Cerner questions hospital bid process

Posted on 04/07/2012 | 2 comments

by Tony Collins

NHS software supplier Cerner has written to Cambridge University Hospitals Foundation Trust questioning a process to procure an electronic patient record system.

The Trust chose Epic and HP as preferred supplier for a common platform for the Cambridge trust and Papworth Hospital Foundation Trust.

Now Cerner, which bid for the contract, is asking for the process to be be re-run, says the Health Service Journal. The Trust told the Health Service Journal its procurement was open and fair.

The Health Service Journal said it had seen Cerner’s letter. It quoted the letter as saying that the Trust’s favouring of Epic was in clear breach of the ‘equal treatment’ principle.

The letter said that Cerner found it difficult not to conclude that the Trust had made a pre-determined decision to award the tender to Epic some time before it designed the procurement process. This gave other vendors no realistic possibility of winning, said the letter.

The trust said it was continuing to proceed with the procurement process for “eHospital”.

Cerner supplies the NHS with the Millennium software, either directly or through BT under the NPfIT.

2 Comments

Posted in Campaign4Change, health, health records, NHS, npfit

Tagged

Medical dictionary should help prevent medication mistakes

Posted on 03/07/2012 | Leave a comment

By Tony Collins

The Department of Health says that a medicines dictionary, which is approved today, will make medical errors less likely by ensuring all staff who work in the NHS and healthcare use the same terminology when referring to medicines.

The Information Standards Board for Health and Social Care has approved the NHS dictionary of medicines and devices – called “dm+d” –  as a standard which, says the Department of Health,  “must be used by all staff”.

The DH says that “all doctors, nurses and pharmacists should move towards using the common medicines dictionary so that information exchanged electronically is accurate and safe”.

Using a single drug terminology will “enable information about patients’ medicines to transfer more effectively between different healthcare settings, reducing the risk of medication mistakes caused by human error”.

The NHS dictionary of medicines and devices is already used in the UK for the exchange of clinical information, including the Electronic Prescription Service and for patients’ Summary Care Records.

Dr Charles Gutteridge, National Clinical Director for Informatics at the Department of Health and Medical Director, Barts and the London NHS Trust said

“The adoption of dm+d is an important milestone. It will mean clearer and consistent communication throughout the NHS ensuring health professionals in all care settings …. I encourage all clinicians to accelerate their use of this common medical dictionary for the benefit of the patients we care for.”

Heidi Wright, from the Royal Pharmaceutical Society (RPS) said “The Royal Pharmaceutical Society supports the need for a single terminology to facilitate interoperability and to enable such initiatives as the Electronic prescription Service (EPS). We believe that the opportunities created for using dm+d are substantial in terms of interoperability, opportunities for comparison and reducing variation, enhancing patient safety i.e. reducing risks associated with system interfaces and providing links to clinical systems such as the British National Formulary .”

The dictionary contains unique identifiers and associated textual descriptions for medicines and medical devices.  It was developed and delivered through a partnership between the Department of Health Informatics Directorate  and the NHS Business Services Authority.

The DH Information Strategy says that  reducing the number of inconsistent or incompatible terminologies will allow better integration between systems and across health and social care, and better information to support care and improvement of care.

Leave a comment

Posted in change, change management, data sharing, Government IT, health, health records, NHS

Chief Procurement Officer quits for private sector

Posted on 03/07/2012 | 1 comment

Tony Collins

John Collington has resigned as Government Chief Procurement Officer after little more than a year in the post.

Collington’s resignation is reported by Peter Smith of Spend Matters. Smith says that Collington is to become Chief Operating Officer of Alexander Mann Solutions, a leading “Recruitment Process Outsourcing” firm.

“We might have expected consultancy, or software, but Collington has been involved in shared services in recent months and has a track record in outsourcing from his time at Accenture and I believe even before that.

“He’s got strong operational skills which should play to the COO role …” says Smith.

