Category Archives: public services

Excerpts from report on GovIT: Recipe for rip-offs – time for a new approach

By Tony Collins

Today’s comprehensive report on the government’s use of IT is replete with strong and important messages, particularly on the domination of government IT by a small number of large suppliers, so-called systems integrators.

That said, Techmarketview, which tracks developments in the IT supplier market, has today attacked the report of the Public Administration Select Committee.  Techmarketview’s analyst Georgina O’Toole concedes she has not looked carefully at the full report but says she is irritated by the summary’s sensationalism.

It may be worth remembering that Parliamentary committees compete with each other for media attention. A bland report will be pointless: it won’t be read. Today’s report of the PASC, though, seeks more often than not to give the balacing view whenever it says something tendentious.  

For ease of explanation the Committee’s report “Recipe for rip-offs – time for a new approach” refers to government as if it were a single entity.

But government is, to some extent, at war with itself. The Cabinet Office is trying to have more influence over departments, in encouraging them to use SMEs,  adopt agile methods, simplify working practices and cut costs; and while the Cabinet Office has a mandate from David Cameron to enforce its wishes, in practice departments are giving strong reasons for not acting:

-long-term contracts are already in force

– EC procurement rules mean that SMEs cannot be preferred over other suppliers

– SMEs give insufficient financial assurances and could go bust at any time

– there are not enough internal staff and skills to manage a plethora of smaller companies

– existing (large) suppliers employ hundreds of SME as subcontractors.

There’s a particularly telling passage in the PASC report. It gave details of an exchange between the Department of Work and Pensions and Erudine, an SME. The Committee was given details of the exchange during a private session.

Erudine had given the department a way of migrating a legacy system onto a more modern, cheaper platform, which could generate potential savings of around £4m a year.

A senior DWP IT official rejected the proposal and suggested that the department was maintaining an interest in SMEs for political reasons – the government’s wish for 25% of contracts to be given to SMEs. This was part of what the DWP official said to Erudine:

“.. we have as you know an ‘interest’ in having SMEs present and working in the department for good political reasons. So you have other value to us … purely political.

“You guys need to be realistic. I will be very candid with you […] it is a huge amount of bother to deal with smaller organisations. Huge. And we wouldn’t necessarily do that because it doesn’t make our lives simpler.”

The Department declined to comment on the exchange and said the views expressed did not represent its own. It told the Committee that in 2009/10 SMEs made up 29.3% of their supplier base, either as a prime contractor or a subcontractor.

The Committee welcomed this assurance from the Department but added:

“… this account does suggest that attitudes at official level risk undermining ministers’ ambitions to increase the number of SMEs Government contracts with directly”.

These are other extracts from the PASC report:

Overcharging by large suppliers – an obscene waste of public money?

They [SMEs] also alleged that a lack of benchmarking data enabled large systems integrators (SIs) to charge between seven  to ten  times more than their standard commercial costs.

**

Having described the situation as an “oligopoly” it is clear the Government is not happy with the current arrangements. Whether or not this constitutes a cartel in legal terms, it has led to the perverse situation in which the governments have wasted an obscene amount of public money.

The Government should urgently commission an independent, external investigation to determine whether there is substance to these serious allegations of anti-competitive behaviour and collusion. The Government should also provide a trusted and independent escalation route to enable SMEs confidentially to raise allegations of malpractice.

Vested interests suppress innovation?

We received suggestions from some SMEs that the major systems integrators used legacy systems as leverage to maintain their dominance. Some SMEs reported that there were solutions that could easily transfer data from old platforms, but that a combination of risk aversion and vested interests prevented these solutions being adopted

Large IT contractors are “not performing well”

The Government’s analysis has shown that its large IT contractors are not performing well. A Cabinet Office review in September 2010 of the performance of the 14 largest IT suppliers found that none of them were performing to a “good” or “excellent” level, with average performance being a middling “satisfactory with some strengths”. Some were performing significantly worse.

