Category Archives: supplier relationships

The unavoidable truths about GovIT – by Cabinet Office official

Posted on 31/10/2011 | 14 comments

The vast majority of GovIT is “outrageously expensive” says Chris Chant. “Things have changed and we haven’t.”

By Tony Collins

Chris Chant is one of the most experienced IT officials in central government. He was CIO at Defra where he led IT service improvement programmes with strategic outsourcing partners  including IBM. His reforms helped to change the way people worked.

He was also CIO at the Government Olympic Executive, part of the Department of Culture, Media and Sport. Now he is an Executive Director in the Cabinet Office working as Programme Director for the G-Cloud initiative.

In a cloud computing event hosted by the Institute for Government in London, Chant told it like it is. The points he make indicate that major change is less of a risk to public finances than keeping the machinery of government as it is.

He began his talk by thanking those in government IT who have been“working their socks off”. He had been talking positively to his teams in the last week and now “it is time to recognise some of the less positive aspects about what we do”.

He added: “We need to face some unavoidable truths head on about government IT as it has been done.”

These were his main points:

“The vast majority of government IT in my view is outrageously expensive, is ridiculously slow, or agile-less, is poor quality in the main and, most unforgivably I think, is rarely user-centric in any meaningful way at all.”

He said it is unacceptable:

–  That “80% of Government IT is controlled by five corporations”.

–  That “some organisations outsource their IT strategy in Government”.

–  That “to change one line of code in one application can cost up to £50,000”.

–  To wait 12 weeks to get a server commissioned for use.  He said: “That’s pretty commonplace. When you think in terms of using a service like Amazon the most problematic thing on the critical path is the time it takes you to get your
credit card out of your wallet and enter the details on screen”.

–  That the civil service does not know the true cost of a service and the real exit costs from those services – the costs commercially, technically and from a business de-integration standpoint. “So  how do we untangle our way out of a particular product or service. I cannot tell you how many times I have had the discussion that says: we need to get away from that but we cannot because of the complexity of getting out from where we are: all the things hanging on to that particular service that we cannot disentangle ourself from.”

– To enter into any contracts for more than 12  months. “I cannot see how we can sit in a world of IT and acknowledge the arrival of the iPad in the last two years and yet somehow imagine we can predict what we are going to need to be doing in two or three, or five or seven or ten years time.”

–  Not to know in government “how many staff we have on the client side of IT”. He said: “I have not yet met anybody who knows what that figure is. People know about small areas but overall we don’t know what that figure is.

– Not to know what IT people do. “So we don’t have any idea of the breakdown of that number that we don’t know either, surprisingly. I think that is outrageous in this climate, and in any climate.”

–  Not to know “what systems we own how much they cost; and how much or even if they’re used”. He said: “I know there are organisations that have turned off tens of thousands of desktop services merely to discover if they are used anymore; and when they do that they discover maybe one per cent are still being used. That’s completely unacceptable.”

– Not to know when users give up on an online service; “and it’s unacceptable not to know why they give up”. He said: “Of course it is unacceptable that they have to give up because the service does not fulfil their needs.”

– to have a successful online service that sends out reminders to use that service through the post.

–  Not to be able to communicate with customers securely and electronically when technology clearly allows that to happen.

– Not to be able to “do our work from any device we choose”. He said: “That is possible and has been for some time. It’s outrageous we cannot do that.”

– To pay up to £3,500 per person per year for a desktop service.

–  That “your corporate desktop to take 10 minutes to boot and the same amount of time to close down”. He said: “But that is the truth of what goes on everyday in Government IT and I suspect the public sector too.”

–  For staff to be unable to access Twitter or YouTube, when they use those services for what they do.

– For call centre staff not to be able to access the very service they are supporting at the call centre. “It sounds funny but  when you think of the consequences of that it is truly dreadful.”

–  To ensure people are working by restricting their access to the Internet. “If we cannot measure people by outputs where on  earth are we?”

Above all, said Chant, “it is unacceptable not to engage  directly with the most agile forward-thinking suppliers that are in the SME  market today and are not among the suppliers we have been using”.

Chris Chant’s talk

This is much of what Chris Chant said:

“A bunch of people have worked their socks off [but], through no  fault of their own, on the wrong thing for some time too… And it’s quite tough being in IT because, a bit like  electricity, it’s one of the rare things people seem to use almost all of the time…but we need to face some unavoidable truths head on about government IT as it has been done.

The vast majority of government IT in my view is outrageously expensive, is ridiculously slow, or agile-less, is poor quality in  the main and, most unforgivably I think, is rarely user centric in any  meaningful way at all…

I’ll give you my personal view of the unacceptable. I have spent a lot of time with teams in the last week talking positively about things and I think it is time to recognise some of the less positive aspects of what we do.

I think it is unacceptable at this point in time to not know the true cost of a service and the real exit costs from those services; the costs commercially, technically and from a business de-integration standpoint – so how do we untangle our way out of a particular product or service? I cannot tell you how many times I have had the discussion that says: we need to get away from that but we cannot because of the complexity of getting out from where we are: all the things hanging on to that particular service that we cannot disentangle ourself from.

I think it is completely unacceptable at this point in time to enter into any contracts for more than 12 months. I cannot see how we can sit in a world of IT and acknowledge the arrival of the iPad in the last two years and yet somehow imagine we can predict what we are going to need to be doing in two to three, or five or seven or 10 years time. It is a complete nonsense.

And to those who say ‘what about a supplier upfront infrastructure: surely you have to fund that somehow?’ I would say: ‘why do we have to treat IT and particularly commodity IT any differently from any other commodity
around?’

Marks and Spencer does not come knocking on the door asking me to guarantee to buy three suits and two shirts a year for the next five years and then they will put a store at the bottom of the road… if you look at a small local garage that has to fund its hydraulic ramps and the computer equipment they now need. They do not ask people to fund that upfront. They go into the market confident of their products and confident of their pricing so they will get people back again and arrange for how that gets funding…

I think it is unacceptable not to know in government how many staff we have on the client side of IT. I have not yet met anybody who knows what that figure is. People know about small areas but overall we don’t know what that figure is. It is also unacceptable that we don’t know what those people do. So we don’t have any idea of the breakdown of that number that we don’t know either,  surprisingly. I think that is outrageous in this climate, and in any climate.

