading major projects, and we need more digital services, better data and management information and for policy and implementation to be linked seamlessly together…”

In the same edition of the Telegraph Andrew Haldenby,  director of the independent think tank Reform, criticises the reform plan which, although not yet published, has been foretold in newspapers including the Financial Times yesterday.

He said the reform plan will “leave the flawed structures of Whitehall in place and do no more than propose some minor variations on a theme”.

We await publication of the paper before we judge it. We hope it will, at least, require the publication of “Gateway” review reports on the progress or otherwise of major IT-enabled projects.

Without timely publication of the Major Projects Authority’s Gateway reports, MPs and the public will continue to learn of failed schemes such as the NPfIT and Firecontrol when it is too late to do much about any rescue; and without contemporaneous publication there will continue to be no accountability for the rigour or otherwise of the reviews, or their outcome.

Civil service reform – meltdown or business as usual? – Institute for Government

Cabinet Office promises unprecedented openness on big, risky projects.

Civil service shake-up – Guardian

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Posted in Campaign4Change, change, change management, Cloud Computing, cost avoidance, cost reduction, culture, Government IT, IT projects, IT-related failures, Major Projects Authority, managing change, openness and transparency, public sector, public services

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Whitehall to relent on secrecy over mega projects – after 10-year campaign?

Posted on 29/05/2012 | 1 comment

By Tony Collins

The Cabinet Office may be about to change its decade-old policy of not publishing reports on  the progress or otherwise of its large, costly and risky IT-based projects.

A change of policy from secrecy to openness would give MPs and the public warning of when a major project is in trouble and needs rescuing or cancelling.

Parliament last to know

For more than a decade campaigners have sought to persuade successive governments to publish “Gateway” reviews, which are short independent audits on the state of big projects.  The secrecy has meant that Parliament is usually the last to know when new national schemes go wrong. IT-related failures have hit many public services including those related to tax, benefits, immigration, passports, the fire service, prisons, schools examinations, student loans, the police and health services.

Now Sir Bob Kerslake, head of the civil service, has hinted to campaigning Conservative MP Richard Bacon that the Cabinet Office may change its policy and publish the “red, amber, green” status of large projects as they are routinely assessed.

Kerslake was replying to Bacon at a hearing of the Public Accounts Committee meeting on transparency. Bacon pointed out at the hearing that the Public Accounts Committee had, years ago, called for Gateway reviews to be published.

Not learning from mistakes

“Something I have always been puzzled by is why government does not learn from its mistakes particularly but not only in the area of IT where things go wrong again and again, again and again,” said Bacon. “I have come to the conclusion government does not learn from its mistakes because it does not have a learning curve. If you don’t have a learning curve you are not going to learn.”

He cited the example of how Ian Watmore, Permanent Secretary at the Cabinet Office, had, at Bacon’s request, arranged for an “Opening Gate” report on Universal Credit to be published in the House of Commons library.

But, said Bacon, when an IT journalist applied to the Department for Work and Pensions, under the FOI Act, for the release of all Gateway reports on Universal Credit, the DWP would not publish any of them  – and even refused an FOI request to release the report Watmore had arranged to be placed in the House of Commons library, which Bacon obtained.  “So there is still a culture of intuitive, instinctive secrecy,”  Bacon said. Kerslake replied:

“Yes, actually we are looking at this specific issue as part of the Civil Service Reform Plan….I cannot say exactly what will be in the plan because we have not finalised it yet, but it is due in June and my expectation is that I am very sympathetic to publication of the RAG [red, amber, green] ratings.”

Bacon pointed out that the Cabinet Office Structural Reform Plan Monthly Implementation Updates had said Gateway reviews would be published.  But the commitment was removed for no apparent reason. When the Cabinet Office was asked why,  it said the Structural Reform Plans were only ever “drafts”.

Bacon asked Kerslake if the Government now plans to publish the Gateway reports.  “The Cabinet Office Structural Reform Plan Monthly Implementation Updates originally said Gateway reviews would be published  and then it somehow got downgraded into a draft; and from what’s publicly available at the moment the position of the government is not to publish Gateway reviews.  You sound as if you’re saying that’s going to change. Is that right?” asked Bacon.

“Watch this space,” replied Kerslake. “I am sympathetic. I generally broadly welcome, in principle, the idea of publishing information but there are lots of risks …”

Peter Gershon introduced Gateway reviews when he was Chief Executive of the Office of Government Commerce, which is now part of the Cabinet Office’s Efficiency and Reform Group. The reviews are carried out at key decision times in a project and are sometimes repeated:

  • Gateway Review 0 – Strategic assessment
  • Gateway Review 1 – Business justification
  • Gateway Review 2 – Procurement strategy
  • Gateway Review 3 – Investment decision
  • Gateway Review 4 – Readiness for service
  • Gateway Review 5 – Benefits realisation

Are Gateway reviews a success?