Openness would help to cut costs

Making detailed information on IT expenditure publicly available for scrutiny would enhance the Government’s ability to generate savings, by allowing external challenge of its spending decisions.

The Government has already taken steps to provide more information about IT projects and expenditure in general, especially through the work of the Transparency Board and its publication of contracts on Contract Finder. To realise the full benefits of transparency, this is not sufficient. More information should be made public by default.

It should publish as much information as possible about how it runs its IT to enable effective benchmarking and to allow external experts to suggest different and more economical and effective ways of running its systems

Will government objectives be achieved?

We received numerous reports from SMEs about poor treatment by both Government departments and large companies who sub-contract government work to SMEs. There is a strong suspicion that the Government will be diverted from its stated policy and that its objective will not be achieved.

The drawbacks of using SMEs as subcontractors to large suppliers

“… subcontracting could lead to the Government paying a high price as it had to cover the margin of both the sub and prime contractor.

**

SMEs approached us informally to express concerns based on their own experiences of subcontracting. We heard of cases where systems integrators [large IT suppliers] had involved SMEs in the bidding process so they could demonstrate innovation, only for the SME to be dropped after award of contract.

In some of these cases SMEs felt that they have provided innovative ideas which had then been exploited by the larger systems integrators. We were also told by SMEs that by subcontracting with an SI they were barred from approaching government directly with ideas that might allow it to radically transform its services and reduce costs. This was because systems integrators did not want the Government to be provided with ideas that could result in them losing business, or having to reduce costs.

“… When we put these [SME] concerns to the Government we were told that their contracting arrangements did not stop subcontractors speaking directly to Departments…However, during our private seminar with SMEs, we were told that this did not reflect their experiences. SMEs reported that they were instructed to approach the systems integrator first in order to obtain permission to talk to a Department and that some Departments refused to deal with them directly.

**

We take seriously the concerns expressed by many SMEs that by speaking openly to the Government about innovative ideas they risk losing future business particularly if they are already in a sub-contracting relationship with a systems integator.

Government should deal directly with SMEs

The Government should reiterate its willingness to speak to SMEs directly, and commit to meeting SMEs in private where this is requested. We recommend that the Government establish a permanent mechanism that enables SMEs to bring innovative ideas directly to government in confidence, thereby minimising the risk of losing business with prime contractors.

Is government policy shutting out SMEs even more?

“…the Government has been moving to act as a single buyer to obtain economies of scale… This approach can be counter-productive. The effect of demand aggregation can be to aggregate supply, further concentrating contracts in the hands of a few large systems integrators.

Departments are following instructions from the Cabinet Office Efficiency and Reform Group to switch away from their existing direct SME contracting arrangements in favour of centralised procurement models. This would mean that SMEs would become tier 2 suppliers behind selected large suppliers, preventing SMEs from contracting directly with departments. The Cabinet Office has confirmed that:

Spend is being channelled into three current channels: a) existing framework contracts where spot buying is undertaken centrally (this is known as Home Office Cix), b) department-specific arrangements based on their unique needs (such as FCO’s arrangements with Hays) and c) an existing contract with Capita, owned and managed by DWP and available to all government departments.

It is unclear to us how narrowing the supply channels will create a more open and competitive market. The nature of this supply-side aggregation of SMEs under large contracts appears to be in direct contradiction of the policy articulated by the Minister when he indicated his desire to encourage Departments to secure more direct contracting with SMEs.

“… the Government’s plan to act as a single buyer appears to be leading to a consolidation towards a few large suppliers. This could act against its intention to reduce the size of contracts and increase the number of SMEs that it contracts with directly. We are particularly concerned with plans to move SME suppliers to an “arm’s length” relationship with Government. The Government needs to explain how it will reconcile its intentions to act as a single buyer, secure value for money and reduce contract size to create more opportunities for SMEs.

