Hospital records of NHS patients sold to insurers?

Posted on 24/02/2014 | 1 comment

By Tony Collins

A headline in the Telegraph yesterday read

Hospital records of all NHS patients sold to insurers

The article said the medical records of every NHS hospital patient in the country have been sold for insurance purposes.

Those in charge of the programme have said it would be illegal for information extracted from GP files to be sold to insurers, who might seek to target customers or put up their prices.

“However, a report by a major UK insurance society discloses that it was able to obtain 13 years of hospital data – covering 47 million patients – in order to help companies “refine” their premiums.

“As a result they recommended an increase in the costs of policies for thousands of customers last year. The report by the Staple Inn Actuarial Society – a major organisation for UK insurers – details how it was able to use NHS data covering all hospital in-patient stays between 1997 and 2010 to track the medical histories of patients, identified by date of birth and postcode.”

The NHS Hospital Episode Statistics were said to be a “valuable data source in developing pricing assumptions for ‘critical illness’ cover”.

Comment

The Department of Health has always denied that the identities of patients could be obtained from anonymised or pseudonymised statistical data, although the disclosure to some commercial and research organisations of dates of birth and postcodes, even without names of patients,  has always made it theoretically possible to identify individuals, especially those with unusual illnesses.

Now the Health and Social Information Centre in its comments to The Guardian seems to hint that it might have been possible in the past to identify individuals.

Sharing “anonymous” NHS statistics with NHS researchers is one thing. Sharing it with insurance companies is quite another.  Albeit with a 6-month delay, the Health and Social Care Information Centre is going ahead with plans for a database of GP-held patent data (as opposed to hospital data which has long been held on a SUS database by BT).

The HSCIC is staffed by some of those from predecessor agencies.  Can its staff be trusted with patient data?

Thank you to campaigner Dave Orr for his email to me on the Telegraph article.  

Telegraph article

Hospital records of 47m patients obtained by insurance society – Guardian

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Posted in Campaign4Change

NHS database: is it a top IT priority?

Posted on 19/02/2014 | 1 comment

By Tony Collins

It’s called the NHS database but the new “giant” medical records system is to be run by the Health and Social Care Information Centre, largely for the benefit of researchers.

Though it may help patients in the longer term, say by helping to identify what treatments work and don’t, it is arguably not the NHS’s most immediate IT priority.

I said on BBC R4’s Today programme this morning that a top NHS IT priority is providing secure links to health records so that patients with acute and chronic illnesses can be treated in one part of the NHS one week and another part of the health service the following week – perhaps in a different county – and have their updated records accessible wherever they go.

At present patients with multiple problems can end up being treated in different NHS or non-NHS centres without each organisation knowing what the other is doing.  This is dangerous for patients and gives the impression the NHS is technologically backwards.

Links can be made to existing medical records – there are millions of electronic records already in the NHS – without creating a big central database. The records can reside where they are at the moment, inside and outside the NHS, and be linked to securely by clinicians and nurses, subject to the patient’s specific consent.

Indeed patients should be able to look at their record online and correct any mistakes.

Research database

My comment on BBC R4 Today that a research database is a good idea has brought a mixed response – understandably, because are risks. We need some facts from the Health and Social Care Information Centre on who is going to run the database, and how information will be made genuinely anonymous.

The HSCIC concedes in its information material that some patient information on the database will be potentially identifiable, but it implies this is acceptable if the organisations using the data can be trusted.

Why must information be potentially identifiable? And to what extent can the HSCIC be trusted to run the database? It is, after all, managing contracts under the National Programme for IT, a scheme which Jeremy Hunt called a “huge disaster”.

How much extra will be paid to BT which runs the SUS database under the “dismantled” NPfIT? It is likely that BT’s Spine and SUS-related work will link into the new “NHS database”. Have any new contracts gone to open competitive tender?

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Posted in BT, BT Health, Campaign4Change, data sharing, Department of Health, e-health, Government IT, health, health records, HSCIC, LPfIT, NHS, npfit

Hospital group wins $106m settlement in Cerner dispute

Posted on 19/02/2014 | 1 comment

By Tony Collins

 A US health organisation Trinity Medical Centre has won a $106m settlement in  a legal dispute with Cerner, which is one the main suppliers of patient record systems to NHS trusts in London and the south.

