Campaign4Change

By Tony Collins

Edward Donald, the chief executive of Reading-based Royal Berkshire NHS Foundation Trust, is reported in the trust’s latest published board papers as saying that a Cerner go-live has been relatively successful.

“The Chief Executive emphasised that, despite these challenges, the ‘go-live’ at the Trust had been more successful than in other Cerner Millennium sites.”

A similar, stronger message appeared was in a separate board paper which was released under FOI.  Royal Berkshire’s EPR [electronic patient record] Executive Governance Committee minutes said:

“… the Committee noted that the Trust’s launch had been considered to be the best implementation of Cerner Millennium yet and that despite staff misgivings, the project was progressing well. This positive message should also be disseminated…”

Royal Berkshire went live in June 2012 with an implementation of Cerner outside the NPfIT.  In mid-2009, the trust signed with University of Pittsburgh Medical Centre to deliver Millennium.

Not everything has gone well – which raises questions, if this was the best Cerner implementation yet,  of what others were like.

Donald said there had been an inevitable impact with:

– patients attending for clinics that did not exist

– patients receiving multiple requests to attend clinics

– patients not receiving follow-up appointments.

Personal letter to patients

Donald told the trust’s board that patients affected would receive a personal letter.  He also said that it was becoming clear that the level of administrative support required to underpin the new system was “high”.

The level of additional support for go-live, and then on an ongoing basis was being quantified. There were 24 additional staff in post. Donald said that he would be discussing this further with the managing director of Cerner “with a view to being reimbursed for this additional cost”.

Was the trust was aware of the additional costs before buying the system? To this question Donald advised the board that the business cases submitted to the board had assumed that administrative costs following implementation would be lower. Donald undertook to distribute a briefing note to the board on the additional short and long term administrative costs to support Cerner Millennium.

[The trust’s Board papers say that Berkshire’s Cerner Millennium system is costing about £30m, which would make it one of the most expensive EPR implementations in the NHS. The papers show that Berkshire’s EPR is funded through loans.]

Had the additional administrative costs had been included in the revised financial forecast for the trust? The Director of Finance advised the board that this was not the case. “However, the additional costs had been included as a potential risk to the achievement of the forecast position,” said the trust’s minutes.

The board noted that the impact of the implementation of the Cerner Millennium system on the ability to deliver performance standards had been considerable.

“In particular, it had been necessary to undertake high volumes of manual data validation to assure accurate reporting. Given this, Monitor had agreed to accept the final validated performance of the Trust at the end of each quarter as the basis for the Trust’s governance rating.”

Cancer waiting times

On some cancer waiting times the EPR system “has had a significant impact on the ability to manage the referral process”,  said the trust’s papers. In addition, there was a backlog of work to be cleared and the production of summary information in key clinical areas.

Patient complaints

The latest information from the trust on its Cerner system is from a freedom of information request submitted by the Health Service Journal which reported last week:

“The Royal Berkshire Foundation Trust’s nursing director has suggested that a high level of complaints about staff is in part down to the implementation of the Cerner Millennium electronic patient record system.”

EPR a “long journey”

In September the head of health informatics at Royal Berkshire was reported as informing a meeting of the trust’s Council of Governors that staff can now start to think of the benefits of the Cerner implementation. She added:

“It’s very important to remember that implementing [Cerner] Millennium is just the start of the process. It will take many years. We’ve got a very long journey until we’ve got the electronic record.”

In response to the getreading.co.uk article Cerner spokesman Simon Hill said:

“The Royal Berkshire NHS Foundation Trust and Cerner have embarked upon a trust-wide change management programme.  The cornerstone of these changes require the installation of Cerner Millennium, the new information system, which gives clinicians real-time access to high quality patient information.

“As with all significant change management programmes, there will be challenges; the Trust and Cerner are working hard to ensure that any disruption is kept to an absolute minimum.

“By improving clinicians’ access to real-time high quality information, the Trust will be able to continue to improve its services to local people throughout the region.”

Comment:

Royal Berkshire NHS Foundation Trust is one of the largest general hospital foundation trusts in Engand. It employs about 4,800 staff and provides acute medical and surgical services to Reading, Wokingham and West Berkshire.

It’s inevitable that in such a large trust the widespread implementation of an all-encompassing system such as Cerner will hit some patients. Some Cerner implementations go well and bring important benefits to hospitals and their patients. Some implementations go badly. One question the NHS doesn’t ask, but perhaps should, is: what level of problems is acceptable with a new electronic patient record system?

