Tag Archives: NHS

Investors’ writ against CSC on NHS contracts – more detail

By Tony Collins

The Guardian has published the 123-page writ against CSC by lawyers acting behalf of some of the supplier’s investors. The writ contains many allegations against CSC and named directors. The company’s response is that it is corporate policy not to discuss litigation.

The legal action appears to have been based, in part, on CSC’s poor share price, which is today near a five-year low, and the supplier’s repeated positive statements and assurances on the performance of its NHS IT contracts and its iSoft Lorenzo software

These are some of the claims made in the document:

– Lorenzo was originally designed by iSoft as a one-size-fits-all software for use in local medical practices. “However, the UK healthcare system is highly diverse, ranging from large university hospitals to small private medical practices to prison medical facilities. Thus, according to the Deputy Head of Testing for Lorenzo, Lorenzo was never the correct software for the job. Lorenzo therefore required significant development before it could be deployed throughout the UK’s healthcare system.”

– In September 2008, after years of delays in Lorenzo’s development [CSC] sent a Delivery Assurance Review Team to England to assess the development and testing of Lorenzo. In mid-September, the Testing Review Team met with the Deputy Head of Testing for Lorenzo, a CSC employee from December 2007 until April 2011. The Deputy Head of Testing told the Testing Review Team that the level of testing and test results for Lorenzo was “abysmal,” and that the various releases on which the project was based could not be delivered on time. Subsequently [a CSC employee] told the Deputy Head of Testing to “shut up,” which he took to mean that he should not further criticise the quality of the testing nor the testing results.

– The Deputy Head of Testing claimed that the Lorenzo software was rife with severe defects that were unacceptable under the NHS Contract. The Deputy Head of Testing said that the software defects were subject to the following ratings: Severity Level I: the defect cause important part of the Lorenzo system to fail. Severity Level II: similar to Severity I, but the defect has a workaround. Severity Level III: the defect is an important defect, but one that would not stop the system from functioning. Severity Level IV: defect is a minor defect and would not impact the Lorenzo system’s function, but would be a nuisance to a software user.

– According to the Deputy Head of Testing, throughout 2008 and 2009, the level of Severity I and II defects in every release of Lorenzo was “high and grossly beyond” what the NHS would accept. According to the Deputy Head of Testing, while CSC publicly reported that it had met certain delivery milestones and therefore could recognize revenue, CSC’s statements in this respect were misleading in view of the software defects detailed above.

– CSC said in November 12, 2008, when analysts asked about missed deadlines, that “Our confidence continues to build on the program. We are pleased with our progress.”

–  In financial statements CSC continued to assert that the NHS contract was profitable and the Company expected to recover its investment.

– Shortly before the Deputy Head of Testing retired from CSC in early April 2011, he sent an email directly to a CSC director, copying several other CSC executives, in which he said ‘You hope that you will succeed by August 2011. I do too but you won’t. The project is on a death-march where almost as many defects are being introduced as are being fixed.”

–  by 2006 CSC had determined that it had no believable plan for delivering on the NHS Contract and should not have booked revenue under the contract from that point forward.

– The significance of the NHS Contract to CSC “placed the project squarely in the spotlight of Wall Street analysts”.

–  CSC “continuously denied media reports critical of CSC’s performance of the contract”

CSC is expected to file its response to the allegations in due course.

CSC sued on losses over disastrous NHS contracts – Observer

CSC class action – document in full on Guardian’s website

CSC repays £170m to DH after non-signing of MoU

By Tony Collins

CSC reports today that it has repaid to the Department of Health £170m of a £200m advance it received earlier this year for NHS IT work that was due to be carried out under a memorandum of understanding.

The MoU was not signed as had been expected by 30 September 2011, so CSC has repaid the money.

But the Department of Health has entered into an “extended advance payment agreement” with CSC for £24m.

In a statement dated 3 October 2011 CSC has also disclosed that uncertainty continues over the future of its NPfIT contracts that are worth about £3bn.

It says that it is having a series of meetings with the NHS and Cabinet Office officials over the “next several weeks” and adds that: “there can be no assurance that the MOU [memorandum of understanding] will be approved nor, if it is approved, what final terms will be negotiated and included in the MOU”.

The statement relates to CSC’s negotiations with the Department of Health and the Cabinet Office’s Major Projects Authority over a draft memorandum of understanding that proposes cutting the cost to taxpayers of CSC’s contracts by about £800m but would cut back planned deployments of Lorenzo by nearly two thirds and could nearly double the cost of each remaining deployment. One Cabinet Office official has described the terms of the memorandum of understanding as unacceptable.

