Tag Archives: npfit

How to cost-justify the NPfIT disaster – forecast benefits a decade away

Posted on 07/06/2013 | 2 comments

By Tony Collins

To Jeremy Hunt, the Health Secretary, the NPfIT was a failure. In an interview with the FT, reported on 2 June 2013, Hunt said of the NPfIT

“It was a huge disaster . . . It was a project that was so huge in its conception but it got more and more specified and over-specified and in the end became impossible to deliver … But we musn’t let that blind us to the opportunities of technology and I think one of my jobs as health secretary is to say, look, we must learn from that and move on but we must not be scared of technology as a result.”

Now Hunt has a different approach.  “I’m not signing any big contracts from behind [my] desk; I am encouraging hospitals and clinical commissioning groups and GP practices to make their own investments in technology at the grassroots level.”

Hunt’s indictment of the NPfIT has never been accepted by some senior officials at the DH, particularly the outgoing chief executive of the NHS Sir David Nicholson. Indeed the DH is now making strenuous attempts to cost justify the NPfIT, in part by forecasting benefits for aspects of the programme to 2024.

The DH has not published its statement which attempts to cost justify the NPfIT. But the National Audit Office yesterday published its analysis of the unpublished DH statement. The NAO’s analysis “Review of the final benefits statement for programmes previously managed under the National Programme for IT in the NHS” is written for the Public Accounts Committee which meets next week to question officials on the NPfIT. 

A 22 year programme?

When Tony Blair gave the NPfIT a provisional go-ahead at a meeting in Downing Street in 2002, the programme was due to last less than three years. It was due to finish by the time of the general election of 2005. Now the NPfIT  turns out to be a programme lasting up to 22 years.

Yesterday’s NAO report says the end-of-life of the North, Midlands and East of England part of the NPfIT is 2024. Says the NAO

“There is, however, very considerable uncertainty around whether the forecast benefits will be realised, not least because the end-of-life dates for the various systems extend many years into the future, to 2024 in the case of the North, Midlands and East Programme for IT.”

The DH puts the benefits of the NPfIT at £3.7bn to March 2012 – against costs of £7.3bn to March 2012.

Never mind: the DH has estimated the forecast benefits to the end-of-life of the systems at £10.7bn. This is against forecast costs of £9.8bn to the end-of-life of the systems.

The forecast end-of-life dates are between 2016 and 2024. The estimated costs of the NPfIT do not include any settlement with Fujitsu over its £700m claim against NHS Connecting for Health. The forecast costs (and potential benefits) also exclude the patient administration system Lorenzo because of uncertainties over the CSC contract.

The NAO’s auditors raise their eyebrows at forecasting of benefits so far into the future. Says the NAO report

“It is clear there is very considerable uncertainty around the benefits figures reported in the benefits statement. This arises largely because most of the benefits relate to future periods and have not yet been realised. Overall £7bn (65 per cent) of the total estimated benefits are forecast to arise after March 2012, and the proportion varies considerably across the individual programmes depending on their maturity.

“For three programmes, nearly all (98 per cent) of the total estimated benefits were still to be realised at March 2012, and for a fourth programme 86 per cent of benefits remained to be realised.

There are considerable potential risks to the realisation of future benefits, for example systems may not be deployed as planned, meaning that benefits may be realised later than expected or may not be realised at all…”

NPfIT is not dead

The report also reveals that the DH considers the NPfIT to be far from dead. Says the NAO

“From April 2013, the Department [of Health] appointed a full-time senior responsible owner accountable for the delivery of the [the NPfIT] local service provider contracts for care records systems in London, the South and the North, Midlands and East, and for planning and managing the major change programme that will result from these contracts ending.

“The senior responsible owner is supported by a local service provider programme director in the Health and Social Care Information Centre.

“In addition, from April 2013, chief executives of NHS trusts and NHS foundation trusts became responsible for the realisation and reporting of benefits on the ground. They will also be responsible for developing local business cases for the procurement of replacement systems ready for when the local service provider contracts end.”

The NAO has allowed the DH to include as a benefit of the NPfIT parts of the programme that were not included in the original programme such as PACS x-ray systems.

Officials have also assumed as a benefit quicker diagnosis from the Summary Care Record and text reminders using NHSmail which the DH says reduces the number of people who did not attend their appointment by between 30 and 50 per cent.

Comment

One of the most remarkable things about the NPfIT is the way benefits have always been – and still are – referred to in the future tense. Since the NPfIT was announced in 2002, numerous ministerial statements, DH press releases and conference announcements have all referred to what will happen with the NPfIT.

Back in June 2002, the document that launched the NPfIT, Delivering 21st Century IT for the NHS, said:

“We will quickly develop the infrastructure …”

“In 2002/03 we will seek to accelerate the pace of development …

“Phase 1 – April 2003 to December 2005 …Full National Health Record Service implemented, and accessible nationally for out of hours reference.”

In terms of the language used little has changed. Yesterday’s NAO report is evidence that the DH is still saying that the bulk of the benefits will come in future.

Next week (12 June) NHS chief Sir David Nicholson is due to appear before the Public Accounts Committee to answer questions on the NPfIT. One thing is not in doubt: he will not concede that the programme has been a failure.

Neither will he concede that a fraction of the £7.3bn spent on the programme up to March 2012 would have been needed to join up existing health records for the untold benefit of patients, especially those with complex and long-term conditions.

Isn’t it time MPs called the DH to account for living in cloud cuckoo land? Perhaps those at the DH who are still predicting the benefits of the NPfIT into the distant future should be named.

They might just as well have predicted, with no less credibility, that in 2022 the bulk of the NPfIT’s benefits would be delivered by the Flower Fairies.

It is a nonsense that the DH is permitted to waste time on this latest cost justification of the NPfIT. Indeed it is a continued waste of money for chief executives of NHS trusts and NHS foundation trusts to have been made responsible, as of April 2013, for reporting the benefits of the NPfIT.

Jeremy Hunt sums up the NPfIT when he says it has been a huge disaster. It is the UK’s biggest-ever IT disaster. Why does officialdom not accept this?

Instead of wasting more money on delving into the haystack for benefits of the NPfIT, it would be more sensible to allocate money and people to spreading the word within Whitehall and to the wider public sector on the losses of the NPfIT and the lessons that must be learnt to discourage any future administrations from embarking on a multi-billion pound folly.