Procurement barriers for SMEs

The way procurement currently operates favours large companies that can afford to commit the staff and resources to navigate the convoluted processes. It also encourages the Government to confine discussions to as few potential contractors as possible.

If the Government is serious about increasing the amount of work it awards to SMEs it must simplify the existing processes

**

We recommend that the Government investigate the practices which seem unintentionally to disadvantage SMEs. When contracts and pre-qualifying questions are drawn up thought must be given to what impact they could have on the eligibility and ability of SMEs to apply for work, and whether separate provision should be made for SMEs. We believe it would be preferable if the default procurement and contractual approach were designed for SMEs, with more detailed and bespoke negotiation being required only for more complex and large scale procurements.

Have Departments the people and skills to handle more SMEs?

Increasing the use of SMEs will place extra pressure on departments. The management of smaller organisations is currently outsourced to the large systems integrators.

For example the Aspire framework provides HMRC with access to over 200 IT suppliers. Mr Pavitt, HMRC Chief Information Officer said that:

“managing those individually would be quite a heavy bandwidth for a Government department”.

It is not clear that Departments are willing to take on the additional work that contracting directly with SMEs implies even where this could yield significant savings…

Ministers need to ensure their officials have the skills, capacity and above all the willingness to deliver on ministerial commitments to SMEs.

On agile methods:

“… greater use of agile development is likely to necessitate behaviour changes within Government. As agile methodology requires increased participation from the business to provide feedback on different iterations of the solution, departments will need to release their staff, particularly senior staff with overall responsibility of the project, to allow them to participate in these exercises.

Agile development is a powerful tool to enhance the effectiveness and improve the outcomes of Government change programmes. We welcome the Government’s enthusiasm and willingness to experiment with this method. The Government should be careful not to dismiss the very real barriers in the existing system that could prevent the wider use of agile development.

We therefore invite the Government to outline in its response how it will adapt its existing programme model to enable agile development to work as envisaged and how new flagship programmes will utilise improved approaches to help ensure their successful delivery….

The Government will have to bear in mind the need to facilitate agile development as it renegotiates the EU procurement directive and revises the associated guidance.

Need for more people with the right skills to manage suppliers

Managing suppliers is as important as deciding who to contract with in the first place. To be able to perform both of these functions government needs the capacity to act as an intelligent customer. This involves having a small group within government with the skills to both procure and manage a contract in partnership with its suppliers.

Currently the Government seems unable to strike the right balance between allowing contractors enough freedom to operate and ensuring there are appropriate controls and monitoring in-house.

The Government needs to develop the skills necessary to fill this gap. This should involve recruiting more IT professionals with experience of the SME sector to help deliver the objective of greater SME involvement.

When disaster strikes is anyone responsible?

We are concerned that despite the catalogue of costly project failures rarely does anyone – suppliers, officials or ministers – seem to be held to account. It is therefore important that, when SROs do move on they should remain accountable for those decisions taken on their watch, and that Ministers should be held accountable when this does not happen.

Open source and open standards

Recent initiatives such as the Skunkworks team, dotgovlabs, data.gov.uk, and the Alphagov project suggest that the Government is moving in this direction

Government should omit references to proprietary products and formats in procurement notices, stipulating business requirements based on open standards. The Government should also ensure that new projects, programmes and contracts, and where possible existing projects and contracts, mandate open public data and open interfaces to access such data by default..

Report’s conclusion

“… The last 10 years have seen several failed attempts at reform. The current Government seems determined to succeed where others have failed and we are greatly encouraged by its progress to date.

“Numerous challenges remain and fundamentally transforming how Government uses IT will require departments to engage more directly with innovative firms, to integrate technology into policy-making and reform how they develop their systems.

“The fundamental requirement is that Government needs the right skills, knowledge and capacity in-house to deliver these changes. Without the ability to engage with IT suppliers as an intelligent customer – able to secure the most efficient deal and benchmark its costs – and to understand the role technology can play in the delivery of public services, Government is doomed to repeat the mistakes of the past.”

