Upper Tribunal refuses DWP leave to appeal ruling on Universal Credit reports

Posted on 26/06/2014 | 1 comment

By Tony Collins

An upper tribunal judge this week refused consent for the Department of Work and Pensions to appeal a ruling that four reports on the Universal Credit programme be published.

It’s the third successive legal ruling to have gone against the DWP as its lawyers try to stop the reports being released.

The DWP is likely to request further consideration of its appeal. History suggests it will devote the necessary legal time and funding to stop the reports being published.

In March 2014, the first-tier information tribunal rejected the DWP’s claim that disclosure of the four reports would inhibit the candour and boldness of civil servants who contributed to them – the so-called chilling effect.

The DWP sought the first-tier tribunal’s leave to appeal the ruling, describing it as “perverse”. External lawyers for the DWP said the tribunal had wholly misunderstood what is meant by a “chilling effect”, how it is manifested and how its existence can be proved.

They claimed the misunderstanding and the perverse decision were “errors of law”. For the first-tier tribunal’s finding to go to appeal to the “upper tribunal”, the DWP would have needed to prove “errors in law” in the findings of the first-tier tribunal.

The judge in that case, David Farrer QC, found that there were no errors in law in his ruling and he refused the DWP leave to appeal. The DWP then asked the upper tribunal to overrule Farrer’s decision – and now the DWP has lost again.

The upper tribunal’s judge Nicholas Wikeley says in his ruling this week:

“This [chilling effect] is a well known concept, and I can see no support for the argument that the [first-tier] Tribunal misunderstood its meaning.

“The Tribunal was surely saying that whilst it heard Ms Cox’s claim that disclosure would have a chilling effect, neither she nor the Department provided any persuasive evidence to that effect.” [Sarah Cox is a senior DWP executive on the Universal Credit programme.]

“Indeed, the Tribunal noted, as it was entitled to, that Ms Cox did not suggest that frank discussion had been inhibited in any way by a third party’s revelation of the ‘Starting Gate Review’.”

In conclusion the judge says:

“I therefore refuse permission [for the DWP] to appeal to the Upper Tribunal.”

The DWP’s lawyers asked the upper tribunal for a stay, or suspension, of the first-tier tribunal’s ruling that the four reports be published. This the judge granted temporarily.  The lawyers also asked for a private hearing, which the judge did not decide on.

DWP too secretive?

John Slater, who has 25 years experience working in IT and programme and project management, requested three of the four reports in question under the FOI Act in 2012. He asked for the UC issues register, high-level milestone schedule and risk register. Also in 2012 I requested a UC project assessment review by the Cabinet Office’s Major Projects Authority.

The Information Commissioner ruled that the DWP should publish three of the reports but not the Risks Register.  In March 2014 the first-tier information tribunal ruled that all four reports should be published.

Excluding these four, the DWP has had 19 separate reports on the progress or otherwise of the Universal Credit programme and has not published any of them.

Work and Pensions minister Lord Freud, told the House of Lords, in a debate on Universal Credit this week:

“I hope we are as transparent as we can be.”

What happens now?

Slater says that as the DWP has been refused permission to appeal it will probably ask for an oral hearing before the upper tribunal. This would mean that the DWP would get a second chance to gets its point across directly in front of the Upper Tribunal rather than just on paper, as it has just tried, says Slater. There is no guarantee that the DWP would be granted an oral hearing.

Comment

If all was going well with the DWP’s largest projects its lawyers could argue, with some credibility, that the “safe space” civil servants need to produce reports on the progress or otherwise of major schemes is having a useful effect.

In fact the DWP has, with a small number of notable exceptions such as Pension Credit, presided over a series of major IT-based projects that have failed to meet expectations or business objectives, from  “Camelot” in the 1980s to “Operational Strategy” in the 1990s. Universal Credit is arguably the latest project disaster, to judge from the National Audit Office’s 2013 report on the scheme.

The”safe space” the DWP covets doesn’t  appear to work.  Perhaps it’s a lack of firm challenge, external scrutiny and transparency that are having a chilling effect on the department.

Upper Tribunal ruling Universal Credit appeal

My submission to FOI tribunal on universal credit

Judge [first-tier tribunal] refuses DWP leave to appeal ruling on Universal Credit reports – April 2014

 

 

 

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Posted in Campaign4Change, DWP, excessive secrecy, FOI, Freedom of Information, Gateway reviews, Government IT, IT-related failures, Major Projects Authority, managing change, Universal Credit

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2 councils cut costs of Capita deals, bringing hundreds of staff in-house

Posted on 25/06/2014 | 1 comment

By T0ny Collins

Councils in Birmingham and Swindon are cutting the costs of their Capita outsourcing deals, in part by bringing hundreds of staff in-house.

Labour-controlled Birmingham City Council, the largest local authority in Europe, is bringing back about 500 staff after the council negotiated with Capita to cut £20m a year from the cost of running Service Birmingham, a contract which started in 2006 and has 7 years left to run, reports the Birmingham Post.

Service Birmingham is two-thirds owned by Capita and a third by Birmingham Council.

Deputy leader Ian Ward is quoted in the Birmingham Post as saying the changes would bring major savings and a greater degree of control over council communications.

“We have negotiated an agreement with Service Birmingham which provides a major step forward in reducing our cost base for ICT. On balance, the council considers the risk of changing ICT provider at this time too risky.

“It would take a considerable period of time to procure and would cost an additional tens of millions up front in early termination charges and re-procurement costs.”

The council will bring the call centre in house by the end of the year, as part of a “One Contact” vision to resolve queries at the first point of contact.