Under the NPfIT BT has installed Cerner at trusts that include the Royal Free, London, Barnet and Chase Farm Hospitals NHS Trust, Weston Area Health NHS Trust, Barts Health NHS Trust, North Bristol NHS Trust and more recently at Croydon Health Services NHS Trust.

The Wall St Journal says a clinical patient accounting program Trinity bought from Cerner in 2008 was defective and didn’t deliver the promised benefits, which Cerner disputed. Trinity sought about $240m in damages; Cerner estimated $4m.

The companies agreed to submit the dispute to arbitration which began in October 2013.

Cerner said it “strongly disagrees” with the award and believes the claim was based on unique circumstances. It called the award the only material judgment against Cerner in its 34-year history.

US lawyer Michael Dagley says his firm won a $106m settlement for North Dakota-based Trinity Medical Centre in an arbitration case against Cerner.

The firm says that Trinity alleged in 2012 that patient accounting software and other services purchased from Cerner were defective, producing thousands of billing errors.

“We think it’s tremendously significant because it represents the first major victory that we’re aware of by a health care provider against a software vendor,” Dagley said in a statement.

“Providers are under pressure to automate and vendors are under pressure to offer integrated products. Providers want one vendor for all their IT needs, so the vendors have this incentive to deliver software to the market as quickly as possible, and that can lead to products being introduced that are immature and defective, which in health care, can cause tremendous damage.”

Last year Cerner said it believed the chance of a material loss related to the matter was remote and it had 147 hospitals and 735 clinics using the patient accounting program.

Despite the settlement Cerner’s share price has held up well.

Trinity Medical Centre is a non-profit organisation with about 2,700 employees.

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Posted in BT, BT Health, Campaign4Change, Cerner, e-health, health, health records, IT projects, legal disputes, NHS, npfit, operational issues

Somerset Council publishes “lessons learnt” from IBM contract

Posted on 18/02/2014 | 7 comments

By Tony Collins

It’s rare for any council to publish the lessons learned from its outsourcing/joint venture contract, but Somerset County Council has set an example.

The council has produced its report to “inform future commissioning”. The council held a workshop to help identify the right lessons.

Written by Kevin Nacey, the council’s Director of Finance and Performance, and published by the Audit Committee, the document is diplomatically worded because the South West One joint venture contract with IBM continues; it was renegotiated in 2013 when the council took back some services and about 100 staff that had been seconded to South West One.

IBM is the majority shareholder in the joint venture company, and is its main funder. The minority shareholders comprise the county council, Taunton Deane Borough Council and Avon and Somerset Police. The joint venture company still provides ICT, finance and human resources/payroll.

Dave Orr, a former council IT employee and campaigner for openness, who spotted Nacey’s report, says it misses some important lessons, which are in Orr’s From Hubris to High Court (almost) – the story of Southwest One.

Lessons

From Somerset County Council’s Audit Committee report:

Contract too long and complicated

“One of the most significant lessons learnt is not to make contracts overly complicated. Both the provider 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.”

Expectations not met

“The partnership between the provider and the three clients has at times been adversarial and at times worked well. What has become clear over time is that any such partnership depends upon having similar incentives and an understanding of each partner’s requirements.

“Requirements change and the nature of local government changed considerably as a result of the national austerity programme. The well-documented financial difficulties faced by the provider early into the contract life also affected its ability to meet client expectations. The net effect is that at times the provider and partner aims in service delivery do not always match and discord and dissatisfaction can occur.”

Client team to monitor supplier “too small”

“The Client function monitoring a major contract needs to be adequately resourced. At the outset the size of the client unit was deemed commensurate with the tasks ahead, such as monitoring a range of performance measures and reporting on such to various management and Member forums.

“Liaison between partners, approving service development plans and approval of payments under the contract were other significant roles performed by the client unit. However, as performance issues became evident and legal and other contractual disputes escalated, the team had to cope with increasing workloads and increasing pressure from service managers and Council Members to address these issues.

“This is a difficult balancing act. You do not want to assemble a large client function that in part duplicates the management of the services being provided nor overstaff to the extent that there is insufficient work if contract performance is such that no issues are created.

“With hindsight, the initial team was too small to manage the contract when SAP and other performance issues were not resolved quickly enough. Sizing the function is tricky but we do now have an extremely knowledgeable and experienced client team.”

Some contract clauses “too onerous”

“Performance indicators need to be meaningful rather than simply what can be measured. Agreement between the provider and the SCC client of all the appropriate performance measures was a long and difficult exercise at the beginning of the contract. Early on in the first year of the contract, there were a large number of meetings held to agree how to record performance and what steps would be necessary should performance slip below targets.