Links:

Jerry Fishenden, adviser to the PASC, gives his view of the report.

Today’s Public Administration Committee report: Recipe for rip-offs – time for a new approach

Government reliance on large IT suppliers is recipe for rip-offs.

Government IT rip-offs – surely time for a new approach – my view of the report

Techmarketview on the report

Good analysis of PASC report – Centre for Technology Policy Research.

MP responds to our campaign on £265m extra spend on Siemens passport IT contract

By Tony Collins

Richard Bacon, a Conservative MP on the Public Accounts Committee, has written to the head of the National Audit Office to ask that he consider an inquiry into £265m of extra payments to Siemens on a passport IT contract.

It comes after the Home Office declined to explain why a contract with Siemens that was expected to cost £80m to £100m ended up costing £265m.

On Monday this week Home Office spokesman Andrew Bell politely declined to answer any of Campaign4Change’s questions on the Siemens contract.

As a result we forwarded to Bacon emails of our questions to the Home Office and its answers.    

Now Bacon has written to Amyas Morse, head of the National Audit Office, drawing his attention to our email exchange with the Home Office.

Says Bacon in his note to Morse:

“I wondered if the NAO might consider looking at the Siemens contract for the IT infrastructure for the passport service?  The Home Office appears to see relatively little need to justify the fact that an £80-100 million contract with Siemens actually cost £365 million.”

Bacon also pointed out to Morse that CSC has replaced Siemens on the passport IT contract. CSC is a main supplier on the NHS National Programme for IT, NPfIT.  In a report due to be published shortly by the Public Accounts Committee, CSC’s work on the NPfIT is likely to be heavily criticised.

Unless the NAO investigates the passport contracts Parliament will have no certain way of knowing whether the CSC passport IT contract, like the Siemens deal, is deviating from the original expected costs, scope or timetable.

Officials are keeping Gateway reviews secret – though these could give MPs an insight into progress of the CSC passport contract.  

My questions to the Home Office, and its reply, are here.

Mutuals: Public sector ethos + drive + vision – excess process = innovation

By David Bicknell

Moving services from direct control to employee-led mutuals is a way for staff to create their own vision for what they want to achieve for the public, free from the constraints of tortuous processes and long-winded decision-making that strangle good ideas. Procurement rules, for example, are often condemned as the greatest block on innovation, as this Guardian article discusses.

It also covers what makes a public sector ethos and discusses the importance of not only changing structure through mutuals, but changing culture as well.

MPs to publish report on Govt IT rip-offs – “time for a new approach”

By Tony Collins

On Thursday the Public Administration Select Committee will publish “Government and IT— a recipe for rip-offs: time for a new approach”.

The report is the culmination of months of investigation by the Committee and its advisers into the way government buys and uses IT.

The Committee’s witnesses included representatives of SMEs who suggested that government IT is dominated by a few large suppliers that charge too much and suppress innovation.

One of the SME representatives, Martin Rice, said the IT industry should apologise.  He told the Committee: “I think the IT industry should  publicly apologise to the citizen for the rip-offs of the last 10 or 20 years.”

He added:
“We are reinventing the wheel and it should not be allowed.  As a taxpayer, I am very angry about this … A lot of these problems have been solved; they are not being brought to the Government because of the oligarchy.  It is not in a profitable interest to bring you these paradigms.  That is why I feel the oligarchy has to stop…”
In written evidence Rice said that prime contractors, being the gatekeepers for some projects, “can and do prevent deployment of innovation that can make subsequent change requests cheap or quick to do as they threaten their lucrative revenue streams”.
Lawyer Susan Atkinson was among those who argued in their written evidence that agile methods can be usefully adopted by departments.

Siemens given extra £265m on passport contract

By Tony Collins

Changing the culture of the Home Office will be quite a challenge – but not an impossible one.