It appears from some EPR implementations in the NHS that there is no such thing as a low point. No level of disruption or damage to healthcare is deemed unacceptable.

Berkshire’s chief executive Edward Donald speaks the truth when he says that the trust’s implementation of Cerner was more successful than at other NHS sites. This is despite patients at his trust attending for clinics that did not exist, receiving multiple requests to attend clinics and not receiving follow-up appointments.

Do all such problems matter? To patients yes. To the NHS perhaps not. It would appear that the NHS is geared to care in only a perfunctory way about patient record IT implementations that worsen the care and treatment for patients. The promise of better patient care in the long-term seems to justify any problems in the meantime.

If problematic IT, data quality, or poor practice in data collection, affect the safety and health of patients – which became a potential issue at Imperial Healthcare NHS Trust – how much does anybody in the NHS really care?

The unfortunate truth is that inherent secrecy within the NHS means that the full impact on patients and details of an unsuccessful EPR implementation can remain hidden.

It is a mark of complacency of the Department of Health and the NHS that the board of the Royal Berkshire NHS Foundation Trust learned that it had met all its Care Quality Commission quality registration standards and would achieve an amber-green governance rating for the quarter. This was an improvement on the amber-red rating for the previous quarter.

In the same minutes the board noted that the trust had “failed to achieve the targets in respect of cancer 62 day waits for first treatment and cancer two week from referral to first seen for all urgent cancers”. Even so this would result in an amber-green governance risk rating.

One wonders whether NHS trusts can receive good ratings for their performance, whatever the actual performance.

The worrying thing for those who use the NHS is that, as far as new IT is concerned, it is like flying in a plane that has not been certified as safe – indeed a plane for which there has been no statutory requirement for safety tests. And if the plane crashes it’ll be easy for its operators and supplier to deny any responsibility. They can argue that their safety and risk ratings were at “green” or “amber-green”.

The lack of interest in the NHS over the adverse effect on patients of patient record implementations means that trusts can continue to go ahead with high-risk EPR go-lives without independent challenge.

Unless there is a political intervention, trusts in England will continue to repeat the cycle in a number of Cerner implementations:

– go-live

– chaos

– a trust admission that potential problems, costs and risks were underestimated

– a public apology to patients

– a trust promise that the problems have been fixed

– trust board papers that show the problems haven’t been fixed or new ones have arisen

– ongoing difficulties producing statutory and regulatory reports

– provision in trust accounts for unforeseen costs

– continuing questions about the impact of the new system on patients

– a drying-up of information from the trust on the full consequences of the EPR implementation, other than public announcements on its successful aspects.

As a commentator on E-Health Insider said: “When will this nonsense stop?”

By Tony Collins

US-based Avantor Performance Materials manufactures chemicals and raw materials used in laboratories for research, pharmaceutical production and medical lab testing. Its electronics products are used in the manufacturing of semiconductors and flat panel displays.

The company has issued a press release saying it has filed a lawsuit against IBM in connection with a failed SAP software implementation.

Its complaint was filed on 8 November in New Jersey. Avantor says it retained IBM to upgrade the company’s global computer systems to an SAP platform. Avantor claims that IBM misrepresented the capabilities of its proprietary software solution.

“IBM representatives assured us that its Express Life Sciences Solution, a pre-packaged software solution, was suitable to run Avantor’s core business processes,” says John Steitz, President and CEO of Avantor. “In fact, the solution—and the service and support offered by IBM throughout the implementation—proved to be woefully misaligned with the unique needs of our company and our customers.”  IBM’s Express Life Sciences Solution runs on SAP.

“Over the past approximately seven months, Avantor has undergone an aggressive, company-wide initiative to recover from the failed SAP implementation, and Avantor is now largely operating at pre-SAP implementation service levels,” says the company which is seeking damages of tens of millions of dollars.

IBM told Reuters the accusations were blown out of proportion and that it was surprised by the move.

“We believe the allegations in the complaint are exaggerated and misguided and are surprised that Avantor chose to file suit,” said IBM which added that it had “met its contractual obligations and delivered a solution that Avantor continued to use in its operations.”