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Posted in Atos, BT, BT Health, Campaign4Change, change, change management, CSC, e-health, excessive secrecy, Fujitsu, health records, IT projects, IT-related failures, legal disputes, Major Projects Authority, managing change, managing outsourced services, NHS, npfit, public sector, public services, Summary Care Record

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Is Major Projects annual report truly ground-breaking?

Posted on 29/05/2013 | 3 comments

By Tony Collins

Francis Maude, the Cabinet Office minister, describes as “nothing short of groundbreaking” a report of the Major Projects Authority which gives the RAG (Rred/Amber/Green) status of more than 100 major projects.

That the report came out late on Friday afternoon as most journalists were preparing to go home, some of them for the whole bank holiday weekend, suggests that the document was a negotiated compromise: it would be published but in such a way as to get minimal publicity.

Indeed the report is a series of compromises. It has the RAG status of projects but not the original text that puts the status into context.

Another compromise: senior civil servants in departments have persuaded Maude to publish the RAG decisions when they are at least six months old.

This enables departmental officials to argue their case in the “narrative” section of the MPA annual report that a red or amber/red decision is out-of-date and that there has been significant improvement since. This is exactly the DWP’s justification for the amber/red status on Universal Credit.

The DWP says in the MPA report: “This rating [amber/red] dates back to September 2012, more than seven months ago. Since then, significant progress has been made in the delivery of Universal Credit. The Pathfinder was successfully launched and we are on course both to expand the Pathfinder in July 2013 and start the progressive national roll-out of Universal Credit in October.”

That the Pathfinder was launched successfully might have nothing to do with Universal Credit’s amber/red status which could be because of uncertainties over how the IT will perform at scale, given the complexities and interdependencies.  The MPA report says nothing about the uncertainties and risks of Universal Credit.

More compromises in the MPA annual report: the Cabinet Office appears to have allowed departments to hide their cost increases on projects such as HMRC’s Real-time Information [RTI] in the vague phrase “Total budgeted whole life costs (including non-government costs).”

The Cabinet Office has also allowed departments to write their own story to accompany the RAG status. So when HMRC writes its story on RTI it says that “costs have increased” but not by how much or why. We know from evidence that HMRC gave to the Public Accounts Committee that RTI costs have risen by “tens of millions of pounds”. There is nothing to indicate this in the MPA annual report.

Another compromise in the MPA annual report: there are no figures to compare the original forecast costs of a project with the projected costs now. There are only the 2012/13 figures compared with whole-life projected costs (including non-government projected spend).

And the MPA report is not comprehensive. It came out on the same day the BBC announced that it was scrapping its Digital Media Initiative which cost the public £98m. The MPA report does not mention the BBC.

The report is more helpful on the G-Cloud initiative, showing how cheap it is – about £500,000. But there is little information on the NHS National Programme for IT [NPfIT] or the Summary Care Record scheme. 

Yet the MPA annual report is ground-breaking. Since Peter Gershon, the then head of the Office of Government Commerce, introduced Gateway reviews of risky IT projects about 12 years ago with RAG decisions, they have remained unpublished, with few exceptions. The Cabinet Office is now publishing the RAG status of major departmental projects for the first time. Maude says

“A tradition of Whitehall secrecy is being overturned. And while previous Governments buried problems under the carpet, we are striving to be more open. By their very nature these works are high risk and innovative.

“They often break new ground and dwarf anything the private sector does in both scale and complexity. They will not always run to plan. Public scrutiny, however uncomfortable, will bring about improvement. Ending the lamentable record of failure to deliver these projects is our priority.”

Comment

The MPA annual report is a breath of fresh air.

Nearly every sentence, nearly every figure, represents compromise. The report reveals that the Universal Credit project was last year given an amber/red status – but it doesn’t say why. Yet the report has the DWP’s defence of the amber/red decision. So the MPA report has the departmental defences of the RAG decisions, without the prosecution evidence. That’s a civil service parody of openness and accountability: Sir Humphrey is allowed to defend himself in public without the case against him being heard.

But it’s still useful to know that Universal Credit is at amber/red.  It implies well into the project’s life that the uncertainties and risks are great. A major project at amber/red at this stage, a few months before go-live, is unlikely to turn green in the short term, if ever.

Congratulations

The Cabinet Office deserves congratulations for winning the fight for publication of the RAG status of each major project. Lord Browne, the government’s lead non-executive director and a member of the Cabinet Office’s Efficiency and Reform group, has said  that billions of pounds of taxpayers’ money is being frittered away because of “worryingly poor” management of government projects.

“Nobody ever stops or intervenes in a poor project soon enough. The temptation is always to ignore or underreport warning signs,” he says.

The management of some large projects – usually not the smaller ones – is so questionable that departments ignore advice to have one senior responsible owner per major project, says the MPA.

The MPA annual report will not stop the disasters. Its information is so limited that it will not even enable the public – armchair auditors – to hold departments to account. Senior civil servants have seen to that.

But the report’s publication is an important development: and it provides evidence of the struggle within Whitehall against openness. Francis Maude and Sir Bob Kerslake, head of the civil service, have had to fight to persuade departmental officials to allow the RAG status of projects to be published. The Guardian’s political editor Patrick Wintour says of the MPA annual report

“Publication led to fierce infighting in Whitehall as government departments disputed the listings and fought to prevent publication.”

Large-scale change

If Maude and Kerslake struggled to get this limited distance, and there is still so much left to reform, will large-scale change ever happen?

Maude and his officials have as comprehensive mandate for change from David Cameron as they could hope for. Yet still the Cabinet Office still seems to have little influence on departments. When it comes to the big decisions, Sir Humphrey and his senior officials hold onto real power. That’s largely because the departments are responsible to Parliament for their financial decisions – not the Cabinet Office.

Maude and his team have won an important battle in publishing the MPA annual report. But the war to bring about major change is still in its very early stages; and there’s a general election in 2015 that could halt Maude’s reform plans altogether.

The Major Projects Authority Annual Report.

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Posted in capacity building, change, change management, DWP, excessive secrecy, Gateway reviews, Government IT, HMRC, IT-related failures, Major Projects Authority, private sector lessons for the public sector, procurement, project management, public sector, public services, Universal Credit

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Decline of the great British government IT scandal

Posted on 07/05/2013 | 5 comments

This is a guest post by SA Mathieson, writer of Card declined: how Britain said no to ID cards, three times over .

Whatever happened to the great British government IT scandal?