Councillors routinely face complaints from constituents about poor service when attempting to phone the council, according to a local political blog, The Chamberlain Files.

Ward said: “It’s not just about how quickly we can answer the telephone or how polite the person answering the phone is. These things are important but we need ensure that queries are resolved to the citizen’s satisfaction.”

The blog quotes Birmingham’s leader Sir Albert Bore as saying that Capita had taken a pragmatic view and recognised the changing circumstances faced by the council.

A clause in the existing contract enabling the council to withdraw ‘at will’ from the Capita agreement within 60 days will remain. A controversial 17% mark-up on purchases has been removed.

The council hopes to gain more value from the new contract by limiting the number of projects it requires Capita to oversee and reducing the number of IT applications run by the authority. Capita was appointed originally because the council did not have the expertise to develop a modern contact centre and had invested little in new technology.

Ward said he hoped the council’s relationship with Capita, which has not always been harmonious in the past, would improve.

“What I also want to see coming out of this challenge is for both parties to work harder to make the partnership work better than it has to date. We need to make sure we have an ICT strategy that is fit for purpose and that will improve our control and planning for projects.”

The contract’s cost has reduced from about £120m a year to £80m a year, says The Chamberlain Files.

Swindon Council

Conservative-controlled Swindon Council is set to save about £2m a year by renegotiating with Capita on back-office services, says the Swindon Advertiser. It says that around 200 Capita staff will move to the council’s employment.

A contract with Capita, worth more than £240 million, was signed in 2007 and was set to last for 15 years.

Council leader David Renard is quoted as saying: “A number of years ago we entered into a 15-year contract with Capita but we obviously now live in a very different world.

“The council has to find savings every year and that means nothing is off the cards, so we have asked to sit down and have a look at the contract.

“The potential saving of £2m is very significant so it is something we have to look at. In fairness to Capita, we have asked to look at the arrangement on a number of occasions and they have been receptive.

“We want to maintain a positive relationship with them because there are things, such as revenue and benefits, which they do very well.”

A Capita spokeswoman said: “Swindon Council has undertaken a thorough review of its budget and services, including those services delivered by Capita.

“The council is considering a range of options to ensure it delivers integrated and effective services and Capita is fully engaged in that process.

“Capita’s priority is to continue delivering high quality services to the council and residents in Swindon, and to keep our employees informed throughout the process.”

Since signing the deal with Capita seven years ago many of the services can now be provided in-house, said the Swindon Advertiser. The council has become less reliant on Capita for some of its services, it says.

The deal with Swindon Council has allowed the company to win contracts with other local authorities and there are now fewer specialists to dedicate their time to Swindon, it adds.

 

 

 

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Posted in Campaign4Change, Capita, local government, managing change, outsourcing, public sector, public services

NHS trusts exit £27m Capita deal

Posted on 24/06/2014 | 4 comments

By Tony Collins

Trusts across Liverpool are pulling out of a £27m deal to buy their payroll and recruitment services from outsourcing company Capita, says the Health Service Journal.

The trusts are not yet half way through 7-year contracts.

Five out of eight North Merseyside providers that transferred services to Capita in 2012 will have brought them back into the NHS, or moved to other providers, by 1 August, according to statements given to HSJ.

The contract terminations follow concerns about the quality of the service provided by Capita HR Solutions.

Royal Liverpool and Broadgreen University Hospitals Trust and neurosciences specialist Walton Centre Foundation Trust confirmed to HSJ that they had ceased to receive any services under the Capita contract.

Royal Liverpool board papers in February said that an initial “informal letter of concern” about the Capita services was sent collectively by the North Merseyside trusts in March last year, but “no significant improvements were seen within three months”.

When Capita’s HR business won the North Merseyside contract in 2011 it hailed it as a “landmark agreement” which marked “the first time NHS trusts have come together in this way to collectively outsource their HR, payroll and recruitment functions”.

A Capita spokeswoman told HSJ  that following a joint review of recruitment, payroll and HR processes, Capita and a number of trusts in North Merseyside have mutually agreed that Capita will no longer provide these services.

In July last year Payroll World reported that the group of Merseyside hospitals had sent a 9-page letter to Capita referring to repeated “minor failings”. It threatened to end the £27m contract.

Among the mistakes were over and underpayments to staff. Another allegation was that Capita breached data protection laws by sending confidential and personal information of employees to other staff and paying up to two months’ salary to individuals that had applied for jobs at one of the hospitals but ultimately failed to be offered a position.

Capita was said to be working closely with the trusts to overcome the issues identified in order to deliver an enhanced service for Trusts and their staff.

But more problems emerged.

Leicestershire and Northamptonshire trusts had problems with a Capita payroll contract in 2008. In 2008 HSJ reported:

“Five NHS organisations with more than 16,000 staff have ended a payroll contract with Capita after a catalogue of errors. The contract had been due to run to 2010 but was terminated last week after just 18 months.”

Hospitals accuse Capita of failings

Capita payroll error leaves 550 NHS employees paid incorrectly

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Posted in Campaign4Change

Labour promises new NAO inquiry into Universal Credit project if elected

Posted on 23/06/2014 | 1 comment

By Tony Collins

“All our [Universal Credit] IT at the moment is working and it’s working well, which is why we’ve taken the decision to roll it out to the whole of the North West,” said Iain Duncan Smith on BBC Radio 5 Live’s Pienaar’s Politics programme at the weekend.

But IDS is not publishing any of the Department for Work and Pensions’ reports on Universal Credit  IT, such as the project assessment reviews, risk registers or issues registers, so it’s difficult to verify independently his assurances that the IT is working well.