“Internal audit advice was taken (and has been at least twice since under further reviews) on the quality and value of the performance indicator regime. It is regrettable and again with hindsight a learning point that too much attention was paid to these contractual mechanisms rather than ensuring the relationship between provider and SCC was positive. Perhaps the regime was too onerous for both sides to administer.”

Too ambitious

“Contract periods need to be different for different services as the pace of change is different. The range of services provided under the initial few years of the contract were quite extensive. On another related point the provider also had to manage different services for different clients.

“This level of complexity was perhaps too ambitious for all parties. Although there are many successful parts to the contract, it is inevitable that most will remember those that did not work so well.

“The contract period of 10 years is a long time for 9 different services to change at the same pace. Of course, service development plans were agreed for each service to attempt to keep pace with service needs as they changed. The secondment model introduced as part of the contract arrangements had been used elsewhere in the country before this contract used it.

“Nevertheless, it was the first time that 3 separate organisations had seconded staff into one provider. In many ways the model worked as staff felt both loyalty to their “home” employer, keeping the public service ethos we all felt to be important, and to Southwest One as they merged staff into a centre of excellence model.”

Hampered by terms of staff contracts

“The disadvantage was that Southwest One was hampered by the terms and conditions staff kept as they tried to find savings for their business model and to provide savings to the Council in recent years given the changing financial conditions we now operate under.

“Another aspect of this contract in terms of complexity is the nature of the partnering arrangement. It is not easy for all partners to have exactly the same view or stance on an issue. Southwest One had to manage competing priorities from its clients and the partners also had varying opinions on the level of performance provided.”

In summary

“This was a very ambitious venture. The service provided in some cases got off to an unfortunate start with the issues generated by SAP problems and relationships were strained and attracted much inside and outside attention.

“All parties have been working very hard to keep good relationships and to fix service issues as they arise. The sheer size and complexity of this contract has proven difficult to manage and future commissioning decisions will bear this in mind.

“Over the years officers running services that receive support from Southwest One have been surveyed regularly on how they feel the contract has been progressing. Despite all of the issues and lessons learnt outlined in this report, it is worth pointing out that many of the customer satisfaction and performance levels under the contract have been met by Southwest One.”

Comment

Well done to Somerset County Council’s Audit Committee and the Council’s auditors Grant Thornton for asking for the report. The South West One contract has been a costly embarrassment for IBM and the council. It has also had mixed results for Taunton Deane and the local police though officials in these two organisations seem locked into a “good news” culture and cannot admit it.

Perhaps the best thing to emerge from the IBM-led joint venture is this “lessons learnt” report. Without it, what would be the point of the millions lost and the damage to council services?

From contracts that don’t work out as expected, councils and central government departments rarely produce a “lessons” report , because nobody requires them to. Why should they bother, especially when it may be hard to get an internal consensus on what the lessons are, and especially when a report may mean admitting that mistakes were made when the contract was drawn up and signed.

Public sector organisations will sometimes do anything to avoid admitting they’ve made mistakes. Somerset County Council and its Audit Committee have shown they are different. Maybe the rest of the public sector will start to follow their example.

Dave Orr’s well-informed analysis of the lessons from Southwest One.

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Posted in Campaign4Change, change management, IBM, Institute for Government, IT-related failures, legal disputes, local government, SAP, shared services, supplier relationships

Is IDS losing his cool over Universal Credit IT?

Posted on 06/02/2014 | 3 comments

By Tony Collins

IDS was polite and calm, almost deferential, when he went before MPs of the Work and Pensions Committee in September 2012.  “Can I say it is always a privilege to be here?” he said.

At at Monday’s hearing of the same committee, though, he was at times tetchy, patronising and mildly bullying. “I don’t think this committee can run the department,” he replied when asked why he hadn’t told the committee in 2012 of problems with the Universal Credit IT project.

Several times he talked over the MP who was asking him questions, with the result neither could be clearly heard.

[If he’s like that at meetings with DWP officials would anyone want to tell him something he doesn’t want to hear? Perhaps his loss of cool on Monday reflected the baffling complexity, and rising costs, of the waterfall part of  Universal Credit’s  IT programme.]

IDS might also have been shaken by the absence of his most authoritative ally, Howard Shiplee, who has been off sick since shortly before Christmas.

