London taxi cab maker’s results hit by IT problems

By Tony Collins

The share price of a company that makes London black cabs lost more than a third of their value yesterday (Tuesday) after announcing poor results and IT-related problems.

Manganese Bronze, which was founded 113 years ago, is an automotive products and services group that includes the London Taxi Company. Its taxis are made at a factory in Coventry, though the parts are sourced from China. Its vehicles sold internationally, including a tranche of 1,000 to Azerbaijan, which showed them off at the Eurovision song contest this year, according to the FT today.

Manganese says on its website it is delaying the release of its half-year results for the six months ended 30 June 2012 because of the need to “restate prior years’ financial results because of accounting errors that have come to light”. The half-year results will be announced on or before 24 September 2012.

In a statement Manganese said that in August 2010 the Group introduced an integrated IT system to help to manage the increasingly complex global supply chain. The company uploaded the closing general ledger balances from the previous IT system.

“Due to a combination of system and procedural errors, a number of transactions relating to 2010 and 2011 and some residual balances from the previous system were not properly processed through the new IT system.

“This problem led to the over-statement of stock and under-statement of liabilities in the financial statements of previous years. The cumulative effect of these errors is an estimated £3.9m understatement of historical losses which go back over several years although the work to apportion the loss between previous years is not yet complete…the balance sheet at 31 December 2011 and the financial results for 2011 and prior years will have to be restated.”

Manganese said it expected “to report net losses for the first half that are substantially higher than last year”. News of the poor results and IT-related problems led to a fall in share price of 34% to 16.5p, compared to a 52-week high of .45.5p. The FT said the company has a market value of just £5m, down from £230m five years ago.

More agile-thinkers like Roo Reynolds please

By Tony Collins

There’s a useful “keep-it-simple” article on agile software development principles by Roo Reynolds who a product manager at the Government Digital Service.

Reynolds quotes Marissa Mayer, former Google product manager, now Yahoo CEO, who said that there are two types of developer: those who seek perfection and those who seek something working today that they can improve on tomorrow.

“You probably want to work with the second sort of developer as much as possible,” says Reynolds. He quotes Voltaire as saying ‘the best is the enemy of the good’.  From Reynolds’ article:

“We start with a Minimum Viable Product, asking ourselves, what’s the simplest thing that could possibly work? We aim to have a working product, albeit a limited one, within a week or two.

“Having something you can point at and get feedback on as soon as possible is definitely better than attempting to polish something to perfection without anyone being able to tell you whether what you’re making is actually what they need.”

He warns against using made-up data, such as Lorem Ipsum text, because:

– it causes existing assumptions to be reinforced rather than challenged

– it lazily misses an opportunity to iron out any difficulties in getting hold of the real data

He concludes that “nothing beats feedback from real users”.

“Testing products with real users is vital. We always start with user needs (generally captured as user stories) and in meeting those needs I’ve learned not to get too comfortable with any implementation until we’ve tried it with a range of real people. Best of all, it’s ok to be wrong. The best way of getting closer to being right is to test real ideas with real people.”

Comment

If these principles had been applied to the NPfIT it might never have been started.  The NPfIT launched with the principle: what’s the most complicated thing that could possibly work?

Too often assumptions were made on the basis of unrepresentative data such as patient records that were up-to-date, accurate and not duplicated. The NPfIT was tested on real users – but then the bad news was all but ignored.

If Reynolds had been advising on the NPfIT, and Tony Blair hadn’t been so gung-ho when he chaired a discussion on NHS IT at a meeting in Downing Street on 18 February 2002, perhaps billions would not have been wasted on the programme.

More like Roo Reynolds in government please.

@rooreynolds

Reynolds’ article, Government Digital Service.

Will coalition sign a new NPfIT deal with CSC?

By Tony Collins

CSC has told investors that its discussions with the UK government on an interim agreement for deploying Lorenzo to the NHS are “continuing positively”.

CSC says that an agreement could commit a certain number of NHS trusts to take Lorenzo. Some of those trusts would be named in the interim agreement and the remainder within six months. CSC refers to them as “committed named trusts”.

[Such a legal commitment for named NHS trusts to take Lorenzo may run counter to the post-NPfIT coalition philosophy of giving trusts the freedom to buy what they want, when they want, and from whom they want. The named trusts might have indicated on a  DH questionnaire a wish to take Lorenzo but an agreement between the government and CSC would commit the trusts irrevocably, or the DH could have to pay CSC compensation for non-deployment.]