It is completely unacceptable we don’t know what systems we own and how much they cost; and how much or even if they’re used. I know there are organisations that have turned off tens of thousands of desktop services merely to discover if they are used anymore; and when they do that they discover maybe one per cent are still being used…

It is unacceptable not to know when users give up on an online service; and it’s unacceptable not to know why they give up. Of course it is unacceptable that they have to give up because the service does not fulfil their needs.

It unacceptable to have a successful online service that sends out reminders to use that service through the post…. Linked to that, it’s completely unacceptable not to be able to communicate with customers securely electronically when technology clearly allows that to happen.

It is unacceptable not to be able to do our work from any device we choose. That is possible and has been for some time.  It’s outrageous we cannot do that.

It is unacceptable to pay – and these figures are Public Accounts Committee figures – up to £3,500 per person per year for a desktop service.

It is unacceptable for your corporate desktop to take 10 minutes to boot and the same amount of time to close down. But that is the truth of what goes on everyday in Government IT and I suspect the public sector too.

It is unacceptable for staff to be unable to access Twitter or YouTube, when they use those services for what they do.

It is unacceptable for call centre staff not to be able to access the very service they are supporting at the call centre. It sounds funny but when you think of the consequences of that it is truly dreadful.

I think it is unacceptable in this day and age to ensure people are working by restricting their access to the Internet. If we cannot measure people by outputs where on earth are we?

It is unacceptable that 80% of Government IT is controlled  by five corporations.

It is unacceptable that some organisations outsource their IT strategy in Government.

It is unacceptable that to change one line of code in one application can cost up to £50,000.

It is unacceptable to wait 12 weeks to get a server commissioned for use. That’s pretty commonplace. When you think in terms of using a service like Amazon the most problematic thing on the critical path is the time it takes you to get your credit card out of your wallet and enter the details on screen.

Above all – and at the heart of a lot of this – it is unacceptable not to engage directly with the most agile forward-thinking suppliers that are in the SME market today and are not among the suppliers we have been using.

So things have changed and we haven’t is what has happened.

A lot of these things could have been explained away five or 10 years ago but I
don’t think they could have been explained away adequately in the last three years, probably at least.

So how does G-cloud help in all of this? I think G-Cloud is about a fundamental change in the way Government and I believe the public sector too does technology. It is not just about cloud computing. It requires a complete change of approach. A cultural change of approach. A change in the way we look at security; a change in the way we look at service management and above all change in the way we procure services we use. So cloud will be cheaper…

Using cloud solutions that have already been secured and accredited
will be cheaper almost always.  We will only pay for what we use. People will only use DR when they use DR.

Over time through the G-Cloud programme, products will be pre-procured and security accredited. They won’t be accredited by the programme itself but by the first users of this, so we don’t have to replicate that work time and time again because that is what a lot of our staff are doing. A lot of the tens of thousands of staff that are working on the client side of government and public sector IT are procuring the same things, accrediting the same things from a security perspective; and it is a complete and utter waste of time and huge money.

You’ll know from the outset the cost of the product and most importantly we will know the cost of exit. Nuclear power looked really cheap all the time somebody chose to ignore de-commissioning of nuclear power stations, and then it became a very different model.

Contracts will be under a year I believe… I don’t believe aggregated demand and long-term contracts bring value for money. Quite the reverse…  why anybody would offer somebody a contract  which meant we could carry on paying them money almost regardless of the service we got, with no meaningful incentive for better performance? That can all change. When we have the ability, through understanding exit and understanding the cost and performance of things, to move out of one product and into another in short order, I guarantee that the price will come down …

… Costs [of streaming] used to be outrageous and the quality was poor until the BBC put together standards on the way it’s done and the BBC can now buy services on daily basis and the cost has dropped by an order of magnitude and the quality is much improved. They know –  the service providers – that tomorrow somebody can go somewhere else. If Marks and Spencer does not provide clothes at the right price and quality people will go down the road and buy somewhere else. It is that, that drives quality and price, not a long-term contract.

[When people see that] products have clear pricing, clear details of what they do, clear details of what exiting that product is going to be like, and it says: ‘Andy Nelson at the Ministry of Justice has used this product over the last year and this is what he says about of it’, that starts to transform what happens on price and quality far and away above anything that any SLA can or ever has given us. So we won’t get ourselves locked in in any way. Not from a commercial or technical perspective. Many products nowadays are designed to get their little feelers locked into every part of your system….

Our staff over time will become skilled system integrators. That’s what will happen in the short term…

We will see people setting up services in minutes instead of years. How?

We have Foundation Delivery Partners – they are departments, local authorities, organisations that come together with others that are looking
to buy cloud products. The FDPs work with a bunch of people from the government procurement service who handle the commercial aspects; they work with staff from CESG to work out security implications and product by product they have begun to break down what it is they need to do, so subsequently that work does not need to be redone.

Over time we will have a model that describes lots of different circumstances of use of products so we will know – the senior risk information officer – will know what has been covered off already and will see the accreditation that has gone on and will know they will only have to fine tune that for the last bit of use in their department. That will dramatically reduce over time the amount of effort that goes into that security.

Large-scale IL3 email is coming soon; and large-scale IL3 collaboration
opportunities…

[The Government Digital Service is off] corporate systems to a solution that is IL0 and IL1 and 2, with IL3 on a few machines to one side. [There are] savings of 82% over adopting the corporate systems. People don’t wait 10 minutes for machines to boot up and shut down.

We don’t have all the answers… Great quality IT centres around an iterative process that gets stuff out and we learn quickly from what users do with it and is improved and improved.  I don’t recall a press release saying Google will update its apps products on 8 May next year. What happens is you notice a little banner saying we have done it differently: do you want to try it? How many times have you seen improvements on eBay and just experienced them as they arrived?

They are intuitive and what people want and they just happen… [Published in last few minutes] is a new cloud framework that is designed specifically to get SMEs across the threshold and working directly with departments, agencies, local authorities, police and health. There is a user guide. It is a key product.

We will watch very carefully how this gets used, and the impact on SMEs. I don’t anticipate any large organisations having difficulty with this. But the target is to get us engaged with SMEs.

We will watch what their problems are and we will correct that as we go. We are already working on the second version of this which will be due out, hopefully, early in the new year. With brilliant support from John Collington in the Government Procurement Service we will be adding new suppliers on a month by month basis which will dramatically change things and really gives us the flexibility we need.