Hidden 

Over a period of more than a year, the DWP and IDS fed the work and pensions committee good news about progress on the Universal Credit IT project. The truth didn’t surface until the National Audit Office published its report on UC in September 2013.

Unknown to the committee in 2012, the DWP was struggling at that time to set out how the detailed design of systems and processes would fit together and relate to the objectives of Universal Credit. This was raised repeatedly in 2012 by internal audit, the Major Projects Authority and a supplier-led review. The committee wasn’t told.

Hence Dame Anne Begg, the softly-spoken chairman, came to Monday’s meeting with a direct question. Why, when IDS came before the Work and Pensions committee in September 2012, did he make no mention of having commissioned a red team review into the Universal Credit project several months earlier.

“Because it was an internal review,” replied IDS. “We were looking the results of that and trying to take whatever decisions were necessary. It was about some of the issues that were going on in the UC team…”

Begg: “But why didn’t you tell us a review was going on?”

IDS: “I don’t tell the committee everything that is happening within the Department until we have reached a conclusion about what is actually happening.”

Begg: “It was an ideal opportunity when you appeared before us in September [2012] that you could have said there were concerns about what was happening with Universal Credit but at that session you were very bullish about how successful everything was.”

IDS: “I still remain very confident about how successful it will be. [Note a difference in tenses between the question and answer]. At the time we were working out how we would make the reset.”

Sir Humphrey

At IDS’s sided was Robert Devereux, Permanent Secretary at the DWP, who seemed at times a parody of Sir Humphrey. [Animated in the delivery of some of his answers Devereux looked as if he was saying something interesting until you listened to the words.]

One MP asked Devereux why the DWP had given written evidence to the committee in 2012 that Universal Credit was on track when it wasn’t. Devereux said that UC was a large and complex programme. “You are constantly evaluating and re-evaluating your forward plans … as you go along things change.” MPs were none the wiser.

Misled?

Begg [to IDS]: Did you not think it appropriate that this scrutiny committee of the House of Commons, which oversees the work the department does, [should have been kept] informed about changes?

IDS: “With respect we did keep the Committee informed as and when we had clarified what we were actually doing and what we thought the problem was and where it existed and how you isolate it and what changes you made. I don’t for one moment agree in any way at all that we hid stuff. We knew we would be accountable to the committee and all would become public… I don’t think this committee can run the department.”

Begg pointed out that IDS had failed to mention a report of the Cabinet Office’s Major Projects Authority in February 2013. That report had notified the DWP of flaws in UC governance, management and programme design – despite the same matters having been raised in previous MPA reports.

Begg:  “You gave oral evidence to us on 10 July [2012] … but you did not refer at that session to the critical Major Projects Authority report or the reset which had already taken place earlier that year.”

IDS: “I cannot remember what I said to the committee. I have no desire to look back.”

Begg said the DWP told the committee that the pathfinder projects demonstrated that the IT systems worked. “You cannot get any more definitive than that,” said Begg. IDS gave no clear answer.

Obfuscation

Mid-way through the hearing, the mood of some of the exchanges was summed up by Labour MP Debbie Abrahams who told IDS:

“I cannot say with the strongest feeling my concern about the hubris that you have demonstrated in the tone to this committee. You haven’t explained, certainly to my own satisfaction – anybody who is watching will draw their own conclusions – you have not given any satisfactory explanation about how you have informed, or kept this committee informed, about the difficulties the department was experiencing.

“There have been obfuscation and smoke and mirrors even up to a few weeks before the report from the National Audit Office [in September 2013]. The memorandum that was released in August – this was clearly saying everything was fine and dandy. It is clearly not. I give you one more opportunity to answer, so you can explain to this committee, why such poor information is provided by your department.”

IDS replied: “I just don’t agree with you, and I don’t agree that we have done anything else but be open and honest about what the issues are, as and when they have been identified and what we would do about them as and when we have made our decisions about them…

Open?

“When we found something wrong we went and sorted it out. As we sorted it out we made clear direction about that, and eventually through the NAO, the PAC [Public Accounts Committee and the [Work and Pensions] committee.

“I think we have been pretty open about it. I don’t think there’s anything more. In fact in a sense we are going round and round in circles here at this committee hearing at the moment.”

Begg:  “We are not convinced you have got it sorted out.”