“Francis Maude gave Collington a glowing testimonial, as we might expect…But then Cabinet Office have to spoil it by talking nonsense …”

The Cabinet Office said Collington has reduced overall spend on goods and services from £51bn to £45bn and spend with SMEs is estimated to have doubled to £6bn, along with a 73 per cent reduction in spend on consultancy and contingent labour.

“We accept he has helped to reduce spend but, given he has no budget of his own, it’s a bit much to say he ‘has reduced overall spend’…” says Smith.

“And as Cabinet Office themselves know very well, they have no clue whether spend with SMEs has doubled, given the robustness (or lack of) around the data …”

It appears that Collington was a believer in incremental reform. He was not a Chris Chant who spoke of the need for radical reform. Chant argued with force  that high costs, present ways of working and the dominance of a few major suppliers were unacceptable.

Collington reported to Ian Watmore who was Permanent Secretary at the Cabinet Office. Watmore has also resigned.

**

Nigel Smith, formerly head of the Office of Government Commerce [now subsumed into the Cabinet Office], was one the harshest critics of the way government bought goods and services.

Smith said in June 2010 that up to £220bn – nearly a third of everything government spent – was on procurement. But there were 44,000 buying organisations in the public sector which bought “roughly the same things, or similar things, in basic commodity categories” such as IT and office supplies. There were 42 professional buying organisations in public sector.

He said there was “massive duplication” of activity. We wonder how much has changed since then.

Spend Matters

Collington appointed Chief Procurement Officer

1 Comment

Posted in capacity building, procurement, reducing cost strategically

Tagged , , , ,

Timetable for HMRC’s work on Universal Credit is “challenging” says NAO

Posted on 28/06/2012 | 1 comment

By Tony Collins

Today’s report of the National Audit Office on the accounts of HMRC is, perhaps diplomatically, silent on the performance of HMRC’s work so far on Universal Credit, other than to say the timetable for roll-out beginning in October next year is “challenging”.

There have been internal assessments of HMRC’s “Real Time Information” [RTI] project, on which the success of Universal Credit is dependent, but none has been published other than the “Starting Gate”.

Today’s NAO report on HMRC says the “timetable for implementation of RTI is challenging”. It adds:

“The Department for Work and Pension’s timetable to implement Universal Credit is driving the timetable to roll-out RTI. The Department for Work and Pensions requires real time PAYE information on employment and pension income to award and adjust Universal Credit.

“It is rolling out Universal Credit from October 2013 to 2017. All employers and pension providers need to be using RTI by October 2013 to meet this timetable.

“The Department met its milestone to start its RTI pilot in April 2012 with ten employers. By July 2012, it expects a further 310 employers will be using RTI. At 31 May 2012, 209 PAYE schemes covering 1.5 million individual records were using RTI.”

NAO report on HMRC’s 2011/12 accounts

HMRC still plagued by IT problems.

Time for truth on Universal Credit

1 Comment

Posted in Campaign4Change, change management, excessive secrecy, Government IT, HMRC, IT projects, outsourcing, Real-Time Information

Tagged ,

HMRC “still plagued by IT problems”

Posted on 28/06/2012 | Leave a comment

By Tony Collins

HMRC has one of the biggest IT outsourcing contracts in central government, a deal worth about £8bn with Capgemini, which began in 2004. Before that, between 1994 and 2004, the main IT supplier was EDS, now HP. But HMRC has had pervasive IT-related challenges for more than a decade.

Today Margaret Hodge, Chair of the Committee of Public Accounts, commented   on a report by the National Audit Office on HM Revenue & Customs’ 2011-12 accounts.

“Sadly it is no surprise that the NAO has found substantial problems with the HMRC’s accounts. This year has seen a litany of tax errors and scandals come to light with mistakes made at the most senior level from the Permanent Secretary for Tax downwards.