Labour, meanwhile, has promised, if it wins the 2015 election,  a new National Audit Office inquiry into Universal Credit.

In an interview with BBC One’s Sunday Politics programme, shadow work and pensions secretary Rachel Reeves said:

“We set up a universal credit rescue committee in the autumn of last year because we had seen, from the National Audit Office [and] from the Public Accounts Committee, report after report showing that this project is …not going to be delivered according to the government timetable.

“We believe in the principle of universal credit, we think it is the right thing to do.”

Reeves criticised ministers for not being open about what had gone wrong with the project. “There is no transparency,” she said. “It’s going to cost £12.8bn to deliver and we don’t know what sort of state it is in.

“So we have said that if we win the next election we will pause… the build of the system for three months, calling in the National Audit Office to do a warts-and-all report on it.”

She said the “pause” would not involve halting the pilot schemes that were already in place. She urged coalition ministers to follow her prescription immediately.

“The government doesn’t need to wait for the next election,” she said. “They could do this today: call in the National Audit Office … and finally get a grip on this incredibly important programme.”

The Department for Work and Pensions has announced the roll-out of UC to all job centres in the north west by the end of this year but the IT will handle only the simplest of cases and some of these involve clerical intervention.

Integration with back-office systems is handled manually, and claims from couples or those with dependents are still not allowed.

The DWP said last month that the IT would be handle claims from couples starting this summer but this now seems unlikely.

UC claimants for the time being must be single, without children, newly claiming a benefit, fit for work, not claiming disability benefits, not have caring responsibilities, not be homeless or in temporary accommodation, and have a valid bank account and National Insurance number.

The National Audit Office in a report on UC last September questioned whether the IT will work for the millions of people whose claims are complicated.

Comment

Labour’s promise of an NAO investigation if it wins power – and its suggestion that the NAO publish an update to its September 2013 report on UC before the next election – are welcome.

Probably the last thing IDS wants at the moment is an up-to-date report by the NAO on Universal Credit. At present IDS and the Department for Work and Pensions can say without fear of authoritative contradiction that the IT is working well.  An NAO update would show whether that assurance is optimistic.

Labour if it wins the election cannot force the NAO to investigate the UC project. No political party instruct the NAO to investigate anything.  The NAO is independent of government and decides what to investigate, often in conjunction with the cross-party Public Accounts Committee.

It’s likely, however, that the NAO would agree to publish a new report on the UC project if Labour wins the next election.

Whoever wins the NAO will publish a new report on UC – it is already monitoring the programme – but is likely to do so sooner if Labour wins.

IDS could still win much credibility for the DWP and himself by deciding to publish the UC project assessment reviews, risk registers, issues registers and high-level milestone schedules.

Universal Credit creeps into north west 

 

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Posted in Campaign4Change, DWP, excessive secrecy, IT projects, IT-related failures, Universal Credit

Medication errors 6 months after “admin” system goes live

Posted on 19/06/2014 | 3 comments

By Tony Collins

When Croydon Health Services NHS Trust went live with Cerner Millennium in October 2013 a spokesman told eHealth Insider:

“The new system will give everyone working at the trust better access to information and an accurate picture of what all of our services are doing. This will allow staff to make quicker, more informed decisions about the care patients need. It will improve the quality, safety and efficiency of care.”

The go-live has indeed brought some benefits. The trust says these include more efficient management of medicines, more detailed patient information being conveyed between shifts and departments, and better management of beds.

But earlier this week Campaign4Change reported on some of the problems associated with the go-live including 50,000 patients on the trust’s waiting list and a “serious incident” declared over diagnostic waits including extended waits for patients with suspected cancer.

Said the trust’s Audit Committee in March 2014 – 6 months after the go-live of the Cerner Millennium Care Records Service [CRS] :

“CRS Millennium Lessons Learned

“KB [COO and Deputy Chief Executive] outlined the context in which the implementation of CRS had taken place from the time the Business case had been approved in 2010 to the commencement of deployment in January 2011 and its subsequent implementation to date.

“She noted the 7 official “go live” dates which were reflected in the lessons learned report many of which fell during a period of organisational change.

“She noted that the deployment in CHS [Croydon Health Services NHS Trust] had been the most comprehensive deployment to take place nationally.

“It was noted that Programme Team had considered the lessons learned from other [NPfIT] Care Records Service deployments as part of the implementation programme at CHS and that there was no evidence of harm to patients despite the challenges around delivery of service.

” However significant operational challenges were experienced and a deep dive into the implementation of CRS was carried out and the findings submitted to the Finance & Performance Committee and the Trust Development Authority.

“In relation to ‘no harm to patients’ SC [Chairman] asked what empirical evidence there was to support the findings of the Deep Dive.

“KB explained from October 2013 to date there were 50,000 patients on the waiting list, but a patient validation exercise had taken place which had confirmed that no patients had come to any harm.

“The potential backlog would be cleared by the end of March but in the meantime those patients on waiting lists would be subject to a further clinical review to ensure that there was no harm.”