In the 2000s, such events kept many journalists gainfully employed. Careers were built around the likes of the NHS National Programme for IT and identity cards. But their numbers have fallen away – both the scandals and the journalists – as this government’s programme of austerity reaches even this area of spending.

In seriousness, despite the fact that there are fewer juicy stories, the apparent decline in the number of government IT scandals is clearly a good thing for Britain. But why has it come about; and is it real, or are there problems below the surface?

The Labour government of 1997 to 2010 had a weakness for big IT projects. Some of this stemmed from a creditable wish to modernise the state, but some came from a starry-eyed over-estimation of what IT could do. This may have been generational: its leaders, in particular Tony Blair, liked the sound of IT but had little experience of using it. Mr Blair’s former communications head Alastair Campbell tells a good anecdote about getting a first text message from his former boss after they had left power… sent a word at a time.

Asking too much of IT had serious implications: neither Mr Blair nor a stream of home secretaries ever addressed the serious concerns about the reliability of biometric technology, on which the national identity scheme was heavily dependent, with David Blunkett once telling the Today programme that the scheme would make “the theft of our identity and multiple identities impossible. Not nearly impossible, but impossible”.

Nor did they realise that IT is better at sharing information than securing it – until HM Revenue and Customs lost 25 million people’s personal data on unencrypted discs in the government’s internal mail service in 2007. This over-confidence in technology and security led to other ‘surveillance state’ projects, such as the ContactPoint database of all children and the e-Borders system to monitor all international journeys (the former abolished, the latter only partially implemented with a third of journeys still not covered). 

Mr Blair and his colleagues also ignored what any good technology leader will tell you: that a successful IT project is really about people, organisations and processes. The NHS National Programme for IT did not fail because of IT – parts of it worked fine, and replacement contracts for its N3 broadband network and NHSmail email service are currently being purchased.

The National Programme’s failure came in trying to push individual NHS trusts, which differ enormously, into installing homogenous patient record software.

Implementing such software is difficult enough in one trust – mainly because highly-skilled medical practitioners don’t take kindly to being told what to do, rather than because of insurmountable IT problems – but is still a better bet than trying to impose systems from above.

The present government has learnt that lesson, setting a timescale for electronic patient records’ introduction but leaving trusts to do the work. If some trusts fail to meet this, the result will be local IT scandals rather than a great British one. This is also the level of accident-prone attempts by local government and police forces to outsource IT, such as Somerset’s Southwest One entanglement with IBM.

By downsizing the surveillance state, such as ditching ID cards and stepping back from greatly increased internet monitoring, as well as introducing the likes of Iain Duncan Smith’s Universal Credit in a sensibly incremental fashion,  this government has reduced the likelihood of UK-wide disasters. But while the great British IT scandal has declined, it is not dead. It is just more likely to take place at a local level, away from the national media and political spotlight.

SA Mathieson’s book, Card declined: how Britain said no to ID cards, three times over, reviews the attempts and failures of governments over the last three quarters of a century to introduce identity cards in Britain, focusing on the Identity Cards Act passed in 2006 and repealed in 2010, an issue he covered as a journalist from start to end. It is available as an e-book for £2.99 (PDF  or Kindle and in print for £4.99. 

This article also appears on SA Mathieson’s website.

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Posted in Government IT, IT projects, IT-related failures, NHS, npfit, Universal Credit

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Why isn’t Universal Credit IT a disaster yet?

Posted on 30/04/2013 | 3 comments

By Tony Collins

voltaireVoltaire said those who walk well-trodden paths tend to throw stones at those who show a new road. 

Iain Duncan Smith has had nothing but criticism in the media for his extreme caution over the go-live yesterday of the innovative Universal Credit scheme. But he told Radio 4’s Today presenter Justin Webb he was learning from the NHS IT scheme and the implementation of tax credits.

[With the NPfIT the Department of Health threw caution to the wind and spent billions on IT work and contracts that were unnecessary. After working tax credits went live the Office of National Statistics estimated that, of the £13.5bn paid out in tax credits in 2004, £1.9bn was in overpayments; and IT-related problems led to delays in issuing payments, which caused hardship for those on low incomes.]

Iain_Duncan_Smith,_June_2007IDS said on R4 Today yesterday:

“What I have introduced here is a deliberate and slower process introduction because I learned from the chaos of tax credits where it collapsed and the chaos of the health department’s changes to their IT systems. I want to do this carefully to make sure we get it right.”

Justin Webb: But your critics say you are not testing the things that could go wrong – children and homeless people are not involved.  When are you going to involve them in a pilot?

IDS: They are all going to be involved as we roll out.

Webb: There will be a pilot that includes those more difficult groups?

IDS: These pilots are to test two things; first of all that the base process works and secondly that all the other issues …

Webb: No homeless people involved in that. The difficult people are not involved?

IDS: What we are doing is testing the basic process. As we roll out from October onwards we then complicate the process and we roll it out in such a way as we are able to bring those people in and ensure that we also test them as we are going through. It’s a perpetual process of rolling out and checking, rolling out and checking. That is the better way to do it. I have done this in the private sector and Lord Freud [work and pensions minister] did this in the banking sector. We have insisted on it because this is the right way to do it. Get it right. Not get it early.

Can IDS be too cautious?

Universal Credit is live on GOV.UK.  To claim it now you need to live in an OL6, OL7, M43 or SK16 postcode, have just become unemployed, fit for work, have no children, not be claiming disability benefits, not have any caring responsibilities, not be homeless or living in temporary accommodation, and have a valid bank account and national insurance number.

But still it’s a test of links between UC  and HMRC’s RTI systems. If the links are working properly the systems should verify that the new UC claimant has recently left PAYE employment. The pilot in Ashton is also a test of the UC payment system and whether the new scheme will encourage claimants to find a job and stay in work longer.

On Sunday, on BBC Radio 5’s Double Take, I praised the Department of Work and Pensions for an ultra-cautious approach in going live with UC.

But IT consultant Brian Wernham, author of Agile Project Management for Government, pointed out to BBC’s World This Weekend that thousands of people will need to claim UC every day from the official start of the scheme in October 2013 to the end of 2017 if the DWP is to complete its UC roll-out within the coalition’s promised schedule.

Yet the limited pilot in Ashton has restricted claimants to about 300 a month. At this rate the roll-out to more than eight million claimants will not be anywhere near complete by the end of 2017.

Comment

The Financial Times quotes Iain Duncan Smith as saying that one million claimants would be receiving universal credit by the end of April 2014.