CSC says the deployed product would be categorized as “base product” or “additional product” for pricing purposes. The DH would commit money to the base product. Other funds would be available centrally available for “additional products,  supplemental trust activity and local configuration”.

The DH would give CSC a structured set of payments following certain product deliveries, as well as additional payments to cover various deployments for the named trusts and payments for work already performed.

If the government does not sign a new deal, and allows CSC’s existing contracts to run down until they expire formally in 2015, this could keep further NPfIT-related costs to the taxpayer to a minimum.  But it risks legal action from CSC, which says the NHS contract is enforceable and that the NHS has no existing right to terminate the contract, unless for convenience (which is unlikely).

If the government had terminated CSC’s contracts for its convenience (as opposed to alleged breach of contract) it would have had to pay CSC a termination fee capped at £329m as of 29 June 2012. CSC would also have been entitled to compensation for the profit it would have earned for the 12 months after the contract was terminated.

If the contract is not terminated, a new deal not signed, and no legal action is taken by either side, the amounts the UK government would have to pay CSC are likely to be minimised.  It is in CSC’s interests to maintain and enhance Lorenzo for those NHS sites that have deployed it.

So will the government sign a new deal with CSC at least to reduce the risks of CSC legal action? Or could the government hold out not signing any agreement until expiry of the contracts in 2015 on the basis that CSC has not delivered all it promised?

If a new deal is signed – and CSC indicates that an agreement is likely – the government may face accusations that it has broken its undertaking to dismantle the NPfIT.

David Camerson intervened personally to have the Cabinet Office’s Major Projects Authority look closely at NPfIT commitments.  His “efficiency” minister Francis Maude is likely to resist the signing of any new agreement

But will CSC accept the government’s refusal to sign a new deal, when such a deal could enable CSC to recover at least some of the $1.485bn (£0.95bn) it recorded as an NPfIT contract charge in the third quarter of 2012?

Ex Government CIO Joe Harley rejoins private sector

By Tony Collins

Former Government CIO Joe Harley has taken a position as non-executive adviser to Amor Group, an IT and business technology provider to the transport, energy and public sectors.

Amor says is taking the place of large systems integrators whose “monopolies are ending”.

It is Harley’s first official role since retiring from the civil service earlier this year.

Amor Group says it has “succeeded in recruiting the man credited with reforming the UK Government’s information communication and technology strategy to act as a strategic adviser”.

Harley was UK Government CIO between 2011 and 2012 and CIO at the Department of Work and Pensions from 2004 to 2012.

Amor has a turnover of about £45m and nearly 600 staff at offices in Aberdeen, Glasgow, Manchester, Coventry, London, Dubai and Houston.

Harley said,

“Amor Group is a new breed of companies that is helping organisations to improve their business performance and to manage their ICT budgets to deliver maximum value in the current economic climate and I am delighted to be helping a company which has grown year on year in a tough market, and that has such great ambitions for growth.

“Businesses are looking to more agile, flexible firms who can act quickly and save costs whilst not lowering service levels. I am looking forward to helping Amor continue that trend.”

John Innes, CEO at Amor, said,  “The days of the large systems integrators and monopolies are ending and we are taking their place. We signed a £18.5m contract last year with the Scottish Government to run its eProcurement service and we’ve seen real traction in International markets with our passenger tracking technology being installed at Dubai Airport and a number of wins for our Energy team in the US.

“What sets us apart is our culture as a company. We understand that technology only has a value when it delivers benefits to an organisation and we focus on delivering those benefits rather than selling heavyweight solutions.”

Harley’s background:

1993 – 1996: BP Alaska, IT director
1996 – 1998: BP Exploration and Downstream Europe, CIO
1998 – 2000: BP, global IT vice president
2000 – 2004: ICI Paints, CIO
2004 – 2012 Director General of Corporate IT and CIO, Department for Work and Pensions. Government CIO from 2011-2012.
Harley led the Universal Credit IT scheme which is due to go live from next October.

Cerner US-wide outage – what went wrong?

By Tony Collins

Hospital EMR and EHR has an account of what caused Cerner’s outage which affected its client sites across the USA and some international customers, according to reports.