“The sheer scale of waste and mismanagement at HMRC never ceases to shock me. Without even mentioning the tax gap, in 2011-12 the Department wrote off a staggering £5.2 billion of tax owed, overpaid nearly £2.5 billion in tax credits due to fraud and error and underpaid around £290 million.

“In some areas the Department is moving in the right direction and has made progress to implement improvement plans. But the Department is still plagued by IT problems; limiting, for example, its ability to link together the debts owed by tax payers across different tax streams.

“With its long history of large scale IT failures, the Department needs to get a grip before it introduces its new real time PAYE information systems and begins the high-risk move from tax credits to the Universal Credit.”

Timetable for HMRC’s work on Universal Credit is “challenging” says NAO.

NAO – HMRC’s 2011/12 accounts

Time for truth on Universal Credit.

Leave a comment

Posted in Government IT, HMRC, IT projects, outsourcing, supplier relationships

Tagged ,

Poor IT suppliers to face ban from contracts?

Posted on 28/06/2012 | Leave a comment

By Tony Collins

The Cabinet Office minister Francis Maude is due to meet representatives of suppliers today, including  Accenture BT,Capgemini, Capita, HP, IBM, Interserve, Logica, Serco, and Steria.

They will be warned that suppliers with poor performance may find it more difficult to secure new work with the Government. The Cabinet Office says that formal information on a supplier’s performance will be available and will be taken into consideration at the start of and during the procurement process (pre-contract).

Maude will tell them that the Government is strengthening its supplier management by monitoring suppliers’ performance for the Crown as a whole.

“I want Whitehall procurement to become as sharp as the best businesses”, says Maude. “Today I will tell companies that we won’t tolerate poor performance and that to work with us you will have to offer the best value for money.”

The suppliers at today’s meeting represent around £15bn worth of central government contract spend.

The representatives will also be:

– asked their reactions on the government’s approach to business over the past two years

– briefed on the expanded Cabinet Office team of negotiators (Crown Representatives) from the private and public sectors. Maude says these negotiators aim to maximise the Government’s bulk buying power to obtain strategic discounts for taxpayers and end the days of lengthy and inflexible contracts.

Spending controls made permanent

Maude is announcing today that cross-Whitehall spending controls will be a permanent way of life. The Government introduced in 2010 temporary controls on spending in areas such as ICT  and consultancy. It claims £3.75bn of cash savings in 2010/11, and efficiency savings for 2011/12, which it says are being audited.

The Cabinet Office says: “By creating an overall picture of where the money is going, the controls allow government to act strategically in a way it never could before. For example, strict controls on ICT expenditure do not just reduce costs but also reveal the software, hardware and services that departments are buying and whether there is a competitive mix of suppliers and software standards across government.”

Maude said: “Our cross-Whitehall controls on spending have made billions of cash savings for the taxpayer – something that has never been done before. That’s why I’m pleased to confirm that our controls will be a permanent feature, helping to change fundamentally the way government operates.”

Leave a comment

Posted in cost reduction, efficiency savings, Government IT, IT-related failures, operational issues, outsourcing, oversight, Politics, private sector lessons for the public sector, procurement, project management, public sector, software quality, supplier relationships

Tagged , ,

Why is MoD spending more on IT when its data is poor?

Posted on 28/06/2012 | Leave a comment

By Tony Collins

The Ministry of Defence and the three services have spent many hundreds of millions of pounds on logistics IT systems over the past 20 years, and new IT projects are planned.

But the National Audit Office, in a report published today – Managing the defence investory –  found that logistics data is so unreliable and limited that it has hampered its investigations into stock levels.

“During the course of our study,” says the NAO, “the Department provided data for our analyses from a number of its inventory systems. However, problems in obtaining reliable information have limited the scope of our analysis…”

The NAO does not ask the question of why the MoD is spending money on more IT while data is unreliable and there are gaps in the information collected.

But the NAO does question whether new IT will solve the MoD’s information problems.