This is now unlikely if not impossible. Even in October when the UC roll-out begins nationally, it will start with simple cases. By April 2014 it is hard to see that there will be 100,000 people claiming UC, let alone one million. Indeed the most complex cases may be handled outside of the main UC system, possibly manually or on a spreadsheet.

Why should the coalition care if the 2017 deadline is not met? A general election on 7 May 2015 means that UC will become the responsibility of a new government. IDS is then unlikely to be the DWP’s secretary of state. He could argue at that time that he should not be held responsible for any delays in the roll-out. Indeed the Tories could be out of government by then.

So what the coalition says now about UC’s future means little or nothing.

That said, the coalition seems to be learning lessons from past IT-related failures. It deserves praise for its extreme caution over the introduction of UC.

It is not doing everything right: the DWP is refusing to publish any of its expensive consultancy reports on the progress of the UC IT systems. Partly that is because of DWP culture and because shadow ministers are waiting to jump on any putative weakness in the UC scheme. Labour’s shadow work and pensions secretary Liam Byrne said on yesterday’s Today programme that universal credit was “a fine idea that builds on Labour’s tax credits revolution”.

liam byrneHe added: “The truth is the scheme is late, over budget, the IT system appears to be falling apart and even DWP [Department of Work and Pensions] ministers admit they haven’t got a clue what is going on.”

But when Byrne was in government he was an unswerving advocate of the disastrous NPfIT. So can his criticism of the UC project be trusted now?

Despite a generally negative media there are no signs yet that UC is a disaster in the making.  Indeed RTI is working so far, which was the biggest single risk.

Cabinet Office minister Francis Maude is said to remain concerned that UC could prove an electoral disaster, and his concern is good for the UC IT project. It means the coalition will continue to roll out UC with extreme caution.

Such a play-it-safe approach might never have occurred before on a major government IT project. So does it matter that UC  takes years to roll out?

Perhaps the roll-out may continue well beyond 2017 but it’s better to complete a simplification of the benefits system over an extended time than pay claimants the wrong amounts or leave the vulnerable without payment altogether.  

Teething troubles on day one of Universal Credit scheme – Guardian

Could HMRC have a major success on its hands? – RTIis working

The vultures circle over Universal Credit IT.

DWP hides the facts on UC IT progress.

Are civil servants misleading IDS over Universal Credit IT progress?

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Posted in Agile, change management, DWP, Government IT, HMRC, innovation, IT-related failures, Major Projects Authority, Universal Credit

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A paperless NHS by 2018? Could it ever happen?

Posted on 16/01/2013 | 1 comment

By Tony Collins

The NHS should go paperless by 2018 to save billions, improve services and help meet the challenges of an ageing population, Health Secretary Jeremy Hunt will say today.

In a speech to the Policy Exchange this evening, the Health Secretary will say that patients should have compatible digital records so their health information can follow them around the health and social care system.

This would mean, says the DH, that in most cases, whether patients needs a GP, hospital or a care home, the professionals involved in their care could see patient histories “at the touch of a button”.

Hunt’s speech comes as two reports are also published which – says the DH – demonstrate the potential benefits of making better use of technology.

The DH says a report by PriceWaterhouseCoopers on the potential benefits of better use of IT “found that measures such as more use of text messages for negative test results, electronic prescribing and electronic patient records could improve care, allow health professionals to spend more time with patients and save billions”.

But the DH press release – and coverage of it by the BBC – does not mention the reservations in Pwc’s report.

Pwc says it could take 10 years or more for the NHS to derive the full benefits from some of the priority actions and further actions mentioned in its report.

Pwc also says that “significant further work is required to further substantiate some of the evaluations of potential benefit, and especially the evaluations of potential financial benefit. This work should be completed before the broad implementation of the recommended actions commences…”

A National Mobile Health Worker report, also published today, was a pilot study on introducing laptops at 11 NHS sites.

On the way towards the 2018 goal, Hunt will say that he wants to see:

– By March 2015 – everyone who wishes will be able to get online access to their own health records held by their GP.

– Adoption of paperless referrals – instead of sending a letter to the hospital when referring a patient to hospital, the GP can send an email instead.

– Clear plans in place to enable secure linking of these electronic health and care records wherever they are held, so there is as complete a record as possible of the care someone receives.

– Clear plans in place for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system.

– By April 2018 – digital information to be fully available across NHS and social care services, barring any individual opt outs.

The NHS Commissioning Board is leading implementation and it has set a clear expectation that hospitals should plan to make information digitally and securely available by 2014/15.

This means that different professionals involved in one person’s care can start to safely share information on their treatment. This is set out in the NHS Commissioning Board’s recent publication ‘Everyone Counts: planning for patients in 2013/14′.

Hunt says:

“The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution.

“It is crazy that ambulance drivers cannot access a full medical history of someone they are picking up in an emergency – and that GPs and hospitals still struggle to share digital records.

“Previous attempts to crack this became a top down project akin to building an aircraft carrier. We need to learn those lessons – and in particular avoid the pitfalls of a hugely complex, centrally specified approach.

“Only with world class information systems will the NHS deliver world class care.”

The Government recently announced it would be making £100 million available to NHS nurses and midwives to spend on new technology.

Challenges

The Pwc report is not an analysis of the costs of introducing shared electronic records across the NHS. But it does mention some of the challenges. It says:

“There are delivery risks to be addressed before the potential benefits can be realised.”

This is Pwc’s list of challenges of introducing better IT in the NHS, especially a shared electronic patient record:

– “The realisation of the potential benefits will depend on the concerted action and commitment of bodies from across the health and social care system.”

– “… the maximum possible benefits presented by this review will not be realised unless key supporting elements are put in place and unless appropriate and timely investments are made.”

–  “The availability of funds to cover one-off investment costs in technologies, information gathering or reworked organisational processes.”

– “The willingness of system bodies to adopt the technologies or commit to information gathering and use.”

–  “The clear and concise documentation of the benefits achieved and challenges faced by pilot programmes or early adopters of technologies or information protocols, to support other organisations in implementing actions in a cost-effective and efficient way.”

– “Strong and positive leadership to promote use of information and technology, and prioritise the commitment of resources and time to it and commitment of bodies from across the health and social care system.

– “The incentivisation of the adoption of the proposed actions, particularly when coordinated system-wide action is required.”

– “Measures to make contracting for the provision of systems and services as easy, quick and cost-effective as possible; and

– “The development of new or revised robust governance processes to not only support programme delivery but scrutinise the delivery of benefits.”