The second manifestation of how serious we are in the cloud is a document to be published tomorrow which will give a very serious indication of intent around the use of cloud…”

Chris Chant’s talk – audio file Government Digital Service

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Posted in Campaign4Change, change, change management, Cloud, Cloud Computing, G-Cloud, government, Government IT, innovation, procurement, public sector, public services, reforms, SME, supplier relationships, Uncategorized

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Government’s new ICT plan – the good, bad and what’s needed

Posted on 24/10/2011 | 3 comments

By Tony Collins

There is much to commend the 102-page Government’s ICT Strategy – Strategic Implementation Plan”.  Its chief assets are the touches of realism.

In the past Cabinet Office documents have referred to the billions that can be cut from the annual government IT spend of £15bn-£20bn. This document is different.

In promising a saving of just £460m – and not until 2014/15 – Cabinet Office officials are not being ambitious, but neither are they making impossibly unrealistic claims. [The press release refers to £1.4bn of savings but there’s no mention of that figure in the document itself.]

The Implementation Plan also points out that the oft-quoted annual government IT spend of £16bn-£17bn is not spending in central government IT alone but includes the wider public sector: local government, devolved administrations and the NHS. The Implementation Plan concedes that there is “no definitive or audited record of ICT spending in central government for 2009/10”, but it adds, “the best estimates suggest this to be around £6.5bn in central government…”

Now at last we have a figure for the cost of central government IT. But we’re also told that the Cabinet Office has no control or strong influence over most of the ICT-related spending in the public sector. The document says:

“Though implementation is not mandatory outside central government, Government will work with the wider public sector to identify and exploit further opportunities for savings through greater innovation, and sharing and re-use of solutions and services.”

That said the document has some laudable objectives for reducing ICT spending in central government. Some examples:

–         50% of central departments’ new ICT spending will be on public cloud computing services – by December 2015. [Note the word “new”. Most departmental IT spending is on old IT: support, maintenance and renewal of existing contracts.]

–         First annual timetable and plans from central government departments detailing how they will shift to public cloud computing services – by December 2011.

–         Cost of data centres reduced by 35% from 2011 baseline – by October 2016. [What is the baseline, how will the objective be measured, audited and reported?]

Drawbacks:

It is a pity the document to a large extent separates IT from the rest of government. If simplification and innovation is to be pervasive and long-lasting senior officials need to look first at ways-of-working and plan new IT in parallel with changes in working practices, or let the IT plans follow planned changes.

Not that this is a black-and-white rule. Universal Credit is an essentially IT-led change in working practices. The technology will cost hundreds of millions to develop – an up-front cost – but the simplification in benefit systems and payment regimes could save billions.

Another problem with the Implementation Plan is that it is in essence a public relations document. It is written for public consumption. It has little in common with a pragmatic set of instructions by a private sector board to line managers. Too much of the Cabinet Office’s Implementation Plan is given over to what has been achieved, such as the boast that “an informal consultation to crowd source feedback on Open Standards has taken place…” [who cares?] and much of the document is given over to what the civil service does best: the arty production of linked geometric shapes that present existing and future plans in an ostensibly professional and difficult-to-digest way.

And many of the targets in the Implementation Plan parody the civil service’s archetypal response to political initiatives; the Plan promises more documents and more targets. These are two of the many documents promised:

“Publication of cross-government information strategy principles – December 2011” …

“First draft of reference architecture published – December 2011.”

Platitudes abound: “Both goals are underpinned by the need to ensure that government maintains and builds the trust of citizens to assure them that the integrity and security of data will be appropriately safeguarded.”

There is also a lack of openness on the progress or otherwise of major projects. There is no mention in the Implementation Plan of the promise made by the Conservatives in opposition to publish “Gateway review” reports.

What’s needed

More is needed on specific measures to be taken by the Cabinet Office when departmental officials resist major reform. The promise below is an example of what is particularly welcome because it amounts to a Cabinet Office threat to withhold funding for non-compliant projects and programmes.

“Projects that have not demonstrated use of the Asset and Services Knowledgebase before proposing new spend will be declined.

“Departments, in order to obtain spend approval, will need to move to adopt mandatory common ICT infrastructure solutions and standards, and spending applications will be assessed for their synergy with the Strategy.”

But these threats stand out as unusually unambiguous. In much of the Implementation Plan the Cabinet Office is in danger of sounding and acting like PITO, the now-disbanded central police IT organisation that had good intentions but could not get autonomous police forces to do its will.

Unless Cabinet Office officials take on more power and control of largely autonomous departments – and overcome the uncertainties over who would take responsibility if all goes wrong – the Implementation Plan could turn out to be another government document that states good intentions and not the means to carry them through.

It’s as if the Cabinet Office has told departmental officials to drive at a maximum speed of 50mph when on official business to cut fuel costs. Will anyone take notice unless the speed limit is monitored? It’s the policing, monitoring and open objective reporting of the Implementation Plan’s intentions that will count.

Otherwise who cares about nameless officials making 100 pages of boasts and promises, even if the proof-reading is impressive and the diagrams look good if you don’t try to follow their meaning?

SMEs and agile to play key role as Government launches ICT plan.

Cabinet Office’s Government ICT Strategy – Strategic Implementation Plan.

Puffbox analysis of Implementation Plan.

Is there a useful job for the Cabinet Office?

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Posted in Campaign4Change, change, change management, Cloud, Cloud Computing, collaboration, G-Cloud, Government IT, improving communications, innovation, open source, openness and transparency, private sector lessons for the public sector, procurement, public sector, public services, reforms, supplier relationships, Uncategorized

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NPfIT – criminal incompetence says The Times

Posted on 05/10/2011 | 2 comments

By Tony Collins

In an editorial not everyone would have seen, The Times said the history of the NPfIT was “one of criminal incompetence and irresponsibility”.

The main leader in The Times on 23 September had the headline “Connecting to Nowhere”.

It said:

“The comically misnamed Connecting for Health will continue to honour its contracts with big companies and to swallow taxpayers’ money for some time to come: up to £11bn on current estimates. The figure demonstrates the truly egregious scale of the previous Government’s incompetence on this issue: this vast sum seems to have been committed irrevocably, even though the project has never achieved its objectives.

“The story is a dismal catalogue of naivity, ambition and spinelessness. NHS managers and officials …were [not] brave enough to question the direction of travel at crucial moments when IBM and Lockheed pulled out of the project early on. Whitehall was sold a grand vision by consultants, software and technology companies charging grandiose fees. It signed contracts that appear to have been impossible to break when the promised land did not appear. Yet no one seems responsible. No one has been sacked. Most of the officials involved have long moved on…

“There have been spectacular failures in the private sector too. But businesses, with tighter controls on spending, tend to halt things earlier if they are going wrong. Many prefer off-the-shelf systems such as SAP or Oracle, which are tried and tested. They know that it is cheaper to adapt their processes, not the software.