In fact the trust is still working through the backlogs; and long waiting times are not the only matters arising from the Cerner Millennium implementation. A medication safety report for the month of March 2004 highlights these lessons:

“The patient was prescribed Furosemide for acute pulmonary oedema on 12/03/2014. The drug was not administered and the reason not documented. On review of the incident, it was identified that there was a mis-communication between both nurses and the fact that they have started using a new computer system had caused confusion which led to the error. Once error identified the dose was given and ward sister has ensured that staff will go for further training if unsure on how to use the CRS Millennium system…

“Third incident was a failure to administer fluids (Normal Saline) in an acute kidney injury patient with an admission creatinine of greater than 700. Again there was confusion with the electronic prescribing system and the nurse thought that patient did not have a drug chart as the electronic prescribing system had gone live whereas in fact there was a paper drug chart for the fluid. The position of the venflon on the patient arm also contributed to the delay. Once error identified the fluids were given but were not running to time and patient improved. Ward sister has ensured that staff will go for further training if unsure on how to use the CRS Millennium system and staff were also briefed about poor documentation of the incident…

“Fourth incident occurred involved a patient prescribed ACS protocol for NSTEMI, Positive trop T. The aspirin 300mg, clopidogrel 300mg and fondaparinux 2.5mg were not administered and not signed for. Omission of medicines was discussed with doctor looking after the patient and the patient did not come to any harm. Omission occurred as agency staff did not know how to use CRS Millennium. On review of incident all staff were briefed on importance of patients being administered medicines on time and in particular a discussion took place between agency staff and for agency staff to have adequate CRS Millennium training. There are champion users nurses on wards who are able to train Agency staff.

NPfIT

Cerner Millennium is provided to the trust under a national contract hosted by the Department of Health and managed via a Local Service Provider (LSP) contract with BT. The contract covers trusts in London and the south of England.

The DH contract expires on 31st October 2015 after which point the DH will no longer fund any of the services currently hosted by them. This includes both the software and licencing costs for Cerner Millennium as well as the BT data storage facilities and other costs.

The DH requires all trusts with Cerner under the NPfIT to commit to an exit strategy before 31st October 2015.

Comment

Is Cerner Millennium merely an administrative system as officials at Croydon Health Services NHS Trust claim it is?  The implication is, with an administrative system, that it cannot be involved in any harm to patients. Officials at Connecting for Health when they ran the NPfIT used to describe Cerner Millennium as an administrative system.

It is the deployment of this “admin” system at Croydon that is implicated in medication errors, a waiting list of 50,000 people, and long waits for diagnostic tests for people with suspected cancer.

If Whitehall and NHS officials cannot see the system as other than administrative, this is a mistake that may help to explain why a poor service for patients, which sometimes has serious potential clinical implications,  is so commonplace, even months after go-live.

50,000 on waiting list and cancer test delays after NPfIT go-live

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Posted in BT, BT Health, Campaign4Change, Cerner, Department of Health, e-health, health, health records, LPfIT, NHS, npfit, project management, public sector, public services, public-private partnerships, SPfIT

50,000 on waiting list and cancer test delays after NPfIT go-live

Posted on 17/06/2014 | Leave a comment

By Tony Collins

Croydon hospitals have built up a waiting list of 50,000 patients since a Cerner electronic patient record system go-live last October, according the trust’s latest board papers.

And, since the go-live, more than 2,200 patients have waited at least 6 weeks for diagnostic tests, of which 160 have been identified as “urgent suspected cancer and urgent patients”.  This backlog may take until the end of August to clear, say the board papers of the Croydon Health Services NHS Trust which includes Croydon’s Mayday Hospital, now the University Hospital.

The trust has declared a “serious incident” as a result of the diagnostics backlog. An SI can be reported when there is possibility of unexpected or avoidable death or severe harm to one or more patients.

“No harm”

The trust concedes that its waiting times pose a “potential clinical risk” but the board papers say several times that there is no evidence any patient has come to harm.  This assurance has been questioned by some trust board members. The trust continues to investigate.

Croydon is the latest in a long line of trusts to have had serious disruption after a Cerner go-live under the NPfIT, with BT as the installation partner.

The trust has kept the implications for patients confidential. This may contravene the NHS’s “duty of candour” – to report publicly on things that go wrong. The duty has come about in the wake of the suffering of hundreds of people in the care of Mid Staffordshire NHS Trust.

Croydon Health Services NHS Trust has decided not to publish its “Cerner Deep Dive” or Cerner “Lessons Learnt” reports, and discussions on the reports have been in Part 2 confidential sections of board meetings.

The trust defended its “Part 2” approach in its statement (below).

Meanwhile the Health and Social Care Information Centre, which runs the NPfIT local service provider contracts, including BT’s agreement to supply Cerner to hospitals in London,  has commissioned Cerner to capture the benefits nationally of Cerner installations.

Q&A

My questions and points to the trust, and its responses are below.

From me to the trust:

Croydon had good reasons to go live with Cerner, and DH funding was a further incentive but the trust does not appear to have been in a position to go live – at any stage – with a Big Bang Cerner implementation. The 7 aborted official go-live dates might have been a sign of why.  It would have been a brave decision to cancel the implementation, especially as:

–  the trust had spent 2 years preparing for it

– DH, BT and Cerner had put a lot of work into it

– there was DH pressure to go live especially after all the missed go-live dates.

The latest board papers say 6 or more times in different places that there has been no harm to patients as a result of the delays and waits.  Some members have raised questions on this and there is the matter of whether the trust is commissioning its own assessments (marking its own work).

On this:

– 50,000 on waiting list

– Cerner deep dive not published

– Lessons Learnt not published (concealment of failures, against the spirit of duty of candour called for by Robert Francis QC and Jeremy Hunt?)

– Diagnostics – an SI reported. The trust has considered the contributing issues which related to Cerner implementation but has not published details of the discussion. Again a concealment of failures?

– An accumulation of over 2,200 patients that were waiting over 6 weeks for diagnostics. Out of that number 160 patients were identified as urgent suspected cancer (USC) and urgent patients.  Can the trust – and patients – be sure there has been no harm?