The writ is reported to claim that the SAP implementation caused a “near standstill” of Avantor’s business.  Avantor in 2010 chose to replace its ERP (enterprise resource planning) platform with SAP.  A global SAP roll-out was planned as part of a rebranding and growth strategy.

Avantor says the implementation failed to provide crucial functionality that Avantor needed to run its core business processes. In the writ Avantor also criticised some of IBM’s consultants.

After go-live a number of errors are said to have emerged, ranging from failure to track or process orders correctly to directing “that dangerous chemicals be stored in inappropriate locations”.  The company paid IBM $13m. It claimed that IBM was seeking more to remedy issues around the software implementation.

Computerworld reports an allegation by Avantor that IBM failed to tell Avantor about risks to the project and hurried towards a go-live date.

Computerworld says the lawsuit alleges that IBM conducted inadequate and truncated testing and recommended that Avantor proceed with the go-live as scheduled – even though Avantor had emphasised that meeting a projected go-live date was less important than having a fully functional System that would not disrupt Avantor’s ability to service its customers.

The resulting system did not process orders properly, lost some altogether, and did not generate paperwork for customs officials, the writ is reported to state.

IBM and Avantor met one of Avantor’s biggest customers, which expressed a concern that its EDI (electronic data interchange) with Avantor for product ordering wouldn’t work after the changeover, according to the suit. The EDI interface failed on go-live, the lawsuit is reported to say.

Avantor was told to cancel every pending order and reset the entire system in the light of pervasive warehouse problems. This was necessary to discover the root cause of the problem, IDG reports the lawsuit as saying.

IBM said it disagreed with the claims and will defend itself against them vigorously. Avantor’s lawsuit is said to accept that IBM made efforts to right the project’s course following a June meeting with Avantor’s then-CEO, Rajiv Gupta.

IBM “began to acknowledge the severity of the situation” and replaced many of the original consultants, according to the ;lawsuit. These workers did extensive redesign and programming.

By Tony Collins

The Independent on Sunday claimed yesterday that the Universal Credit programme is a year behind schedule, software issues could push that back further, and the budget has been exceeded by £100m.

It says the launch of Universal Credit, which is scheduled for next October, “ will now be limited to small regional projects”.

There is little in the article to support its claims. But the Department of Work and Pensions has provided no evidence to indicate that the claims are wrong.

“A reorganisation of the complex IT system, following the departure this month of key senior civil servants in charge of universal credit, could mean an overrun of £500m by next spring,” says the paper. “Six pilot projects that are testing direct payment of benefits to tenants in housing associations have reported errors including the wrong amount of money being sent on the wrong date.”

One project involving just 400 claimants initially proved chaotic, says the paper. It quotes a government adviser on information technology as saying that work and pensions secretary Iain Duncan Smith,  like other ministers before him, has been “hypnotised by promises of what an online system can deliver”. Warnings were given to him more than a year ago. “They were ignored.”

The paper also suggests the Department for Work and Pensions is hiding £300m of rising costs by reallocating them to child support payments.

Comment:

Pilot projects are supposed to highlight things that need rectifying; and the DWP has long planned only a limited go-live next October. But the DWP’s repeated claim that key executives are leaving the programme because UC is moving from design to delivery and implementation is wearing thin. The DWP is hiding its internal reports which could reveal the programme’s uncertainties, challenges and assumptions.

This is a pity because there are parts of UC that appear to be going well and others that are not. It is difficult to obtain an overview.

In some ways UC is following the usual train tracks of a conventional government IT disaster:

– Defensive, secretive programme leaders saying, disingenuously, that their programme is the most scrutinised in history.

– The programme’s benefits are always referred to in the future tense.

– Well-meaning realists who point out the problems, uncertainties, and assumptions are derided as defeatists.

Iain Duncan Smith appears to be isolating himself by telling Parliament that all is going well. Tradition on IT disasters dictates that those responsible for a project hear only what they want to hear; they filter facts according to their internal mind map, and they don’t wish to have around them any executive whose version of the truth is off-message. As in Barnet Council’s outsourcing plans, the official programme consists of what is going well and the risks that are being satisfactorily mitigated. Nothing is going badly. But in the case of UC few are convinced, not even the DWP’s permanent secretary Robert Devereux.

Some third-party software specialists say that HM Revenue and Customs is trying to cope with difficult if not impossible deadlines on implementing Real-Time Information, on which the success of UC depends.