Comment:

On the face of it Hunt’s good intentions and the DH’s press release on his speech are little more than political rhetoric.

Indeed it appears that Hunt commissioned the Pwc report to give an independent voice to a political announcement. Pwc concedes in its report that it was commissioned to highlight the “potential benefits that could be achievable through the more efficient and effective use of information and technology in the NHS and social care before any action is taken”.

It is inconceivable that the NHS will be paperless or have shared electronic patient records by 2018. Each ward in every major hospital has a range of paper forms. These will take an unknown number of years to standardise for the purposes of electronic records; and shared electronic records will not take place across the NHS without enormous changes in culture and practice, and initial investments.

Nearly every secretary of state for health, shortly after coming to the post, is given a draft speech by his officials about the NHS’s having shared electronic patient records by a distant date.  A new government will be in power by 2018 and Hunt’s promise in January 2013 will have long been forgotten.

Yet Hunt’s announcement is still welcome because it will continue to add energy to the very slow move to shared electronic records.

It is astonishing in a technological age that patients with chronic diseases such as diabetes, or have complex health problems, can be treated at different specialist centres in various parts of the UK without their records being shared. A patient can be seen within a week in two different hospitals without each hospital sharing the patient’s most recent notes and diagrams.   This problem has to be grabbed by the throat – but not with a centralised system or database as proposed in the NPfIT.

Hunt recognises this. He talks of the need for records to be linked – from where the data currently resides. But Hunt needs to say how it will happen, and provide some limited investment for it to happen – tens and not hundreds of millions of pounds.

The political will is there – but without the means to achieve a shared electronic record it may never happen.

Pwc report

Jeremy Hunt challenges the NHS to go paperless by 2018 – DH press release

Going paperless would save the NHS billions – BBC online

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Posted in Campaign4Change, e-health, ERP, Government IT, health, health records, NHS, npfit, operational issues

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Summary Care Record “unreliable”

Posted on 05/10/2012 | 1 comment

By Tony Collins

The  central Summary Care Record database (which is run by BT under its NPfIT Spine contract) is proving unreliable, Pulse reports today.

The SCR is supposed to give clinicians , particularly those working in A&E and for out-of-hours services, a view of the patient’s most recent medicines, allergies and bad reactions to drugs.

But one criticism of the scheme has always been the lack of any guarantee that the data in the SCR could be accurate or complete.

Researchers at University College, London, led by Trisha Greenhalgh, found in a confidential draft report that doctors were unable to trust the SCR database as a single source of truth. They found in some cases that  some information on the database was wrong, and what should have been included in the patient’s record was omitted for unknown reasons.

Now Pulse reports that some GP-derived information is going on the patient’s SCR, and some isn’t. One problem is that GPs must use smartcards to update the SCR database and some don’t use them.

The General Practitioners Committee of the British Medical Association has raised the matter with the Department of Health.

Dr Paul Roblin, chief executive of Oxfordshire, Buckinghamshire and Berkshire local medical committee told Pulse that  smartcards were not often used in Buckinghamshire, because they slowed down the practice IT system for normal use, with one practice reporting that it had interfered with allergy data.

Dr Roblin said that this made the record ‘unreliable’ and said that although most GPs would prefer to take their own history rather than relying on the SCR, and would double check all details with the patient, other health professionals may not realise the record is incomplete, and may not check the data.

He said “Drugs lists might not be complete and recent allergies may not be uploaded. The Summary Care Record is unreliable. Don’t rely on it. It’s an expensive initiative without a lot of benefit.”

Dr Chaand Nagpaul, GPC lead negotiator on IT, said the current arrangements  undermine the benefit and usefulness of summary care records.

“The GPC have suggested workaround systems for practices who do not use smartcards, such as a ‘mop-up’ session where all new data is uploaded on to the national spine once a day. However, the DH decided against this option.”

There may be professionals who believe the SCR database  represents an up to date record said Nagpaul.

A DH spokesperson said that most practices which have created Summary Care Records use smartcards.

[Whether justified or not the SCR  scheme is believed to have cost about £250m so far.]

In 2010 Professor Ross Anderson at Cambridge University argued that the SCR could do more harm than good.

Richard Veryard also wrote on the unreliability of the SCR in 2010.

The Devil’s in the Detail – UCL report on the Summary Care Record.

Summary Care Record – where does the truth lie?

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Posted in BT, BT Health, Campaign4Change, change management, culture, data sharing, e-health, Government IT, health, health records, NHS, npfit, Summary Care Record

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DWP starts media campaign on Universal Credit IT tomorrow

Posted on 19/09/2012 | Leave a comment

By Tony Collins

The Work and Pensions Secretary Iain Duncan Smith has told MPs his department is launching a “major exercise” tomorrow to inform the media about Universal Credit, including progress with the IT project.

The public relations push will include a demonstration to journalists of the Univeral Credit front-end, and an explanation of the ability of “agile” to rectify problems as you go along. Duncan Smith said there is a lot of ignorance in the media, and suppositions, that need tackling head on.

His full statement on the PR campaign is at the foot of this article.

Comment

Iain Duncan Smith’s remarks to MPs sound remarkably like the statements that were made in the early part of the National Programme for IT in the NHS, when DH ministers and senior officials were anxious to correct ignorance and suppositions in the media – and to show journalists the front end of new electronic patient record systems.

Several times journalists were invited to Richmond house in Whitehall, the HQ of the DH, to hear how well the NPfIT was going. So anxious were the minister and leading officials to give a good impression of the programme that, on one occasion, trade journalists who had an insight into the NPfIT’s progress and could ask some awkward questions in front of the general media were barred from attending.

I would like Universal Credit to succeed. In concept it simplifies the excessively complex and costly benefit system. The worrying thing about the scheme, apart from the DWP’s overly sensitive reactions to scepticism in the media, is the way UC seems to be following the path which led to NPfIT’s downfall.

The Secretary of State attacks the media while trying to show UC in a glowing light and at the same time keeps secret all the DWP’s interview reviews and reports on actual progress. Duncan Smith says that the DWP wants to be open on UC but his department is turning down FOI requests.

There is no doubt that Duncan Smith has a conviction that the programme is on course, on budget, and will deliver successfully. But there still a morass of uncertainty for the DWP to contend with, and lessons to be learnt from pilots, some of which could be important enough to require a fundamental re-think. That’s to say nothing of HMRC’s Real-Time Information project which is part of UC.