“This newspaper is in favour of serious investment in technology, which could play an important part in economic growth. The NHS debacle has done enormous damage to this country’s reputation for expertise in IT systems. The lessons for the future are clear. Governments must hire people who can make informed and responsible procurement decisions. Patients, in every way, are going to end up paying the price.”

A separate article in The Times 0f 23 September included comments by Campaign4Change whose spokesman said that if the Department of Health continues to spend money on NPfIT suppliers it will probably get poor value for money.

Comment:

Compare the remarks in The Times with those of David Nicholson, Chief Executive of the NHS and Senior Responsible Owner of the NPfIT who refused to agree to a request by 23 academics to have an independent review of the scheme. Nicholson could not contain his enthusiasm for the NPfIT when he told the Public Accounts Committee on 23 May 2011:

 “We spent about 20% of that resource [the £11.4bn projected total spend on the NPfIT] on the acute sector. The other 80% is providing services that literally mean life and death to patients today, and have done for the last period.

“So the Spine, and all those things, provides really, really important services for our patients. If you are going to talk about the totality of the [NPfIT] system … you have to accept that 80% of that programme has been delivered.”

It’s difficult to accept Nicholson’s figures. But even if we do, we’d have to say that the 20% that hasn’t been delivered was the main reason for the NPfIT: a national electronic health record which hasn’t materialised and isn’t likely to in the near future.

The contrasting comments of The Times and Nicholson’s are a reminder that the civil service hierarchy at the Department of Health operates in a world of its own, unanswerable to anyone, not even the Cabinet Office or Downing Street.

Can the Department of Health be trusted to oversee health informatics when it has such close relationships with major IT companies and consultants? While Katie Davis is in charge of health informatics there is at least an independent voice at the DH. But as an interim head of IT how long will she last? The DH has a history of not being keen on independent voices.

Nicholson: still positive after all these years.

NPfIT goes PfffT.

Beyond NPfIT.

Surge in tenders for non-NPfIT systems.

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Posted in Campaign4Change, Government IT, legal disputes, NHS, npfit, openness and transparency, outsourcing, procurement, public sector, public services, supplier relationships, Uncategorized

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Investors’ writ against CSC on NHS contracts – more detail

Posted on 03/10/2011 | 5 comments

By Tony Collins

The Guardian has published the 123-page writ against CSC by lawyers acting behalf of some of the supplier’s investors. The writ contains many allegations against CSC and named directors. The company’s response is that it is corporate policy not to discuss litigation.

The legal action appears to have been based, in part, on CSC’s poor share price, which is today near a five-year low, and the supplier’s repeated positive statements and assurances on the performance of its NHS IT contracts and its iSoft Lorenzo software

These are some of the claims made in the document:

– Lorenzo was originally designed by iSoft as a one-size-fits-all software for use in local medical practices. “However, the UK healthcare system is highly diverse, ranging from large university hospitals to small private medical practices to prison medical facilities. Thus, according to the Deputy Head of Testing for Lorenzo, Lorenzo was never the correct software for the job. Lorenzo therefore required significant development before it could be deployed throughout the UK’s healthcare system.”

– In September 2008, after years of delays in Lorenzo’s development [CSC] sent a Delivery Assurance Review Team to England to assess the development and testing of Lorenzo. In mid-September, the Testing Review Team met with the Deputy Head of Testing for Lorenzo, a CSC employee from December 2007 until April 2011. The Deputy Head of Testing told the Testing Review Team that the level of testing and test results for Lorenzo was “abysmal,” and that the various releases on which the project was based could not be delivered on time. Subsequently [a CSC employee] told the Deputy Head of Testing to “shut up,” which he took to mean that he should not further criticise the quality of the testing nor the testing results.

– The Deputy Head of Testing claimed that the Lorenzo software was rife with severe defects that were unacceptable under the NHS Contract. The Deputy Head of Testing said that the software defects were subject to the following ratings: Severity Level I: the defect cause important part of the Lorenzo system to fail. Severity Level II: similar to Severity I, but the defect has a workaround. Severity Level III: the defect is an important defect, but one that would not stop the system from functioning. Severity Level IV: defect is a minor defect and would not impact the Lorenzo system’s function, but would be a nuisance to a software user.

– According to the Deputy Head of Testing, throughout 2008 and 2009, the level of Severity I and II defects in every release of Lorenzo was “high and grossly beyond” what the NHS would accept. According to the Deputy Head of Testing, while CSC publicly reported that it had met certain delivery milestones and therefore could recognize revenue, CSC’s statements in this respect were misleading in view of the software defects detailed above.

– CSC said in November 12, 2008, when analysts asked about missed deadlines, that “Our confidence continues to build on the program. We are pleased with our progress.”

–  In financial statements CSC continued to assert that the NHS contract was profitable and the Company expected to recover its investment.

– Shortly before the Deputy Head of Testing retired from CSC in early April 2011, he sent an email directly to a CSC director, copying several other CSC executives, in which he said ‘You hope that you will succeed by August 2011. I do too but you won’t. The project is on a death-march where almost as many defects are being introduced as are being fixed.”

–  by 2006 CSC had determined that it had no believable plan for delivering on the NHS Contract and should not have booked revenue under the contract from that point forward.

– The significance of the NHS Contract to CSC “placed the project squarely in the spotlight of Wall Street analysts”.

–  CSC “continuously denied media reports critical of CSC’s performance of the contract”

CSC is expected to file its response to the allegations in due course.

CSC sued on losses over disastrous NHS contracts – Observer

CSC class action – document in full on Guardian’s website

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Posted in Government IT, legal disputes, NHS, npfit, supplier relationships

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CSC repays £170m to DH after non-signing of MoU

Posted on 03/10/2011 | 1 comment

By Tony Collins

CSC reports today that it has repaid to the Department of Health £170m of a £200m advance it received earlier this year for NHS IT work that was due to be carried out under a memorandum of understanding.

The MoU was not signed as had been expected by 30 September 2011, so CSC has repaid the money.

But the Department of Health has entered into an “extended advance payment agreement” with CSC for £24m.