They say that HMRC has been making shortcuts with scoping and definition of requirements.  Certainly HMRC has found that national insurance numbers are not useful unique identifiers for employee records because many people don’t have them or have meaningless duplicates such as AB123456. This puts employers under pressure to come up with consistently unique identifiers for staff, for the benefit of HMRC’s RTI systems.

It could end up with employers being blamed, at least in part, for HMRC’s many duplicate records. Indeed employers could be among the scapegoats for any failure of Universal Credit.

If the DWP wanted to separate itself from the IT disasters of previous governments it would publish the facts on UC, the pilot projects and RTI. It’s only when the problems are admitted that they can be tackled.

RTI is a good idea: it could cut HMRC’s administration costs in the longer run; and UC is a good idea if properly implemented, so long as the disabled are not penalised because of it. UC may greatly simplify the benefits systems in the long run.

But while the DWP and Duncan Smith have a bunker mentality people will continue to think they have much to hide. And they probably do.

PS: There are allegations from within the UC teams that there is charging by some contractors for man-days not fully worked, and that over-charging is not difficult because of the thousands of man-days being worked and invoiced. There are also claims that the main UC systems have gone through several versions – version eight at last count – but none has yet been shown to the main groups of business users. Clearly these allegations need investigating.

By Tony Collins

Earlier this week it emerged that Malcolm Whitehouse, Programme Director, Universal Credit, Department for Work and Pensions, has stepped down from the role.

Now  Government Computing reports that Steve Dover, Corporate Director, Universal Credit Programme Business, is being  replaced on the UC programme by two directors whose roles are new. Dover’s future role within DWP has not yet been announced.

The overall head of Universal Credit, Terry Moran, who is COO and second permanent secretary, DWP  – and the senior responsible owner of UC (person in charge of making sure UC’s benefits are realised)  – is on sick leave.

Comment:

It’s regarded as good practice on successful programmes to have a continuity of leadership.  The DWP says changes at the top are because the programme is moving from design to delivery and implementation, which is puzzling.

Whitehouse is being replaced by DWP benefits director Hilary Reynolds. Dover is being replaced by Janice Hartley and Sue Moore who have been appointed to director posts for the delivery of Universal Credit, reporting to Hilary Reynolds as Programme Director. The roles are new, not direct replacements for Steve Dover’s job.

The DWP’s organisation chart shows that Dover reported to Whitehouse, and Whitehouse to Moran.

The DWP says it is aiming to bring in new people with different skill sets. But how does disrupting continuity at the top of UC help a programme that, according to work and pensions secretary of state Iain Duncan Smith, is already so successful?

Universal Credit departures continue.

Director of Universal Credit steps down.

By Tony Collins

Malcolm Whitehouse, the programme director and man in charge of Universal Credit, has stepped down from the role.

Computer Weekly says he’s been replaced by the benefits director at the Department for Work and Pensions Hilary Reynolds who will remain in his position in the short-term to help manage the leadership transition. His next position is yet to be announced.

Computer Weekly reports on speculation that up to five senior figures will depart from the Universal Credit programme.

A DWP press office spokeswoman said Whitehouse’s departure was part of the programme’s move from design phase to implementation. She said the department was aiming to bring in new people with different skill sets.

“With the early roll-out of Universal Credit starting in less than six months’ time, the programme is moving from system design to delivery. To reflect this, there have been some staff changes as we shift the focus onto implementation.”

The Public Accounts Committee and the Public Administration Committee, in their separate reports on the lessons from IT disasters in government, have urged permanent secretaries to keep key people in post from project design to delivery of benefits.

Whitehouse has worked at the DWP for nine years, having taken the role as programme director in July 2011. This summer he gave a positive report on the progress of Universal Credit to the House of Commons’ Work and Pensions Committee.

Thank you to David Moss for alerting me to Whitehouse’s stepping down.

How’s the Universal Credit programme going?

Malcolm Whitehouse steps down.

By Tony Collins

The Cabinet Office minister Francis Maude has criticised the high cost of Government IT and called on CIOs to be innovative, radical and pioneering as their departments move away from the “big, sclerotic SI contracts”.

His speech at an event for IT professionals was not unlike Chris Chant’s last year when Chant said the vast majority of GovIT was  “outrageously expensive”. Chant was then Executive Director in the Cabinet Office , heading  G-Cloud initiative.