It makes the point that the problem had little or nothing to do with the cloud.

The Los Angeles Times reports that within minutes of the outage, doctors and nurses reverted to writing orders and notes by hand, but in many cases they no longer had access to previous patient information saved remotely with Cerner.

“That information isn’t typically put on paper charts when records are kept electronically,” said the newspaper which quoted Dr. Brent Haberman, a pediatric pulmonologist in Memphis as saying, “If you can’t get to all the patient notes and all the previous data, you can imagine it’s very confusing and mistakes could be made…A new doctor comes on shift and doesn’t have access to what happened the past few hours or days.”

Hospital EMR and EHR

Some hospitals cope well through the outage

Maude gives up on plan to publish regular reports on major projects

By Tony Collins

Cabinet Office minister Francis Maude has given up on publishing regular “Gateway” reports on the progress or otherwise of big IT and construction projects.

Publication of the independent reviews has proved a step too far towards open government.  Were Maude to insist on publishing Major Projects Authority “Gateway” review reports, it would alienate too many influential senior civil servants whose support Maude needs to implement the Civil Service Reform Plan of June 2012.

Gateway reviews are independent reports on medium and high-risk projects at important stages of their lifecycle.  If current and topical the reviews are always kept secret. One copy is given to the project’s senior responsible owner and the Cabinet Office’s Major Projects Authority keeps another. Other copies have limited distribution.

In opposition Maude said he would publish the reviews; and when in power Maude took the necessary steps: the Cabinet Office’s “Structural Reform Plan Monthly Implementation Updates” included an undertaking to publish Gateway reviews by December 2011 .

When some officials, particularly those who had worked at the Office of Government Commerce, objected strongly to publishing the reports (for reasons set out below), the undertaking  to publish them vanished from further Structural Reform Plan Monthly Implementation Updates.  When asked why, a spokesman for the Cabinet Office said the plan to publish Gateway reviews had only ever been a “draft” proposal.

The anti-publication officials have thwarted even Sir Bob Kerslake, head of the Home Civil Service, who replaced Sir Gus O’Donnell.  When in May 2012 Conservative MP Richard Bacon asked Kerslake about publishing Gateway reviews, Kerslake replied:

Yes, actually we are looking at this specific issue as part of the Civil Service Reform Plan….I cannot say exactly what will be in the plan because we have not finalised it yet, but it is due in June and my expectation is that I am very sympathetic to publication of the RAG [red, amber, green] ratings.”

Inexplicably there was a change of plan. The Civil Service Reform Plan in fact said nothing about Gateway reports. It made no mention of RAG ratings. What the Plan offered on openness over major projects was an undertaking that “Government will publish an annual report on major projects by July 2012, which will cover the first full year’s operation of the Major Projects Authority.”  (This is a far cry from publishing regular independent Gateway assessments on major projects such as the IT for Universal Credit.)

Even that promise has yet to materialise: no annual report has been published. The Cabinet Office originally promised Parliament an annual report on the Major Projects Authority by December 2011. The Cabinet Office says that the annual MPA report has been delayed because the “team is now clear that it makes sense to include a full financial year’s worth of data and analysis in its first report”.

When eventually published the annual report will, says the Cabinet Office,  “make for a far more informative and comprehensive piece, and will include analysis of data up to 31 March 2012. This will be the first time the UK government has reported on its major projects in such a coherent and transparent way.”

Even so it’s now clear that the Cabinet Office is discarding its plans to publish regular Gateway review reports. Maude wants cooperation with officials, not confrontation.  He made this clear in the reform plan in which he said:

“Some may caricature this action plan as an attack on the Civil Service. It isn’t. It would be just as wrong to caricature the attitude of the Civil Service as one of unyielding resistance to change. Many of the most substantive ideas in this paper have come out of the work led by Permanent Secretaries themselves.”

But Maude is also frustrated at the quiet recalcitrance of some officials.  To a Lords committee that was inquiring into the accountability of civil servants, he said

“The thing for me that is absolutely fundamental in civil servants is that they should feel wholly uninhibited in challenging, advising and pushing back and then when a decision is made they should be wholly clear about implementing it.

“For me the sin against the holy ghost is to not push back and then not do it – that is what really enrages ministers, certainly in talking to ministers in the last government and in the current government. It is by no mean universal, but it is far more widespread than is desirable.”