Gateway reviews are now supplemented by regular assurance audits carried out for the Cabinet Office’s Major Projects Authority. None of the reports is published.

Gateway reviews have not stopped costly failures such as Firecontrol or the NPfIT.  One permanent secretary told an MP that the reviews in his department were considered unimportant by senior responsible owners, for whom the reports are written. This may be because SROs often have charge of many projects; and even their SRO responsibilities are often in addition to their main jobs.

But Gershon had high hopes of Gateway reviews when they were introduced in February 2001. This is evident from the number of times he referred to Gateway reviews at one hearing of the Public Accounts Committee in December 2001.

 “… as the Gateway review process cuts in, which I have referred to on a number of occasions when I have appeared at this Committee …”

“… Through things like the Gateway process we are helping to sharpen the focus on the whole life aspects of these and other forms of complex projects in public sector procurement…”

“ …First, we have the introduction of the Gateway review process…”

“ … The Gateway process is a demonstrable example of how we have introduced a technique to support that whole life approach…”

“… If you look at the guidelines around the Gateway review process that is one of the things that is tested by these independent reviews …”

“… we recognised that that was a problem some time ago, which is why in the Gateway review one of the things that is explicitly tested is things like the skills and capabilities of the team at the design and build stage and that the skills and capabilities of the team at the procurement stage …”

“… in this area with the Gateway review process, from when we first launched it last February, we have been helping the department take a whole life approach to these forms of complex projects …”

“… Part of the Gateway Review process is to get a much sharper insight on to where we see good things happening where we can encourage other clients to replicate them…”

“… Now, with the Gateway Review process, my experience has been because of where we have deliberately focused the attention on the early life of projects where there is the greater scope for management to take corrective action, the accounting officers are paying a lot of attention to the recommendations that are emerging because, much to my surprise, most of them do not seem to like coming here defending what has gone wrong in the past. They seem to welcome the recommendations that we are providing to them to help try to get projects on to much stronger foundations in the future…”

“… With the Gateway Review, my experience has been that the Accounting Officers respond to the recommendations very positively…”

“…Gateway Reviews explicitly test how the department is planning in the pre-contract phase to secure ongoing value for money in the post-contract phase…”

“… Take, firstly, the Gateway Review process. That is testing various points in the life cycle of the project, from the very earliest stage…”

“… I would certainly expect in Gateway Reviews that the review team would be testing what methods were in place to facilitate the ongoing management of the contract…”

“… I think it is encouraging that Sir Ian Byatt thought the Gateway Review process had sufficient value to recommend it in his own review…”

And so forth.

Comment:

We applaud Richard Bacon MP for his persistent call for Gateway reports to be published.

Gateway reviews have defeated expectations that they would stop failures; and the National Audit Office tells us that central departments don’t even request Gateway reviews on some big and risky projects although they are supposed to be mandatory.

But Gateway and other project assurance reports could prove invaluable if they are published. In the public domain the reports would enable Parliament and Francis Maude’s “armchair auditors” to hold officials and SROs to account for projects that are in danger of failing. That would be an incentive for officialdom to fail early and fail cheaply; and Gateway reviewers may take greater care to be neutral in their findings – not too lenient, or too harsh – on the basis that the reports would be open to public scrutiny. SROs would also have to take the review reports seriously – not just put them in a draw because nobody knows about them anyway.

We welcome Kerslake’s comments but hope that he and his colleagues plan to publish more than the RAG (Red/Amber/Green) status of projects. Otherwise they will be missing an opportunity.  Gateway reports and other assurance reviews are expensive. Reviewers can earn up to £1,000 a day. This money  could be well spent if the reviews are to be published; but it will add to public waste if the reports are kept secret and continue to be deemed pointless or unimportant by departments.

It is ironic, incidentally, that the Ministry of Justice, which introduced the FOI Act, gives advice to departments to keep the RAG status of Gateway reviews confidential. In its advice on Gateway reviews and the FOI, the MoJ tells departments that the “working assumption” is that the substance of the Gateway reports should be kept confidential until at least two years have elapsed.

It’s time for a culture change. Maybe the Civil Service Reform Plan next month will be worth reading.

