Why was NHS e-Referral service launched with 9 pages of known problems?

By Tony Collins

Were GPs guinea pigs for live testing of the new national NHS e-Referral Service?

Between 2004 and 2010 the Department of Health marked as confidential its lists of problems with national NPfIT systems, in particular Choose and Book.

So the Health and Social Care Information Centre deserves praise for publishing a list of problems when it launched the national “e-Referrals” system on Monday. But that list was 9 pages long.

The launch brought unsurprised groans from GPs who are used to new national systems going live with dozens of known problems.

The e-Referral Service, built on agile “techniques” and based on open source technology, went live early on Monday to replace “Choose and Book” for referring GP patients to hospitals and to other parts of the NHS.

Some GPs found they could not log on.

“As expected – cannot refer anything electronically this morning. Surprise surprise,” said one GP in a comment to “Pulse” on its article headlined “Patient referrals being delayed as GPs unable to access e-Referrals system on launch day.”

A GP practice manager said: “Cannot access in south London. HSCIC debacle…GPs pick up the pieces. Changing something that wasn’t broken.”

Another GP said: “I was proud never to have used Choose and Book once. Looks like this is even better!”

Other GPs said they avoided using technology to refer patients.

“Why delay referral? Just send a letter. (Some of us never stopped).”

Another commented: “I still send paper referrals – no messing, you know it has gone, no time wasted.”

Dr Faisal Bhutta, a GP partner in Manchester, said his practice regularly used Choose and Book but on Monday morning he couldn’t log in. “You can’t make a referral,” he said.

The Health and Social Care Information Centre has apologised for the disruption. A statement on its website says:

“There are a number of known issues, which are currently being resolved. It is not anticipated that any of these issues will pose a clinical safety risk, cause any detriment to patient care or prevent users from carrying out essential tasks. We have published the list of known issues on our website along with details of how to provide feedback .”

But why did the Centre launch the e-Referral Service with 9 pages of known problems? Was it using GPs as guinea pigs to test the new system?

Comment

The Health and Social Care Information Centre is far more open, less defensive and a better communicator than the Department of Health ever was when its officials were implementing the NPfIT.

But is the HSCIC’s openness a good thing if it’s accompanied by a brazen and arrogant acceptance that IT can be introduced into the NHS without a care whether it works properly or not?

In parts of the NHS, IT works extraordinarily well. Those who design, test, implement and support such systems care deeply about patients. In many hospitals the IT reduces risks and helps to improve the chances of successful outcomes.

But in other parts of the NHS are some technology enthusiasts – at the most senior board level – who seem to believe that all major IT implementations will be flawed and will be improved by user feedback.

The result is that IT that’s inadequately designed, tested and implemented is foisted on doctors and nurses who are expected to get used to “teething” troubles.

This is dangerous thinking and it’s becoming more and more prevalent.

Many poorly-considered implementations of the Cerner Millennium electronic patient record system have gone live in hospitals across England with known problems.

In some cases, poor implementations – rather than any faults with the system itself – have affected the care of patients and might have contributed to unnecessary deaths when records needed urgently were not available, or hospitals lost track of urgent appointments.

A CQC report in March 2015 said IT was a possible factor in the death of a patient because NHS staff were unable to access electronically-held information.

In another incident a coroner criticised a patient administration system for being a factor in the death of three year-old Samuel Starr whose appointment for a vital scan got lost in the system.

Within NHS officialdom is a growing cultural acceptance that somehow a poor IT implementation is different to a faulty x-ray machine that delivers too high a dose of radiation.

NHS officials will always brush off IT problems as teething and irrelevant to the care and safety of patients. Just apologise and say no patient has come to any harm.

So little do IT-related problems matter in the NHS that unaccountable officials at the HSCIC have this week felt sufficiently detached from personal accountability to launch a national system knowing there are dozens of problems with the use of it.

Their attitude seems to be: “We can’t know everything wrong with the system until it’s live. So let’s launch the system and fix the problems as GPs give us their feedback.”

This is a little like the NHS having a template letter of regret to send to relatives and families of patients who die unexpectedly in the care of the NHS. Officials simply fill in the appropriate name and address. The NHS can then fix the problems as and when patients die.

It’s surely time that bad practice in NHS IT was eradicated.  Board members need to question more. When necessary directors must challenge the blind positivism of the chief executive.

Some managers can learn much about the culture of care at the hospitals that implement IT successfully.

Patients, nurses and doctors do not exist to tell hospital managers and IT suppliers when electronic records are wrong, incomplete, not available or are somebody else’s record with a similar name.

And GPs do not exist to be guinea pigs for testing and providing feedback on new national systems such as the e-Referral Service.

e-Referral Service “unavailable until further notice”

Hundreds of patients lost in NPfIT systems

Hospital has long-term NPfIT problems

An NPfIT success at Croydon? – Really?

Physicians’ views on electronic patient records

Patient record systems raise some concerns, says report

Electronic health records and safety concerns

Sensible advice on planning an end to 10-year outsourcing deal

By Tony Collins

Dave Orr used to work in IT at Somerset County Council. Since retiring in 2011 he has, among other things, watched closely the undoing of Southwest One, IBM’s 10-year outsourcing/joint venture deal with the county council, Taunton Deane Borough Council and Avon and Somerset Police.

From FOI answers, reading council papers and meetings with councillors and officials he has learned a great deal about what works and what doesn’t in a large outsourcing deal.

For nearly four years after the creation of Southwest One in 2007  he saw events from the inside, as an employee of the county council.

Now that Southwest One is approaching its natural end in 2017 and Taunton Deane councillors are considering “succession planning”,  Orr has sent them his advisory paper.

These are some of the points Orr made to Taunton Deane’s councillors:

– It’ll cost more to unravel the contract with IBM than council officers say.

“From previous freedom of information disclosures, it cost this Council around half a million pounds to get into this controversial contract with IBM back in 2007 and I believe that it will cost at least that, to get out of the contract and implement the succession option,” says Orr.

“The current project budget request before you tonight for £47,000 is clearly a “starter for 10” and you can expect further costs, including a significant write down on the remaining book value of SAP.

“Back in 2005, the councils [Somerset County Council and Taunton Deane Borough Council] decided from the outset that a large outsource of so-
called “back office” services in a joint venture was “the right answer”; the next two and a half years were spent working backwards from that answer to try and make a viable Business Case.