Comment

Monday’s hearing shows how ministers and officials justify the hiding of reports on costly IT-enabled projects that are going wrong. IDS didn’t even tell MPs in July 2013 that the Major Projects Authority had four months earlier recommended an immediate pause in the programme.

Most worrying of all, officials and IDS seem content that the DWP gave the work and pensions committee – in September 2012 and July 2013 – a good news story on the state of the Universal Credit IT project while truth about the project’s problems stayed hidden.

IDS suggested it was not necessary to tell MPs about reports until ministers have “reached a conclusion about what is actually happening” That may be never.

It’s time for public accounts and work and pensions MPs to insist on seeing Major Projects Authority reviews, and other reports, on the progress or otherwise of big government IT-enabled programme such as UC. MPs should not have to wait for an NAO report to get the truth.

Governments, whatever their hue, will always refuse to publish these reports contemporaneously, such is the will of departmental heads. They have been refusing to publish the reports for more than 20 years.

But if MPs keep insisting with an unbreakable tenacity on their publication  – and for publication before they are out of date – it may eventually happen, and gone will be the power of ministers and officials to mislead MPs on the state of big IT-enabled programmes.

Until publication happens, is there much point in MPs questioning IDS or his officials on the UC IT programme? They will get only the public relations version of the truth.

 

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Posted in Campaign4Change, DWP, excessive secrecy, IT-related failures, Major Projects Authority, openness and transparency, procurement, project management, public services, Real-Time Information, Universal Credit

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Officials black out IT security report after it’s published in full

Posted on 05/02/2014 | 1 comment

By Tony Collins

In one of the most bizarre regressions since the FOI Act came into force in 2005, officials at Somerset County Council have redacted an audit report on SAP security weaknesses after the report was published in full.

The result is that anyone can see links to both reports. This is the report with parts of it redacted – blacked out. These are links to the full versions, which were published before the redactions – here and here.

The report was written by auditors Grant Thornton for Somerset County Council and highlights weaknesses in a database that is shared by the council, Taunton Deane Borough Council and Avon and Somerset Police.  The database is part of a SAP system run by Southwest One on behalf of the three authorities.

Southwest One is an IBM-led enterprise that provides IT and other services to the three authorities under a controversial outsourcing contract. Dave Orr has written comprehensively about the deal.

Somerset published the Grant Thornton report in full. The media including Campaign4Change published some details of the IT security weaknesses mentioned in the Grant Thornton report. It appears that Avon and Somerset Police asked officials at Somerset to black out details of some of the weaknesses.

Somerset-based FOI campaigner Dave Orr says the blacking out is to save the blushes of the police.

Says Orr: “Much of the redaction in the Somerset County Council IT Controls report by Grant Thornton, especially generic and available password advice in Section 3, is not based in a genuine security threat, but looks to be rooted in a Police culture that seeks to avoid criticism and/or embarrassment.”

Somerset MP Ian Liddell-Grainger says:

“SAP was built on the cheap by IBM to serve three different customers – the County Council, Taunton Deane district council and the Police. It would have made sense to bung in a few partitions to stop council eyes taking a peek at police matters, or vice versa. But that would have cost money – perish the thought.”   

 Police SAP systems’s “significant” security weaknesses. 

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Posted in Campaign4Change, Freedom of Information, IT security, local democracy, local government, outsourcing, public sector, public services, public-private partnerships, SAP, security, supplier relationships

Of mice and IT elephants – guest blog

Posted on 04/02/2014 | 4 comments

By John Pearce

I heard your interview on BBC’s World at One today Tony. You were saying there may be potential for fleet-of-foot small IT firms to access government contracts. It was music to my ears.

You referred to the NHS and Universal Credit IT disasters and the way contracting has been dominated by a few big beasts and multi-nationals.  You killed the myth that “big is beautiful”  and praised “new rules”  to break up projects into smaller units.

Small can be perfectly formed and powerful. Businesses like ours are quick-reflex mice stuck behind the elephants blocking the doors. Why don’t they just sit out of the way, in the room, like other elephants?

We are an SME in IT.  We have great pedigree, an innovative product, a presence in education and are ready to break into the business world and government work more generally. But without the bulk and buying power to advertise, lobby and bid for the current huge projects we have not been able to do much, if anything. We are encountering elephant in the door syndrome.