In a statement dated 3 October 2011 CSC has also disclosed that uncertainty continues over the future of its NPfIT contracts that are worth about £3bn.

It says that it is having a series of meetings with the NHS and Cabinet Office officials over the “next several weeks” and adds that: “there can be no assurance that the MOU [memorandum of understanding] will be approved nor, if it is approved, what final terms will be negotiated and included in the MOU”.

The statement relates to CSC’s negotiations with the Department of Health and the Cabinet Office’s Major Projects Authority over a draft memorandum of understanding that proposes cutting the cost to taxpayers of CSC’s contracts by about £800m but would cut back planned deployments of Lorenzo by nearly two thirds and could nearly double the cost of each remaining deployment. One Cabinet Office official has described the terms of the memorandum of understanding as unacceptable.

CSC says today that “progress is continuing in development and deployment projects under the contract in cooperation with the NHS, although progress has been constrained due to the uncertainty created by the government approval process”.

It adds:

“Humber NHS Foundation Trust has been confirmed as the early adopter for mental health functionality to replace Pennine Care Mental Health Trust, which withdrew as an early adopter in April 2011, and CSC and the NHS are preparing to formally document this replacement under the contract.

“On April 1, 2011, pursuant to the company’s Local Service Provider contract, the NHS made an advance payment to the company of £200m related to the forecasted charges expected by the company during fiscal year 2012.

“The amount of this advance payment contemplated the scope and deployment schedule expected under the MOU and the parties had anticipated that the MOU would be completed and contract amendment negotiations would be underway by September 30, 2011.

“… the advance payment agreement provided the NHS the option to require repayment of the advance payment if the parties were not progressing satisfactorily toward completion of the expected contract amendment by September 30, 2011.

“Because completion of the MOU has been subject to delays in government approvals and, as a result, contract amendment negotiations have not progressed, the NHS required the company to repay approximately £170m of the April 1, 2011 advance payment on September 30, 2011, and the company agreed and made the repayment as requested.

“Also on September 30, 2011, the NHS and the company entered into an extended advance payment agreement providing for an advance payment of approximately £24m to the company in respect of certain forecasted charges for the company’s fiscal year 2012.

“The extended advance payment agreement acknowledges that the company’s Local Service Provider contract, as varied by the parties in 2010, is subject to ongoing discussions between the parties with the intention of entering into a memorandum of understanding setting out the commercial principles for a further set of updated agreements.

“The company intends to discuss the extended advance payment structure and certain fiscal year 2012 deployment charges with the NHS in connection with the MOU negotiations.

“However, there can be no assurance that the parties will enter into the MOU or that the company’s forecasted charges under the contract for the remainder of fiscal year 2012 will not be materially adversely affected as a result of the delay in completing the MOU and the related contract amendment.”

Meanwhile some investors of CSC have taken legal action against the company.

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CSC NPfIT deal is a crucial test of coalition strength

Posted on 28/09/2011 | 1 comment

By Tony Collins

Comment:

The Cabinet Office’s Major Projects Authority has intervened in NHS Connecting for Health’s running of the NPfIT.

In particular the Authority has taken a role in the negotiations between CSC and the Department over the future of about £3bn worth of local service provider contracts.

Had the Authority not intervened a memorandum of understanding between CSC and the DH is likely to have been signed several months ago. Fortunately for taxpayers a deal wasn’t signed.

According to a leaked Cabinet office memo the deal would have been poor value for money. It would have cut £700m or more from the cost of CSC’s contracts but doubled the cost to taxpayers of the remaining deployments.

The Cabinet Office memo said the “offer [from CSC] is unattractive”. It added:

“This is because the unit price of deployment per Trust under offer roughly doubles the cost of each deployment from the original contract”.

It could be said that signing such a deal with CSC would be as naive as a shopkeeper asking a Cadbury wholesaler to change his order from 100 chocolate bars to 30, and thus agreeing to paying Cadbury double the price for each bar.

Now it transpires that the official within the Cabinet Office who wrote the memo expressing concern about CSC’s offer is leaving. This could imply that an “unattractive” deal between the Department of Health over Lorenzo will go through after all.

Indeed the Cabinet Office has published its assessment of the NPfIT – the “Major Projects Authority Programme Assessment Review of the National Programme for IT” – which includes a section on CSC that suggests a new deal with the supplier may be signed, even though critics say the NPfIT contract with CSC should be “parked” with no further action taken on it.

The DH has accused CSC of breach of contract and vice versa. A legal dispute can be avoided by parking the contract with the agreement of both sides. If the DH signs a new deal with CSC it will be a sign that the intervention of the Cabinet Office has come to little or nothing.  It will also be a sign of coalition weakness. If the coalition cannot have an effect on a deal the DH has long wanted to sign with CSC when can it effect in terms of central government reform?

This is the worrying  section in the report – dated June 2010 – of the Major Projects Authority:

“… if the decision is taken to allow the Lorenzo development and deployments to continue there needs to be a considerable strengthening of the renegotiated position first to give CSC the opportunity to step up to its failings and for a clear statement of obligations on all parties and a viable and deliverable plan to be created and adhered to.

“There is no certainty that CSC would deliver fully in the remaining time of the contract, but the terms of the renegotiation could enable them to have a completed Lorenzo product which can compete in the market which replaces Local Service Providers…”

Other parts of the Major Projects Authority report are highly critical of Lorenzo. It says that in the North, Midlands and East of England there have been “major delays in the development of …Lorenzo”. As a result of the delays “interim and legacy systems have been used to maintain operational capability”.

The report also says the “productisation of Lorenzo is not mature” and adds: “This is evidenced by the fact that bespoke code changes are still being used in response to requirements from the early adopter trusts. This issue will be exacerbated if the remaining product development (of the modules referred to as Deployment Units) is not completed before future implementation roll-outs commence.”

The report says there is a need to be “certain about the capacity and capability of CSC to furnish sufficient skilled resources to undertake the level of roll-out needed to satisfy the existing schedule”.

It continues: “During the review it was mentioned that on occasion, people needed to leave the Morecambe Bay activity to go to the Birmingham installation at short notice to resolve problems. At this stage of the programme, CSC skills, schedule and utilisation rate, including leveraged resources, should be available to support a proposed roll-out schedule…”

There is still a “significant degree of uncertainty both about the planning of [Lorenzo] implementations and also the capability of the solution. The four key trusts chosen to implement the Lorenzo solution are in very different situations. University Hospitals Morecombe Bay is close to sign-off whilst Pennines Trust has stated its desire to leave the programme. Birmingham Women’s Hospital Trust is being held back by one issue which views have suggested are about a difference of opinion with the Supplier believing that they have met the Deployment Verification Criteria whilst the Trust is not happy about the level of functionality delivered. Connecting for Health expect to resolve this difference of opinion soon.”