“Please do not make that fundamental mistake again. Please do not rush into a preferred option early on in Phase One, without making sure that you have a clear view of what sort of Council and what services you will be delivering in future.

“This state is currently referred to by officers as the ‘New Operating Model’.

“If you don’t know what sort of Council you want to be, then how will you know what sort of IT you will need to support this Council? Or what option is best for delivering the IT needed?

– Don’t leave key decisions to council officers

“It is for you as councillors to lead and guide the officers, not for an early  preferred option to lead you.

“Clearly, the original Southwest One business case was flawed, as no-one  modelled for static or falling budgets; the ridiculous claims by IBM of £192m of
procurement savings were never ever there – good times or bad.

“All that shows is that predicting the complex and fast changing real world in a fixed written contract for 10 years is next to impossible.”

The end of IBM’s joint venture?

Separately Orr points out that Southwest One’s partners are now running three separate procurement exercises to determine what will happen at the end of contract. The three organisations undertake to simply “inform each other” of progress.

Orr says it makes sense for Avon and Somerset Police to go its own way when the Southwest One contract ends – although it shares a SAP system configured for use by the three organisations – but it would be a wasted expense for Somerset County Council and Taunton Deane to have separate procurements as they will share offices in future.

Excessive secrecy?

Orr also makes the point that councillors who take part in discussions on succession planning will be legally bound to secrecy.

But would excessive secrecy give a licence to a small group of officers and councillors to act almost as they want, incompetently, or in ignorance of the full facts?

Somerset County Council concedes that the 3,000-page Southwest One contract, which was signed in 2007, and was replete with literals because it was signed in a rush, has proved difficult to implement.

Will the same mistakes be made again, even though the council has produced several “lessons learned” reports?

The forthcoming discussions will involve IBM so secrecy will be a dominant issue.

But some of the discussions are deemed so secret that officers need not consult councillors on every important matter – which means that even those councillors who are bound by legal non-disclosure agreements may be excluded from some decisions.

Officers will tell councillors what’s happening only when officers decide that councillors should be consulted. Officers say they’ll consult councillors “when required”.  It will be up to officers to decide what “when required” means.

In discussions with possible outsourcers what if one council officer favours a company for reasons that aren’t clear?  Who among the lay councillors will stop mistakes being made if they don’t know everything that’s going on?

Campaign4Change has previously quoted the late Lord Chief Justice Lord Bingham on openness but it’s worth requoting:

“… Modern democratic government means government of the people by the people for the people.

“But there can be no government by the people if they are ignorant of the issues to be resolved, the arguments for and against different solutions and the facts underlying those arguments.

“The business of government is not an activity about which only those professionally engaged are entitled to receive information and express opinions.

“It is, or should be, a participatory process. But there can be no assurance that government is carried out for the people unless the facts are made known, the issues publicly ventilated.

“Sometimes, inevitably, those involved in the conduct of government, as in any other walk of life, are guilty of error, incompetence, misbehaviour, dereliction of duty, even dishonesty and malpractice.

“Those concerned may very strongly wish that the facts relating to such matters are not made public.

“Publicity may reflect discredit on them or their predecessors. It may embarrass the authorities. It may impede the process of administration. Experience however shows, in this country and elsewhere, that publicity is a powerful disinfectant.

“Where abuses are exposed, they can be remedied. Even where abuses have already been remedied, the public may be entitled to know that they occurred.

FOI exempt

Somerset’s officers have warned councillors that discussions over succession planning will be exempt from the FOI Act to “protect commercial interests”.

Says Somerset:

“Members on the [Joint Members Advisory] Panel should not disclose to any person outside the Panel any information which falls within the above definition. Much of the information provided to the Panel will fall into this definition. Therefore, it is anticipated that all information will be kept confidential, unless it is specifically agreed that the information can be shared.”

Any sharing of information will need the agreement of named council officers.

Comment

Sensible advice from Dave Orr.

Leaving officers to decide what to tell councillors, hiding away discussions behind locked doors, forcing some councillors to sign confidentiality agreements, and trusting supplier assurances that outsourcing deals don’t really go wrong – it’s all made up by the media – are factors that make outsourcing failure almost inevitable.

And it’s undemocratic for a cabal of officers and councillors to treat one of the council’s most important decisions as a private matter.

Any councillor whose authority is considering a major outsourcing deal may, perhaps, wish to think about all the councillors and officers who have waved enthusiastically from the open window of their train carriage as they headed unknowingly on a track ending at a precipice – councillors and officers from:

– Bedfordshire County Council which paid £7.7m to terminate an unsatisfactory £250m 12-year outsourcing deal prematurely. The then leader of the council, said the decision to end the partnership was to “improve quality and performance”.

– Suffolk County Council which looked to become a “light” organisation and outsource a lot of its duties but found it “simply did not work” according to then leader Mark Bee.

– Sandwell Council which left its planned 15-year partnership with BT, called Transform Sandwell, nine years early. Councillors were unhappy with the service.

– Liverpool Council which said last year it would save £30m over 3 years by ending its outsourcing/joint venture Liverpool Direct with BT.

– Birmingham City Council which plans to end  its £1bn outsourcing deal with Capita early and has taken a 500-strong contact centre back in-house.

– Cornwall Council, which is only 2 years into a 10-year outsourcing contract with BT, and says the supplier has not met key performance indicators, and not delivered on jobs promises.

Southwest One – the complete story

Somerset starts planning for life after Southwest One

Why some US companies are giving up on outsourcing (Forbes)

Lessons from Indiana’s outsourcing deal with IBM

Is HMRC spending enough for help to replace £10.4bn Aspire contract?

By Tony Collins

Government Computing reports that HM Revenue and Customs is seeking a partner for a two-year contract, worth £5m to £20m, to help the department replace the Aspire deal which expires in 2017.

HMRC is leading the way for central government by seeking to move away from a 13-year monopolistic IT supply contract, Aspire, which is expected to cost £10.4bn up to 2017.

Aspire’s main supplier is Capgemini.  Fujitsu and Accenture are the main subcontractors.