“The Department has acknowledged the information and information systems gaps and committed significant funds to system improvements. However these will not address the risk of failure across all of the inventory systems nor resolve the information shortfall.”

MPs on the Public Accounts Committee, who will question defence staff on the NAO report, may wish to ask why the MoD’s is so apparently anxious to hand money to IT suppliers when data is poor and new technology will not plug information gaps.

Comment:

MPs on the Public Accounts Committee found in 2003 (Progress in reducing stocks) that the MoD was buying and storing stock it did not need. Indeed after two major fires at the MoD’s warehouses at Donnington in 1983 and 1988 more than half of the destroyed stock did not need replacing. Not much has changed judging by the NAO’s latest report.

It’s clear that the MoD lacks good management information. Says the NAO in today’s report:

“The summary management and financial information on inventory that is provided to senior staff within Defence Equipment and Support is not sufficient for them to challenge and hold to account the project teams…”

But will throwing money at IT suppliers make much difference? The MoD plans the:

–  Future Logistics Information Services project, which is intended to bring together and replace a number of legacy inventory management systems; and

–  Management of the Joint Deployed Inventory system which will provide the armed services with a common system for the inventory they hold and manage.

But is the  MoD using IT spending as proof of its conviction to improve the quality of data and the management of its inventory?

Managing the defence inventory

Leave a comment

Posted in cost reduction, Defence, Government IT, IT projects, IT-related failures, oversight, private sector lessons for the public sector, project management, public sector, public services, software quality, supplier relationships

Tagged ,

We operated on the wrong organ – but hey, it’s OK.

Posted on 27/06/2012 | Leave a comment

By Tony Collins

When a surgeon operates on the wrong organ the NHS calls it “wrong site surgery” (a euphemism which makes it sound like an official part of a medical student’s curriculum).

A surgical intervention on the wrong organ could never be a source of reassuring news unless it’s in the board papers of an NHS trust.  NHS board papers are, more often than not, the source of good news announcements, statistics and graphs. Bad news is between the lines.

This was North Bristol NHS Trust’s account of what it said was a “surgical intervention [that] was performed on the wrong organ in a patient”. The operation was complex due to distortion of the patient’s anatomy. “This incident has resulted in some long term harm for the patient although the patient has since fully recovered.” The trust reports more reassuring news:

–  the patient has been fully informed

–   and given an apology

–    a full investigation has been carried out and lessons learnt

–   the consultant surgeon was experienced, and was assisted by another specialist

–   the World Health Organisation Surgical Safety Checklist was used correctly and as such, could not have prevented this error.

–  the case was discussed at directorate clinical governance meetings and disseminated widely to raise awareness of distorted anatomy with clinical staff.

–  the Clinical Risk Committee, Commissioners and the National Patient Safety Agency are assured that human error is an acceptable reason for this incident and that all procedures were carried out correctly.

Comment:

It sounds reassuring that all procedures had been carried out correctly, and that the World Health Organisation Surgical Safety Checklist was used correctly. But if a sleeping driver injures someone, should his colleagues be assured that he’d just put the car through an MoT and was driving under the speed limit?

Trust board papers need to connect with everyday reality. I’d venture to suggest they are not the place for announcements on managerial successes.

The same trust reported the separate case of an  “Unintended retention of a foreign object post surgical intervention”. The retained object was a small microvascular clamp and this was removed during a subsequent operation,

“which resulted in a satisfactory outcome for the patient”.  Good news then.

We wonder how the trust will report the findings from its investigation of recent IT troubles.

Leave a comment

Posted in Campaign4Change, improving communications, NHS, public services

Tagged

RBS/Natwest: Some lessons from the IT crash – Bank of England Governor.

Posted on 26/06/2012 | 1 comment

By Tony Collins

Sir Mervyn King, Governor Bank of England, promised today that there would be a “very detailed inquiry” once problems at RBS/Natwest are back to normal.

Such a report would be unusual because the cause or causes of IT-related crashes in the public and private sectors are usually kept secret unless in rare cases a legal action comes to court.