– “… external assurance through an external clinician will provide the assurance that no patients have suffered harm as a result of the length of the waiting times”. Bringing in an external clinician to provide an assurance no patients have been harmed seems to pre-judge the outcome.  The trust appears to be marking its own work, especially as the backlog of patients awaiting diagnostics may not be cleared until the end of August.

– Managing public and GP perceptions? “Members agreed that GP interactions should be held off until the investigations had produced definite findings. However the Communications Department are on standby to publish information to GPs if required, and the Trust is ready to react to other enquiries. The Trust will in any event publish the incident report after the investigation has been completed.”

– “… the implementation of Cerner in October 2013 had an impact on activity levels and the delivery of RTT standards”. Again no report on this published.

– “An independent assessor would re-check all patients to assure that no harm has resulted. The Committee noted the progress report and requested that this is referred to a Part 2 meeting of the Trust Board …” Concealment of failures again?

– In the past the DH has been prepared to treat patients as guinea pigs in Cerner Big Bang implementations. The philosophy appears to be that the implementations will inevitably be disruptive but it’s for the good of patients in the longer term. That this approach may be unfair on patients in the short term, however, seems not to trouble the NHS hierarchy.

It’s clear clinicians and IT staff are doing their best and working hard for the benefit of patients but the implementation was beyond their control. Meanwhile complaints are increasing, Croydon Health Services was one of the lowest rated trusts for overall patient experience and a sizeable minority of local residents don’t choose the local hospitals for care or treatment. That said some patients rate their care very highly on NHS Choices (although some don’t). The University hospital is rated 2.5 stars out of 5.

One of the most surprising statements in the board papers is this: “… despite the weaknesses in the programme, the overall success of the deployment had been recognised at a national level”. A success? Can the trust in essence say what it likes? Nobody knows for sure what the facts are, given that the trust decides on what to publish and not to publish.

The trust’s response to the above points and questions:

“Due to a temporary failure of our administrative systems, the Trust found in February 2014 that a number of patients who needed to be seen by the imaging service were in breach of the six week waiting standard.

“We have taken immediate action to correct this and are undertaking a thorough review to confirm that no patients were harmed as a result.  The Trust is now working hard to treat patients currently on our waiting lists.  This is referenced in our publicly available Board papers.

“CRS Millennium has delivered a number of improvements that support improving patient experience at the Trust, including more efficient management of medicines, more detailed patient information being conveyed between shifts and departments and better management of beds within the organisation.”

Lessons?

Below are some of the lessons from Croydon’s Cerner go-live. Although the trust hasn’t published its “Lessons Learnt” report, some of lessons are mentioned in its latest board papers:

  • Insufficient engagement from operational and clinical colleagues
  • Time pressures were felt when a full dress rehearsal stretched the capabilities of the information team.
  • Insufficient time and resources were allocated to completion of the outline business and full business cases, as well as to due diligence on the options and costs.  [Business cases for Cerner are still unpublished.]
  • Trust directors agreed that a business case for a project of the size and complexity of the CRS Millennium should have taken longer than 6 weeks to prepare.
  • A failure of senior managers to take stock of the project at its key stages.
  • Too strong a focus on technical aspects
  • Clinicians not always fully appreciating the impact of the changes the system would deliver
  • The hiring of an external change manager to lead the deployment who proved to be “less than wholly successful because of the resulting deficiency in previous experience or knowledge of the culture of the organisation”.
  • The individual left the organisation part way through deployment which led to further challenges.
  • The right people with the right skills mix were not in place at the outset to achieve the transformational change necessary to successfully deploy a new system such as CRS

Comment 

NHS trusts have good reason to modernise their IT using the widely-installed  Cerner electronic patient record system, especially  if it’s a go-live under the remnants of the NPfIT, in which case hospitals receive DH funding and gain from having BT as their installation partner.

But why does a disruption that borders on chaos so often follow NPfIT Cerner implementations? Perhaps it’s partly because the benefits of Cerner, and the extra work required by nurses and doctors and clerical staff to harvest the benefits, is underestimated.

It is in any case difficult to convey to busy NHS staff that the new technology will, in the short-term, require an increase in their workload. Staff and clinicians will need to capture more data than they did on the old system, and with precision. The new technology will change how they work, so doctors may resent it initially, especially as there may be shortcomings in the way it has been implemented which will take time to identify and solve.

The problem with NPfIT go-lives is that they take place in an accountability void. Nobody is held responsible when things go badly wrong, and it’s easy for trusts to play down what has gone wrong. They have no fear of authoritative contradiction because they keep their implementation assessments confidential.

What a difference it would make if trusts had an unequivocal duty of candour over electronic health record – EHR – deployments. They would not be able to go live until they were ready.

The disruption that has followed NPfIT Cerner go-lives has been serious. Appointments and tests for suspected cancer have been lost in the administrative confusion that follows go-live. There have been backlogs of appointments for tens of thousands of patients. Operating theatres have gone under-used because of mis-scheduled appointments.

Now and again a patient may die unnecessarily but the problems have been regarded by the NHS centrally as collateral damage, the price society pays for the technological modernisation of the NHS.

Richard Granger, when head of the NPfIT, said he was ashamed of some Cerner installations. He described some of them as “appalling” but since he made his comments in 2007, some of the Cerner installations have been more disruptive than those he was referring to.

Provided each time there is no incontrovertible evidence of harm to patients as a result of a go-live, officials give the go ahead for more NPfIT Cerner installations.

Guinea pigs?

Disruption after go-live is too often treated as an administrative problem. Croydon’s statement refers to a “temporary problem with our administrative systems”. But new patient record systems can harm patients, as the inquest on 3-year-old Samuel Starr heard.

