Category Archives: public services

Will private sector involvement in mutuals make for a perfect partnership?

Although The Times today has been reporting that the Coalition might be getting some cold feet about its plans for public service reform – the Public Services Reform White Paper now looks as if it may be delayed in the wake of  recent discussions about NHS reform – there is little doubt that the role of the private sector in partnerships is being discussed.

The Guardian recently carried a piece in which Craig Dearden-Phillips, founder and chief executive of Stepping Out, a business helping parts of the public sector become a social enterprise, wondered  whether the marriage between public manager and the private sector will work?

“One concern is the compatibility of each side’s goals,” he says. “So far, public sector mutuals tend to be more focused on social rather than commercial aims. Few appear to have share capital financially worth much to staff. They tend to be defined by a passion for people, place or profession, and they often aspire to stay local and be more personal. Every person I have met who leads a spun-out organisation is motivated by social purpose. They identify strongly with public sector values – albeit ones that see a mutual or social enterprise as the appropriate vehicle for this.

“A private company, however, will, quite rightly, be mostly concerned with its shareholders’ or directors’ interests, and that will include a strong focus on growth, either by merger or acquisition and on cutting costs quickly.

“These are legitimate goals, and, arguably, the only way to create large organisations. But you can see a potential tug-of-war here, with one side driven by a growth agenda and the other living in fear of becoming remote from its community – and of losing control to a private partner.

“Can both sides meet at least somewhere in the middle, with private investors accepting the potential constraints on return introduced by being partly employee-owned and former public managers bowing to some of the commercial imperatives of  investors?

“As someone working every day alongside public managers, I hope we can find ways to bring necessary investment and expertise to the table. Unlike in continental Europe, this is unlikely to come from the state. So we need to examine closely how to do this while ensuring the values we hold close are upheld.”

A thank you to IM&T and medical staff at Trafford General Hospital

By Tony Collins

My thanks to the IM&T and medical teams at Manchester-based Trafford General Hospital who made my visit last week so useful.

A special thanks to IM&T manager Steve Parsons and his assistants Laura Slatcher and Karen Ambrose for their patient and clear explanations. I am also grateful to Peter Large,  Director of Planning, Performance & Service Improvement; Simon Musgrave, Medical Director;  Julie Treadgold, Matron, and their teams.

It was enlightening to see how IT at Trafford General Hospital is changing the working lives of doctors and nurses – and making a difference for patients.

The technology and business media, when reporting on IT in the NHS, often mention the National Programme for IT – NPfIT –  and the tens of millions of patients who have GP-held electronic records, or who have received packs of marketing material on the Summary Care Records scheme. Thus the media coverage of NHS IT is often of the abstract and hazy world of contract negotiations and huge sums spent with major IT companies.

My visit to Trafford Healthcare NHS Trust was a reminder of how much some IM&T managers are achieving on small budgets, outside of central, politically-driven IT-led programmes.

At Trafford I saw what buy-in among doctors and nurses means in practice, such as the timely completion of electronic forms that make it easy to see, on large touch screens located in a room close to each ward, when a patient’s next medical check is due, when a VTE (Venous thromboembolism) check is overdue, when an A&E patient has been waiting too long to be seen or treated, and the reasons for the breaches.

So much essential information is available from the ward touch screens – such as graphs showing whether, say, medication is having the desired effect, over hours or days,  on a patient’s neutrophil blood cells; and it’s easy to see whether a patient has yet to have an x-ray reviewed by a specialist. Indeed a doctor with the relevant smartcard authorisation can call up their patients’ x-rays on the ward’s touch-screen.

Behind all these screens is the patient’s electronic record that includes archived, scanned notes, diagrams and charts. If the local GP has authorised it – and so far about half in Trafford’s catchment area have – A&E department hospital doctors will soon be able to access the GP-held patient record also.

Trafford’s hospital-wide technology is designed to be integrated with departmental systems by the in-house team. It is delivered by suppliers whose contracts are firmly under the control of the local Trust.  It’s technology outside of the NPfIT – and it works.

So while officials in Whitehall have spent years trying to make an overly ambitious NPfIT deliver, some trusts, Trafford among them, have been giving measurable and visible technological support to clinicians who have welcomed the changes because they have seen improvements in the safety monitoring and timely treatment of their patients.

We plan to report further on the improvements at Trafford and at other hospitals.

Agile can fix failed GovIT says lawyer


In a guest blog, commercial lawyer Susan Atkinson argues that agile development is not an evangelical fad ill-suited to government IT.

The blog by Alistair Maughan in Computer Weekly in which he argues that Agile will fail GovIT’  is quite extraordinary [1].  It is extraordinary in that it completely overlooks the poor track record of GovIT to date. It also makes a damning attack on the adoption by the Government of agile without explaining the potential benefits.