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Posted in change management, cost reduction, culture, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, IT-related failures, Major Projects Authority, managing change, NHS, npfit, openness and transparency, oversight, Politics, project management, public sector, public services, Universal Credit

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Fire ‘superstations’ without software cost £1m a month – The Times

Posted on 24/05/2012 | Leave a comment

By Tony Collins

The Times reports today that taxpayers are paying more than £1m a month on the rent and upkeep of fire control rooms across England that have never been used. The purpose-built control centres look ready for immediate use, with open-plan desks fitted with desktop monitors and keyboards, and huge screens on a wall at the front of the control rooms which are supposed to help fire and rescue crews mobilise appliances and manage incidents.

Only there’s no working software.  The Department for Communities and Local Government negotiated the end of a contract with the main contractor EADS for software to run the regional control centres in December 2010. Officials concluded that the software could not be delivered within an acceptable timeframe. The regional control centres were completed before the IT project was cancelled.

The cost of the centres has been uncovered after a request under the FOI Act. The Times devotes much of its page three to a story under the headline:

Revealed: scandal of the £1m-a-month fire service ‘superstations’ lying empty.

Only one of nine regional centres is in use. The other eight incur rent, electricity, water and repair costs at £1,134,566 a month. Costs will be incurred for years because there are no break clauses in the agreements to lease the buildings. Two leases come to an end in 2027, one in 2028, two in 2032, three in 2033 and one in 2035.

A spokesman for the Department said that agreement has been reached for a further two of the buildings to be used by local fire authorities. Officials are searching for public or private sector tenants to occupy the other regional centres.

Lord Prescott, the former Deputy Prime Minister, who authorised the start of the technology project in 2004,  said he had been kept in the dark by civil servants on the rising costs of the scheme. He said it had been on budget when he left the department in 2007.

Eric Pickles, the Communities Secretary, said the failure of Firecontrol was an “expensive reminder of why you can’t trust Labour to run anything”. But the Coalition’s coming to power has not stopped central government IT-related failures.

Why Firecontrol failed

Firecontrol  followed the same tracks to a cliff edge that have caught out civil servants, ministers and suppliers on other government  computer-related projects.

The National Audit Office and the Public Accounts Committee found that  the Firecontrol project was rushed, had little support from those who would use it, costs and complexity were underestimated, there was an over-reliance on consultants and a lack of accountability for decisions made  – or not made.

The idea was to replace 46 local control rooms with nine, linked regional centres, which would be equipped with new standardised computer systems to handle calls, mobilise equipment and manage incidents.

But the project was cancelled in December 2010 with ministers unsure the technology would ever work. The NAO estimates that £469m will be wasted on the project.

The NAO found that the scheme was “flawed from the outset”, largely because local fire and rescue officers did not want regional centres or major changes in the way they worked.  Introducing any large new system is difficult but with enthusiastic support serious problems can sometimes be overcome; but introducing a complex new system without support from those who would use it means staff will have little incentive to find ways around problems.

The NPfIT [National Programme for IT in the NHS] failed in part because it lacked support among GPs and NHS staff; and the complexity of introducing standardised technology in semi-autonomous hospitals – each one with different ways of working – was underestimated. It was the same with Firecontrol.

The complexity of introducing standardised systems in regional centres with no goodwill among staff – was underestimated.  From the start many local fire and rescue officers criticised the lack of clarity on how a regional approach would increase efficiency. “Early on, the Department’s inconsistent messages about the regionalisation of the Fire and Rescue Service led to mistrust and some antagonism,” said the NAO.

The technology project was rushed while local fire crews were excluded from project discussions. “The project progressed too fast without essential checks being completed. For example Departmental and Treasury approval was given without proper scrutiny of the project’s feasibility or validation of the estimated costs and savings,” said the Public Accounts Committee. The project went ahead before the full business case was written.

A review of the project as early as April 2004 found that the scheme was already in poor condition overall and at significant risk of failing to deliver. But the “Gateway” review report was kept secret for seven years.

Is the stage set for IT disasters in government to continue? So far the Coalition has decided, like Labour, to keep secret all internal reports on the progress or otherwise of its mega projects, including Universal Credit, though the policy on secrecy may be about to change, which Campaign4Change will report on separately.

Firecontrol – same mistakes repeated on other projects.

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Posted in Campaign4Change, change management, consultants, culture, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, IT projects, IT-related failures, local government, managing change, npfit, openness and transparency, Politics, project management, public sector, public services

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Farewell to Ian Watmore – the antithesis of Sir Humphrey

Posted on 17/05/2012 | 4 comments

By Tony Collins

A good insight into the departure of Ian Watmore comes from Peter Smith of Spend Matters who says:

 “He (Watmore) lives in Cheshire still (and does a weekly commute to London) and this seems to be driven by personal factors – he wants to do more non-executive stuff,  work with charities, education bodies, and support his wife who is being ordained as a vicar shortly.