HMRC says it wants its IT services to be designed around taxpayers rather than its own operations. Its plan is to give every UK taxpayer a personalised digital tax account – built on agile principles – that allows interactions in real-time.

This will require major changes in its IT,  new organisational skills and changes to existing jobs.

HMRC’s officials want to comply with the government’s policy of ending large technology contracts in favour of smaller and shorter ones.

Now the department is advertising for a partner to help prepare for the end of the Aspire contract. The partner will need to help bring about a “culture and people transformation”.

The contract will be worth £5m to £20m, the closing date for bids is 6 July, and the contract start date is 1 September.  A “supplier event” will be held next week.

But is £5m to £20m enough for HMRC to spend on help to replace a £10.4bn contract?

This is the HMRC advert:

“HMRC/CDIO [Chief Digital Information Officer, Mark Dearnley] needs an injection of strategic-level experience and capacity to support people and culture transformation.
“The successful Partner must have experience of managing large post-merger work force integrations, and the significant people and cultural issues that arise. HMRC will require the supplier to provide strategic input to the planning of this activity and for support for senior line managers in delivering it.
“HMRC/CDIO needs an injection of strategic level experience and capacity to help manage the exit from a large scale outsourced arrangement that has been in place for 20+ years.
“HMRC is dependent on its IT services to collect £505bn in tax and to administer £43bn in benefits each year. The successful supplier must have proven experience of working in a multi-supplier environment, working with internal and external legal teams and suppliers and must have a proven track record of understanding large IT business operations.
“HMRC/CDIO needs an injection of strategic level experience and capacity to help HMRC Process Re-engineer and ‘Lean’ its IT operation. HMRC/CDIO requires a Programme Management Office (PMO) to undertake the management aspects of the programme.
“It is envisaged that the Lead Transformation Partner will provide leadership of the PMO and work alongside HMRC employees. The leadership must have significant experience of working in large, dynamic, multi-faceted programmes working in organisations that are of national/international scale and importance including major transformation…”

Replacing Aspire with smaller short-term contracts will require a transfer of more than 2,000 Capgemini staff to possibly a variety of SMEs or other companies, as well as big changes in HMRC’s ageing technologies.

It would be much easier for HMRC’s executives to replace Aspire with another long-term costly contract with a major supplier but officials are committed to fundamental change.

The need for change was set out by the National Audit Office in a report “Managing and replacing the Aspire contract”  in 2014. The NAO found that Capgemini has, in general,  kept the tax systems running fairly well and successfully delivered a plethora of projects. But at a cost.

The NAO report said Aspire was “holding back innovation” in HMRC’s business operations”.

Aspire had made it difficult for HMRC to “get direction or control of its ICT; there was little flexibility to get things done with the right supplier quickly or make greater use of cross-government shared infrastructure and services”. And exclusivity clauses “prevented competition and stifled new ideas”.

Capgemini and Fujitsu made a combined profit of £1.2bn, more than double the £500m envisaged in the original business plan. Profit margins averaged 16 per cent to March 2014, also higher than the original 2004 plan.

HMRC was “overly dependent on the technical capability of the Aspire suppliers”. The NAO also found that HMRC competed only 14 contracts outside Aspire, worth £22m, or 3 per cent of Aspire’s cost.

Although generally pleased with Capgemini,  HMRC raised with Capgemini, during a contract renegotiation, several claimed contract breaches for the supplier’s performance and overall responsiveness.

When benchmarking the price of Aspire services and projects on several occasions, HMRC has found that it has often “paid above-market rates”.

HMRC did not consider that its Fujitsu-run data centres were value for money.

Comment

HMRC deserves credit for seeking to replace Aspire with smaller, short-term contracts. But is it possible that HMRC is spending far too little on help with making the switch?

HMRC doesn’t have a reputation for caution when it comes to IT-related spending.  The total cost of Aspire is expected to rise to £10.4bn by 2017 from an original expected spend of £4.1bn. [The £10.4bn includes an extra £2.3bn for a 3-year contract extension.]

Therefore a spend of £5m to £20m for help to replace Aspire seems ridiculously low given the risks of getting it wrong, the complexities, the number of staff changes involved, the changes in IT architecture, and the legal, commercial and technical capabilities required.

The risks are worth taking, for HMRC to regain full control over ICT and performance of its operations.

If all goes wrong with the replacement of Aspire, costs will continue to spiral. The Aspire contract lets both parties extend it by agreement for up to eight years. HMRC says it does not intend to extend Aspire further. But an overrun could force HMRC to negotiate an extension.

As the NAO has said, an extension would not be value for money, since there would continue to be no competitive pressure.

Campaign4Change has never before accused a government department of allocating too little for IT-related change. There’s always a first time.

Government Computing article

 

Does Barnet know if it’s saving money with Capita?

By Tony Collins

Are council outsourcing contracts becoming so unfathomably complex that officials and leading councillors have no real idea whether they’re saving money?

A Somerset County Council report on the lessons learnt from its troubled outsourcing/joint venture deal with IBM emphasized the importance  of “not making  contracts overly complicated”.

The report said:

” Both the provider [IBM] and the Council would agree that the contract is incredibly complicated. A contract with over 3,000 pages was drawn up back in 2007 which was considered necessary at the time given the range of services and the partnership and contractual arrangements created…

“The sheer size and complexity of this contract has proven difficult to manage.”

For years there have been arguments in Somerset over whether the council has saved or spent more as a result of the relationship with IBM.  The absence of audited figures means nobody knows for certain.

It seems to be the same at Barnet. An absence of audited figures – the council does not have to produce them for an outsourcing contract – means that nobody knows for certain if Capita is costing or saving money.

It’s likely that councillors who supported the outsourcing to Capita, and critics of the deal, will never agree on whether local residents are better or worse off.

Now a Barnet resident and respected blogger Mr Reasonable, who studies the accounts of the local council as part of his efforts to be more open and accountable, has offered £250 to charity if the Tory leader Richard Cornelius provides evidence of how Capita is making savings as promised.

Mr Reasonable made the offer on 24 May 2015 and has heard nothing. His request to Barnet was followed up by Aditya Chakrabortty, senior economics commentator at the Guardian. The council didn’t reply within his deadline. Says Chakrabortty:

“If you want to see the world of outsourcing at its most illogical, spend a bit of time with detail-hunters like Mr Reasonable.