The immigration minister Damian Green has revealed in a Parliamentary reply that Siemens received at least £265m more than expected on a contract to build and run passport IT systems.

The extra money to Siemens was funded by the fees charged to passport applicants. The Home Office requires that the Identity and Passport Service covers its costs from passport fees – which have more than trebled since the start of the contract.

In September 1999, the fee payable by a member of the public making a postal application for a standard 10-year passport was:

– £21 for a standard passport

– £31 for passports issued over-the-counter.

Today a passport costs:

– £77.50 for a standard passport

– £129.50 for one over-the-counter.

Campaign4Change asked the Home Office for an explanation of the extra payments to Siemens. Its spokesman gave only a general account which answered none of our specific questions.  

When we expressed gratitude to Andrew Bell in the Home Office’s press office for his quick response to our questions and pointed out that he hadn’t answered any of them he replied: “We have nothing to add”.

What’s clear is that the Home Office may be under new coalition management but its culture of non-accountability and secrecy haven’t changed.

It’s also clear that, with Gateway reviews remaining secret, Parliament has no certain way of knowing when any large IT-enabled change contract is deviating substantially from the contract in time, scope or costs.

In 2009 the Home Office replaced Siemens with CSC as the main passport IT supplier contract. Have extra payments been made to CSC under its £385m 10-year passport contract? Parliament has no idea, and neither do we.

Damian Green reveals extra payments to Siemens

This was Damian Green’s reply to a question by SNP MP Dr Eilidh Whiteford.

Dr Whiteford: To ask the Secretary of State for the Home Department what the original estimate, at current prices, was for the cost to the public purse of the Siemens IT system for the Passport Agency; what the final cost, at current prices, was at the time of completion; and whether additional costs have been incurred since completion.

Damian Green: At the time of contract award, the anticipated contract value was between £80 to £100m over a 10-year period. The contract duration extended to 11 years at a total cost of approximately £365m.”

Green added: “The increase in costs over the term of the Siemens contract can be attributed to numerous factors including additional demand for passports, enhancements of the IT infrastructure and business processes to accommodate changes in policy, response to changes in security threats and customer service improvements.”

How well did Siemens perform on its £365m passport contract?

Siemens had mixed success on its passport contract. It helped introduce the new  Passport Application Support System [PASS] in 1999 which failed badly, in part because of errors in scanning forms; and nobody realised until too late that extra processing time on applications was slowing down the issuing of passports.

The result was that  hundreds of passport applicants had to cancel their holidays or change their travel dates. A national roll-out of PASS was delayed, and the new work processes and system eventually stabilised.

When the contract finished in 2009, CSC was appointed to build and run new IT systems under a £385m 10-year contract which included replacing  the PASS. An  upgrade of PASS in 2007 destabilised the system temporarily.

The incident made staff at the Identity and Passport Service realise that they could not  subject the PASS system to further major changes without risking disruption to internal operations.

A year earlier,  in 2006, the Identity and Passport Service had a failure with its introduction of an electronic passport application system EPA2. To its credit the Service later published the lessons from the project. This decision on openness came from managers at the passport service,  rather than from within the Home Office HQ.

Home Office culture of secrecy remains

To see if anything has changed on openness and accountability since the last administration we asked the Home Office the following:

a)       Does the Home Office consider the contract with Siemens to have been value for money?

b)       Has, or will, the Home Office publish any information on the contract to justify or explain the extra spend, such as Gateway reviews?

c)       Any comment please on a suggestion that Parliament should be kept informed of such increases.

d)       Are there any plans to explain or tell Parliament about any increases in the cost of the [replacement] contract with CSC?

This was the reply of the Home Office’s spokesman Andrew Bell:

“The parliamentary answer – enclosed below – covers some of this.

“In addition, to note that Siemens contract was for developing and maintaining the IT infrastructure for IPS  [Identity and Passport Service] to issue passports. It also included support for processing applications such as the scanning of the documents required for passports.

