Tag Archives: public services

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

EU rules should be changed to give mutuals chance to run public services before full open competition

By David Bicknell

A post by Third Sector has made the case for public spin-outs such as mutuals to be exempted from EU procurement rules.

The piece quotes Stephen Lloyd, head of charity and social enterprise at City of London law firm Bates Wells and Braithwaite, who said that EU procurement rules were  currently based on the concept that public service provision was done either by the state or the private sector.

Lloyd said, “We want to move services out of the state and into a social economy, and the rules are not set up to support that. If you set up a new social enterprise to deliver something that was previously delivered by the state, and it has to compete with big business from day one, it won’t work.

“There needs to be a transition process. These organisations need to be protected. The government needs the agreement of the EU that it’s allowed to do so, and this is its opportunity to get it.”

Third Sector says that the Government’s response to the European Commission green paper is that employee-led spin-outs should have time to run services before having to compete with big business.

In its proposals to the European Commission, the Government says, “The revised Directives should make clear that, in circumstances, such as the development of employee led organisations/mutuals, employees should be able to gain experience of running public services for a period of, for instance, three years, prior to full and open competition.”

Are civil servants giving more work to SMEs – or less?

By Tony Collins

David Cameron, in a speech to a Government procurement conference on 11 February 2011, gave a pledge to ensure that  “25% of all government contracts are awarded to small and medium-sized enterprises”.

He said: “If we meet this goal it will mean billions of pounds worth of new business opportunities for SMEs”.

The Government has since dropped its pledge to give SMEs 25% of public sector contracts, though it remains an “aspiration”. To back this up, departments are under pressure to show they have awarded more work to small and medium-sized businesses.

As part of David Cameron’s Transparency commitments, all departments are required to publish each new contract let over £10,000 and state whether this contract has been let to a SME.

This information is available on the new Contracts Finder website alongside tender documents and opportunities. As part of the business plan process each department is also required to measure and publish the percentage of their third party spend that goes directly to SMEs.

The Government says it is investigating how best to collect data on spend with SMEs as sub-contractors.

That said, the firm target of 25% has been dropped because European tendering rules do not allow officials to give contracts specifically to smaller businesses.

The Cabinet Office says its official position now is:

“We will promote small business procurement, in particular by introducing an aspiration that 25% of government contracts should be awarded to small and medium-sized businesses.”

The Cabinet Office minister Francis Maude has been more cautious. He said at the time of Cameron’s talk that “as much as” 25% of public service contracts will be awarded to the private and voluntary sector in a bid to break up existing public service monopolies.

Have plans for more SME work gone into reverse? 

eWeek Europe now reports the concerns of SMEs that the 25% aspiration may give way to plans to consolidate government administrative work which could end up with major suppliers being given even more work.

eWeek Europe says that at the first meeting of the ‘New Suppliers to Government’ working group, which was put together by the Cabinet Office, members said the government’s aspiration to place 25% of its business with SMEs is in direct conflict with projects such as Sir Philip Green’s ‘Efficiency Review’,  which pushes for consolidation within the supply chain.

“There are two competing tensions inside the government,” said Mark Taylor, CEO of Sirius and lead for the New Suppliers to Government working group. “One of them is the Cabinet Office’s stated commitment to getting more SME involvement. However, the other drive within government is pushing things the other way…

 “The implication of that programme is they will reduce the number of people they buy from to a very small amount of very large suppliers,” said Taylor. While this can be an effective way to cut costs through economies of scale, it is not appropriate to every sector, added Taylor.

In the case of IT innovative ideas are coming from smaller companies, which can help reduce government spending through agile processes and open source.

Taylor cited the Ministry of Justice’s Cipher project as an example of how SMEs are being elbowed out of contracts as a result of these conflicting objectives. In March 2011, the MoJ cancelled freelance IT contractors supplied through SMEs and transferred their work to outsourcing company Capita and its £123m Cipher contract.

“The solution that we are proposing is very simple,” said Taylor. “In the private sector, companies of whatever size will purchase from whichever entity makes the most sense. If it’s a commoditised service, buy it from a huge supermarket at commodity prices. If it’s a specialised service that is appropriate for the business, buy it from an SME.”

Stephen Allott, the Cabinet Office’s crown representative for SMEs, has said it will take up to two years for Whitehall to stop excluding small businesses from work they could do more effectively than larger rivals.

Allott was quoted in the Telegraph as saying that meaningful reforms were being rolled out, but that they would take time to be implemented. “There are a lot of things that need to be fixed,” he said.

Comment:

There is a real risk that the coalition’s laudable aspirations to change the way government works will fall victim to a combination of strong lobbying by the big suppliers and overwhelming forces within the civil service to keep things much as they are, which usually means playing safe – or that is how it is perceived – by continuing to rely on the large suppliers, the so-called systems integrators.   