So we continue doing what we do, scurrying like mad, working unreasonable but happily given hours. It is not in the country’s interest for us to be tired, blocked and trapped. We fear being swallowed up, of losing our identity. I suppose it might be quicker than being slowly squashed under an elephant’s backside.

iAbacus

Dan O’Brien, my business partner, is young, creative, dynamic and rushed off his feet.  I am three of those and old.  He has run a small successful software company for 15 years. I had a successful senior career in education and in business as consultant, evaluator, writer and publisher.  I created a deceptively simple, improvement model for individual, team and organisation. So, Dan and I created an on-line version.

We launched “The iAbacus” in 2012 and were finalists in the BETT2014Awards [hosted by Jo Brand] on 22 January 2014.  There were lots of mice competing with us and the usual elephants. But before we announce the winner let’s have a look at the iAbacus focusing on school governance. 

We dream of developing this and moving into business generally. We see a huge potential for this “empowering personnel” approach applied to NHS and civil service personnel. Up to now the elephants have blocked the way, or grinned through the windows while they ate ice buns. Can elephants grin?

We didn’t win the Bett2014 Big Cheese but it was a great show – it makes people like us feel good.  Yes, coming back to the office was disappointing but we are nibbling away, on-line, working in education but, even in this field I know so well, customers can be sniffy too – “small is ugly and simple is simplistic; let’s go for the big suppliers”. 

New rules

Will the Cabinet Office’s new rules work?

 Not unless there is support for small outfits like ours who, intent on the day to day business, will struggle writing the bids and attending the selections. We’ll keep running and swerving around elephant bottoms but we need muscle power and finance for the advertising and lobbying. We need to elbow past the elephants, get an audience with buyers.  Is there anyone out there?  Echo…echo….echo…

Or, are there friendly elephants out there who could help us, encourage and include us?  Could the regulations persuade them?  How about a clause like the one when planning new houses?  Every housing project has to include a percentage of affordable homes. How about every IT contract having to include a percentage of SMEs?  

I want to one of them. I want to be a Trojan Mouse!

John Pearce is a freelance consultant, working across education, business and community. After a successful career in teaching and headship, he became Deputy Chief Inspector for Nottinghamshire County Council. He was a BETT2014 finalist for The iAbacus which he created with Dan O’Brien.

john@iabacus.co.uk   dan@iabacus.co.uk

BBC’s World at One focus on government IT.

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Posted in Campaign4Change, Government IT, SME

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Universal Credit head Howard Shiplee off sick

Posted on 03/02/2014 | 5 comments

By Tony Collins

Howard Shiplee, who joined the Department for Work and Pensions in May 2013 as Director General of the Universal Credit Programme, has been off sick since shortly before Christmas.

A DWP spokeswoman told Campaign4Change that Shiplee is in regular touch with the programme through conference calls and would be back working full-time on UC as soon as he is fit.

Today  [3 February 2013] Shiplee’s boss Iain Duncan Smith is due to appear again before the Work and Pensions Committee  to answer questions about UC. The DWP spokeswoman said Shiplee is looking forward to returning to the UC project.

Comment:

The job of Director General of UC is well paid –  £258,750 according to the Daily Mail. But it may also be the most stressful IT-related job in central government. UC is probably the most high profile of all IT-enabled projects in central government and it faces many challenges, according to the National Audit Office.  IDS is determined that the IT will succeed – though whether he will still be the minister in charge of UC after the general election next year is uncertain.  

Shiplee is well regarded – he was previously the construction director for the successful 2012 Summer Olympics in London. Keeping his reputation for successful delivery on the UC project will not be easy.  Campaign4Change wishes him a speedy recovery.   

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Posted in Campaign4Change

Ex BP executive to run Major Projects Authority

Posted on 03/02/2014 | Leave a comment

By Tony Collins

John Manzoni is to join the civil service as Chief Executive of the Cabinet Office’s Major Projects Authority.

The former BP executive brings 30 years’ commercial experience to the job. He was  recently President and CEO of Canadian oil and gas company Talisman Energy Inc. He spent 24 years at BP, holding senior strategic and operational leadership roles at global, regional and local level. 

He was a member of the BP plc Main Board from 2003- 2007.  The Major Projects Authority was set up in 2011 with a mandate from the Prime Minister to turn around poor project management in Government. It reviews major projects and has the power to stop them in extreme cases.

Manzoni will need a stomach for polite confrontation if his Major Projects Authority is to continue to be effective. Some long-standing  executives in departments prefer to carry on without the influence – they call it interference – of the Cabinet Office. 