“He tells me about phoning his local library to see if a children’s book was in stock. The call was of course routed to a Capita call centre in Coventry, where staff spent ages unable to help before connecting him back to the librarians just down the road. By his calculations, for that wasted call Capita would charge Barnet £8.

“Outsourcing is full of these invented costs, which is how the privateers make their billions.

“Mr Reasonable can tell you about how Barnet now pays £800 for a day’s training in how to take minutes, or £14,628 for just two months of occupational health assessments. In both cases these are services that would previously have been provided in-house for minimal cost…

“These examples would be comic, if they didn’t cost blameless taxpayers so much money…”

Commercial confidentiality

Mr Reasonable says all the commercially sensitive elements of Barnet’s contracts with Capita are redacted and there are “numerous clauses relating to incentives and penalties which would have made publishing a single payments schedule almost impossible”.

It’s also impossible he says to know what Capita has billed for or not.

“I have asked repeatedly to see the evidence of precisely what we are paying for and a detailed explanation of why the payments are so high. Whilst a few promises of evidence were made when the previous COO was in place, none actually materialised.”

Open day?

He adds:

“If Barnet Council is serious about openness then why not host an open day where they go through the contract in detail so that we can understand exactly what we are paying for?

“I would have thought it would have made sense for Capita to get involved with this, to work through the contract with interested citizens and to demonstrate clearly how much money they are saving.

“So I hereby throw down a challenge to the Chief Executive Mr Travers, to Richard Cornelius and to Capita – host an open day, bring bloggers and critics in and show them what you are doing, how the contract is working in reality what money is being paid to whom and how much is really being saved – evidence is essential.

“Indeed a few Conservative councillors might want to come along as well seeing as they voted for this contract. I know some of them privately had serious concerns about the contract but were worried about making those views public.

“And to put my money where my mouth is, I will donate £250 to a charity of Richard Cornelius’ choice if he makes this contract open day happen.”

Comment 

Outsourcing deals should be signed on the basis of pure pragmatism, never because of an ideology.

Barnet’s deal with Capita (and Somerset’s) was signed for largely ideological reasons. Somerset wanted to “go beyond excellence” and Barnet’s ruling councillors want to be immortalised by establishing a new frontier for local government – a “commissioning council” whereby all services are bought in.

It might have been cheaper for Barnet’s residents if the council had given its ruling councillors immortality by building statutes of them in the council’s grounds.

Will council officers have enough time or understanding of the nuances of the contract, with its maze of incentives and penalties,  to know whether they are saving money or not?

In any case how accurate were the pre-outsourcing baseline figures and assumptions on which to make a comparison between what services were costing then, and what they are costing now?

There is no equivalent in local government of the National Audit Office, no organisation that will audit a local government outsourcing deal and publish the results.

This means councillors can say what they like in public about the success of a deal without fear of authoritative contradiction. Their critics can only speculate on what is really happening while they try to shine a light at the dense fog that is commercial confidentiality.

It appears that more and more councils are seriously considering large-scale outsourcing, perhaps on the basis that they can promise guaranteed savings without anyone being able to hold them to account on whether genuine savings materialise.

The first we’ll know anything is awry is when a council report, years into a contract, reveals some of the difficulties and says a resolution is being discussed with the supplier; and it’s another year or two before the contract is terminated at considerable extra cost to the council – and nobody is in post from the time of the original contract to be held accountable.

Is this really the shape of local government outsourcing to come?

Mr Reas0nable

 

DWP gives out “selective” information on welfare reform even to its auditors

By Tony Collins

If the National Audit Office cannot obtain reliable and comprehensive information from the DWP, who can?

The NAO is the department’s auditor. Its head Amyas Morse signs off (or rather qualifies) the DWP’s accounts. His staff also produce regular “value for money” reports on the DWP’s projects and performance.

But an NAO report published today on welfare reform gives more than a hint of the problems its auditors face when trying to verify the information the DWP gives them.

The report “Welfare reform – lessons learned says the DWP failed twice to answer the NAO’s questions. Then, when the NAO gave the department its draft report, the DWP provided some information – which the NAO describes as “selective”. It is worth quoting the NAO’s comment in full:

“We have relied largely on our past audit reports to understand the implementation of welfare reform. Past work provides a sufficiently strong and comparable evidence base to identify different approaches and what works well and less well.

“We requested audit evidence from the Department for Work & Pensions (the Department) in August and November 2014.

“This would have allowed us to validate or comment on the Department’s performance more broadly and how they have subsequently addressed issues identified in previous reports. However, the Department failed to send the evidence despite requests.

“Following receipt of a draft report in April 2015, the Department provided some evidence on how it has tried to address issues identified in previous reports and how other welfare reforms have considered these themes.

“In the Department’s view it has made progress across programmes since the time of our initial reports. This includes addressing concerns about programme management on Universal Credit and reducing the time taken to process Personal Independence Payment claims.

“Given the selective nature of the evidence provided and the limited time to review a wide range of programmes, we were unable to audit the evidence or consider the additional information in detail…”

Separately, the DWP is in a protracted legal case to prevent the publication under FOI of four old – 2012 – reports on the Universal Credit programme.  A one-day hearing will be held in London on 15 July 2015.

Comment

The DWP is astonishingly thin-skinned. Its officials are probably not hiding anything – they just don’t want anybody knowing how well, or how badly, they are managing projects and programmes such as Universal Credit.

Since Universal Credit went live press officers have been allowed to give out only selective information on Universal Credit. It has  been difficult to establish from them that the programme has had 6 programme directors and 6 senior responsible owners since 2010.

The NAO’s latest report says the DWP needs to “recognise openly” when it has not met expectations. It needs greater internal challenge, says the NAO.

But the DWP seems unable to change its culture of defensiveness and the selective release of information to Parliament, the public and even its own auditors.

Why is it spending so much public money on trying to stop the release of the four UC reports?

Better than anyone else the late Lord Chief Justice Lord Bingham has summed up the need for openness:

“… Modern democratic government means government of the people by the people for the people. But there can be no government by the people if they are ignorant of the issues to be resolved, the arguments for and against different solutions and the facts underlying those arguments.

“The business of government is not an activity about which only those professionally engaged are entitled to receive information and express opinions.