Mervyn King told the Treasury Committee today:

“Once the current difficulties are over then we will need the FSA to go in and carry out a very detailed investigation to find out first of all what went wrong but even more importantly why it took so long to recover.

“Computer systems will always go wrong from time to time. The important things are your back-up systems and the time it takes to implement recovery. As of now we have kept in very close touch. My office was in touch with senior RBS management right through the weekend. Our banking director was in touch with RBA and FSA on this right since this problem began … It is still going to take time to catch up, to get back to normal.

“The important thing now is that we provide whatever support is needed to let them put it right. Once it is back to normal then we must carry out a very detailed inquiry.

“To my mind, one of the big lessons from this is that it shows everyone is how important the basic functions of banking actually are: what can go wrong when the system of payments from person to another is interrupted. Fortunately it has been one bank, albeit a very big bank, and customers of that bank have been affected, and of course customers of other banks have been affected, and payments have not gone through.

“I hope this is a reminder, a demonstration, to everyone, for example, of what might have happened if we had not rescued RBS in the autumn of 2008. The whole payment system would have collapsed. [It is] why it is so important to ensure you have a banking system where the people running it are completely focused on this essential service function of banking to provide … customers with a functioning payment system.

Learning from supermarkets.

“I have been driven by the belief that the nature of banking and providing these kinds of services is very different from investment banking operations. Those are important but they are very different. When you go out and see how supermarkets operate, the senior management is utterly focused on ensuring that the IT systems, the ordering systems, the delivery system, works hour by hour. That is very important to ensure that that is true of the banking system as well…”

Comment:

History  is, to some extent, the story of the unforeseen, in which case a published report on the cause of the problems at RBS/Natwest could be helpful to other banks and major organisations whose ageing systems are vulnerable to an unforeseen failure of huge proportions.

A published report on the crisis may show systemic management failures. The mere fear of such a report would be an added deterrent – additional to potential losses and payments of compensation – to any bank that does not give the attention it should to operational systems, even when those systems support a retail banking operation that may represent a small part, perhaps only 2% of a bank’s balance sheet.

It is ironic that RBS is publicly owned. Will the IT disaster now be added to the list of other public sector failures? Did RBS, now in the public sector, drop its IT-related standards and caution in part because the commercial imperative was absent?

Natwest/RBS – what went wrong?

1 Comment

Posted in Government IT, IBM, IT projects, IT-related failures, managing outsourced services, operational issues, software quality, supplier relationships

Natwest/RBS – what went wrong?

Posted on 25/06/2012 | 4 comments

By Tony Collins

Outsourcing to India and losing IBM mainframe skills in the process? The failure of CA-7 batch scheduling software which had a knock-on effect on multiple feeder systems?

As RBS continues to try and clear the backlog from last week’s crash during a software upgrade, many in the IT industry are asking how it could have happened.

Stephen Hester, RBS’s boss, told the BBC today:

“In simple terms there was a software change which didn’t go right. Although that was put right quickly there then was a big backlog of things that had to be reprocessed in sequence. That got on top of our technical teams … it is like the landing path at Heathrow. Once you get out of sequence it takes a time to get back into sequence even if the original fault is put right.

“Our people are working incredibly hard … I am pleased to report that as of today RBS and Natwest systems are operating normally.

“We need to make sure they stay normal for the next few days. There is still some significant catch-up today, much less tomorrow and so on as we go through the week.”

The immediate technical cause of the problems might not have been too difficult for those inside the bank to establish – but finding out how and why it happened, why processes were not in place to stop a backlog of work building up, and why testing of the upgrade did not pre-empt the failure may take weeks and possibly months to establish.

Attributing blame could take many years. After BSkyB appointed EDS to supply a CRM system in 2000, and the project failed, it was ten years later before a court reached a judgment on blame. The cause of the failed project was never definitively established.