The state of GovIT

The Government spends about £16bn per year on IT. The spend has been growing steadily in recent years and, without radical intervention, shows no sign of abating. [2]  A compelling number of studies has found that about one quarter of all IT projects (in both the public and private sector) are cancelled and about half are delivered late, over budget or both. [3]   This would suggest that public funds in the order of several billion pounds per year are being invested by the Government in failed IT projects.

In 2005 Edward Leith, Chairman of the Public Accounts Committee, commented that:

“far too often major IT enabled projects in government departments are late, well over budget, or do not work at all – an enormous waste of taxpayers’ money” [4]

The problem is so serious that shortly after coming into power the Coalition Government introduced the ICT Moratorium, under which any new ICT contracts and contract extensions/modifications above a value of £1m could not be entered into without specific agreement by the Treasury.

The waterfall model

Why is the track record of IT projects so dreadful?  Until fairly recently virtually all IT projects have been managed using the waterfall model.  The waterfall model enshrines a sequential development process, in which development is seen as flowing steadily downwards – like a waterfall – through the phases of conception, initiation, analysis, design, construction and testing. The output of each phase provides the input for the next stage.

There are two very significant consequences of the waterfall model.  Firstly, all of the requirements of the customer are specified before the project starts.  However, this fetters the ability of the customer to respond to change and to exploit emergent opportunities over the course of the project.  Secondly, the customer does not receive anything of tangible value until all of the requirements have completed testing at the end of the project.   This means that it can be many months and possibly years before the customer can realise its investment in the project.

The waterfall model has come under increasing criticism for a number of reasons over recent years.  Major studies point to the use of the waterfall model as the cause of failure for many IT projects.

Agile is not “an evangelical fad

Agile has developed from a grassroots movement in the US in the 1990s as a backlash to the waterfall model, and its influences originate in Japan. The theory of agile is based upon, and supported by, complexity science, systems dynamics, economic theory and behavioural studies, amongst others.

The adoption of agile has steadily increased since 2001 when the Agile Manifesto was created.  Originally agile was largely the premise of the IT departments (even though agile is not necessarily IT-specific), but it is now widely used on an organisational basis, in virtually all industry sectors, and extensively in North America, Japan and the Scandinavian countries.

Some of the most remarkable examples of the use of agile are found in Google, Yahoo! and salesforce.com.  Indeed, salesforce.com has delivered a 41% annual return to shareholders over a sustained period, and it credits this result in no small part to its adoption of Scrum in 2006. [5]

BSkyB v EDS and DeBeers v Atos

The cases of BSkyB v EDS and DeBeers v Atos do not show that “when Agile projects go wrong, they can go spectacularly wrong” .The decision in BSkyB v EDS  doesn’t make any reference to agile.  The project was actually based on the waterfall model and used rapid application development (RAD) – which isn’t agile – for rapid development of prototypes, the feedback from which was fed back in to the requirements.

The project outsourced by DeBeers to Atos began, ostensibly, with an agile approach, but then switched to a more traditional approach after the project began to run into difficulties. However, the parties do not appear to have contracted on an agile basis. It is very difficult to run a project on an agile basis within the constraints of a traditional contract, because the waterfall model and agile model are quite different.  Despite the references by the principle technical architect to DSDM (Dynamic Systems Development Method), which is an agile methodology, it is not clear from the decision how the project was in fact run in an agile way.   For example, it appears to have always been the intention that a sequential model of development would be used, which is wholly inconsistent with an agile approach.

A  general lack of understanding of agile best practice  

Agile is merely an umbrella term for lightweight methodologies, of which Scrum and Extreme Programming (XP) are the most widely used.  Each of the methodologies is quite different.  For example, the Rational Unified Process (RUP) is far more prescriptive than Scrum.  For there to be a sensible debate on agile we need to ensure that the participants share a common understanding of agile best practice.

Agile is compatible with fixed price

Contrary to what is suggested, it is possible to agree a fixed price for an agile contract.  Under an agile contract the project is sub-divided into modules or releases, each of which is initiated by means of a statement of work.  The releases can be charged for on a fixed price basis, or the units of work (often measured by reference to story points) can be charged for on a fixed price basis.

However, “a watertight contract, clear deliverables … with a fixed price and appropriate remedies” is a fallacy.  Any project must be performed and delivered under certain constraints, which have traditionally been identified as:  (i) Scope (features and functionality), (ii) Resources (cost and budget) and (iii) Schedule (time).  These three constraints compete against each other and exist in an ‘unbreakable’ relationship, as illustrated by the ‘Iron Triangle’. [6]

For example, bringing forward the scheduled end date by adding more resources will increase cost, or, adding to the scope will increase time and cost.  So, if all three constraints are fixed, there is no give in any of them if there is any uncertainty or unforeseen events arise during the project, and it has been proven that this will inevitably adversely impact on quality and the project objectives.