And the MPA report says the latest implementation of Lorenzo 1.9 is “a long way short of the full functionality of the contracted solution which has four stages of functionality and is intended to be rolled currently out to 221 trusts”.

Lorenzo was originally due to have been delivered by the end of 2005.  If, after all the MPA’s criticisms, a new Lorenzo deal is signed what will this say about the ability of the Cabinet Office to influence decisions of civil servants?

In 2006 an internal, confidential report of CSC and Accenture on the state of Lorenzo and its future was positive in parts but listed a multitude of concerns. The summary included these words: “…there is no well-defined scope and therefore no believable plan for releases beyond Lorenzo GP…”

The current outdated NPfIT deal with CSC should be set aside , and no further action taken on it by both sides. CSC will continue to have a strong presence in NHS IT, at least because many trusts that have installed iSoft software will need upgrades.

But if a new NPfIT deal is signed with CSC it will greatly undermine the credibility of the Cabinet Office’s attempts to effect major change on the machinery of departmental administration; and it could help consign the so-called reforms of central government to the dustbin marked  “aspirations”. It will certainly give ammunition to the coalition’s critics. The Government has said it is dismantling the NPfIT. It didn’t say it was prolonging it.

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Firecontrol: same mistakes repeated on other projects

Posted on 20/09/2011 | 2 comments

By Tony Collins

A report published today by the Public Accounts Committee on the £469m Firecontrol project reads much like its others on government IT-enabled project disasters.

Margaret Hodge, chair of the Committee said:

“This is one of the worst cases of project failure that the committee has seen in many years. FiReControl was an ambitious project with the objectives of improving national resilience, efficiency and technology by replacing the control room functions of 46 local Fire and Rescue Services in England with a network of nine purpose-built regional control centres using a national computer system.

“The project was launched in 2004, but following a series of delays and difficulties, was terminated in December 2010 with none of the original objectives achieved and a minimum of £469m being wasted.

“The project was flawed from the outset, as the Department attempted, without sufficient mandatory powers, to impose a single, national approach on locally accountable Fire and Rescue Services who were reluctant to change the way they operated.

“Yet rather than engaging with the Services to persuade them of the project’s merits, the Department excluded them from decisions about the design of the regional control centres and the proposed IT solution, even though these decisions would leave local services with potential long-term costs and residual liabilities to which they had not agreed.

“The Department launched the project too quickly, driven by its wider aims to ensure a better co-ordinated national response to national disasters, such as terrorist attacks, rail crashes or floods. The Department also wanted to encourage and embed regional government in England.

“But it acted without applying basic project approval checks and balances – taking decisions  before a business case, project plan or procurement strategy had been developed and tested amongst Fire Services. The result was hugely unrealistic forecast costs and savings, naïve over-optimism on the deliverability of the IT solution and under- appreciation or mitigation of the risks. The Department demonstrated poor judgement in approving the project and failed to provide appropriate checks and challenge.

“The fundamentals of project management continued to be absent as the project proceeded. So the new fire control centres were constructed and completed whilst there was considerable delay in even awarding the IT contract, let alone developing the essential IT infrastructure.

Consultants made up over half the management team (costing £69m by 2010) but were not managed. The project had convoluted governance arrangements, with a lack of clarity over roles and responsibilities. There was a high turnover of senior managers although none have been held accountable for the failure.  The committee considers this to be an extraordinary failure of leadership. Yet no individuals have been held accountable for the failure and waste associated with this project.”

Comment:

Firecontrol was a politically-motivated project which used  bricks, mortar and IT to try and change the way people worked. The users in the fire service didn’t want a single national approach of nine new regional centres – complete with new hardware and software – just as NHS clinicians, in general, did not want the National Programme for IT [NPfIT]. The Firecontrol regional centres were built anyway and the NPfIT went ahead anyway.

One lesson is that, in the public sector, you cannot engage users who won’t support the scheme. If they want to change, and they want the new IT, they’ll find ways to overcome the technology’s deficiencies. If they don’t want the scheme – and fire personnel did not want Firecontrol – the end-users will be incorrigibly harsh evaluators of what’s delivered, and not delivered.

It’s better to get the support of users, and involve them in the prototype design and test implementations, long before the scheme is finalised. It’s different in the private sector because the support of users is not essential – those who don’t accept business change and the associated IT will be expected to quit.

So what today is the mistake that is being repeated? The Public Accounts Committee touched on it when it said that the Department for Communities and Local Government – which was responsible for Firecontrol –  “failed to provide appropriate checks and challenge”.

During the life of Firecontrol, the Office of Government Commerce carried out “Gateway reviews” which independently assessed progress or otherwise. The reviews  could have provided an early warning of a project that was about to waste hundreds of millions of pounds. But the Gateway review reports were not published. They had a limited internal distribution and, it appears, were ignored.

According to the Public Accounts Committee, a Gateway review in April 2004, near the start of the Firecontrol project, said the scheme was in poor condition overall and at significant risk of failing to deliver.

Why was this Gateway review not published? If it had, Parliament and the media could have held ministers to account – and perhaps have campaigned to stop the project before millions were thrown away.

There was indeed a media campaign in 2004 – and before – to have Gateway reviews published, but ministers – and particularly civil servants – said no.

Now the same thing is happening. The civil service has persuaded the coalition government to carry on Labour’s tradition of keeping Gateway reviews secret. So Parliament and the media will continue to be kept in the dark on whether a major project is going wrong.

By the time details of the reviews are published, perhaps years later in a report of the National Audit Office,  it may be too late to rescue the scheme. By then tens or hundreds of millions may have been wasted. Gateway reviews should be published around the time they are written, not years later.

Ministers do not have to pander to civil servants. They are paid to stand up to them. They receive a premium over the salary of MPs in part to be independent voices – to provide a challenge.

Subservient ministers in the DWP are among those who continue to allow Gateway reviews to remain hidden. If you ask the DWP under the Freedom of Information Act for the release of the Starting Gate report on Universal Credit (which I am told is not the same as a Gateway review report) the DWP will refuse your request. It refused mine.