“It is, or should be, a participatory process. But there can be no assurance that government is carried out for the people unless the facts are made known, the issues publicly ventilated.

“Sometimes, inevitably, those involved in the conduct of government, as in any other walk of life, are guilty of error, incompetence, misbehaviour, dereliction of duty, even dishonesty and malpractice.

“Those concerned may very strongly wish that the facts relating to such matters are not made public. Publicity may reflect discredit on them or their predecessors. It may embarrass the authorities. It may impede the process of administration. Experience however shows, in this country and elsewhere, that publicity is a powerful disinfectant.

“Where abuses are exposed, they can be remedied. Even where abuses have already been remedied, the public may be entitled to know that they occurred.” R v Shayler(2002) UKHL 11, (2003)1 AC 247.

Thank you to John Slater for providing Lord Bingham’s quote.

Welfare reform – lessons learned

DWP wastes money on another Universal Credit FOI appeal

After billions spent on NHS IT, a carrier bag to transfer x-ray images

By Tony Collins

After fracturing my angle (slipping on a slope while mowing the lawn) I’ve been surprised how well parts of the NHS work – but not when it comes to the electronic transfer of records and PACS x-ray images from one trust area to another.

The minor injuries unit at one trust wasn’t able to send its PACS images to another trust’s orthopaedic department because it used a different PACS.  [The NHS has spent more than £700m on PACS ]

“Can’t we email the images?” said a senior nurse at the minor injuries unit. In reply the clinician looking at my x-rays gave a look that suggested emailing x-rays was impossible,  perhaps for security and cost reasons. [PACS images are sometimes tens of MBs.]

In the end the minor injuries unit (which within its own sections shared data electronically) had to download my x-rays onto CD for me to take the other trust’s orthopaedic department.  The CD went into a carrier bag.

The next day, at a hospital with an orthopaedic department, after 4-5 hours of waiting in a very busy A&E, I gave a doctor the CD. “I don’t think we can read that,” he said. “We don’t have any computers which take CDs.”

After a long search around a large general hospital the tired doctor eventually found a PC with a CD player. Fortunately the minor injuries unit had downloaded onto the disc a self-executing program to load the x-rays. Success. He gave his view of the fracture.

Even then he didn’t have my notes from the minor injuries unit.

Comment

My care was superb. What was surprising was seeing how things work – or don’t – after the NHS has spent more than £20bn on IT over the past 20 years.

The media is bombarded with press releases about IT innovations in the NHS. From these it’s easy to believe the NHS has the most up-to-date IT in the world. Some trusts do have impressive IT – within that trust.

It’s when records and x-rays need to be transferred outside the trust’s area that the NHS comes unstuck.

As a nurse at my GP’s practice said, “Parts of the NHS are third-world.”

Since 2004 billions has been spent on systems to create shareable electronic patient records.  But it’s not happening.

Within those billions spent on IT in the NHS, couldn’t a little bit of money be set aside for transferring x-rays and patient notes by secure email? That’s the real innovation the NHS needs, at least for the sake of patients.

In the meantime the safest way for x-rays and notes to be transferred from one trust to another is within the patient’s carrier bag.

The best reason to remember the coalition government?

By Tony Collins

A day before people go to the polls to elect a new government is, perhaps, a good time to remember a momentous achievement of the old one.

It’s rare in any government for politicians to override the settled wishes and views of senior public officials.

In “Yes Minister” Sir Humphrey usually gets his way over his minister – which many politicians say reflects reality.

liam foxBut in 2011 the defence secretary Liam Fox did something remarkable: he went against the fervent wishes of an officialdom that had, since 1996, persuaded prime ministers and successive defence ministers that two pilots, beyond any doubt, had caused the deaths of 25 top intelligence and security officers who were on board a Chinook helicopter, ZD576, that crashed on the Mull of Kintyre on 2 June 1994.

All 29 were killed in the crash including two pilots Flight Lieutenants Rick Cook and Jonathan Tapper and senior crewmen, Malm Graham Forbes, and Sgt Kevin Hardie.

It was under a Conservative government that two RAF air marshals found that Cook and Tapper caused the crash and were grossly negligent. The defence secretary at the time, Malcolm Rifkind, agreed with the decision to blame the pilots.

Later he changed his mind and said officials had given him incomplete information. He was unaware of the history of problems with a new “Fadec” fuel-control system fitted to the Chinook Mark 2 – the helicopter type that crashed on the Mull of Kintyre.

The safety-critical Fadec [full authority digital engine control] system was controlled entirely by error-ridden software that controlled the flow of fuel to the Chinook’s two jet engines.

The system was so unreliable that a day before the crash, test pilots had stopped flying Chinooks fitted with the new Fadec.  The system caused engines to behave unpredictably – at times surging or running down without leaving a trace of any fault.

At the time of the crash there were internal disagreements within the RAF over the seriousness of the Fadec-related problems.  A senior RAF software engineering specialist wrote in 1993 that the Fadec had an undocumented feature in the processor that was “positively dangerous”.

When Chinook ZD576 crashed there were no black boxes, no eyewitnesses, and no survivors to say what happened in the last minutes and seconds.  It is not known for certain whether the pilots were in control.

One of the air marshals who found the pilots grossly negligent drew his conclusions, in part, from data obtained from the crashed Chinook by the manufacturer of an RNS252 navigation system. The air marshal described the RNS252 as a “black box”.

RNS 252 chinookData obtained from the RNS252 was not independently verified; it’s unusual in any civil air accident investigation to draw conclusions on the cause of a crash from a system that has not been independently proven to be accurate.

None of this was known to the Conservative government when it announced to Parliament in 1994 that the gross negligence of the two pilots caused the crash.

The then prime minister John Major later changed his mind about the pilots being to blame. He wrote in The Times in May 2004:

“We may never know what truly caused this tragedy. It follows, therefore, that there is no justification for blaming pilot error… We owe justice to the dead. I am not persuaded that they have had it.”

RAF rules at the time of the crash were that dead pilots could not be found grossly negligent unless there was “absolutely no doubt whatsoever” about the cause of an accident.

The doubts of Major, Rifkind and James Arbuthnot , a Conservative defence minister, deepened as the years went by and more evidence of the Chinook Mark 2’s technical problems  came to light.