“The Identity and Passport Service awarded this new contract for providing this service to Computer Sciences Corporation (CSC) in October 2009.”

**

Campaign4Change has given details of the Home Office’s replies to us to a campaigning MP.

We are grateful to publicservice.co.uk for its article which drew our attention to Damian Green’s reply.

Link:

MP asks NAO to consider an inquiry after our article on the Siemens passport contract.

Lewisham discussions highlight town hall debates over possible future role of mutuals

By David Bicknell

Evidence is emerging of ongoing talks taking place  within councils over the possible mutualisation of services.

This blog post from Liberal Democrat councillor Alex Feakes references work on mutualism that Lewisham Council has done in South London. This debate, which has been covered on the Sydenham Town Forum and in the South London Press, is a useful snapshot of  policy discussions over mutuals that could follow up and down the country.

Mutuals: Four companies shortlisted as a partner for My Civil Service Pension

By David Bicknell

Four companies have been identified as potential partners for new mutual venture, My Civil Service Pension.

The four – Xafinity, JLT, Wipro and Capita – have been chosen from an initial tender list of 50 potential partners.

There is an article on the shortlist on the Guardian Public Leaders Network.

Mutuals: ‘Managers are the biggest barrier to employee ownership’

By David Bicknell

In the aftermath of the Open Public Services White Paper, Stephen Kelly, who is in charge of the Coalition’s plan to mutualise the public sector, has been interviewed in the Daily Telegraph here.

Meanwhile, in this clip from a Policy Exchange debate on mutuals, Julian Legrand has been quoted as saying managers are the biggest barrier to employee ownership

Did officials tell MPs the whole truth on NPfIT payments to CSC?

By Tony Collins

Conservative MP Richard Bacon wrote to the NHS Chief Executive Sir David Nicholson yesterday warning that a failure to disclose information to the Public Accounts Committee was a “very serious matter”.

Bacon, a long-standing member of the Public Accounts Committee, wrote to Nicholson about advance payments to CSC under the NHS National Programme for IT.

The MP is concerned that the Department of Health did not mention a £200m advance payment to CSC at a hearing of the Public Accounts Committee on the NPfIT detailed care records systems on 23 May 2011; and the payment wasn’t mentioned in the Department’s subsequent memo to the committee.

Said Bacon in his letter:

“I understand that the advance payment of £200m to CSC was made in April 2011 but the Department of Health’s memo of 7 June 2011 doesn’t mention it. 

“The failure to disclose to the PAC an advance payment of £200m is a very serious matter.  The fact that the payment appears to have happened after 31 March 2011 is scarcely the point.

“What is going on? … 

CSC declared the £200m advance payment in regulatory announcement

CSC has told regulatory authorities in the US that on 1 April 2011, pursuant to the NPfIT contract, the “NHS made an advance payment to the Company of £200 million ($320 million) related to the forecasted charges expected by the Company during fiscal year 2012”.

The payment was reported by E-health Insider last month.

It appears that the Department decided to give the committee details of advance payments to CSC up until 31 March 2011. The undisclosed £200m payment to CSC was made the next day, 1 April.

As the Department of Health wrote to the committee on 7 June there is no clear reason for its choice of 31 March as the cut-off date for informing MPs of advance payments to CSC.

It would not be the first time the Department has withheld the latest information on the NPfIT from what it regards as outsiders, such as Parliament and the media.

When the National Audit Office was investigating the NPfIT several years ago it was not told of the latest Ipsos MORI survey on NHS perceptions of the National Programme.

The Department instead gave the NAO an older and more positive Ipsos MORI survey. The NAO confirmed to me it had not seen the latest survey [which had some negative findings on the NPfIT].  

Today some in the Cabinet Office are exasperated at the disdain with which some officials at the Department of Health – not all – treat outside supervisory organisations such as the NAO, the Public Accounts Committee and the Cabinet Office.