So we have to accept the word of civil servants that the Universal Credit programme is going well; but haven’t there been enough IT-related disasters in government for all to know that the word of civil servants on whether things are going well needs to be tested independently? The publication of Gateway reviews – and Starting Gate reviews – could help outsiders hold a department to account. It’s time ministers began to realise this.

Are ministers such as Iain Duncan Smith in control of their departments – or are their civil servants in control of them?

Links:

Margaret Hodge on BBC “Today” programme 20/9/11 – “what could go wrong did go wrong” – did PA Consulting get away without blame?

What the NPfIT and Firecontrol have in common.

Firecontrol:  should PA Consulting share some responsibility for what happened?

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An NHS success story – what’s to learn from it?

Posted on 06/09/2011 | Leave a comment

By Tony Collins

IM&T at Trafford General Hospital makes visits to hospital safer for patients and gives managers the information they need to monitor the work of clinicians. Even doctors like the advanced technological environment and come up with ideas for improvements. So what lessons can be learnt? Here are four:

–           Be in control of your IT suppliers. Too often in the public sector it’s the other way around

–           Don’t buy from suppliers that seem excessively secretive and talk much about their proprietary information – which may include your data. Know their systems well enough to produce the reports you want, when you want them and in the format you want, rather than wait for your information to be given to you when the suppliers want to give it, and in their format.

–           Don’t impose change. Have the push come from the business users [in Trafford’s case clinicians] who understand what technology can do for them.

–           Keep IT in the background – not centre stage.

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Advanced health technology on a £1.5m yearly budget

Posted on 02/09/2011 | Leave a comment

By Tony Collins

[This is the final part of a 3-part series on how Trafford Healthcare NHS Trust’s IM&T team achieves much on a small budget]

Trafford General Hospital bought its main systems outside of the £11.4bn the National Programme for IT [NPfIT]. The hospital, though, is one of the most technologically-advanced in the UK.

Part one of our series on Trafford Healthcare NHS Trust covered the clinical support for IM&T, integrated systems, and the openness that’s required of the trust’s suppliers.

Part two covered the trust’s  control of its data, how NPfIT could ever have worked, how patients benefit from the IM&T,  why doctors keep their smartcards on them at all times, links between hospital and GP systems, the real-time view of free beds, why duplicated patient records are rare, board support for  integrated electronic patient record systems, and some of the remaining challenges.

Some of  Trafford’s further challenges include:

–           Securing the agreement of all GPs in the area to share a synopsis of their records. About half have agreed so far.

–           Scanning in all paper notes to the EPR. At present about 50% of patient notes have been scanned and are available to clinical staff as “PDF” files, normally with chapter headings. They include diagrams, charts and handwritten text.

–           Dealing with any uncertainties that arise when the Trust is acquired – in all probability by Central Manchester Foundation Trust .

–           Maximising the IM&T opportunities that the acquisition will bring both Trusts in terms of modernising systems and extending the concept of the shared electronic patient record across a wide area of Manchester.

Costs

Trafford has 14 people working on IM&T and IT infrastructure related matters who handle support, infrastructure and integration. The total yearly cost, including salaries, is about £1.5m in capital and revenue which covers the spend with all of Trafford’s  IM&T suppliers.

This compares with costs of between £23m and £31m for each NPfIT installation at acute trusts in London and the South – and these sums do not include the costs of running a hospital’s IM&T and associated infrastructure. Neither do the NPfIT costs include the salaries for an acute hospital’s IT and IM&T staff.

Steve Parsons, Head of IM&T, says of his hospital’s technology: “This is bargain stuff”.

If Trafford can do so much for so little, can centrally-bought NPfIT systems costing many times more – for less – still be justified? The Department of Health argues that NPfIT systems offer more than non-NPfIT. But how much more could Trafford offer its clinical staff, in terms of proven technologies and integration?

Asked where he’d put Trafford in a league table of UK hospitals with systems that clinicians need and want to use, Peter Large, Director of Planning, pauses and says with a slight smile: “Let’s be modest – in the top 10%.”

He’s probably not joking.

**

•           Since writing this article Parsons and his team have been short-listed by the eHealth Insider Awards for the trust’s electronic whiteboard project, in the category of “innovation in healthcare interoperability”.

Part one: How does this IM&T team achieve so much for so little money?

Part two: How does this IM&T team achieve so much for so little money? (2)

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How does this tech team achieve so much on so little money? (2)

Posted on 01/09/2011 | Leave a comment

By Tony Collins

One reason doctors and nurses hold the tech team at Trafford General Hospital in high regard is the quiet professionalism of Steve Parsons who’s a civil engineer and Head of IM&T at Trafford Healthcare NHS Trust in Manchester.

Civil engineering is a  world where openness  is allied to safety. Parsons  designed buildings and pumping stations in the water industry where managers don’t tolerate unnecessary secrecy from their suppliers. From there he became involved in managing IT-led change and came to Trafford General Hospital in 2000.

“It’s having an analytical questioning mind, not just accepting what people say. I will ask all the questions that can make me seem a pain. You want to know why it [a supplier’s software] is going to work,” he says.

“If they don’t give me the confidence that their product is going to work under certain conditions I will not want it. I will not take a black box without knowing what is going to happen with it. I am not having that dependency. I want to strip it down to its basics. It has to be practical. Where else is it working? What is the underlying database?”

Patient data and suppliers 

He says that hospital data belongs to the hospital, not the supplier. “There are people working in the health service who will say: ‘we are the system supplier. It is our data.’ But ours is patient data. This is client’s data, not the supplier’s.”

To an outsider – one who doesn’t work in the NHS – the most surprising thing about seeing the IM&T engine rooms at Trafford General is the complexity and the different ways each ward works. These complexities have to be managed to give doctors and nurses a seamless view of what is happening with each patient.

Could the NPfIT ever have worked?

It’s remarkable, given these complexities, that anyone thought a national system – the National Programme for IT in the NHS –  could ever have worked. It’s hard enough to integrate IM&T within a single hospital let alone on a regional or national scale.

Parsons and Peter Large, Director of Planning at Trafford Healthcare NHS Trust,  consider it lucky that Trafford went live with the Graphnet patient record technology as early as 2003, several months before the tenders for the NPfIT systems were awarded.

It meant that, while some in the NHS were waiting in eager anticipation for NPfIT systems that never arrived, Trafford’s technical staff were learning in precise terms what clinicians wanted and converting this knowledge into working systems. At no point did the promised national systems offer more than Trafford’s.