Duncan Smith says the UC project is not due to be complete until 2017 which gives the DWP ample time to get it right. But ministers and officials in the last administration gave the NPfIT 10 years to complete; and today, nine years later, the scheme is being officially dismantled.

Did NPfIT ministers really know or understand the extent of the project’s true complexities and uncertainties?  Did they fully grasp the limited ability of suppliers to deliver, or the willingness of the NHS to change?  But they were impressed with the patient record front-end system and they organised several Parliamentary events to demonstrate it to MPs.

The NPfIT public relations exercises – which included DH-sponsored DVDs and a board game to market the NPfIT – were all in the end pointless.

Should Duncan Smith be running Universal Credit?

This is another concern. Duncan Smith is much respected and admired in Parliament but he appears too close to UC to be an objective leader. At a hearing of the Work and Pensions this week Duncan Smith took mild criticism of UC as if it were a verbal attack on his child.

It is doubtful anyone working for Duncan Smith would dare give him bad news on UC , though he attends lots of departmental meetings. Doubtless he listens to all those who agree with him, those who are walking press releases on the progress of the UC programme. He’d be a good marketing/PR man on UC. But surely not its leader. Not the one making the most important decisions. For that you would need somebody who’s free from the politics, who is independently minded, and who welcomes informed criticism.

Is there any point in a demo of front-end systems?

Seeing a front-end system means little or nothing. The question is will it work in practice when it is scaled up, when exceptions come to light, and when large numbers of people try to contact the helpdesks because they cannot get to grips with the technology and the interfaces,  or have particular difficulties with their claim.

What will a media campaign achieve?

If the NPfIT experiences are anything to go by, journalists who criticise the UC project will be made to feel stupid or uninformed.

In a totalitarian regime the media could be forced to publish what the government wants people to believe. Will the DWP’s PR campaign be designed to achieve the same end without the slightest attempt at coercion?

Duncan Smith’s comments to MPs

Below is some of what Iain Duncan Smith told Work and Pensions Committee MPs this week. He had been asked by a Committee MP to have a dialogue with the media to ensure that people believe that Universal Credit is a good thing.

Duncan Smith:

“On Thursday we are carrying out a major exercise in informing the median about what we are doing, looking at the system front-end, about budgets and all the elements the committee has been inquiring into.

“We will take them through that, show them that. We are going to open up much more. It is such an important system that I want people to learn what it is all about.  There is a lot of ignorance in the media and suppositions made; things that are important to tackle head on. Everyone says you mustn’t have a big bang; you are not going to be ready in time. The time we deliver this is 2017 when it is complete.  That is over four years…”

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Posted in Agile, Campaign4Change, change, change management, culture, DWP, e-health, excessive secrecy, FOI, Government IT, IT projects, managing change, managing outsourced services, NHS, npfit, Politics, procurement, project management, public sector, public services, Real-Time Information, Universal Credit

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Universal Credit – a chance to do things differently.

Posted on 13/09/2012 | 2 comments

By Tony Collins

Comment

In his comment on the article “Is Univeral Credit really on track – the DWP hides the facts”  Nik Silver asks in essence: why shouldn’t progress reports by IBM and McKinsey on Universal Credit be kept between the parties and not made public?

He says that criticism is usually helpful if the two parties can speak frankly without external interference.

It’s a reasonable point – if you are judging the public sector by the private sector’s standards. A private company would not make public consultancy reports it has commissioned on the progress or otherwise of a particularly costly project. Why should it?

Private v public sector approaches on big projects

But if the project goes wrong the private sector board will be accountable for the loss of money, or opportunity, or both. A private company’s board cares about a failed project because it cares about the bottom line.  If there is cogent criticism in a consultancy report, it will ignore that criticism at its peril.

Those standards don’t always apply in the public sector. There is no bottom line to worry about, no individual responsibility. What matters is reputation. We have seen too many public sector failed projects where the desire to maintain face, politically and internally, distorts the truth on projects.

Several ministers were proclaiming the £11bn NHS IT plan, the NPfIT, to be a success while it was going disastrously wrong. On the Rural Payment Agency’s IT-based Single Payment Scheme Parliament discovered that bad news was covered up. Ministers Lord Bach and Lord Whitty said they were misled by their officials.

When the truth financially came out it was too late to turn around the project cheaply and easily. The Environment, Food and Rural Affairs Committee said that if such a failure had happened at a major plc, the board would have faced dismissal.

Cover up when a project goes wrong also happens in the private sector. But case studies indicate that when a private sector board finds out it has been lied to, it does its utmost to put things right. The bottom line is the motivation.

In the public sector it sometimes happens that nothing is done to put serious problems right because there is no acceptance there are any serious problems. Nobody is allowed to accept internally that things are going wrong. A state of unreality exists. Some know the project is doomed.  Some at the top think it’s on track. The truth in the consultancy reports remains hidden, even internally. [The DWP couldn’t find the IBM and McKinsey reports when we first asked for them.]

Like Nik Silver, we would like Universal Credit to succeed. We are not sure it will, because the truth is not coming out. Unless serious problems are admitted they cannot be tackled.

Public sector

In the public sector a disaster does not usually become apparent until things are so bad the seriousness of the problems cannot be denied. It may be that Universal Credit will be a success if it is delayed or changed substantially in scope. That won’t be possible without reports such as IBM’s and McKinsey’s being published.  In the meantime Iain Duncan Smith, the Work and Pensions Secretary, will  continue to be given papers showing that all is well.  If the IBM and McKinsey reports are published now, and they contain some serious high-level criticisms, perhaps impinging on policy and excessive complexity, the ills may be cured or at least tackled. If these and other progress reports are made public now the corrigible criticisms could create a political climate to address those ills.

At present Universal Credit looks like so many IT-based change programmes of the past.  One side says the project is becoming a disaster and the other side says all is well.  The truth I am sure is that some things look good and some things bad. The bad probably won’t be addressed unless Parliament, together with all those who have a professional interest in the project – and the public – know about it.

The way of the past is to keep everything hushed up until it’s too late. Now there’s a chance to do things differently.

Is Universal Credit really on track? – The DWP hides the facts.

Nik Silver’s website

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Posted in Agile, Campaign4Change, change management, Government IT, IBM, IT projects, npfit, openness and transparency, operational issues, private sector lessons for the public sector, project management, public sector, public services, Universal Credit

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Is Universal Credit really on track? The DWP hides the facts.