CSC says today that “progress is continuing in development and deployment projects under the contract in cooperation with the NHS, although progress has been constrained due to the uncertainty created by the government approval process”.

It adds:

“Humber NHS Foundation Trust has been confirmed as the early adopter for mental health functionality to replace Pennine Care Mental Health Trust, which withdrew as an early adopter in April 2011, and CSC and the NHS are preparing to formally document this replacement under the contract.

“On April 1, 2011, pursuant to the company’s Local Service Provider contract, the NHS made an advance payment to the company of £200m related to the forecasted charges expected by the company during fiscal year 2012.

“The amount of this advance payment contemplated the scope and deployment schedule expected under the MOU and the parties had anticipated that the MOU would be completed and contract amendment negotiations would be underway by September 30, 2011.

“… the advance payment agreement provided the NHS the option to require repayment of the advance payment if the parties were not progressing satisfactorily toward completion of the expected contract amendment by September 30, 2011.

“Because completion of the MOU has been subject to delays in government approvals and, as a result, contract amendment negotiations have not progressed, the NHS required the company to repay approximately £170m of the April 1, 2011 advance payment on September 30, 2011, and the company agreed and made the repayment as requested.

“Also on September 30, 2011, the NHS and the company entered into an extended advance payment agreement providing for an advance payment of approximately £24m to the company in respect of certain forecasted charges for the company’s fiscal year 2012.

“The extended advance payment agreement acknowledges that the company’s Local Service Provider contract, as varied by the parties in 2010, is subject to ongoing discussions between the parties with the intention of entering into a memorandum of understanding setting out the commercial principles for a further set of updated agreements.

“The company intends to discuss the extended advance payment structure and certain fiscal year 2012 deployment charges with the NHS in connection with the MOU negotiations.

“However, there can be no assurance that the parties will enter into the MOU or that the company’s forecasted charges under the contract for the remainder of fiscal year 2012 will not be materially adversely affected as a result of the delay in completing the MOU and the related contract amendment.”

Meanwhile some investors of CSC have taken legal action against the company.

.

Investors sue CSC

By Tony Collins

The Observer reported yesterday that some CSC investors are suing the company, saying it was giving assurances about the “Lorenzo” software when it had been warned that the software project was on a “death march”.

According to the class action complaint, which was brought on behalf of a number of investors led by a major Canadian fund, the Ontario Teachers’ Pension Plan, CSC knew in May 2008, through reports and testing, that Lorenzo was “dysfunctional and undeliverable”.

The complaint cites one member of an internal CSC “delivery assurance review team” which visited the UK and India, where Lorenzo was developed, in early 2008.

He said the team were consistent in the message that CSC could not meet its deadline. “We could not deliver the solution set that we had contracted with the NHS.”

The review team member added that, at the time, “costs were building up on the balance sheet and the project was behind schedule”. The review team knew that the contract was a loser and CSC should have recognised a loss in 2008, according to The Observer, quoting the team member.

Lorenzo’s deputy head of testing told a second delivery review team that test results were “abysmal”. According to court filings, the test official was later told by his boss to “shut up”, which he took to mean he should no longer criticise testing.

Shortly before retiring in April this year, the deputy head of testing emailed CSC chief executive Michael Laphen saying: “The project is on a death march where almost as many defects are being introduced as are being fixed. Look at the defects reports.” Despite these internal concerns, CSC told investors that Lorenzo and CSC’s work for the NHS was on track.

Investors said they dismissed negative media reports on the basis of reassurances from CSC that the NHS work was on track, making significant progres in testing, and receiving positive feedback from the NHS. In response to press coverage, CSC is said to have told investors: “The press speculated wildly and inaccurately on the status of the NHS programme.”

CSC has made no statement.

Lorenzo is the main NPfIT product to be delivered and deployed to NHS trusts by CSC under contracts worth about £3bn. The Cabinet Office and the Department of Health are negotiating with CSC to continue or drop Whitehall’s commitments to CSC Lorenzo deployments.

CSC’s share price today stood at $26.85,  close to a five-year low.

Class action document – Guardian website

Simon Bowers’ article in The Observer

 

 

CSC NPfIT deal is a crucial test of coalition strength

By Tony Collins

Comment:

The Cabinet Office’s Major Projects Authority has intervened in NHS Connecting for Health’s running of the NPfIT.

In particular the Authority has taken a role in the negotiations between CSC and the Department over the future of about £3bn worth of local service provider contracts.