It’s likely that Maude will keep Gateway reports secret so long as he has the cooperation of officials on civil service reforms.

Why officials oppose publication

The reasons for opposing publication were set out in the OGC’s evidence to an Information Tribunal on the Information Commissioner’s ruling in 2006 that the OGC publish two Gateway reports on the ID Cards scheme.

Below are some of the OGC’s arguments (all of which the Tribunal rejected).  The OGC went to the High Court to stop two early ID Cards Gateway reports being published, at which time OGC lawyers cited the 1689 Bill of Rights. The ID Cards gateway reports were eventually published (and the world didn’t end).

The OGC had argued that publishing Gateway reports would mean that:

–  Interviewees in Gateway reviews gave their time voluntarily and may refuse to cooperate.  (The Information Commissioner did not accept that officials would cease to perform their duties on the grounds the information may be disclosed.)

– Interviewees would be guarded in what they said;  reviewers would be less inclined to cooperate; and disclosure would result in anodyne reports. These three arguments were given in evidence by Sir Peter Gershon, the first Chief Executive of the OGC.

– Civil servants would be reluctant to take on the role of senior responsible owner of a project.

– Critics of a project would have ammunition which could discourage other departments and agencies from participating in the scheme.

– Cabinet collective responsibility could be undermined if Ministers were interviewed for a review.

– Criticisms in the reviews could be “in the newspapers within a very short time”, and the media could misrepresent the review’s findings. (The Tribunal discovered that those involved in the reviews were generally more concerned with their programme than possible adverse publicity.)

– Reports would take longer to write.

– The public would not understand the complexities in the reports.

Why Gateway reports should be published

The Tribunal found that OGC fears about publishing were speculative and that disclosure would contribute to a public debate about the merits of ID Cards, and provide some insight into the decision-making which underlay the scheme. Disclosure would ensure that a complex and sensitive scheme was “properly scrutinised and implemented”, said the Tribunal.

Was OGC evidence to Tribunal fixed?

The Tribunal was also suspicious that the OGC had submitted several witness statements that used identical wording. The Tribunal said the witnesses should have expressed views in their own words.

It found that disclosure could make Gateway reviewers more candid because they would know that their recommendations and findings would be subject to public scrutiny; and criticisms in the reports, if made public, could strengthen the assurance process.

Importantly, the Tribunal said the disclosure would help people judge whether the Gateway process itself works.

Comment

Hundreds of Gateway reports are carried out by former civil servants who can earn more than £1,000 a day for doing a review (although note Peter Smith’s comment below). As the reports are to remain secret how will the reviewers be held properly accountable for their assessments? No wonder officials don’t want the reports published.

Any idea how many projects we have and what they’ll cost? – Cabinet Office.

Whitehall cost cutting saves £5.5bn

Too many government PRs – not enough project experts?

By Tony Collins

MP Richard Bacon, a long-standing member of the Public Accounts Committee,  has asked the National Audit Office to find out how many major departments have more press officers than the Cabinet Office’s Major Projects Authority has staff to manage billions of pounds worth of government projects.

Bacon’s question will be answered in a forthcoming report of the Public Accounts Committee.

He wants to compare the paucity of staff at the Major Projects Authority, which has the important job of overseeing high risk government projects, with the generous numbers of press officers who have the less important job of publicising the work of central departments.

Set up in 2010, the Major Projects Authority has only 38 full-time people whereas several central departments have more than that number in press officers.

Whereas the Government Communications Centre GCHQ has only three press officers, the Department of Health has many more than 38.

There are 205 projects in the Government Major Project Portfolio, with a combined whole-life cost of £376bn, and annual cost of £14.6 bn. Thirty nine of those projects had a delivery confidence rating of ‘red’ or ‘amber/red’, according to an NAO report “Assurance for major projects” in May 2012.  The Major Projects Authority reports on 160 high risk projects.

The NAO says the Authority does not have sufficient resources to carry out its role in the central assurance system to best effect.

“The Authority is reporting on 160 more projects as part of the portfolio and carrying out more in-depth assurance work, but has 40 per cent less staff than the body it replaced.”

The NAO says limits on the number and skills of the staff available for project review teams has led to difficulties in the timely scheduling of reviews. And there is an overdependence on key individuals.