It may be that the only effective way the CEO of the Major Projects Authority can influence in the civil service is by heaping praise on departmental officials while recommending changes he hopes the department will take seriously.

The formidable David Pitchford was interim head of the Authority until he left last September.

Manzoni says: 

“Some of the largest and most complex projects can be found in Government and it’s the scale of the challenge that makes this role interesting. Working with Departments, and at the service of talented civil servants, the MPA has already delivered remarkable improvements.

“To me, the key to its continued success is the quality of project professionals at the centre and in departments. It always comes down to the people.

“If we get this right, it will be a sustainable agenda that is good for all seasons and all political persuasions. It’s hard to fight against the logic of spending large amounts of money more effectively and improving public services at the same time.”
Cabinet Office minister Francis Maude says: “John has an impressive record of leading global operations and delivering complex, challenging briefs…

“As part of this Government’s long-term economic plan we must to continue to improve the Civil Service’s management of major projects. Last year the Major Projects Authority saved hard-working taxpayers £1.7bn. I’m confident that with John’s leadership we can go even further and make a real difference to the delivery of these projects which matter to all of us.”
Danny Alexander, Chief Secretary to the Treasury adds: “The Major Projects Authority has real power to intervene in failing projects and stop taxpayers’ money being wasted, and it is already turning around our record of delivering Britain’s most important projects.

“John’s experience speaks for itself …”

Sir Bob Kerslake, Head of the Civil Service says: “Improved project delivery is a crucial part of our Civil Service Reform Plan- indeed, in the future, no one will lead a major project without completing extensive training at the Major Projects Leadership Academy.

“It is fantastic that John Manzoni is bringing his extensive experience to lead the next generation of Civil Service project managers.”

Stephen Kelly, Chief Operating Officer says “The MPA’s success lies in delivering quality outcomes on time within budget, and we are passionate to see MPA become the leading authority in world class project implementation.

“The fusion of private sector best practice with strong public service ethos is key to this future. The MPA has already had a strong start working with departments delivering major public projects and I have no doubt that John’s leadership and proven success will accelerate our delivery.”

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Posted in Campaign4Change, Major Projects Authority

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Dare anyone criticise this IT project – with the CEO as leader?

Posted on 03/02/2014 | Leave a comment

By Tony Collins

Croydon Health Services NHS Trust has had mixed success with its go-live of the Cerner Millennium system.

It is said to be a technical success but last week board members of the Croydon Clinical Commissioning Group expressed concerns about ongoing problems with the system.

Fouzia Harrington, director of quality and governance told the Croydon Advertiser: “The implementation [of Cerner] itself went well in technical terms, but there have been some implications about how it has been used by staff.

“It’s had far more impact in terms of the time it takes to book people in, for example. There have also been implications in terms of lost information about patients.

“There has been a lack of information about hospital activity, which has an impact on finances and, potentially,the quality of services patients are receiving…”

David Hughes, a lay member of the board, was not satisfied with that reassurance.

“You say that no harm has occurred,” he said,  “but while we’ve had no direct incident so far, patient care has definitely suffered.

“You talk about increased waiting times and there’s a risk that harm may occur because of the difficulty in getting in touch with clinicians who actually know what is going on with the patient.

“I’m very concerned from a quality point of view that our main provider has a serious problem with its information systems.”

Hughes called for action. Although the trust may not be aware of an incident yet it may “come out through further investigation that there has been”.

Some waiting times have increased,  the CCG cannot be certain of exact levels of activity at the hospital, and missing information has made it difficult to commission some services.

The concerns were raised at a board meeting on Tuesday.

Dr Tony Brzezicki, chairman of the CCG, said new system would eventually lead to improvements.  “Hospital patients had five sets of notes before. That in itself posed a risk that Cerner will mitigate,” he said.

“However, there have been administrative delays which mean longer waiting times for patients.There are also issues for the service to primary care which is a significant risk. Some of the problems have been resolved though I am concerned at the time scale because they are certainly impacting on my practice.”

Success

John Goulston is the Croydon Health Services NHS Trust CEO. One of his previous jobs was as Programme Director of the London Programme for IT at NHS London. The LPfIT was formerly part of the National Programme for IT. 

As well as CEO, he chairs the trust’s Informatics Programme Board which has taken charge of bringing Cerner Millennium to Croydon’s community health services and the local University Hospital, formerly the Mayday.