“There will be a competition to replace him but Melanie Dawes (?) will be the interim Perm Sec.”

Watmore leaves in June at the height of his civil service career. It would be too easy to cite his background as UK Managing Director of Accenture to say that he came to the civil service with a sympathy for big suppliers and not upsetting the smooth-running of the government IT machine.

Indeed he will not go down in civil service history as a heavy-handed enforcer of central government reforms: he respects too much the work of senior civil servants and particularly CIO colleagues to be seen as an opponent whose will cannot be overcome.

Rather he has been an authoritative go-between, a pragmatist who has sought to implement the radical cost-saving measures demanded by the Cabinet Office minister Francis Maude without giving departments any excuse to cite central diktats as the reason for disruption to frontline services.

Watmore gave an insight into his relationship with Maude at a Parliamentary committee hearing earlier this year. His comments also exploded the myth that the private and public sectors can be run on comparable lines.

“I have been on both sides of the divide on private and public,” said Watmore. “The thing that is different about  the public sector is the combination of leadership from the ministerial class and the civil service class. There is no corporate analogue for it. People talk about the way it analogises to the business world—I don’t think it does; it is different…

“I work on a daily basis with Francis Maude. I am not going to make any political comments about Francis, but as a man I feel that he cares about what he is doing;  he knows his stuff and he drives us very hard. In response, I give, shall we say, robust advice in return. Mostly, he listens and sometimes I defer to him and we come back to the same place we started, but more often than not we flesh out the differences behind closed doors and then we come out on a united front. I think that is the best way to get civil service and ministerial leadership. If you have a weakness in one part or the other, the whole thing breaks down.”

At Campaign4Change we will remember Watmore’s career in the civil service for his openness, honesty and lack of ego.

When answering questions before Parliamentary committees, some permanent secretaries seem to see MPs as adversaries. These civil servants’ replies are characterised by clever, evasive or adversarial comments.  They apologise if the mistakes were before their time but usually they’re protective of their departments, as if defending their children against criticism by outsiders.

Watmore is the antithesis of the archetypal civil servant.  Whereas, for example, most civil servants want to keep confidential internal “Gateway” reports on the progress or otherwise of high-risk IT and construction projects, Watmore is on record as saying he would like them published (though they haven’t been).

And he has earned respect among MPs for his straightforwardness. He’ll speak lucidly on his department’s achievements, but not his own.

How much effect he has had on other departments is hard to gauge. It’s difficult to see how the most ruthless enforcer in the Cabinet Office could ever have much influence in other departments.

For though the Cabinet Office has powers from David Cameron to enforce cost-savings,  departmental heads remain accountable for their own decisions. Watmore has spoken of the tensions between the Cabinet Office and departments.  He told MPs earlier this year:

“There are lots of examples where we and Departments have common cause. There will be times when we challenge what they want to do and it can be a tense relationship. Sometimes we agree with what they were going to do anyway, and other times they agree with us, but it means that we are engaging with them.”

Chair: How well is it working on a scale of one to 10 … on the cross-departmental working?

Watmore: “On the whole cross-departmental working, I would say it is somewhere around the six or seven mark. There is more to do.”

Watmore shuns the trappings of high office.  He doesn’t even have an office. “I refuse to have one,” he told MPs this year. “I don’t believe in physical offices for managers. I hot-desk wherever I happen to feel it is appropriate to work that week…

“What I tend to do is I move around and I sit with a different group in the Cabinet Office for a week. Initially people think it is a bit odd having the Permanent Secretary sitting next to them but once you carry on as normal they realise you are just another person working there.

“You actually get to find out quite a lot about how the operation works by being there with the staff for a week as well as hearing from them in a more formal setting…

“It is how I operated when I was in business so it is a long-term way of working. But when I came into Government I discovered it by accident; when I wanted to move the staff from two different bits of Government into a new building and introduce flexible working, hot-desking and all the rest of it, I said, ‘If it is good enough for the rest of the staff, it should be good enough for me…’

Will Maude find someone authoritative and influential but without a big ego to replace Watmore at the top of the Cabinet Office? A difficult assignment.

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Posted in capacity building, efficiency savings, governance, Government IT, Major Projects Authority, openness and transparency, procurement, public sector, supplier relationships

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