Had the Authority not intervened a memorandum of understanding between CSC and the DH is likely to have been signed several months ago. Fortunately for taxpayers a deal wasn’t signed.

According to a leaked Cabinet office memo the deal would have been poor value for money. It would have cut £700m or more from the cost of CSC’s contracts but doubled the cost to taxpayers of the remaining deployments.

The Cabinet Office memo said the “offer [from CSC] is unattractive”. It added:

“This is because the unit price of deployment per Trust under offer roughly doubles the cost of each deployment from the original contract”.

It could be said that signing such a deal with CSC would be as naive as a shopkeeper asking a Cadbury wholesaler to change his order from 100 chocolate bars to 30, and thus agreeing to paying Cadbury double the price for each bar.

Now it transpires that the official within the Cabinet Office who wrote the memo expressing concern about CSC’s offer is leaving. This could imply that an “unattractive” deal between the Department of Health over Lorenzo will go through after all.

Indeed the Cabinet Office has published its assessment of the NPfIT – the “Major Projects Authority Programme Assessment Review of the National Programme for IT” – which includes a section on CSC that suggests a new deal with the supplier may be signed, even though critics say the NPfIT contract with CSC should be “parked” with no further action taken on it.

The DH has accused CSC of breach of contract and vice versa. A legal dispute can be avoided by parking the contract with the agreement of both sides. If the DH signs a new deal with CSC it will be a sign that the intervention of the Cabinet Office has come to little or nothing.  It will also be a sign of coalition weakness. If the coalition cannot have an effect on a deal the DH has long wanted to sign with CSC when can it effect in terms of central government reform?

This is the worrying  section in the report – dated June 2010 – of the Major Projects Authority:

“… if the decision is taken to allow the Lorenzo development and deployments to continue there needs to be a considerable strengthening of the renegotiated position first to give CSC the opportunity to step up to its failings and for a clear statement of obligations on all parties and a viable and deliverable plan to be created and adhered to.

“There is no certainty that CSC would deliver fully in the remaining time of the contract, but the terms of the renegotiation could enable them to have a completed Lorenzo product which can compete in the market which replaces Local Service Providers…”

Other parts of the Major Projects Authority report are highly critical of Lorenzo. It says that in the North, Midlands and East of England there have been “major delays in the development of …Lorenzo”. As a result of the delays “interim and legacy systems have been used to maintain operational capability”.

The report also says the “productisation of Lorenzo is not mature” and adds: “This is evidenced by the fact that bespoke code changes are still being used in response to requirements from the early adopter trusts. This issue will be exacerbated if the remaining product development (of the modules referred to as Deployment Units) is not completed before future implementation roll-outs commence.”

The report says there is a need to be “certain about the capacity and capability of CSC to furnish sufficient skilled resources to undertake the level of roll-out needed to satisfy the existing schedule”.

It continues: “During the review it was mentioned that on occasion, people needed to leave the Morecambe Bay activity to go to the Birmingham installation at short notice to resolve problems. At this stage of the programme, CSC skills, schedule and utilisation rate, including leveraged resources, should be available to support a proposed roll-out schedule…”

There is still a “significant degree of uncertainty both about the planning of [Lorenzo] implementations and also the capability of the solution. The four key trusts chosen to implement the Lorenzo solution are in very different situations. University Hospitals Morecombe Bay is close to sign-off whilst Pennines Trust has stated its desire to leave the programme. Birmingham Women’s Hospital Trust is being held back by one issue which views have suggested are about a difference of opinion with the Supplier believing that they have met the Deployment Verification Criteria whilst the Trust is not happy about the level of functionality delivered. Connecting for Health expect to resolve this difference of opinion soon.”

And the MPA report says the latest implementation of Lorenzo 1.9 is “a long way short of the full functionality of the contracted solution which has four stages of functionality and is intended to be rolled currently out to 221 trusts”.

Lorenzo was originally due to have been delivered by the end of 2005.  If, after all the MPA’s criticisms, a new Lorenzo deal is signed what will this say about the ability of the Cabinet Office to influence decisions of civil servants?

In 2006 an internal, confidential report of CSC and Accenture on the state of Lorenzo and its future was positive in parts but listed a multitude of concerns. The summary included these words: “…there is no well-defined scope and therefore no believable plan for releases beyond Lorenzo GP…”

The current outdated NPfIT deal with CSC should be set aside , and no further action taken on it by both sides. CSC will continue to have a strong presence in NHS IT, at least because many trusts that have installed iSoft software will need upgrades.