How patients benefit from Trafford’s IM&T   

In a room close to each ward is a 46” screen known as the “whiteboard” which shows lists of every patient, whether in a bed or visiting outpatients. Allied to the patient’s name are relevant details including colour-coded alerts to warn if a VTE [thrombosis] check hasn’t yet been done, an observation is overdue or an x-ray has not been assessed. In A&E the icon turns red if a patient has waited for three hours, and purple if more than four hours.

Also on the whiteboards, breaches of Department of Health guidelines on waiting times are shown clearly for each patient. The screen also shows which doctor is responsible for any breaches of waiting times.

If nothing else, these system alerts and icons – which include ticking clocks – show how technology can make treatment and care safer for patients.

Why doctors keep their smartcards at all times 

Clinical staff must use smartcards to access the system, and they are unlikely to forget them because they also allow access to the car park.

In trials of NPfIT systems, some doctors were reluctant to use smartcards because of the time taken to log on each time they returned to the computer. At Trafford log-on takes a few seconds, and Imprivata’s single sign-on means that holders of smartcards do not have to remember different passwords. Take out the smartcard and the screen goes blank.

Says Parsons: “We are dependent on EPR now. A year ago one or two consultants refused to look at the EPR. Their secretaries had to print off the last letter from outpatients because they would rather not look at it on a screen. That’s changed.”

Patients give their details only once 

In parts of the NHS patients give their name and address every time they visit a different part of the hospital. At Trafford General Hospital a new patient has a file created at, say, A&E. It is then available to all parts of the hospital, ready for staff to order electronically a blood test or x-ray, or book an appointment.

Links to GPs 

Through Sunquest’s Anglia order communications system and using the HL7 messaging standard, GPs can from their desks order hospital blood tests and x-rays, and get the results in their inboxes. The orders and test results are recorded in the hospital’s Graphnet EPR.

If the local GP has authorised it – and so far about half in Trafford’s catchment area have – A&E doctors will soon be able to see a synopsis of the GP-held patient record which would show any treatments outside the Manchester area as well as medications and significant medical events. The synopsis comes into a hospital server that is controlled by GPs, using their local Emis or Vision systems. In return, GPs have access to their own patients within the hospital-based EPR where they can see all the records related to a patient’s episodes of treatment .

Real-time view of free beds

On the whiteboard, staff can see when beds are due to become vacant, doctors having given the system an estimated time and date of departure for each inpatient. If a doctor fails to give an estimate the system shows an alert.

Says Laura Slatcher who is an assistant to Parsons, “Doctors are restricted with what they can do with the patient’s record  – cannot make referrals, cannot update whiteboards – unless the estimated discharge date is kept up to date. Doctors will complain that they cannot get on because clerks or nurses haven’t kept this administrative information up to date.”

The estimated discharge date is also useful to ensure that the system has alerted district nurses if the patient, after leaving hospital, needs physiotherapy, dietary monitoring or help from social services.

Bed management is a module now removed from the “Lorenzo” system as part of the Department of Health’s plans to cut the costs of NPfIT contracts.

Duplicated patient records are rare

Parsons and his team have done much to tackle the bane of hospital administration: duplicate patient records. Says Parsons: “We have a central patient index which is updated nightly from all GP practices. If you say your name we check date of birth and previous addresses, maybe from the GP – you may still get two people with the same name living in the same house.

“Once we have updated John Jone to John Jones, the central system will update all other related systems to the new spelling. One single ID for everyone avoids having duplicates which could end up with patients having the wrong records. That’s critical to get right.”

Medical Director Dr. Simon Musgrave says: “Duplicates are a fairly rare event now.”

Staff in A&E can create duplicates very easily from patient provided information but “we have systems in place to track those in the following 24 hours and merge them back to the correct record”, says Parsons.

The hospital’s old iSoft patient administration system had 150,000 duplicate files in a database of 460,000 patients. That was typical for an acute hospital says Parsons.

Trafford dispensed with its patient administration system –  it doesn’t have one, having replaced it with the Graphnet’s EPR and Ultragenda from iSoft [now owned by CSC].

EPR goes beyond Trafford

Many doctors are sceptical of the need to make electronic patient records available across England, which was one of the main – and ultimately unsuccessful – aims of the NPfIT. The sceptics say it is very rare for patients to need treatment outside their locality.

Trafford has 250,000 patients in its catchment area but its EPR has 1.4 million records which includes most people in Manchester.

Board support

Trafford adopted the Department of Health’s pre-NPfIT strategy in the late 1990s which called for hospitals to install, incrementally, six levels of EPR – electronic patient records. Level one was a patient administration system and departmental systems. The highest, level six, was a full multi-media EPR online.

Says Parsons: “I have been fortunate of having the support of the Trust Board throughout the 10-year period of staying on a strategy that said: ‘we will continue to build that six-level EPR and all that went with it until an equivalent and better came from the National Programme for IM&T  through Connecting for Health’.”

Reporting, accountability and safety 

Trafford publishes hundreds of reports to operational managers: how long patients have been in their bed or how have they waited, how many patients have had certain types of forms filled in such as VTE forms. Every morning emails to consultants tell them the number of patients they had admitted the day before and how many have not had, say, thrombosis assessments.

Standard reports from some suppliers to the NHS may be too limited for Trafford’s demands, says Parsons. “Some of the questions we are asking require difficult algorithms. On bed occupancy for example doctors get credits for the numbers of patients they are caring for. The standard unit for care is one day or night in hospital.  If somebody is in for six hours, if you work in units of one day, nobody gets credits for that. We want to break IM&T down to parts of days and look at trends.”

Challenges remaining

Ensuring patient safety during the transition from paper to computer needs careful management.

Says Musgrave, Trafford General’s Medical Director: “When you ask for an x-ray [on paper] you fill out a form, get the x-ray done, and the x-ray report is written on a piece of paper which comes back to you so your secretary gets a bit of paper that says “cancer” on it. That’s the end point, the safe point, and you do something about it.

“If you order it on a computer and you do not have a paper record, you have to have some other different system for making it safe.  How do you know the x-ray has been ordered, has been done, and been reported? And what is the report? There is no back-stop there unless you invent one via the computer.”

“Will we ever do entirely without paper?” asks Parsons. “Hmm.”

Part one – How does this tech team achieve so much on so little money?

Final part – How does this tech team achieve so much on so little money?

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