Posted on 11/09/2012 | 6 comments

By Tony Collins

The Department for Work and Pensions has told Campaign4Change that consultancy reports it commissioned on Universal Credit would, if disclosed under FOI, cause “inappropriate concern”.

Who’s to say the concern would be inappropriate?

At the weekend a spokesman for the Department for Work and Pensions told the BBC: “Liam Byrne (Shadow Work and Pensions Secretary) is quite simply wrong. Universal Credit is on track and on budget. To suggest anything else is incorrect.”

But the DWP has decided not to disclose reports by consultants IBM and McKinsey that could throw light on whether the department is telling the truth. Though the reports cost taxpayers nearly £400,000, the public has no right to see them.

The DWP told us: “Disclosure [under FOI] would … give the general public an unbalanced understanding of the [Universal Credit] Programme and potentially undermine policy outcomes, cause inappropriate concern (which in turn would need to be managed) and damage progress to the detriment of the Government’s key welfare reform and the wider UK economy.”

Comment

In refusing to publish the costly reports from IBM and McKinsey the Department for Work and Pensions makes the  assumption that the Universal Credit IT programme will be better off without disclosure. But does the  DWP know what is best for the Universal Credit project?  Is the DWP’s own record on project delivery exemplary? Some possible answers:

–  The DWP has a history of big IT project failures, some of which pre-date the “Operational Strategy” project in the 1980s to computerise benefit systems. MPs were told the Operational Strategy, as it was called, would cost about £70om; it cost at least £2.6bn.  Today, decades later, the DWP still has separate benefit systems and relies on “VME” mainframe software that dates back decades.

– NAO reports regularly criticise the DWP’s management of projects, programmes or  suppliers. One of the latest NAO reports on the DWP was about its poor management of a contract with Atos , which does fit-to-work medical assessments.

– The DWP hasn’t broken with tradition on the awarding of megadeals to the same familiar names. Though Universal Credit is said to be based, in part, on agile principles, Accenture and IBM are largely in control of the scheme and the department continues to award big contracts to a small number of large companies. HP, Accenture, IBM and Capgemini are safe in the DWP’s hands.

–  The NAO has qualified the accounts of the DWP for 23 years in a row because of “material” levels of fraud and error.

So is the DWP in an authoritative position to say that the taxpayer and the Universal Credit IT project are better off without disclosure of consultancy reports when the DWP has never done it differently; in other words it has never disclosed its consultancy reports?

Can we trust what DWP says?

Without those reports being put in the public domain can we trust what the DWP says on the success so far of the Universal Credit programme?

Unfortunately departments cannot always be trusted to tell the truth to the media, or Parliament, on the state of major projects.

In 2006 the then health minister Liam Byrne praised the progress of the NHS National Programme for IT, NPfIT. He told the House of Commons that the NPfIT had delivered new systems to thousands of locations in the NHS. “Progress is within budget, ahead of schedule in some areas and, in the context of a 10-year programme, broadly on track in others.”

That was incorrect. But it was what the Department of Health wanted to tell Parliament.

Now it is the DWP that is praising Universal Credit and it is Liam Byrne criticising the programme. This time Byrne may have a point. The problem is we don’t know; the DWP may or may not be telling the truth – even to its Work and Pensions Secretary Iain Duncan Smith.

It would not be the first time ministers were kept in the dark about the real state of big IT projects: ministers were among the last to know when the Rural Payment Agency’s Single Payment Scheme went awry.

And while the NPfIT was going disastrously wrong, progress on the programme was being praised by ministers who included Caroline Flint, Lord Hunt, Lord Warner, John Reid, Andy Burnham, Ivan Lewis and several others. Even a current minister, Simon Burns, gave Parliament a positive story on the NPfIT while the programme was dying.

So while DWP spokespeople and Iain Duncan Smith praise the Universal Credit IT programme can anyone trust what they say? Though Duncan Smith sits on an important DWP steering group on Universal Credit, does he know enough to know whether he is telling the truth when he says the programme is on track and on budget?

At arm’s length to ministers, officialdom owns and controls the facts on the state of all of the government’s biggest projects – and the facts on Universal Credit’s IT programme will continue to stay in locked cupboards unless the Information Commissioner rules otherwise, and even then the DWP will doubtless put up a fight against disclosure.

The IBM and McKinsey reports were so well hidden by the DWP that, for a time, it didn’t know it had them.

The DWP gave the reasons below for rejecting our appeal against the decision not to publish. The DWP’s arguments against publishing the reports on Universal Credit are the same ones that, hundreds of years ago, were used to ban the publication of Parliamentary proceedings: that reporting would affect the candour of what needed to be said. That proved to be nonsense.

By hiding the reports the DWP gives the impression it doesn’t want the truth about Universal Credit to come out – leaving the department and Iain Duncan Smith free to continue saying that the scheme is on track. Indeed Duncan Smith said yesterday that he “has nothing to hide here”. That is evidently not true.

The reports we’d requested were:

– Universal Credit end-to-end technical review” (IBM – cost £49240).
– Universal Credit delivery model assessment phases one and two. ( McKinsey and Partners – cost £350,000).

DWP’s letter to us:

7 September 2012
Dear Mr Collins,

…You asked for a copy of the Universal Credit Delivery Model Assessment Phase 1 and 2, and the Universal Credit End to End Technical Review.

I am writing to advise you that the Department has decided not to disclose the information you requested.

The department has conducted an internal review and the information you requested is being withheld as it falls under the exemptions at section 35(1)(a) and (formulation of Government policy) and Section 36 (2) (b) and (c) (prejudice to the effective conduct of public affairs) of the Freedom of Information Act. These exemptions require the public interest for and against disclosure to be balanced.

These reports from external consultants discuss the merits or drawbacks of the UC delivery model and an assessment of whether the IT architecture is fit for purpose. This must be candid otherwise; the Department and the taxpayer will not secure value for money. Such reports can therefore be negative by nature in their outlook.

The Department considers that premature disclosure of these reports could lead to future consultants’ reports being less frank. In addition, there is a risk that this may lead to an absence of a recorded audit trail of the more candid elements. This is not in the public interest. Similarly, key staff selected to be interviewed by consultants are likely to be inhibited if they think their candour is likely to be recorded and released.

It is vital that the Department’s ability effectively to identify, assess and manage its key risks to delivery is not compromised. The willingness of senior managers to fully engage in a timely manner and support consultants assessment and assurance of key IT projects in an unrestrained, frank and candid way is vital to the effectiveness of the process.