But if a new NPfIT deal is signed with CSC it will greatly undermine the credibility of the Cabinet Office’s attempts to effect major change on the machinery of departmental administration; and it could help consign the so-called reforms of central government to the dustbin marked  “aspirations”. It will certainly give ammunition to the coalition’s critics. The Government has said it is dismantling the NPfIT. It didn’t say it was prolonging it.

NPfIT to be “dismantled” – brick by brick

By Tony Collins

A Department of Health press release issued this morning is headlined:

                        Dismantling the NHS National Programme for IT

I asked a senior official at the Department what is new in the announcement. The official’s diplomatic reply was simply: “I am not sure how to answer that.”

There is nothing new. There is no evidence in the press release of the Department’s claim that the NPfIT is being dismantled. Negotiations continue with CSC over its £3bn worth of NPfIT contracts and BT’s deals will remain in place.

Spending on the NPfIT has been about £6.4bn so far – and about £4bn has yet to be spent. The Government has succeeded in persuading some in the general public that the NPfIT is dead. The Daily Mail’s front page has the headline:

                                £12bn NHS Computer System is Scrapped

The online version of the story has had more than 460 comments, which suggests it has been widely read.

The actual announcement gives a hint of the conflicting views among civil service and ministers. The first paragraph of the Department of Health’s press release says the NPfIT is being dismantled and the second paragraph praises the scheme.

“The government today announced an acceleration of the dismantling of the National Programme for IT, following the conclusions of a new review by the Cabinet Office’s Major Projects Authority (MPA). The programme was created in 2002 under the last government and the MPA has concluded that it is not fit to provide the modern IT services that the NHS needs. In May 2011 the Prime Minister announced in the House of Commons that the MPA would be reviewing the NHS National Programme for IT. 

 “The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service.  Their delivery accounts for around two thirds of the £6.4bn money spent so far and they will continue to provide vital support to the NHS. However, the review reported the National Programme for IT has not and cannot deliver to its original intent.”

The signs are that the scheme will be dismantled brick by brick – and will be almost completely dismantled by the time the NPfIT contracts with BT and CSC expire in 2013 and 2014.  The coalition has achieved a PR coup with the Daily Mail story because the public has the impression that in these austere times a £12bn NHS IT scheme initiated by Labour has been scrapped.

The reality is that nothing has changed.

Department of Health announcement

End of NPfIT? – Campaign4Change on BBC R4 Today programme

By Tony Collins

Link to Campaign4Change audio on BBC R4 Today programme

BBC Radio 4’s Today programme this morning reported a Daily Mail article that the National Programme for IT in the NHS is being scrapped and that a coalition announcement is to be made this morning.

The Mail says that the money spent on the NPfIT would pay for 60,000 nurses for a decade, and that the scheme will be replaced by a “cheaper alternative”.

It says that there will be a new urgency in “dismantling the scheme”. Campaign4Change told the BBC R4 Today programme this morning that the NPfIT is not being scrapped and that about £4bn has yet to be spent on it. It said that trusts have the freedom to buy their own IT systems but using their budgets. The NPfIT will continue to provide Cerner and Lorenzo systems that are subsidised centrally, which gives the NHS an incentive to continue using NPfIT.

There is a difference of opinion within Whitehall over the NPfIT: that the Cabinet Office takes a rigorously independent view of the NPfIT and wants to wind it down. The Department of Health’s civil servants at a press conference last year justified the spend on the programme and said the contracts with CSC and BT would continue.  Campaign4Change told Today that the Cabinet Office should have the final say, not the Department of Health.

The Government clearly wishes it to be known that the NPfIT is being scrapped but that is not what is happening in practice. Contracts with CSC, which at present are worth about £3.2bn, are unlikely to be scrapped because of the compensation that would have to be paid to the supplier. The contracts may be cut back  by about £800m, though the cost of deployments remaining may double. BT’s contracts worth more than £1bn are also likely to remain.

The Daily Mail says the NPfIT will be “replaced with cheaper regional alternatives” and that the Coalition will “today announce it is putting a halt to years of scandalous waste of taxpayers’ money on a system that never worked”.

“Following an official review, the ‘one size fits all’ IT project will be replaced by much cheaper regional initiatives, with hospitals and GPs choosing the IT system they need.

“And a new national watchdog will be established to ensure such huge sums can never again be thrown away on uncosted projects.”

The decision to accelerate the dismantling of the scheme has been made by Health Secretary Andrew Lansley and Francis Maude, the Minister for the Cabinet Office, says the Mail.

It quotes from what appears to be a leaked memo from the Major Projects Authority of the Cabinet Office which has been reviewing CSC’s contracts.