Arbuthnot, in particular, campaigned vigorously for the pilots’ names to be cleared, as did many other MPs and peers.

But nobody could persuade a succession of Labour defence ministers that the pilots might not have been to blame. Tony Blair, when prime minister, wrote twice to the families of the dead pilots repeating the MoD and RAF line that there was no new evidence to justify a reopening of the inquiry into the crash.  Defence secretaries John Reid, Geoff Hoon, George Robertson, Bob Ainsworth, John Hutton and Des Browne took the same position.

The MoD even set up a small team to answer many questions from MPs and peers – and the families of the pilots – about the crash investigation, the Fadec system, and other technical shortcomings that raised questions about the airworthiness of the Chinook Mark 2.  The team’s official retort was that there was no new evidence to justify a new inquiry.

But it was the MoD, RAF and their ministers who were judge and jury on what represented new evidence – and they dismissed as irrelevant every leaked internal RAF software engineering memo on the poor state of the Chinook Mark 2.

In opposition some conservatives said they would hold a new inquiry into the crash if they came to power. Cameron was among them. Liberal-Democrats wanted also wanted a new inquiry, particularly the ardent campaigner Menzies Campbell.

Labour MPs and peers also campaigned for a new inquiry particularly the peer Martin O’Neill. Crossbench peer Lord Chalfont led a Parliamentary group that campaigned on behalf of the Cook and Tapper families.

Families of some of the VIPs who died in the crash supported the campaign.

When the coalition was formed, Cameron and Clegg did what they’d promised and set up a new inquiry, led by a retired judge Lord Philip

His report recommended that the finding of gross negligence be set aside; and he and his privy counsellors had strong criticisms, not of the air marshals who had made their finding in good faith, but of officialdom. Lord Philip’s report said:

 “Since 1995 the Ministry of Defence has continued resolutely to defend the finding of gross negligence and to rebuff all public and private representations that the finding should be reconsidered even when the representations included cogent arguments based on a sound understanding of the effect of the relevant Regulations.

“We find it extremely regrettable that the Department [MoD] should have taken such an intransigent stance on the basis of an inadequate understanding of the RAF’s own Regulations in a matter which involved the reputation of men who died on active service.”

The Philips report did not, and could not, set aside the finding of the air marshals. Whether right or wrong, the finding had a firm legal status. There was no right of appeal.  How could the finding be set aside?

Then came the coalition’s arguably most important machinery-of-government decision:  Liam Fox convened a special meeting of the Defence Council.  Chaired by the defence secretary, the Defence Council provides the formal legal basis for the conduct of defence in the UK through a range of powers.

It comprises the chief of defence staff and senior service officers and senior officials who head the armed services and the MoD’s major corporate functions.

How the Defence Council came to its vote to set aside the finding of the air marshals is not known. There are rumours one or two of its members were replaced before the vote.

John Cook, the father of Rick, did not live to see his son’s reputation restored. John Cook died in 2005. A former British Airways Concorde pilot, he had been concerned about the lack of black boxes on the crashed Chinook. He was also concerned about the air marshals’ partial reliance, in drawing their conclusions, on the manufacturer’s data derived from the RNS252.   On John Cook’s death, the campaign for justice was taken up by his other son Chris.

Mike Tapper, the father of Jonathan, began the campaign to his the pilots’ names a few days after the crash  when it appeared that some officials were suggesting to the media that the likely cause was pilot error.

In fact the cause – or causes – of the crash will never be known. Much of the helicopter was destroyed in the fire that followed impact.  It might have been caused by pilot error. It might have been the result of technical malfunctions, or combination of human and technical factors. What’s certain is that there is doubt over the cause.

Liam Fox and his coalition colleagues have proved that when public officials are wrong – and even when, in their misconceptions, they have persuaded two prime ministers and successive defence secretaries to adopt their arguments – that those misconceptions can be overturned if the political will is strong enough.

Many political decisions of the coalition government will soon be forgotten. But correcting a grievous and long-standing miscarriage of justice against two Special Forces pilots who could not speak for themselves will never be forgotten.

It will never be forgotten by the campaigners who are too numerous to mention; and it will never not be forgotten by the children of the two pilots.

A model council outsourcing report?

By Tony Collins

Cornwall Council signed a questionable outsourcing deal in 2013 but it deserves praise for the candour of the report it published on 8 April 2015 on the performance of BT.

It’s rare for any council to report in detail on what percentage of key performance indicators have been met by the outsourcing supplier, or on the contractual commitments met and not met.

The council has a tradition of being run by groups of independent councillors. It’s currently run by an independent/Liberal Democrat coalition.

Is the report published on its outsourcing contract with BT Cornwall the sort of document all councils with major outsourcing deals should publish?

Cornwall’s report

BT tries to rescue Cornwall outsourcing deal

BT tries to rescue its faltering IT outsourcing deal in Cornwall

bt cornwall logoBy Tony Collins

Cornwall council logoBT has appointed a new senior management team in Cornwall to help rescue a faltering IT-based outsourcing deal there.

Two years into the 10-year contract, BT has not met commitments and guarantees it gave when setting up BT Cornwall to take over the running of ICT, human resources, document management and other services for Cornwall Council,  Peninsula Community Health and Cornwall Partnership NHS Foundation Trust.

BT has made improvements in the past two months. If these are not sustained the council says that it will consider its options including early termination.

A BT spokesperson told Campaign4Change this week “We are working closely with our partners in this project to ensure we deliver on all aspects of the contract.”

A table in an officers’ report to the council this month puts the situation bluntly. The only commitment that is met 100% is for baseline savings – which are deducted at source.

Overview of BT Cornwall’s performance against commitments and guarantees

KPI measures Achieved (185/289) – 64%

PI measures Achieved (266/402) – 66%

Service Transformation (percentage of plans completed) – 38%

Financial contractual baseline savings (10% & 11.6%) – 100%

Trading gain share received (est £17.4m over 10 years) – £0

Guaranteed new jobs in Cornwall (yrs 1 & 2 111 new jobs target / 35.1 created) – 32%

Committed new jobs in Cornwall (yrs 1 & 2) – 0

Cornwall Council rushed into signing a contract with BT, before local elections in May 2013. This appears to be acknowledged in the report to the council. It says that, in the timescales available, due diligence and analysis before the contract signing was not at an ideal level.