It appears that some in the Department regard these organisations as necessary by-products of democracy that must be tolerated but not encouraged.

Comment:

Major change is unlikely to happen in Whitehall or at least within the Department of Health and NHS Connecting for Health if officials are allowed, with ease, to dismiss their scrutineers with a wave of their hand.

The culture of allowing the DH to withhold the truth about the NPfIT needs tackling. All credit to Bacon and the Cabinet Office for trying to do just that. It’s likely that Katie Davis, the interim health CIO, will also seek to make the DH less introspective and defensive, at least in terms of the NPfIT and health informatics generally.   

**

Bacon’s letter to Sir David Nicholson

This is Bacon’s letter dated 14 July2011 to Nicholson, copied to the head of the National Audit Office Amyas Morse, the chair of the Public Accounts Committee Margaret Hodge, and the Cabinet Office. 

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I do not seem to have received a reply to my email of 27 June below.

Making advance payments of any kind at all is wholly at variance with the Department of Health’s long-stated boast that the NPfIT contracts “only pay for delivery”, but let us leave aside this basic point for the moment.

I understand that the advance payment of £200 million to CSC was made in April 2011 but the Department of Health’s memo of 7 June 2011 doesn’t mention it.  The failure to disclose to the PAC an advanced payment of £200 million is a very serious matter.  The fact that the payment appears to have happened after 31 March 2011 is scarcely the point.

What is going on?  Please reply to my email below with its various questions without further delay.

Yours sincerely

Richard Bacon MP for South Norfolk, Member of the Public Accounts Committee

Bacon’s earlier letter to Nicholson, dated 27 June 2011

Dear Sir David

NATIONAL PROGRAMME FOR IT IN THE NATIONAL HEALTH SERVICE

I am writing following the hearing of the Public Accounts Committee on Monday 23 May 2011, to follow up on two important issues that were raised during your evidence:

1.       ADVANCE PAYMENTS TO SUPPLIERS

In your supplementary memorandum to the PAC following the hearing you gave a total of advance payments made up to 31 March 2011, in respect of all contracts over the whole period of the Programme, of £2,532m of which suppliers have retained £1,328m. You also identified a further £119 million of advance payments to be earned or refunded.  Since the memorandum was received by the PAC, it has been reported that the NHS made an advance payment of £200 million to CSC in April 2011. http://www.ehi.co.uk/news/acute-care/6971/nhs-made-£200m-april-advance-to-csc

I should be most grateful if you would let me know the answers to the following questions:

1.       Is this report accurate?

2.       Why was this payment was not reported to the PAC, either during the hearing or in the subsequent memorandum?

3.       What was the justification for this payment and what value does it represent to the NHS?

4.       What will happen in respect of this payment if a new memorandum of understanding is not in fact signed with CSC?

5.       I would also be grateful if you would comment on the CSC filing with the US Security and Exchange Commission, which states that in the opinion of the company, if the NHS were to terminate the current contract “for convenience” it would owe fees totalling less than the $1 billion asset value CSC now has on its books for the contract.   How is this consistent with the claim at the PAC  hearing by Ms Connelly that the cost of terminating the CSC deal could “potentially leave us exposed to a higher cost than if we completed as it stands today”?

2. THE COST OF DEPLOYING CERNER MILLENNIUM AT NORTH BRISTOL

Second, I would be grateful if you could comment on the cost of deploying Cerner Millennium at North Bristol, reported in your memorandum as £21 million, including service for 56 months, and on the current expected go-live date.  Specifically:

6.       Can you explain why the delivery date agreed with BT at the contract “reset” was 4th June 2011?

7.       Why it was then revised to 2nd July 2011?

8.       And why it now appears that there is no agreed delivery date at all?

9.       Can you also give your best comparison of the cost of deploying the Cerner Millennium system at North Bristol, with the cost to University Hospitals Bristol of deploying the System C Healthcare Medway system outside the National Programme?  It would appear from media reports that this latter contract includes deployment of functionality including PAS, Accident and Emergency, maternity, theatres, clinical data collection, and a data warehouse and reporting system, as well as integration of third party and current Trust applications.  According to the National Audit Office, the average cost for each new site under the BT South contract is £28.3 million, but the cost of the Medway system to UHB has been reported as £8.2 million over seven years. (http://www.guardian.co.uk/healthcare-network/2011/may/19/university-hospitals-bristol-foundation-trust-awards-e-patient-contract)   What is the justification for this apparent difference?