“There is a risk that if key staff departed, considerable skills and knowledge would be lost to the assurance system,” says the NAO.

Bacon told MPs at a hearing of the Public Accounts Committee, “Having watched so many car crashes over so many years, I want this [Major Projects] Authority – I have been a huge fan of it ever since its inception – to be able to carry out its role to best effect… There are county councils with a bigger press office than Mr Pitchford’s team.” David Pitchford is Executive Director, Major Projects Authority.

Bacon asked Amyas Morse, the head of the NAO, to find out which major departments of state  have press offices with more than 38 people in them. Morse’s reply is likely to be in a table in the PAC’s forthcoming report on the assurance of high risk projects.

Comment: 

Bacon’s question had little to do with the work of government PR officers. He is making the point that government is right to have set up the Major Projects Authority but, by providing the money for  only 38 people, it sends out the message that departmental press offices are more important than the independent oversight of 160 major high risk projects that have a whole-life cost of tens of billions of pounds.

Clearly the MPA needs more people. It needs to do continuous assurance on high risk projects, not just the occasional report; and it is a pity its reports are not published. The sad fact is that if it published them departments would not cooperate in the MPA’s reviews.

There is another, perhaps tangential point, raised by Bacon’s question: how important are departmental press officers?

This is probably a horrible generalisation but, with some notable exceptions (there are some excellent PR people on the informatics desk of the Department of Health and at the Cabinet Office) central government’s PR officers are useful to central departments for their ability to discourage the dissemination of bad news.

Some departments have non-PR staff who vet questions from journalists before they will allow a PR to answer. Do senior officials consider their press office to be more important than assurance on high risk projects and programmes?

Some lessons from a major outage

By Tony Collins

One of the main reasons for remote hosting is that you don’t have to worry about security and up-time is guaranteed. Support is 24x7x365. State-of-the-art data centres offer predictable, affordable, monthly charges.

In the UK more hospitals are opting for remote hosting of business-critical systems. Royal Berkshire NHS Foundation Trust and Homerton University Hospital NHS Foundation Trust are among those taking remote hosting from Cerner, their main systems supplier.

More trusts are expected to do the same, for good reasons: remote hosting from Cerner will give Royal Berkshire a single point of contact to deal with on technical problems without the risks and delay of ascertaining whether the cause is hardware, third party software or application related.

But what when the network goes down – across the country and possibly internationally?

With remote hosting of business-critical systems becoming more widespread it’s worth looking at some of the implications of a major outage.

A failure at CSC’s Maidstone data centre in 2006 was compounded by problems with its recovery data centre in Royal Tunbridge Wells. Knock-on effects extended to information services in the North and West Midlands. The outage affected 80 trusts that were moving to CSC’s implementation of Lorenzo under the NPfIT.

An investigation later found that CSC had been over-optimistic when it informed NHS Connecting for Health that the situation was under control. Chris Johnson, a professor of computing science at Glasgow University, has written an excellent case study on what happened and how the failure knocked out primary and secondary levels of protection. What occured was a sequence of events nobody had predicted.

Cerner outage

Last week Cerner had a major outage across the US. Its international customers might also have been affected.

InformationWeek Healthcare reported that Cerner’s remote hosting service went down for about six hours on Monday, 23 July. It hit “hospital and physician practice clients all over the country”. Information Week said the unusual outage “reportedly took down the vendor’s entire network” and raised “new questions about the reliability of cloud-based hosting services”.

A Cerner spokesperson Kelli Christman told Information Week,

“Cerner’s remote-hosted clients experienced unscheduled downtime this week. Our clients all have downtime procedures in place to ensure patient safety. The issue has been resolved and clients are back up and running. A human error caused the outage. As a result, we are reviewing our training protocol and documented work instructions for any improvements that can be made.”

Christman did not respond to a question about how many Cerner clients were affected. HIStalk, a popular health IT blog, reported that hospital staff resorted to paper but it is unclear whether they would have had access to the most recent information on patients.

One Tweet by @UhVeeNesh said “Thank you Cerner for being down all day. Just how I like to start my week…with the computer system crashing for all of NorCal.”

Another by @wsnewcomb said “We have not charted any pts [patients] today. Not acceptable from a health care leader.”

Cerner Corp tweeted “Our apologies for the inconvenience today. The downtime should be resolved at this point.”