“The authority said the IT scheme, set up in 2002, is not fit to provide services to the NHS – which as part of austerity measures has to make savings of £20billion by 2014/15.

It concluded: ‘There can be no confidence that the programme has delivered or can be delivered as originally conceived.’

The report is said to recommend that the Government  “dismember the programme and reconstitute it under new management and organisation arrangements”.

It added: “The project has not delivered in line with the original intent as targets on dates, functionality, usage and levels of benefit have been delayed and reduced.

“It is not possible to identify a documented business case for the whole of the programme.Unless the work is refocused it is hard to see how the perception can ever be shifted from the faults of the past and allowed to progress effectively to support the delivery of effective healthcare.”

Daily Mail article on the NPfIT today

Department of Health announcement

Cabinet Office tells mutuals future is bright despite Central Surrey Health struggles over NHS deal

By David Bicknell

The Cabinet Office has encouraged would-be mutual and social enterprises to see the government’s plans to open up public services as a positive move that yields new opportunities despite a flagship mutual reportedly losing out on a major contract to a commercial organisation for NHS services.

The Financial Times reported yesterday that Assura Medical has been named as preferred bidder for a five- year contract worth about £90m a year for community health services in Surrey, beating a bid by Central Surrey Health, the flagship social enterprise that runs services in the neighbouring area.

A Cabinet Office spokesman was quoted as saying: “This is not the end for Central Surrey Health; they continue to provide critical services for the people of Surrey. Across the public sector we have started to see the emergence of a new wave of mutuals.

“The government has ambitious plans to support front-line staff who want to form mutual organisations and take control of the services they provide. We are working to ensure that all organisations bid for contracts on a level playing field. We are currently conducting a listening exercise on the Open Public Services white paper, it’s vital that mutual organisations contribute to the discussion.”

The government wants to see the fledgling mutual and social enterprise sector grow to encourage a million staff to leave the public sector and sell services back to local government and the NHS.

In a press release issued by Social Enterprise UK, Peter Holbrook, the organisation’s chief executive encouraged the government to create a financial level playing field and give mutual and social enterprises the chance to gain a foothold in the commercial world:

“If Central Surrey Health, the government’s flagship mutual social enterprise, which has demonstrated considerable success in transforming health services and increasing productivity can’t win, what does this say for the future of the mutuals agenda?

“Central Surrey Health reinvests all the profits it makes locally. It is difficult to imagine how Assura, with shareholders expecting a financial return, could do more to benefit people in Surrey.

“It is not enough for government to open up markets; it needs to create fair markets that benefit society. Some of the financial criteria used in contracts create an unequal playing field in which social enterprises are unable to compete because they may not have the same financial backing as private sector providers.  Unless swift action is taken to address this we will see social enterprises and mutuals lose out to the private sector.

“Public sector workers will be understandably anxious about spinning out from the NHS and setting up a social enterprise on the back of this news. The government needs to take action to reassure them that they will not be operating in markets weighted against them.

It has been argued by unions that mutualisation hides a privatisation agenda with mutuals at risk of losing out to commercial operators as contracts come up for renewal. Central Surrey’s own contract is reported to be up for renewal next year.

Central Surrey Health was the UK’s first social enterprise to leave the NHS and set up as an employee-owned business four years ago. Central Surrey Health is contracted to deliver community nursing and therapy services on behalf of the NHS and other organisations (e.g. Surrey County Council) to the 280,000 population of central Surrey. It is owned by the nurses and therapists it employs, who each own a 1p, not-for-dividend share.

It has been selected by the Cabinet Office to help mentor employee-owned organisations coming out of the public sector. Twelve fledgling public service spin-offs have been chosen by the Cabinet Office to be ‘Pathfinders’ for the rest of the public sector. As mentors, Central Surrey Health will work with and support staff on Pathfinder projects to help them develop sustainable, efficient and pioneering employee-led services. Last November it was also named as the Prime Minister’s first Big Society Award winner.

Hammersmith& Fulham Pathfinder to launch in 2012

Why this SME’s innovative ideas may help Nick Clegg understand the real causes of the riots

Could a new approach detect the early warning signs of radicalism in a way that ordinary research, surveys and intelligence gathering couldn’t? Or spot when programmes to reduce re-offending aren’t working?

In this guest blog, Andrew Moore, chief operating officer at DAV Management, whose customers include large public and private sector organisations, explains why government research into complex situations, such as the causes of the recent riots or making offender management more effective, requires a different approach that goes beyond supporting preconceived hypotheses to give new insights and fresh perspectives, and crucially, offers a means of detecting the early signals of situations that are developing in communities which can either be encouraged for the wider good or damped down before they can pose a threat.