It’s time officials stopped regarding patients as guinea pigs in IT go-lives. It compounds the lack of accountability when trusts such as Croydon keep the reports from the go-live secret.

Trusts need better technological support but not at the cost of treating any harm to patients as collateral damage.

A tragic outcome for Cerner implementation at Bath?

Openness and honesty is a rarity after health IT problems

Mishandled electronic health record transition

A botched Cerner EHR implementation?

Trinity Medical Center reaches Cerner settlement

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Posted in BT, BT Health, Campaign4Change, Cerner, Department of Health, health, health records, HSCIC, LPfIT, NHS, npfit, openness and transparency, SPfIT

Tagged

How well is new passport IT coping with high demand?

Posted on 13/06/2014 | Leave a comment

By T0ny Collins

In 1989 when the Passport Agency introduced new systems avoidable chaos ensued. A decade later, in 1999, officials introduced a new passport system and avoidable chaos ensued. Jack Straw, the then Home Secretary, apologised to the House of Commons.

Last year HM Passport Office introduced, after delays,  a replacement passport system, the Application Management System. It was built with the help of the Passport Office’s main IT supplier CSC under a 10-year £385m contract awarded in 2009.

The Passport Office said at the time the new system was designed “to be easier to use and enable cases to be examined more efficiently”. So how well is the system coping with unusually high demand, given that an objective was to help passport staff deal with applications more efficiently?

The answer is that we don’t know: open government has yet to reach HM Passport Office. It publishes no regular updates on how well it is performing, how many passports it is processing each month or how long it is taking on average to process them. It has published no information on the performance of the Application Management System or how much it has cost.

All we know is that the system was due to be rolled out in 2012 but concerns about how well it would perform after go-live led to the roll-out being delayed a year. In the past 18 months it has been fully rolled out.

Comment

Has there been a repeat of the IT problems that seriously delayed the processing of applications in 1989 and 1999? In both years, passport officials had inadequate contingency arrangements to cope with a surge in demand, according to National Audit Office reports.

Clearly the same thing has happened for a third time: there have been inadequate contingency arrangements to cope with an unexpectedly high surge in demand.

How is it the passport office can repeatedly build up excessive backlogs without telling anyone? One answer is that there is a structural secrecy about internal performance.

Despite attempts by Francis Maude and the Cabinet Office to make departments and agencies more open about their performance, the Passport Office is more secretive than ever.

It appears that even the Home Secretary Theresa May was kept in the dark about the latest backlogs.  She gave reassuring statistics to the House of Commons about passport applications being processed on time – and only days later conceded there were backlogs.

It’s a familiar story: administrative problems in a government agency are denied until the truth can be hidden no longer because of the number of constituents who are contacting their MPs.

David Cameron said this week that up to 30,000 passport applications may be delayed.

One man who contacted the BBC said he had applied for a passport 7 weeks before he was due to travel. The passport office website said he should get a new passport in 3 weeks. When it had not arrived after 6 weeks he called the passport office and was told he’d be called back within 48 hours. He wasn’t, so he called again and was told the same thing. In the end he lost his holiday.

In 1989 the IT-related disaster was avoidable because managers continued a roll-out even though tests at the Glasgow office had shown it was taking longer to process passport applications on computers than clerically. Backlogs built up and deteriorating relations with staff culminated in industrial action

In 1999 electronic scanning of passport applications and added security checks imposed by the new systems caused delays and lowered productivity.  Even so a national roll-out continued. Contingency plans were inadequate, said the National Audit Office.

Does the “new” Application Management System show down processing of applications? We don’t know. The Passport Office is keeping its 2014 statistics to itself.

Decades of observing failures in government administration have taught me that chaos always seems to take officialdom by surprise.

If departments and agencies had to account publicly for their performance on a monthly and not just an annual basis, the public, MPs, ministers and officials themselves, would know when chaos is looming. But openness won’t happen unless the culture of the Passport Office changes.

For the time being its preoccupation seems to be finding whoever published photos of masses of files of passport applications seemingly awaiting processing.

The taking and publication of the photos seems to be regarded as a greater crime than the backlogs themselves.  To discourage such leaks the Passport Office has sent a threatening letter to staff.

But innocuous leaks are an essential part of the democratic process. They help ministers find out what’s going on in their departments and agencies.  Has government administration really come to this?

 

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Posted in Campaign4Change, CSC, excessive secrecy, Government IT, IT and the Business, IT projects, Passport Office

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CEO and CIO resign after troubled EHR go-live

Posted on 05/06/2014 | Leave a comment

By Tony Collins

At the foot of the Blue Ridge Mountains, Georgia, in America’s deep south, about 70 miles from Atlanta, is Athens .

It was named at the turn of the 19th century to associate its university with Aristotle and Plato’s academy in Greece. It is home to the Athens Regional Medical Centre, one of the USA’s top hospitals.

There on 4 May 2014 the Centre went live with what it described as the most meaningful and largest scale information technology system in its 95-year history – a Cerner EHR implementation.

Now the Centre’s CEO James Thaw and CIO Gretchen Tegethoff have resigned. The Centre’s implementation of the electronic health record system seems to have been no more or less successful than at UK hospitals.

The main difference is that more than a dozen doctors complained in a letter to Thaw and Tegethoff.  A doctor leaked their letter to the local paper.

“Medication errors”

The letter said the timescales to install the Cerner EHR system were too “aggressive” and there was a “lack of readiness” among the intended users. They called the system cumbersome.