10.   As the Senior Responsible Owner for the National Programme, can you give your explicit undertaking that the North Bristol contract represents value for money for taxpayers?

I look forward to receiving your reply.

With many thanks

Yours sincerely

Richard Bacon

Mutuals: Government must deliver on radical public services agenda, says Institute for Government

By David Bicknell

Responding to the Government’s Open Public Services White Paper launched by David Cameron this week, the Institute for Government says the agenda is a radical one, but failure to deliver will come at a cost.

Commenting on the launch, the Institute’s Programme Director, Tom Gash said:

“There’s not much that is new in this white paper but it is still a radical agenda for change. Other governments have tried and failed to remodel public services. The difference this time is that the stakes are higher. With massive cuts to public spending, if these measures don’t work, the state will not be in a position to shore up services.

“A white paper by itself doesn’t change anything. To make this vision a reality, a lot of work lies ahead. Failure to take these next steps in any of the policy areas covered by the paper will lead to the risk of future u-turns, uncertainty and failure”.

The Institute argues that several key issues need to be addressed going forward. These include:

  • Mechanisms for accountability in service delivery must be thought through. Voting in a local election is very different from choosing your GP but in future there are likely to be different combinations of accountability mechanisms for different services.
  • Whilst removing top-down targets  and giving greater autonomy to frontline professionals, government must still be clear on the lowest level of service permissible before this autonomy is withdrawn or restricted.
  • Transparency – data will need to be accurate, timely and accessible if people are going to be able to use it to exercise their choices.
  • Ministers will have to be willing to relinquish power. They’ll still be held responsible for local decisions even though they no longer have control over them.
  • As public services are opened up to new providers, ministers must be absolutely clear about who is responsible for what.
  • Mutuals will need to have the scope to blend state and private investment and not be soley dependent on a single source of funding.
  • Commissioning for outcomes must focus on those outcomes that are measurable. But measuring outcomes is often harder than measuring outputs. For example, it is easy to measure whether a hip operation took place. It is less easy to measure whether or not the operation has improved the patient’s quality of life.

The Institute argues that policies in the white paper are at different stages of their development.  Ministers, central and local government and practitioners will all have work to do if they are to ensure that they are implemented in a way that genuinely improves public services and the lives of citizens. Drawing on its publication Making Policy Better, the Institute recommends that departments will need to:

  • Carry out a “reality check” on policies, involving implementers and/or users of services in testing or piloting them.
  • Consult those affected by changes and address the issues that arise as a result of these consultations.
  • Ensure that policies have been properly costed and that they are resilient to external risks.
  • Make sure the role of central government is properly thought through and that it is clear who is accountable for delivering particular services and the criteria on which they will be judged to have succeeded or failed.
  • Have plans in place for collecting feedback on how policies are being delivered in practice and the mechanisms are in place to act on this feedback.
  • Make sure that policies are implemented in a way that allows government to assess whether they have worked or not and how they can be adapted and strengthened.

 Gash added:

“In order to avoid repeating the experience of the beleaguered NHS reforms, the coalition will need to invest a good deal of time and resources in delivering its radical programme for reforming public services. To publish a white paper and then walk away will not be enough but today’s announcement, with its emphasis on consultation and analysis seems to show that government has learnt from its mistakes and is ready to take the time to deliver something which could change forever the way citizens choose and receive their services”.