Improving the Citizen Experience

An innovative approach to surveys and research

There is a currently a great deal of interest within government circles to determine how best to engage with its various stakeholders in different, more effective (and understandably less expensive) ways.

There’s the Big Society, the attempt to establish ‘happiness’ as a measure of the nation’s wellbeing (rather than just good old GDP), the need to engage citizens in a more direct and effective manner, with services designed around them rather than the structure of government.  In addition there are specific events that trigger the Government’s need to interact with sections of the population, such as the recent announcement by Nick Clegg that he wants to engage with communities affected by the summer riots in England, in order to understand who did what and why.  Then there are the government’s internal stakeholders – its employees, with whom it is seeking an altogether more symbiotic relationship – devolving power to the people on the front line who frequently know how to run services in a more effective and efficient manner.

Mutualisation’ and ‘Third Sector’ are terms that I suspect everyone is likely to become more familiar with over the next few years, even if now they may require some defining.  The long running debate about the future of the NHS is a very good case in point. And there’s the stated desire to get SMEs delivering innovation as part of effective government procurement.  As an interesting adjunct to this, let’s not forget that employees are also citizens, creating a fascinating cross-over of interlinked perspectives.

Of course there are other groups who may be thought of as stakeholders and these will have a very specific perspective on the delivery of public services.  I’m thinking here of offenders – those serving their debt to society and for whom the government is seeking ways to improve rehabilitation, reduce re-offending and become much more effective at identifying those most susceptible to radicalisation, extremism or self-harm. This of course has been brought into sharper focus by discussions over the severity of post-riot sentencing.

All in all, this represents a hefty agenda of public services reform and one which will test the government’s strategic planning and policy implementation ability to the max.  With such degrees of change being considered, it is encouraging to hear that government is embarking upon a listening exercise to garner the views of citizens, employees and service users, as some recipients of public services are now known.  Understanding what people want in order to deliver services they will use is a laudable objective, but what a task this must represent.  How on earth do you make this achievable?  Consider for a moment the potential population sample.  What constituency would you choose?  How do you get people to participate with sensible and meaningful responses?

Even if you can get all this feedback, how do you make sense of it?  How would you store, manage and interpret the sheer volume of data, relating to so many different aspects of life and stakeholder groups?  How could you be sure it doesn’t end up as an exercise designed to prove (or disprove) preconceived positions?  How would you spot the things that you don’t recognise – the identification of a strong belief system (that could make or break any changes in the way public services are delivered); the early signs of a rise in community ‘temperature’ that could lead to the kind of civil disorder witnessed in cities across England during August this year; or the indicators that some offenders are significantly more willing (and likely) to rehabilitate under certain conditions?  I could go on but I don’t want to labour the point.

It’s clear that in an exercise that will fundamentally change how most people interact with both central and local government, it makes sense to give those people a voice.  But this has to be in a controlled and manageable way, so that it is quick and easy to understand what that voice is telling you; gaining truly unique insights and fresh perspectives from which actionable decisions can be made and monitored that make a real difference to people’s lives, be they citizens, employees or service users – or, in some circumstances, perhaps a combination of all three!

Making people part of the process in this way is also an effective way of getting buy-in.  People are more likely to feel engaged, even if it’s by proxy (i.e. evidence of meaningful consultation establishes a degree of credibility) and by its very nature, changes the basis of the relationship between government and those stakeholders with whom it is seeking to engage.

*********************

So what’s the point in all this, why are these things being suggested as anything new?  After all, the idea of planning, shaping and delivering services against a well-defined need is surely common sense and is recognised as such by most people.  Well, as they say, the problem with common sense is that it’s not that common.  The truth is that the kind of knowledge and insight that is likely to be required by government in order to shape and deliver its vision for public services, is difficult (if not impossible) to gain from traditional methods and technology. A different approach is required.

What if you were able to poll large samples of the population on a variety of different topics and have the findings presented to you quickly and simply, in a way that wasn’t mediated by ‘experts’ and allowed you to interact directly with the data – at both a quantitative and qualitative level?  What if you were able to see things that you hadn’t expected; things that blew away commonly held perceptions about citizens or employees – giving you a clear and substantiated view of how people are feeling, what they really think of particular programmes and initiatives and how they are responding to specific policies and interventions?  Imagine being able to detect early opportunities to take action on a particular initiative that enabled you to maximise the benefits downstream or damp down a threat before it was even recognised as such.