Maude said that the government spends more than £1.2bn a year on hosting contracts. “Much of that is spent with just one or two suppliers,” said Maude. “And it’s more money than those suppliers are investing in their own cloud, the future of their own business.”

He continued:

We know we’re not getting value for money – recently a big SI and an SME bid on the Cloudstore for hosting. The SI bid £4m. The SME bid £50k.

Maude said the plan is to consolidate hosting and use collective requirements to run it.

“I’m particularly keen to explore mutualising it. I’ve asked my IT Reform team to come up with proposals by Christmas and I hope you will contribute to their work with your own energy and ideas.”

Reform is too slow

Much of Maude’s speech appeared to show a frustration that change in government IT is happening too slowly.

“We’ve made progress on all aspects of the IT strategy – but we need to go much further and faster.”

He did not mention any department in particular but the Department for Work and Pensions is among those that continue to award large long-term contracts to major IT companies, much as it used to, on the basis that civil servants do not want to risk any disruption to benefit systems .

Maude said:

“At the moment we spend more than 1% of GDP on the administrative IT to run government.  That’s far too much. It is imperative that Government reduces its IT budget further in the next 3 years – while delivering more digital, innovative, user-focused services.

Big is not beautiful

“So how can we get there? Firstly it’s crucial that we continue to move away from the mentality that big is beautiful.

“For too long Government IT has been too expensive, over-specified and run in contract structures that encourage complexity, duplication and fragmented user services.

“For the most part contracts were consistently awarded to a limited number of very large suppliers on long-term, exclusive contracts – whilst we shut out smaller more innovative suppliers.

“… Government repeatedly found itself paying large amounts for systems that were delivered late, over budget and not even to the quality required…

“Shockingly when we came into office SMEs – despite accounting for half the turnover in the UK economy – were winning only around 6.5% of Central Government’s procurement spend.

“This Government has set out an aspiration for a quarter of our business to go – directly or indirectly – to SMEs by 2015. And that means creating a more competitive and open marketplace for buying IT services and solutions.

“This process has started – we have cut red tape, introduced G-Cloud and increased the visibility of contracts across the board and we are giving firms a chance of redress through the Cabinet Office’s ‘Mystery Shopper’ Scheme.

“But there’s more to do. I am reiterating my requirement that for any IT programmes not being displaced by digital solutions, no project, framework or contract can be over £100m.

No contract extensions

And to ensure we are in charge of our own destiny rather than the supplier – we will have no contract extensions – the conditions and pricing that were signed up to even three years ago are ruinous in comparison to what is available now, when the price of IT keeps dropping.”

Open standards

“We need to change the way we procure and run technology systems – introducing Open Standards and using a wider group of smaller, innovative suppliers…”

Allowing Government to inter-operate would mean “we don’t have to build the same thing thirty or forty times”.

He said that open standards will improve competition for government contracts.  In a consultation on open standards more than 70% of respondents supported the view that mandation of open standards, or of particular standards, would improve value for money in the provision of government services.

“Following this consultation I am today publishing our Open Standards Principles. These set out that Royalty Free open standards are key to levelling the playing field for open source and proprietary software in government IT.

“And that competition between open source and proprietary software can result in lower licensing costs and increased innovation in government IT.

“…All Government bodies must comply with the Open Standards Principles or apply for an exemption. And a challenging comply or explain process is being implemented, through the existing IT spend controls process.”

Maude said that reforms can happen only with strong, radical, innovative leadership – “people who will challenge the status quo and can inspire change in every corner of Whitehall. And that’s where I expect you to come in.”

Cloudstore

The Government’s CloudStore allows public sector organisations to purchase a range of the best IT services off the shelf from on a pay-as-you-go basis, rather than having to develop their own systems.

Maude said there have been 99 purchases of IT services totalling over £2.2m through the CloudStore and 70% of this  has been with SMEs.

He thanked Chris Chant – who retired in April –  and the current Director Denise McDonagh and her team for their work on G-Cloud.

“I’ve heard suppliers say they can’t believe how easy G-Cloud is to use – which is not what you’re used to hearing about Government procurement,” said Maude.

Comment:

Maude says all the right things  – as did Chris Chant last year. Bill Crothers, Liam Maxwell and Mike Bracken are among the excellent adjutants to Maude. But if this strong team – which is backed by the Prime Minister –  cannot significantly change the way government runs, and how much it spends on IT, who can?

Maude’s speech

DWP defends £316m contract award to HP