Official cause of system crash

The official cause of RBS/Natwest’s problems was given at the weekend by Susan Allen, Director of Customer Services, RBS Group which includes Natwest and Ulster Bank. She told Paul Lewis of BBC’s Moneybox programme:

“Earlier this week we had a problem in our overnight backup. So a piece of software failed that started all the updates that happened to our systems overnight.

“What that has meant practically is that information on customers’ accounts has not been updated… It is horrendous.

“The underlying problem has been fixed, so the computer software that failed has been replaced. That is in and working. The challenge we now have is bringing all the systems back up and working through all the data that should have been gone through over the last three nights …

“We have 12 million customers in Natwest and RBS and just over 100,000 in Ulster Bank. So it is affecting a serious number of people. It is having a terrible impact.

“We are encouraging all of our customers to call us, come and see us in our branches … we have branches open late .. and have doubled the number of people on the phone. Call centres are open 24 hours a day.”

Call centres use 0845 numbers which are chargeable for some. Lewis asked, Why are you making people pay to fix a problem that’s your fault?

“Customers should not be having to pay for those calls,”replied Allen. “If that is a problem for people we will take a look at that.”

Lewis: Will you re-imburse people for their calls?

“Absolutely. We recognise there will be lots of different expenses as a result of this. We apologise and want to make sure they are not out of pocket. If people have got claims they should put them through to us…we will need the information to deal with the claims.”

Lewis: Will you refund charges by credit card companies for late payments?

“We will. We will… we will make sure nobody is out of pocket… in one instance we got cash in a cab to a customer’s home… clearly we trust our customers so if we can see that somebody has a certain amount coming in every week we will give them money against that. So we ask people to come in and bring identification with them such as their bank card, we will do what we can to help.

“We will look after our customers. We realise this has had a huge impact on people. We are not underestimating it … clearly there are things that have gone wrong and we cannot put everything right.”

Lewis: How much damage has this done to the reputation of the bank?

“Time will tell. For us it is pretty devastating. We pride ourselves on being a bank that really cares about our customers and wants to deliver great service. We absolutely mean it.”

Lewis: Should you get a bonus?

“We only get performance bonuses when we perform and this has not been a good performance.”

Comment:

Her explanation of the cause of the IT crash is unclear but otherwise Susan Allen’s answers to Paul Lewis’s questions were exemplary. Her openness and unaffected humility is surely the best way to handle a PR crisis. Small comfort for the millions affected though.

Technical cause of the crash?

Some of those commenting to The Register appear to have a good knowledge of RBS systems. There are suggestions RBS has lost some important IBM mainframe software skills in outsourcing.

One or two have suggested that the crash was caused by a failure of the bank’s CA-7 batch scheduling software. In February RBS had an “urgent requirement” in Hyderabad, India, for people with four to seven years experience of CA7.

One comment on The Register said that RBS runs updates on customer accounts overnight on an IBM mainframe, via a number of feeder systems that include BACS. “The actual definitive customer account updates were carried out by a number of programs written in assembly language dating back to about 1969-70, and updated since then. These were also choc-full of obscure business rules … and I do not believe anyone there really knew how it all worked anymore, even back in 2001…

“Of course the moral is complex mainframe systems require staff with the skills, and in this case, the specific system knowledge to keep things smooth. The fewer of these you have, the more difficult it is to recover from problems like this.”

Robert Peston, the BBC’s Business Editor, asks whether outsourcing was to blame.

“In my conversations with RBS bankers, there is an implication that outsourcing contributed to the problems – though they won’t say whether this is an issue of basic competence or of the complexities of co-ordinating a rescue when a variety of parties are involved.”

An RBS spokesperson told The Register that the software error occurred on a UK-based piece of software.

Some lessons from the crisis – Bank of England Governor.

4 Comments

Posted in Campaign4Change, India, IT and the Business, IT projects, IT-related failures, M&A, managing outsourced services, operational issues, outsourcing, supplier relationships

Tagged