It all sounds too good to be true, but advances in cognitive based solutions, using micro-narratives (snippets, stories, reports and other qualitative data) captured from samples of your target ‘audience’ and self-indexed by them to provide meaning from which incisive action can be taken, are turning these scenarios into reality.

The problem for strategists and policy and decision makers is that the environment in which they are operating is hugely complex; there are many small causes that interact and interweave to produce an end result, but no one cause is dominant.  The whole environment is continually adapting and changing and you can’t measure it at a point in time – it’s constantly evolving.  This is what’s known as a ‘complex adaptive system’.  It’s the kind of environment where outcomes are difficult to predict.  It’s highly sensitive to small changes, meaning emerges through interaction and, with the benefit of hindsight, you might be able to see where, when and why things have happened and how you could have dealt with a particular situation, but at the time it was erratic and novel.  Sadly, hindsight does not lead to foresight and processes to prevent a similar situation occurring next time will fail, because the next time things will happen differently.  The August riots in England were a perfect example of this scenario, where multiple small, erratic events interacted and evolved to produce a disproportionate, unpredictable and, in this case, catastrophic outcome, which the government is still trying to understand the cause of.

Complex situations frequently occur when you are dealing with people because they are inherently unpredictable and often driven by emotion.  The bad news for government is that, one way or another, people are at the heart of all of the major change initiatives and civil events that are currently under the policy spotlight.  You begin to get a sense for the scale of the challenge.  Not an overnight thing this.  [By the way, if you’re having difficulty getting to grips with the concept of a complex adaptive system think of mayonnaise.  If you’ve ever tried to make this from scratch you’ll know how uncertain it feels as the ingredients combine and the mayo gradually emerges.  One slip and it will curdle, the end result is never the same and it can’t be reverse engineered].

Fortunately, when trying to get to grips with a complex situation, a cognitive approach again comes to our rescue.  It enables us to probe the situation, sense what’s happening where and why and then respond accordingly.  It’s liberating for policy makers as it opens the door for innovation, enabling organisations to try things and see what works best in particular situations.  Fast feedback loops promote a low-risk, ‘safe-to-fail’ environment where those ideas that aren’t working are quickly identified and turned off, enabling us to get behind those that are delivering tangible results.  In this way, new services and new ways of working can evolve, meaning that the end result has a much higher chance of widespread adoption and, hence, long-term success.

The really good news for government is that game changing solutions of this type are really in the sweet spot when it comes to getting ‘more for less’, as today’s economy demands.  The levels of investment required are a fraction of the amounts that have typically been associated with major government change initiatives.  They are also much simpler to implement and run.  Once set up, data capture, analysis and reporting can be built into an organisation’s day to day operational processes, supporting (and stimulating) how it interacts with the citizens or service users it serves, or the employees it depends upon for the delivery of those services.  For example, making it part of how Offender Managers (previously known as Probation Officers) interact with offenders to try and reduce re-offending would be an excellent way to capture how the latter group is responding, say, to changing institutional attitudes and behaviours, revealing to what extent infantilisation (i.e. treating offenders in a condescending manner, as if still children) is being reduced.

*******************

A recent case in Canada illustrates how the solution can be implemented to improve the delivery of healthcare services.  In this instance, the authorities in British Columbia initiated a programme to help them understand the perspectives of all parties implicated in the unfortunate death of an elderly patient.  This had resulted from a breakdown in communication and subsequent decision making following the patient’s admittance to hospital suffering from congestive heart failure. Not unusually in these circumstances the single, sentinel event of the patient’s death was seen from very different perspectives by the various groups involved.  By adopting a cognitive based approach the authority was able to bring together front line and management staff to make sense of these conflicting perspectives and, as a result of the unique ‘safe-to-fail’ experimentation techniques supported by the approach, it was able to trial and subsequently implement changes in both policy and service delivery that will not only help to prevent similar incidents occurring in the future but also raised the quality of healthcare provided to patients more generally.

Just think how powerful such an approach would be for Nick Clegg in his quest to understand the complex human behaviours and emotions that came together to fuel the aforementioned riots in England.  And to have this at your disposal not only as a platform from which to take decisive action now but also to generate alerts when the ‘community temperature’ again begins to rise, must surely present a huge opportunity that any civil authority worth its salt would want to take advantage of. Instead it would appear that research initiatives are being launched by those with an interest in understanding and curing society’s ills that, albeit well-meaning and based on credible empirical evidence, may still ultimately turn out to be incomplete.  My concern would be that if a traditional research approach is adopted to try and make sense of what is essentially a complex situation (as I have defined above) then such initiatives risk revealing only those things that are readily recognisable and, having been mediated by ‘experts’, support preconceived hypotheses.  They are likely to  miss the opportunity to discern unexpected findings arising directly from the contribution of the people affected by (and involved in) the riots and fail to detect the early signals of situations that are developing in those communities, which can either be encouraged for the wider good or damped down before they can cause further unrest.  Addressing these issues by adopting a cognitive based approach will provide a much more effective feed into future policy decisions and social interventions.