One HIStalk reader praised Cerner communications. Another didn’t:

“Communication was an issue during the downtime as Cerner’s support sites was down as well. Cerner unable to give an ETA on when systems would be back up. Some sites were given word of possible times, but other sites were left in the dark with no direction. Some sites only knew they were back up when staff started logging back into systems.

“Issue appears to have something to do with DNS entries being deleted across RHO network and possible Active Directory corruption. Outage was across all North America clients as well as some international clients.”

Colleen Becket, chairman and co-CEO of Vurbia Technologies, a cloud computing consultancy, told InformationWeek Healthcare that NCH Healthcare System, which includes two Tampa hospitals, had no access to its Cerner system for six hours. The outage affected the facilities and NCH’s ambulatory-care sites.

Lessons?

A HIStalk reader said Cerner has two electronic back-up options for remote hosted clients. Read-only access would have required the user to be able to log into Cerner’s systems, which wouldn’t have been possible with the DNS servers out of action last week.

Another downtime service downloads patient information to local computers, perhaps at least one on each floor, at regularly scheduled intervals, updated say every five minutes. “That way, even if all connection with [Cerner’s data centre] is lost, staff have information (including meds, labs and more) locally on each floor which is accurate up to the time of the last update”.

Finally, says the HIStalk commentator, “since this outage was due to a DNS problem, anyone logged into the system at the time it went down was able to stay logged in. This allowed many floors to continue to access the production system even while most of the terminals couldn’t connect.”

But could the NHS afford a remote hosted service, and a host of on-site back-up systems?

Common factors in health IT implementation failures

In its discussion on the Cerner outage, HIStalk put its finger on the common causes of hospital IT implementation failures. It says the main problems are usually:

– a lack of customer technical and implementation resources;
– poorly developed, self-deceiving project budgets that don’t support enough headcount, training, and hardware to get the job done right;
– letting IT run the project without getting users properly involved
– unreasonable and inflexible timelines as everybody wants to see something light quickly up after spending millions; and
– expecting that just implementing new software means clearing away all the bad decisions (and indecisions) of the past and forcing a fresh corporate agenda on users and physicians, with the suppplier being the convenient whipping boy for any complaints about ambitious and sometimes oppressive changes that the culture just can’t support.

Cerner hosting outage raises concerns

HIStalk on Cerner outage

Case study on CSC data centre crash in 2006

Will health IT market “heat up” when NPfIT contracts expire?

By Tony Collins

At a second-quarter earnings call, Marc Naughton, Chief Financial Officer at US-based health software supplier Cerner, singled out the UK as one country where there will be probably be “a lot of demand” for new health IT products and services subject to capital being available.

He said,

“As more and more of those trusts are becoming foundation trusts, which means they control their capital outlet – outlay as opposed to the government putting the dollars out there – we think that’s going to turn into a more normalised US-type market where each trust is going to go out to the market and look to acquire technology.

“In 2015, the current NHS [NPfIT] contracts expire. So almost all of those trusts are going to be looking in the market in some form or fashion, probably depending on their access to capital.

“So we think that market is one that could heat up in 12 to 18 months from now, assuming that they can get access to capital. But it is going to be a little bit lumpy.”

 

Trust buys extras-laden system for 20% of BT’s price

By Tony Collins

An NHS Trust has paid £1.8m for the “Rio” patient record system and a host of extras – which raises fresh questions about why the Department of Health paid BT £9m for each Rio deployment under the NPfIT.

BT’s deal with the Department of Health under the NPfIT costs taxpayers £224.3m for 25 deployments of Rio – about £9m for each one. The deal included support for five years, until October 2015.

But a deal struck directly between Cambridgeshire and Peterborough NHS Foundation Trust and Rio’s supplier CSE-Healthcare Systems includes support for a year longer – six years in total. At £1.806m the cost of Cambridgeshire and Peterborough’s deal is about 20% BT’s price.

Cambridgeshire and Peterborough has secured more extras. CSE-Healthcare Systems will supply Cambridgeshire and Peterborough with:

  – Medical software development services

– Software consultancy services

 – Computer support services

– System implementation planning services

– Software implementation services

– Project management consultancy services

– Business and management consultancy services

– Medical software package

– Database and operating software package

– Information systems and servers

– Computer and related services

– Software support services

It’s not clear though whether the deal includes disaster recovery – which the Department of Health argues is one reason for the price paid to BT for Rio.