Goulston reported to his board that the Cerner go-live – on 30 September and 1 October last year – was a success.

“Our partners Cerner, BT and Ideal have commented that the Trust has undertaken one of the most efficient roll-outs of the system they have worked on, with more users adopting the system more quickly and efficiently than other trusts … the success we have achieved to date is the result of the efforts of every single system user and all staff members,” said Goulston.

Goulston has said the trust deployed the “largest number of clinical applications in a single implementation in the NHS”. 

The Department of Health provided central funding, and the trust paid for implementation “overheads”.  The Health and Social Care Information Centre was the trust’s partner for the go-live.

The Croydon Advertiser asked Croydon Health Servicesa series of questions about Cerner, including its cost to the NHS, but was sent a short statement.

A spokesman told the Advertiser the system would improve patient administration and means that nurses have access to “quality, detailed information” when delivering care.

He added: “During the initial switch over of systems in September while staff were getting used to the system, some patients did need to wait slightly longer to check in for their clinic appointments.

“The trust has maintained and surpassed our 18 week referral to treatment targets from the initial roll out.”

Croydon’s response

Campaign4Change put some questions to the Croydon trust. These are the questions and its responses: .

Is the trust being completely open – taking seriously the duty of candour –  about problems arising from the Cerner Millennium go-live?

“The Trust takes its duty of candour on all issues very seriously; we believe that transparency is essential in running a modern NHS organisation. We are held to account by our board at public meetings, where the public are able to attend and question our senior management team, by our local health overview and scrutiny committee and our commissioners.

“Recent press coverage on CRS Millennium appeared in the local press when the system was discussed in a public meeting of our commissioners.”

As the CEO is leading the Cerner Millennium project, does this make it difficult for trust staff and trust directors to say anything even mildly critical about the implementation?

“Staff opinions on the implementation of CRS Millennium, both positive and negative, are welcomed by the Trust. Staff have given their frank opinions of the system directly to the Chief Executive both in our monthly all staff meetings and at the open staff engagement surgeries held by our Chief Executive and Chairman. All staff opinions are taken seriously and are acted upon appropriately.”

Given the CEO’s enthusiasm for the implementation is there a special onus on the press office to defend the implementation and play down problems? [I note that the Croydon Advertiser implied its questions had not been answered, and that the Trust gave a short statement instead.]

“The communications team respond to and facilitate a large number of external requests, including from the media, in a transparent, timely and appropriate manner. This same approach is followed on questions about CRS Millennium.

“CRS Millennium will bring about many improvements to patient care and Trust efficiency and we are enthusiastic about communicating these; it is unfortunate that recent press coverage did not consider these positive benefits in any depth.”

A comment on the Croydon Advertiser’s website says:

“When I checked in to out-patients I supplied all my personal details; however the post code I gave was declared invalid by the new system. That filled me with confidence. I also gave my contact as a mobile; however they tried to ring me using an old landline number.”

Comment

It’s generally accepted that having a high-level sponsor for an IT project is essential but when the lead is the CEO, does that make it difficult for people to challenge and constructively criticise?

A “good news” culture tends to prevail – as happened on Universal Credit, on the BBC’s Digital Media Initiative, and within the Department of Health on the NPfIT. Nobody dared to speak the whole truth to power. The truth tends to surface only when a new administration takes over or, in the case of Universal Credit, the minister obtained his own independent reports on project progress.

Campaign4Change put it to the Croydon trust that board directors see reports on the Cerner implementation only every two months and much can happen in the intervening period. This it did not deny.

Even if the trust’s directors met daily would they dare to challenge the CEO? And will the full facts  ever emerge? Things could be much better than CCG directors believe  – or much worse.

After nearly every major NPfIT implementation of the Cerner Millennium system in London and beyond (such as North Bristol) the facts were scarce, and reassurances that no patients had come to harm were plentiful. 

Here we go again?

**

Should lessons have been learned from these Cerner go-lives?

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

GPs asked to contact hundreds of patients who may have missed treatment after hospital’s cancer referrals blunder  – Pulse

London LMCs alert over Imperial cancer waits mix-up – Pulse.

GPs kept in the dark over hospital cancer blunder – Pulse

 IT system has increased waiting times and led to lost patient data.

Patient records go-live success – or NPfIT failure

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Posted in BT, BT Health, Campaign4Change, Department of Health, e-health, excessive secrecy, health, health records, LPfIT, NHS, npfit, openness and transparency, operational issues