If you’re new to the concept of cognitive based solutions it can be a bit of a challenge to get to grips with how they work and just what they give you, but once you’ve experienced the power of the knowledge and understanding that they deliver, you start to see applications everywhere you look.  The big advantage is that it’s easy to get started with low-cost, low-risk pilots that can start to make a difference to any organisation in a very short space of time.

To learn more, visit http://davmanagement.com/default.asp?id=833&ver=1

Contact Andrew Moore at andrew.moore@davmanagement.com

Or call +44 (0)1189 974 0100

An NHS success story – what’s to learn from it?

By Tony Collins

IM&T at Trafford General Hospital makes visits to hospital safer for patients and gives managers the information they need to monitor the work of clinicians. Even doctors like the advanced technological environment and come up with ideas for improvements. So what lessons can be learnt? Here are four:

–           Be in control of your IT suppliers. Too often in the public sector it’s the other way around

–           Don’t buy from suppliers that seem excessively secretive and talk much about their proprietary information – which may include your data. Know their systems well enough to produce the reports you want, when you want them and in the format you want, rather than wait for your information to be given to you when the suppliers want to give it, and in their format.

–           Don’t impose change. Have the push come from the business users [in Trafford’s case clinicians] who understand what technology can do for them.

–           Keep IT in the background – not centre stage.

Advanced health technology on a £1.5m yearly budget

By Tony Collins

[This is the final part of a 3-part series on how Trafford Healthcare NHS Trust’s IM&T team achieves much on a small budget]

Trafford General Hospital bought its main systems outside of the £11.4bn the National Programme for IT [NPfIT]. The hospital, though, is one of the most technologically-advanced in the UK.

Part one of our series on Trafford Healthcare NHS Trust covered the clinical support for IM&T, integrated systems, and the openness that’s required of the trust’s suppliers.

Part two covered the trust’s  control of its data, how NPfIT could ever have worked, how patients benefit from the IM&T,  why doctors keep their smartcards on them at all times, links between hospital and GP systems, the real-time view of free beds, why duplicated patient records are rare, board support for  integrated electronic patient record systems, and some of the remaining challenges.

Some of  Trafford’s further challenges include:

–           Securing the agreement of all GPs in the area to share a synopsis of their records. About half have agreed so far.

–           Scanning in all paper notes to the EPR. At present about 50% of patient notes have been scanned and are available to clinical staff as “PDF” files, normally with chapter headings. They include diagrams, charts and handwritten text.

–           Dealing with any uncertainties that arise when the Trust is acquired – in all probability by Central Manchester Foundation Trust .

–           Maximising the IM&T opportunities that the acquisition will bring both Trusts in terms of modernising systems and extending the concept of the shared electronic patient record across a wide area of Manchester.

Costs

Trafford has 14 people working on IM&T and IT infrastructure related matters who handle support, infrastructure and integration. The total yearly cost, including salaries, is about £1.5m in capital and revenue which covers the spend with all of Trafford’s  IM&T suppliers.

This compares with costs of between £23m and £31m for each NPfIT installation at acute trusts in London and the South – and these sums do not include the costs of running a hospital’s IM&T and associated infrastructure. Neither do the NPfIT costs include the salaries for an acute hospital’s IT and IM&T staff.

Steve Parsons, Head of IM&T, says of his hospital’s technology: “This is bargain stuff”.

If Trafford can do so much for so little, can centrally-bought NPfIT systems costing many times more – for less – still be justified? The Department of Health argues that NPfIT systems offer more than non-NPfIT. But how much more could Trafford offer its clinical staff, in terms of proven technologies and integration?

Asked where he’d put Trafford in a league table of UK hospitals with systems that clinicians need and want to use, Peter Large, Director of Planning, pauses and says with a slight smile: “Let’s be modest – in the top 10%.”

He’s probably not joking.

**

•           Since writing this article Parsons and his team have been short-listed by the eHealth Insider Awards for the trust’s electronic whiteboard project, in the category of “innovation in healthcare interoperability”.

Part one: How does this IM&T team achieve so much for so little money?

Part two: How does this IM&T team achieve so much for so little money? (2)