The letter referred to “medication errors … orders being lost or overlooked … (emergency department) and patients leaving after long waits”. An inpatient wasn’t seen by a physician for five days.

“The Cerner implementation has driven some physicians to drop their active staff privileges at ARMC [Athens Regional Medical Centre],” said the letter. “This has placed an additional burden on the hospitalists, who are already overwhelmed. Other physicians are directing their patients to St. Mary’s (an entirely separate local hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. … Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”

The boldness of the letter has won praise in parts of the wider American health IT community.

It was signed by the centre’s most senior medical representatives: Carolann Eisenhart, president of the medical staff; Joseph T. Johnson, vice president of the medical staff; David M. Sailers, surgery department chair; and, Robert D. Sinyard, medicine department chair.

A doctor who provided the letter to the Athens Banner-Herald refused a request to openly discuss the issues with the computer system and asked to remain anonymous at the urging of his colleagues.

Swift action

One report said that at a meeting of medical staff 200 doctors were “solid in their vote of no confidence in the present hospital administration.”

Last week Thaw wrote in an email to staff: “From the moment our physician leadership expressed concern about the Cerner I.T. conversion process on May 15, we took swift action and significant progress has been made toward resolving the issues raised … Providing outstanding patient care is first and foremost in our minds at Athens Regional, and we have dedicated staff throughout the hospital to make sure the system is functioning as smoothly as possible through this transition.”

UK implications?

The problems at the Athens centre raise questions about whether problematic Cerner installations in the NHS should have consequences for CEOs.  Health IT specialists say that, done well, EHR implementations can improve the chances of a successful recovery. Done badly an EHR implementation can harm patients and contribute to death.

The most recent installations of Cerner in the NHS, at Imperial College Healthcare NHS Trust and Croydon Health Services NHS Trust, follow the pattern of other Cerner EHR go-lives in the NHS where there have been hints of problems but the trusts are refusing to publish a picture of how patients are being affected.

What has gone wrong at Athens Regional?

IT staff, replying to the Banner-Herald’s article, have given informed views on what has gone wrong. It appears that the Athens Regional laid off about a third of the IT staff in February 2014, about three months before go-live.

Past project disasters have shown that organisations often need more, not fewer, IT staff, advisers and helpers, at the time of a major go-live.

A further problem is that there appears to have been little understanding or support among doctors for the changes they would need to make in their business practices to accommodate the new system.  Had the organisation done enough to persuade doctors and nurses of the benefits to them of changing their ways of working?

If clinicians do not support the need for change, they may focus unduly on what is wrong with the new system. An organisation that is inherently secretive and resentful of constructive criticism will further alienate doctors and nurses.

Doctors who fully support an EHR implementation may find ways around problems, without complaining.

One comment on the Banner-Herald website says:

“While I have moved on from Athens Regional, I still have many friends and colleagues that are trying to work through this mess. Here is some information that has been reported to me…

“Medications, labs and diagnostic exams are not getting done in a timely manner or even missed all together. Some of this could be training issues and some system.

“Already over worked clinical staff are having to work many extra hours to get all the information in the system. This obviously takes away from patient care.

“Senior leadership tried to implement the system in half the amount of time that is usually required to do such things, with half the staff needed to do it. Why?

“Despite an environment of fear and intimidation the clinical staff involved with the project warned senior administration that the system was not ready to implement and posed a safety risk.

“I have ex-colleagues that know staff and directors that are involved with the project. They have made a valiant effort to make things right. Apparently an 80 to even a 100 hour work week has been the norm of late.

“Some questions that I have: where does the community hospital board stand with all this? Were they asking the questions that need to be asked? Why would the software company agree to do such a tight timeline? Shouldn’t they have to answer some questions as well?”

“Hopefully, this newspaper will continue to investigate what has happened here and not cave to an institution that spends a lot of money on frequent giant full page ads.

“Please remember there are still good people (staff, managers and administrators) that work at ARMC and I am sure they care about the community they serve and will make sure they provide great patient care.”

“The last three weeks have been very challenging for our physicians, nurses, and staff,” said Athens Regional Foundation Vice President Tammy Gilland. “Parts of the system are working well while others are not. The medical staff leadership has been active in relaying their concerns to the administration and the administration has taken these concerns very seriously. Maintaining the highest quality of patient care has always been the guiding principle of Athens Regional Health System.”

Keeping quiet

NHS trusts go quiet about the effect on patients of EHR implementations despite calls by Robert Francis QC and health secretary Jeremy Hunt for openness when things go wrong.

Imperial College Healthcare NHS Trust, which comprises St Mary’s Paddington, Hammersmith Hospital, Charing Cross Hospital, Queen Charlotte’s and Chelsea Hospital, and Western Eye hospital in Marylebone Road, went live with Cerner– but its managers and CEO are refusing to say what effect the system is having on patients.

An FOI request by eHealth Insider elicited the fact that Imperial College Healthcare had 55 different consultants working on the Cerner Millennium project and 45 Trust staff. The internal budget for electronic patient record deployment was £14m.

Croydon Health Services NHS Trust, which comprises Croydon University Hospital (formerly Mayday) and the Purley War Memorial Hospital, went live with Cerner last year, also under BT’s direction.

The trust has been a little more forthcoming than Imperial about the administrative disruption, unforeseen extra  costs and effects on patients, but Croydon’s officials, like Imperial College Healthcare’s spokespeople,  refuse to give any specific answers to Campaign4Change’s questions on the Cerner implementation.

Comment

It was probably unfair of doctors at Athens Regional to judge the Cerner system so soon after go-live but their fierce reaction is a reminder that doctors exist to help patients, not spend time getting to grips with common-good IT systems.