BT made contractual commitments over new jobs, service transformation, key performance indicators, and performance indicators. The council’s report says that some contractual commitments have not been met.

The report also says the council “might be paying twice for replacement assets”.

There were delays in securing contract novations with suppliers which meant, as an interim measure, the council “had to pay suppliers and reclaim the monies from BT Cornwall”.

As part of their bid submission, BT estimated trading gain share to the public sector partners of £17m over the 10 years of the contract. “To date, no gain share has been received from trading. It is recognised, however, that this is not a contractual commitment,” says the report.

BT Cornwall made a contractual commitment to deliver a minimum of 197 additional jobs to Cornwall over the life of the contract with 111 of these being delivered in the first two years. “Of these, 35 have been delivered so far.”

There was also a commitment to try and deliver a further 240 jobs in the first two years and none of these has been delivered.

The Service Desk has failed to cope with or process the number of incidents being reported. Users have abandoned calls after “lengthy and fruitless waits for assistance”. The report adds: “The latest KPIs demonstrate that there is still some way to go in terms of Service Desk performance.”

There have been concerns among some councillors about reports of job losses within BT Cornwall, and the loss of expertise that had been transferred to BT Cornwall from the council.

A problematic upgrade to Windows 7  left users on Windows XP and in some cases unable to access their desktop or laptop. The report says:

“Despite being discussed extensively throughout the dialogue stages of the contract, it was noted that the delivery of Windows 7 had been under-resourced and the deployment methodology inefficient.

“Fortunately, because the government had negotiated the extension of support to Windows XP, the Council had not suffered the very serious consequences the delay would otherwise have caused.

“It is fair to say that the council is not entirely blameless for the long delay to the upgrade process as many officers failed to attend for their upgrade appointment. That said, had BT Cornwall adopted a more user-friendly method of upgrade, the ‘no-shows’ would not have been such a problem.

“There has also been an issue around the number of software applications which have required Windows 7 compatibility but, again, this was an issue which BT were aware of during the dialogue leading up to the Contract and knowing the challenging timescale, it was their responsibility to design a methodology and/or to commit the resources required to ensure the complexities were addressed and the process completed by the due date.

“Members have asked for an estimate of the time lost and financial cost to the council caused by the overall delay and the operational downtime as a result of issues with upgrades which have prevented use of laptops/PC’s and meant teams/individuals have been unable to work effectively or at all for periods of time.

“It is not possible to calculate this accurately any more than the time lost through unjustified ‘no-shows’ or late notification to BT Cornwall of software applications can be estimated. It is also difficult to estimate the downtime due to the failings of the upgrade process when compared with the problems inevitably caused by the large organisational transition to a new operating system.”

Andrew Wallis cornwall

Andrew Wallis, an independent councillor in Cornwall and cabinet member, says on his blog that is concerned that BT Cornwall has had two years to deliver on the contract and has failed.

“There is only so many second-chances you can give. For me, if by summer BT Cornwall do not deliver their commitments, than I am afraid we must be in the area of looking to terminate the contract …”

 The council’s report highlights:

–  A lack of challenge to requests for replacement equipment.

 – ICT support much reduced

– Performance under the Service Level Agreement down.

– Projects taking longer to be initiated.

 – Peninsula Community Health and Cornwall Partnership NHS Foundation Trust unhappy with the responses they had received from BT Cornwall in respect of the delivery of their ICT services.

New management

bt logo

The new management at BT Cornwall includes an interim chief executive, Gavin Finlayson, an interim chief technical officer, Phil Healy, and an interim project delivery director, Chris Swann.

Ian Dalton, President of BT,  Global Government and Health, who is head of the public sector for BT in the UK, has written to Cornwall Council this month to restate BT’s commitment to the 10-year service delivery agreement.

Comment

Campaign4Change warned in 2013 that the signing of a deal was being rushed – Council approves BT deal after hurried talks.

We also said that if the promises, commitments and guarantees came to nothing, nobody in the public sector – officer or councillor – would be held accountable. And nobody has.

How is it that councils – whose officers are supposed to be professionals – can continue to sign outsourcing deals that are clearly at the outset no more than superficially attractive and which put public money and service to users at obvious risk?

Services at Cornwall seem to have worsened since the deal was signed. So why were councillors given rosy reports on the future of services, jobs and IT support in the period running up to contract’s signing?

Better surely if councillors had received neutral reports on the pros and cons of outsourcing. Too often naive councillors are in awe of beautiful marketing brochures – sometimes commissioned by the council itself -that eulogize the benefits of outsourcing and put the risks in the appendices.

The word “guarantee” means little before an outsourcing deal is signed. Indeed in 2003 we suggested the “G” word be banned from the outsourcing lexicon.

BT’s corporate management, having realised how bad things were in Cornwall, appears to be doing all it can to rescue the deal. But can it afford to employ people it doesn’t really need, to meet a contractual commitment?

It’s extraordinary that the BT Cornwall outsourcing deal went through the full council with hardly a word of opposition.

There again, councillors believe their officers are the professionals who would not sign an ill-considered outsourcing deal. Or would they?

Isn’t it time that the elected representatives of the public became more professional themselves before putting services to users and so much public money at risk?

Public sector outsourcing failures – European Services Strategy Unit reports

Cornwall Council approves BT deal after hurried talks – 2013

BT Cornwall is not working for Cornwall Council as it should – councillor Andrew Wallis’s blog

Cornwall Council report

DWP will fight to stop publication of Universal Credit reports whoever wins in May

By Tony Collins

dwpOn 7 July 2004 the Work and Pensions Committee called on the DWP to be “significantly more open about its IT projects”.

Today – 11 years later – the DWP is fighting to stop publication of four reports that would throw light on early problems with the IT work on Universal Credit.

And the DWP has continued to keep secret millions of pounds worth of reports on the progress or otherwise of its big projects, including those that have a major IT element,  Universal Credit in particular.

The Department is preparing for a new one-day hearing as part of its legal efforts – which have lasted two years so far – to stop the four reports on Universal Credit being published under the FOI Act.