Comment:

Disaster recovery does not explain how or why the Department of Health agreed to pay BT five times more for Rio than paid by Cambridgeshire and Peterborough.

What is not in doubt is that if BT, like Accenture and Fujitsu before it, had left the NPfIT, the programme would have been indelibly stamped a disaster – at a time when the Department of Health and ministers were proclaiming it an unacknowledged success (in the run up to a general election).

Was BT paid a hugely costly premium to stay in the NPfIT?  If so, should tax money have been used to secure the affections of a supplier whose profits were otherwise being squeezed on the contract?

Last year the Department of Health gave the Public Accounts Committee an explanation of its Rio payments to BT, some of which is below. The explanation is long, vague and defensive enough to sound like the excuses of a young boy who, when questioned by his teacher, gives various accounts of why he took a classmate’s sweets.

What the DH told MPs

This is what the DH told the Public Accounts Committee last year, after one of its MPs Richard Bacon queried the payments to BT for Rio (and Cerner).

“Assessing the value for money of the RiO prices was part of the CCN3 [change control note 3] negotiation process … The CCN3 negotiation process was lengthy and involved many iterations challenging the component parts of the BT cost model. This included ensuring that rates offered were competitive and that the effort ascribed to various activities was justifiable.

Taken together, competitive rates and reasonable effort comprise value for money. BT was required to provide numerous iterations of financial models. These models were reviewed in detail by the Authority, resulting in multi-million pound savings.

The Authority negotiated reduced day rates on all of the BT labour within the contract. In addition, BT’s profit margin on the contract was also significantly reduced. Other commitments were also obtained by the Authority, in particular around sub-contractor pricing; for example, Cerner has confirmed that the pricing provided to the Authority (via BT) is the best it provides to any of its customers.

The Authority then requested further financial assurances and agreed with BT that a requirement of signing CCN3 would be that a verification exercise would be conducted by third party, independent financial experts (KPMG)…

In October 2010 KPMG were requested by the Authority to verify the costs presented by BT, including those for RiO, in the CCN3 Financial Model.

The approach adopted by KPMG was as follows:

—  Their work focussed on the Cost Data sheet within the CCN3 Financial Model and was conducted on a sample basis, designed to provide a high coverage of costs with a reasonable sample size.

—  The cost elements for potential duplicate entries were reviewed.

—  The cost rates associated with BT labour were validated to cost rate cards and payroll records.

—  The hours presented in the Model associated with BT labour were reviewed for reasonableness.

—  Sub-contractor and other supplier costs were validated to the agreements entered into by BT with their suppliers.

—  Cost elements and supporting documentation requested from BT were sampled to substantiate the costs provided…

On 3 November 2010 KPMG concluded that “BT has provided underpinning evidence to support the agreed delivery costs” and that “no proposed adjustments are required for Agreed Delivery Costs”.

None of the trusts consulted had purchased the same RiO product offering and all trusts varied significantly from the offering provided to NPFIT trusts, making a direct price comparison difficult. However, trusts within the programme typically had significant advantages to those outside the programme, namely:

—  The ability to influence the functionality of the product.

—  Centrally provided and hosted hardware.

—  Centrally-provided disaster recovery with 100% capacity and availability.

—  No additional development costs for subsequent releases.

—  Spine connectivity.

BT estimate that the monthly charge for hardware, disaster recovery, service management and Spine connectivity to be in the region of £42,500 per month or just over £2 million of value over a 48 month contract term.

Furthermore the NPFIT investment in the development of the RiO has significantly enhanced the functionality of the product to the benefit of all trusts. Examples of functionality in the latest deployed version (v5) and soon to be deployed (R1, 2011) of RiO include:

—  Standard assessment forms.

—  Care-plans and reports.

—  Spine connectivity, enabling integration with central demographics services, and functionality to support smart cards and role based access controls.

—  Waiting lists.

—  Results reporting.

—  Prevention, screening and surveillance.

—  SNOMED.

—  Inpatient prescribing.

—  Functionality to support multi-disciplinary care planning.

DH statement to MPs on Rio (and Cerner) prices paid to BT

MP seeks inquiry into £546m NHS deal with BT.

Breakdown of £546m NPfIT payment to BT