Would an NHS CEO resign after a rebellion by UK doctors over a problematic EHR implementation? It’s highly unlikely – especially if trusts can stop news leaking out of the effects on patients. In the NHS that’s easy to do.

Athens Regional CEO resigns

A tragic outcome for Cerner Millennium implementation?

Athens Regional is addressing computer problems encountered by doctors

Athens Regional is addressing computer problems after patients put at risk

CEO forced out?

 

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Posted in BT, BT Health, Campaign4Change, Cerner, change management, CIO, consultants, cost reduction, Department of Health, e-health, excessive secrecy, FOI, Freedom of Information, health records, IT-related failures, LPfIT, NHS, npfit, public sector, public services

Chinook crash 20 years ago – still a mystery

Posted on 02/06/2014 | 1 comment

By Tony Collins

As the BBC reports, memorial services are to be held in Northern Ireland and Scotland today to mark the 20th anniversary of an RAF air crash in which 29 people died.

Security personnel from the Royal Ulster Constabulary, MI5 and the Army died, alongside the four crew. Chinook ZD576 crashed on the Mull of Kintyre on 2 June 1994.

The following year two air marshals found the pilots of ZD576, Flight Lieutenants Jonathan Tapper and Rick Cook, grossly negligent. The finding  astonished the families of the pilots and many others, including RAF pilots, because of the lack of evidence of what was happening in the cockpit, or with the aircraft, as it approached the Mull of Kintyre.

The aircraft was not fitted with a flight data or cockpit voice recorder, and much of it was destroyed by fire.

Even so the MoD and successive Labour ministers, including the then Prime Minister, Tony Blair,  supported the finding of negligence.

A 17-year campaign to clear the names of the pilots brought to light documents that called into question the airworthiness of the Chinook Mk2, the aircraft type that crashed. A particular concern was the poor quality of newly-fitted “Fadec” software that controlled fuel to the Chinook two jet engines.

As new leaks of documents cast further doubt over the airworthiness of the aircraft type, the MoD and its ministers appeared to become more resolute in their criticism of the pilots.

In blaming them the MoD and RAF hierarchy placed reliance on evidence provided by the aircraft’s manufacturers, including the supplier of Chinook ZD576’s “TANS” navigation computer.

It wasn’t until 2011 that the finding of gross negligence was set aside by the then Defence Secretary Liam Fox. He apologised to the families of the pilots.

Questions remain about whether the aircraft type was fit to fly and whether it was right for the MoD and RAF hierarchy to have placed so much reliance on the uncorroborated evidence of manufacturers in blaming the pilots.

The MoD told the BBC:

“Exhaustive investigations have been carried out, both by the MoD and independent bodies, and no evidence of technical or mechanical failure were identified.”

[There was little independent evidence of anything – either actions by the pilots, or what was happening with the aircraft.]

Two memorial services will be held today to mark the anniversary – one at Police Service Northern Ireland headquarters in Belfast and another on the Mull of Kintyre.

An MoD spokesman said: “Our thoughts remain with the families of all those who died in the tragic Mull of Kintyre incident.”

Set the record straight on Chinook crash – Guardian letters

Chinook crash – memorials mark 20th anniversary – BBC

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Posted in Campaign4Change

If an insurer wants your medical records should your GP say no?

Posted on 28/05/2014 | 3 comments

By Tony Collins

Pulse reports that the Information Commissioner’s Office is to put questions to Aviva after learning that it has been requesting patients’ full GP records to underwrite some insurance policies.

An ICO spokesperson told Pulse it would be contacting insurer Aviva to ‘understand more’ about their use ‘subject access requests’ for collecting medical information on patients and ‘how these accord with the [Data Protection] Act’.

Aviva confirmed to Pulse that it has been using the method – with customer consent – for almost 12 months.

In a response to the article, an anonymous GP publishes his practice’s standard reply to such questions from insurers:

“Thank you for your medical records subject access request.  We formally decline to undertake this.

“We draw your attention to paragraph “2.12 Access to patient records from insurers and mortgage providers” on page 112 of the ‘Information Governance Review: To Share or Not to Share’ published in March 2013.

“The Panel also heard concerns that insurers and mortgage lenders may seek to use their influence to request whole records from GPs, as a condition of supplying insurance or a mortgage.

“The General Medical Council has issued specific guidance for GPs112 and the British Medical Association and the Association of British Insurers (ABI) have produced joint guidelines 113 to allow relevant data about patients to be shared appropriately with insurers on a basis of explicit, written consent.

“In addition, principle 3 of the Data Protection Act 114 offers further safeguards as it allows organisations to hold only ‘adequate, relevant and not excessive’ personal data about an individual.

“This means insurers and mortgage lenders cannot hold more information about an individual than they need. The act also requires organisations to identify in advance and then request only the minimum amount of data needed for a particular purpose.

“The Review Panel concluded that these guidelines, combined with the safeguards offered by the Data Protection Act offer sufficient to prevent inappropriate sharing of whole records with insurers and mortgage lenders.

“We suggest that you apply for a PMA report in the normal way.  Alternatively the patient may apply for a copy of their records having made a pre payment of £50 to the practice and is at liberty to send you any or all of their medical records.

“We cannot guarantee that the patient may withhold part of their medical record. You have a duty not to hold any more information than you require.

“I would like to advise that I believe you to be in breach of the DPA, in particular paras 112, 113 and 114 of the Information Governance Review. If we receive another similar request from your company we will be compelled to report the matter to the Information Commissioner.”

 

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Posted in Campaign4Change, data protection, health, health records