Most customers want to fix Resources and Schedule which means that Scope must be allowed to vary.  The question, therefore, is how can the customer derive value if the Scope may change?  Agile solves this problem by prioritising the requirements of the customer on an ongoing basis throughout the project, ensuring that the highest priority requirements are delivered on time and within budget.

In any event, many projects are actually over-specified.  It has been shown that 64% of software features are rarely or never used. [7]  So it may well be the case that the overall needs of the customer can be met without the need to deliver the lowest priority requirements, in which case it may be possible to achieve significant cost-savings by ending the project earlier than originally planned.

This can be contrasted with the traditional waterfall method under which the customer doesn’t receive anything of tangible value until all of the requirements have been delivered.

The Government is right to want to manage its budgets tightly.  However, it has been proven that uncertainty is inherent in the process of software development.

For this reason any estimates regarding price (or, indeed, regarding the amount of effort involved or schedule) are subject to large amounts of uncertainty at the start of the project.  This amount of uncertainty is only reduced as the software definition is refined over the course of the project, as illustrated by the ‘Cone of Uncertainty’. [8]

It is unrealistic to rely on estimates made at the start of the project when the level of uncertainty is at its greatest.  The Government has experienced so many problems with overruns on fixed price contracts that today many of its contracts for software development are no more than a variation of time and materials.

Compliance with public procurement rules

EU public procurement rules require public sector bodies (PSBs) to ensure suppliers are treated on equal terms and to avoid discrimination on the grounds of country of origin.  The contract should be awarded to the most economically advantageous tender, using pre-defined and objective criteria.  Detailed up-front specifications and a fixed price are not a requirement.   Contracts awarded for the provision of consultancy services or, indeed, legal services, are a good example of this.  In any event, in an agile contract the scope of the project is outlined in the form of the objectives of the project, the metrics for success and the constraints.

In Finland, which is also subject to the EU public procurement rules, there are a number of agile contracts that have been awarded by PSBs in full compliance with these rules.

Contractual rights and remedies in an agile contract

I disagree that “Agile contracts lack clear contractual delivery obligations or remedies”.  An agile contract only differs from a traditional contract in terms of how the solution is delivered.  There is no reason why, for example, provisions regarding the treatment of intellectual property rights, data protection, assignment and so on should be treated any differently.

In fact a customer has more remedies under an agile contract than under a traditional one.  Under a traditional contract it is very difficult for a customer to enforce any of its rights before the acceptance date – which can be many months or even years away – because up until then all of the requirements are merely work in progress.  Often it is difficult to determine in the acceptance tests whether the software delivered meets the requirements because there have been so many change requests to the requirements in the intervening period that it is hard to establish what the requirements are.

Under an agile contract there are contractual rights and remedies at the end of each release.   The supplier commits to deliver by each release completion date fully tested and working software that is ready to deploy and which represents an agreed number of completed units of work.  As mentioned above, units of work are often measured by reference to story points.

Equally important is the ability of the customer to plan adaptively throughout the development project, re-focusing the work of the supplier at the start of each iteration based on its findings from the work delivered to date.  Not only does this give the customer much greater flexibility, but it also means that many disputes can be avoided by correcting misunderstandings at an early stage.

The discrete roles of the customer and the supplier

Whilst agile advocates the collaboration of the customer and the supplier, their roles are quite different and – contrary to what is suggested – clearly defined.

The supplier has responsibility for the technical domain and the customer has responsibility for the business domain.  In other words, the customer is responsible for articulating the business processes to be codified, and the supplier is responsible for designing and writing the code.  To that extent the roles are clearly demarcated.

However, input from both parties is essential, as software development is nothing more than the codification of business processes.    It is unrealistic for the customer to transfer all responsibility for delivery to the supplier.

Cross functional teams

The blog states that agile “is not suited to public sector management structures” for the reason that decision-making is centralised in government, whereas “agile decision-making … flows down”.  Arguably, it is not agile that is not suited to public sector management structures, but public sector management structures that are not suited to agile.  The Institute for Government acknowledges that organisational culture within government is a significant barrier to the adoption of agile:

“The existing governance and commercial processes, not to mention the fundamental mindset shift required, pose specific and difficult challenges.” [9]

However, that is not a reason for rejecting the new IT strategy.  There is currently a trend for organisations in many different industries and disciplines to move away from hierarchical and siloed departmental structures and towards decentralised cross functional teams.  This approach is advocated by TQM (total quality management), lean, systems thinking, and in business management books such as ‘The Leader’s Guide to Radical Management: Reinventing the Workplace for the 21st Century’ by Stephen Denning.