Disclosure would also give the general public an unbalanced understanding of the Programme and potentially undermine policy outcomes, cause inappropriate concern (which in turn would need to be managed) and damage progress to the detriment of the Government’s key welfare reform and the wider UK economy.

While we recognise that the publication of the information requested could provide an independent assessment of the key issues and risks, we have to balance this against the fact that these reports includes details of ongoing policy formulation and sensitive information the publication of which would be likely to prejudice the effective conduct of public affairs.

The Department periodically publishes information about the introduction of Universal Credit, and this can be found on the Departments website here http://www.dwp.gov.uk/policy/welfare-reform/universal-credit/

Yours sincerely
Ethna Harnett

We have appealed the DWP’s refusal so the matter is now before the Information Commissioner’s Office.

Universal  Credit programme on course for disaster – Frank Field

Has the DWP lost £400,000 of reports it commissioned on Universal Credit?

Millions of pounds of secret DWP reports

NAO criticises Atos benefits contract

DWP scraps £141m IT project three months after assurance to MPs

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Posted in Agile, Campaign4Change, change, change management, DWP, excessive secrecy, Freedom of Information, Government IT, HMRC, IBM, IT projects, managing outsourced services, npfit, outsourcing, Universal Credit

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Well done Eric Pickles – more open government to engulf councils

Posted on 29/08/2012 | 2 comments

By Tony Collins

Few people have noticed but changes to the law next month could force councils to be much more open about big spending decisions including those that involve contracting out IT and other services.

It is a pity though that similar changes will not apply to the NHS.

The Local Government Association says that councils are already more open than Whitehall which is true.

Even so some councils are innately secretive about IT-related spending decisions, and discussions about projects that go wrong. Somerset County Council was notoriously secretive about its Southwest One joint venture with IBM in 2007. The deal has not made the expected savings and has consistently made losses. IBM claims the deal is a success.

Haringey Council’s “Tech refresh” project which went way over budget is another example. Evasive answers to opposition questions and meetings in secret were the norm.

Liverpool City Council was extraordinarily defensive and secretive about progress or otherwise on its Liverpool Direct Ltd joint venture with BT. The deal included giving BT control of IT.

Better public scrutiny

Now Local Government Secretary Eric Pickles has announced that changes to the law will mean that all decisions including those affecting budgets and local services will have to be taken in an open and public forum.

Ministers have put new regulations before Parliament that would come into force next month to extend the rights of people to attend all meetings of a council’s executive, its committees and subcommittees.

Pickles says the changes will result in greater public scrutiny. “The existing media definition will be broadened to cover organisations that provide internet news thereby opening up councils to local online news outlets. Individual councillors will also have stronger rights to scrutinise the actions of their council.

“Any executive decision that would result in the council incurring new spending or savings significantly affecting its budget or where it would affect the communities of two or more council wards will have to be taken in a more transparent way as a result.”

Councils will no longer be able to cite political advice as justification for closing a meeting to the public and press. Any intentional obstruction or refusal to supply certain documents could result in a fine for the individual concerned.

The changes clarify the limited circumstances where meetings can be closed, for example, where it is likely that a public meeting would result in the disclosure of confidential information. Where a meeting is due to be closed to the public, the council must now justify why that meeting is to be closed and give 28 days notice of such decision.

Chris Taggart, of OpenlyLocal.com, which has long championed the need to open council business up to public scrutiny, said

“In a world where hi-definition video cameras are under £100 and hyperlocal bloggers are doing some of the best council reporting in the country, it is crazy that councils are prohibiting members of the public from videoing, tweeting and live-blogging their meetings.”

These are the changes to be made by the  The Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012 (the 2012 Regulations) which will come into force on 10 September 2012.

– Local authorities will have to provide reasonable facilities for members of the public to report council proceedings (regulation 4). This will make it easier for new ‘social media’ reporting of council executive meetings, opening proceedings to blogging, tweeting and hyper-local news/forum reporting.

– In the past council executives could hold meetings in private without giving public notice. From 10 September 2010 councils must give 28 days notice where a meeting is to be held in private, during which time people may make representations on why the meeting should be held in public. When the council wants to over-ride the notice period, it must publish a notice as soon as reasonably practicable explaining why the meeting is urgent and cannot be deferred (regulation 5).

– A document explaining the key decision to be made, the matter in respect of which a decision would be made, the documents to be considered before the decision is made, and the procedures for requesting details of those documents, has to be published (regulations 9).

– The new regulations create a presumption that all meetings of the executive, its committees and subcommittees are to be held in public (regulation 3) unless a narrowly-defined legal exception applies.

– Where the council has a document that contains materials relating to a business to be discussed at a public meeting, members of the local authority have additional rights to inspect such a document at least five days before the meeting (regulation 16). Previously no timescale existed.

– Where the council decides not to release the whole or part of a document to a member of an overview and scrutiny committee as requested by a councillor, it must provide a written statement to explain the reasons for not releasing such document (regulation 17).

– Documents relating to a key decision including background papers must be on the relevant local authority’s website (regulations 5, 6, 7, 9, 10, 14, 15, and 21).

Comment

Well done to Eric Pickles and the coalition. These are important and welcome changes. If council decision-makers know their discussions will be open to scrutiny they may give proper consideration to risks as well as the potential benefits of big IT-related investments. With inadequate scrutiny the potential benefits often drive decisions, which was the case with the flawed setting up of Southwest One. The press office at Liverpool City Council was so used to controlling information that its spokesman was outraged at questions we asked about its outsourcing venture with BT.

But what about the NHS?

It’s a pity the NHS is not subject to the new legal changes. Few trusts are open about their big IT-related investments; and when things go wrong, as has happened with some Cerner implementations, NHS trusts tend to lock all the doors, talk in whispers and instruct their press offices to issue statements that claim “teething troubles” have been largely addressed. The trust and everyone reading the statement know it is disingenuous but the facts to prove it are kept under wraps.

Organisations such as Imperial College Healthcare NHS Trust are taking decisions about major IT upgrades that could affect the safety, health and lives of patients without proper scrutiny. Pickles may want to mention his legal innovations to Andrew Lansley.

Eric Pickles announcement on opening up council discussions and decisions 

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Posted in BT Health, Campaign4Change, Cerner, decision-making, e-health, excessive secrecy, health, health records, improving communications, IT-related failures, local government, managing outsourced services, NHS, npfit, openness and transparency, operational issues, outsourcing, Politics, public sector, public services, public-private partnerships, shared services

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