A first-tier tribunal judge in March 2014 ordered the DWP to publish the reports. The following month the same judge refused the DWP leave to appeal, but the DWP’s external lawyers appealed to an upper tribunal for leave to appeal.

Now a judge has ordered a new one-day hearing in London, at a date yet to be set.

While the appeals continue the DWP does not have to publish the reports. In the light of this, DWP officials plan to continue their legal fight to stop publication of the reports, irrespective of who wins the election next month.

Indeed the case could go on for years. That legal costs for taxpayers are mounting seems no deterrent to the Department’s officials.

The four reports are already dated – they go back to 2012. The reports are the risks register, issues register, milestone schedule and project assessment review. All are about the Universal Credit programme.

John Slater, a programme and project management professional, requested three of the reports under FOI. I requested the project assessment review. 

Lamentable

Little has changed – the DWP has remained defensive and secretive – since 2004 when the Work and Pensions Committee said in its weighty report “Department for Work and Pensions Management of Information Technology Projects: Making IT deliver for DWP Customers”:

“The record on IT by DWP and its predecessor the Department of Social Security, has been lamentable …”

The report referred to the DWP’s habit of setting “unrealistic deadlines” on big projects, a problem that years later hit Universal Credit.

The Committee in 2004 added that the DWP was keeping reports secret to avoid embarrassment:

“We felt that on occasions the secretive approach adopted by the Department and the Government … had little to do with commercial confidentiality and more to do with departments using it as an excuse to withhold information that rightly belonged in the public domain, but which might embarrass the Department if released publicly.

“In our view the lack of Parliamentary accountability is part of the reason for the relatively high number of defective IT projects.”

The secrecy is not the fault of the DWP’s major suppliers -who include IBM, HP, Accenture, BT and Fujitsu. The Work and Pensions Committee said:

“During our enquiry, we were struck by how open IT suppliers seemed prepared to be in contrast with the tendency of officials to invoke commercial confidentiality.”

universal creditIn an echo of the Work and Pensions Committee’s 2004 report, the Public Accounts Committee said in February 2015, in its report: Universal Credit: progress update:

“… a lack of openness remains within the Department, as does an unwillingness to face up to past failings.

“The Department refused to accept the extent of previous failings, despite the overwhelming evidence we heard last year that the programme’s management had been extraordinarily poor prior to the reset, and the small numbers claiming Universal Credit.

“Furthermore, since early 2012, the Department has been fighting a protracted legal case to prevent the publication of documents relating to the management of Universal Credit…”

Ministers powerless?

Ministers have so far been unable to persuade civil servants to publish contemporaneous reports on the government’s big IT-enabled projects and programmes.

Francis Maude came to power in 2010 expecting to publish “Gateway” reviews on IT schemes but senior civil servants refused, arguing in part that publication would have a “chilling effect” on those writing and researching the reports.

Maude gave up on trying to get the reports published but gained reluctant agreement from permanent secretaries to publishing the traffic light status of large projects – but only after these assessments have lost their topicality in the form of a six-month time lag.

FOI campaigners say there are several reasons senior civil servants do not want reports on big IT-based projects, including Universal Credit, published.

The main reason, they say, is tradition: departments have always kept secret their internal independent reports on the progress or otherwise of major schemes.

Another reason is that officials do not always implement the reports’ recommendations. If nobody outside a department’s inner circle knows what a report’s recommendations or findings are, will it matter if they go unimplemented?

A further reason is that disclosure of the reports may cause embarrassment by confirming that a department’s ministers and officials have been economical with the truth – giving Parliament and the media the wrong impression about a project’s successful progress.

Lucrative

Another reason for keeping the reports secret may be that it enables civil servants and consultants who write the reports to be kind – perhaps even deferential – to their Whitehall colleagues by producing positive reports on projects that may later go awry.

Writing and researching the reports can be lucrative work. They are sometimes worth £1,000 a day to some consultants. A positive report with comfortable conclusions is more likely to bring further commissions than a generally negative one.

Indeed an upper tribunal judge Edward Jacobs, in a ruling on the case of the four reports, hinted that they were so positive even a hostile press would be pressed to find things to criticise.

Jacobs said that if he grants a rehearing of the case it is possible that the new tribunal “will need to consider that some of the contents (of the four reports) could hardly be presented badly even in the most hostile media coverage”.

Why disclosure is important

Officials working on Universal Credit have repeated mistakes of the past: setting unrealistic deadlines, underestimating complexity and not being open about project problems – even internally: their minister, Iain Duncan Smith, to get the unvarnished truth, had to set up his own “red team” reviews to bypass civil servants who had been giving him information.

As John Slater has pointed out, the late Lord Chief Justice Lord Bingham made an important statement on the need for openness:

“… Modern democratic government means government of the people by the people for the people. But there can be no government by the people if they are ignorant of the issues to be resolved, the arguments for and against different solutions and the facts underlying those arguments.

“The business of government is not an activity about which only those professionally engaged are entitled to receive information and express opinions. It is, or should be, a participatory process. But there can be no assurance that government is carried out for the people unless the facts are made known, the issues publicly ventilated.

“Sometimes, inevitably, those involved in the conduct of government, as in any other walk of life, are guilty of error, incompetence, misbehaviour, dereliction of duty, even dishonesty and malpractice. Those concerned may very strongly wish that the facts relating to such matters are not made public.

Publicity may reflect discredit on them or their predecessors. It may embarrass the authorities. It may impede the process of administration. Experience however shows, in this country and elsewhere, that publicity is a powerful disinfectant. Where abuses are exposed, they can be remedied. Even where abuses have already been remedied, the public may be entitled to know that they occurred.

Comment

The DWP’s culture of secrecy seems to overwhelm all new ministers who go along with it because they cannot run such a huge and complex department without the full support of their officials.

That’s perhaps why officials, on the matter of openness on IT projects, need never take seriously criticisms by the Information Commissioner, the Public Accounts Committee or the Work and Pensions Committee.

If officials have taken little notice of MPs for more than a decade, why should they start behaving differently under a new government?

The taxpayer suffers in the end. The DWP’s lamentable record on running major IT-based projects will probably continue, with huge financial losses and without accountability, while money continues to be poured into fighting pointless FOI legal battles.

It seems unlikely – and indeed would set a precedent – but perhaps a new set of ministers at the DWP will dare to try and change the culture.