Conclusion

 The age of the Internet has made possible collaborative working and joined-up thinking on a scale never previously experienced.  But it has also brought about innovation and a pace of change at a rate that is pushing traditional project methods and contracts to breaking point.  Agile offers a solution for managing projects in this increasingly dynamic environment.

The Government should be applauded for taking the bold step to change its IT strategy to adopt agile.  However, it is inevitable that, like any innovation, such a significant change in strategy will be met with resistance.

It will require changes to be made not only on the part of the government, as highlighted by the Institute for Government, but also on the part of suppliers and supporting partners, including the legal profession.

But there is already evidence that agile can fix failed GovIT.  A number of public sector bodies, including the Ministry of Defence and the Metropolitan Police, are already using agile with great effect.  We now need to move forward the debate to discuss how the challenges to the adoption by government of agile can be overcome.


[1] The blog ‘Agile will fail GovIT, says corporate lawyer’ published by Computer Weekly on 26 April 2011.

[2]   Latest total spend based on the estimate in the ‘Operational Efficiency Programme’ final report published by HM Treasury in April 2009.

[3] ‘Software Estimation: Demystifying the Black Art’by Steve McConnell.

[4] As reported in The Telegraph in 2005.

[5]  The blog ‘Six common mistakes that salesforce.com didn’t make’ by Steve Denning and published on the Forbes website on 18 April 2011.

[6] The ‘Iron Triangle’ was invented by Dr Martin Barnes in 1969 and popularised in the Project Management Body of Knowledge (PMBOK Guide) issued by the Project Management Institute (PMI).

[7] Standish Group study reported at XP 2002 by Jim Jonson, Chairman.

[8] The original conceptual basis of the ‘Cone of Uncertainty’ was developed by Barry Boehm in 1981. The model has since been validated, based on data from a set of software projects at the US Air Force, NASA’s Software Engineering Lab and other sources.

[9] ‘System Error: Fixing the flaws in government IT’ published by the Institute for Government in March 2011.

**

Susan Atkinson is a Legal Director at gallenalliance Solicitors, based in London.  She is a commercial lawyer specialising in IT and with a particular interest in Agile and Lean. She has been advising the Institute for Government on an ad hoc basis on the contractual implications for the government in outsourcing agile projects, and has contributed to the Institute’s report ‘System Error: Fixing the Flaws in Government IT’.

 

How to set up an employee-owned mutual

By David Bicknell

There was a useful piece in the Guardian on Saturday about how to set up a mutual.

The article, ‘From councils to co-ops: how public workers can form a mutual’, suggests “employee-owned mutuals offer an attractive third way to the cuts programme”, and offers an eight-point plan on how to set one up.

All Party Group lauds promise of mutualising public services – but warns against economic motives

By David Bicknell

An article in Community Care magazine has said employee-led mutuals could positively transform public services as long as they are not driven by economic motives.

The magazine cites a report by the All-Party Parliamentary Group on Employee Ownership, which found the coalition government had made “significant process” with its commitment to mutualise public services, including social work.

But the all party group warned that, although many employee-led mutuals had reported efficiencies, cost-cutting alone “should not be the prime motivator for seeking out mutual ownership models”.

The MPs, chaired by Conservative MP Jesse Norman, identified some concerns about the timing of the mutuals intitiative. Trade unions in particular have suggested it is being driven by financial considerations rather than the desire to give frontline workers more freedom and control.

“Several witnesses told us that the timing of the public service mutuals initiative, during a time of deep budget cuts at central and local government level, was inflicting severe damage on how the initiative was perceived and how it was being implemented,” the report said.

“The group is concerned to hear that some spin-outs appear solely driven from very senior level, typically under the pressure of the need for immediate short term cuts, with the wider base of employees engaged only after the process had started.

The APPG, set up in 2007 to raise awareness of the benefits of employee ownership, also noted that the “plethora” of employee ownership models available had caused confusion among frontline workers.

Norman said policy makers should do more to connect would-be mutuals with experts and ensure that advice is accessible.

You can download the report here

Newcastle Council to be in vanguard of public services reform, including using mutuals?

By David Bicknell

There is an interesting piece in the Guardian’s Society pages today about the ambitions of Newcastle Council in pushing through public services reform.

Peter Hetherington’s article  says that Nick Forbes, the new Labour leader in Newcastle has two problems to grapple with: budget cuts this year of £45m, and reinvigorating the existing management regime.

Forbes is quoted as saying that one of the big challenges is to reinvent the concept of public services in the 21st century in a way that matches Labour’s values of equality and fairness and co-operation. “There’s the opportunity to capitalise on what the government is saying around mutuals and workers’ co-operatives and develop genuinely new models that give service users and staff a stronger ‘say’ but also protect essential public services from the destructive forces of market competition.”