For decades the big companies have had their way and have been paid very well for services of mixed quality. One result of the domination of big suppliers is that inefficiency is endemic. The Cabinet Office minister Francis Maude wants government to change and we support him. He’ll need to do more to make change happen, though. Meanwhile the civil service is doing what it does best: keeping the hands of ministers off the steering wheel. Maude is being given so much work that, in his words, it’s difficult to “keep all the plates spinning”.

Many in the Cabinet Office want to support Maude and effect reform. But can they do it when Maude is distracted by having too much work, the big suppliers are doing all they can to keep and expand their existing contracts, and departmental civil servants are confortable in their existing SI relationships?

eWeek Europe

An example of one SME’s innovative ideas

Agile – a series of London Tea Parties

By Tony Collins

Anyone interested in agile techniques  – users and suppliers, public and private sectors – is invited to share ideas at a London Tea Party on 22 September at the Cafe Zest, 2nd Floor of the House of Fraser on Victoria Street, from 4pm – 6pm.

It is arranged by Abby Peel who has recently joined Mark O’Neill in the Innovation and Delivery team within the Government Digital Service. Peel is Head of Community.

Peel says that “AgileTea”  is an informal get-together for those who work with agile methods, are interested in it, or who know nothing about it but want to know more.

An example of agile in government is the Government e-petitions website which was launched recently to much public interest after being developed by the Innovation team in six weeks.

AgileTea will be the first of a regular series of informal, BarCamp style events that will bring together like-minded people to hear, contribute and engage in discussion of agile methods.

Each meeting will have guest speakers. Anyone can ask to give a short presentation of up to 10 minutes.  At the first AgileTea speakers will be Richard Pawson  from Naked Objects who’ll talk on “Experience of very large scale agile development at the Irish Department of Social Protection” and Mark Foden of Foden Grealy who’ll speak on “Where agile fits”.

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)

Civil service “full of brilliant people terribly managed”

By Tony Collins

Andrew Adonis was transport secretary in Tony Blair’s government. Last year he became director of the Institute for Government which Adonis describes as a thinktank that speaks truth to power.  Among other things it produced the excellent System error: fixing the flaws in government IT which advocates an agile approach to innovation at the front line.  

Now in an interview with Politics.co.uk  Adonis points out the institutional weaknesses of the civil service.  “My criticisms are about the machine,” he says. “My own view is that the civil service is full of brilliant people who are terribly managed.”

One of the biggest problems is what he calls the  “laughably” named permanent civil service. People change jobs because of a merry-go-round culture which makes no sense, he says.  It’s not a problem that’s going away: since the general election ten of the 16 departments of state have had changes in their permanent secretary.

“The machine really is very badly run,” he says.

Comment

What Adonis says is important because institutional resistance to change and innovation is largely because what exists is said to be work well. It doesn’t work well because government administration costs tens of billions much more than it should and the National Audit Office has found that fraud and error in two of the biggest departments, HMRC and DWP, are at unacceptable levels. 

It’s time that the point made by Adonis, and many others of some authority, is given more credence.  Systems within government need changing and, particularly, simplifying  – not in a rush and not without proper thought and testing.

The old argument that government administration aint broke so leave it alone doesn’t stand up to independent scrutiny. It is broke and it needs intelligent, inventive and cheap-to-implement change.

Met Office has IBM secondee as CIO

By Tony Collins

The Met Office gained ministerial approval to appoint an IBM employee for a year as secondee CIO, until the end of October 2011, according to information released under the FOI Act.

It appears that the salary of the IBM executive David Young is being paid, at least in part, by the Met Office. In documents released under the FOI Act the Met Office has redacted [edited out] details of Young’s proposed remuneration and performance bonus.

As a trading fund within the Department for Business, Innovation and Skills, the Met Office is required to operate on a commercial basis. It was part of the Ministry of Defence at the time of Young’s appointment. His recruitment was approved by the Secretary of State.

Internal emails show that the Met Office apparently overcame a recruitment ban and constraints on secondments.

Having your CIO seconded from your biggest IT supplier may be novel but it could be controversial because of the perception of a potential conflict of interest.

It would not the first time a public authority has been involved in a controversy after seconding an IBM employee as head of IT.

In 1993 a report of the district auditor criticised the then Wessex Regional Health Authority after it transpired that a member of the health authority was a director of IBM. The IBM director at Wessex promoted a controversial and successful bid for core systems to be supplied to the health authority by IBM and Andersen Consulting (later Accenture). The director later asked that his letter lobbying for the contract be destroyed.

The auditor also found that the Wessex authority bought an IBM mainframe without proper legal authority, the members of the authority having not been informed. The authority paid an unnecessarily high sum for the mainframe and there were doubts the machine was needed. A decision to proceed with the purchase of the mainframe at Wessex was made on the advice of the regional health authority’s new regional information systems manager who was an IBM secondee.

The Met Office, however, has given full consideration to the potential for a conflict of interest in appointing Young as its CIO. It said in a statement this week:

“Full consideration of any potential conflicts of interest regarding David Young’s appointment were fully considered prior to his appointment and his terms of engagement specifically cover these.

“The Met Office complies with specific rules set by the government with regard to procurement and purchases of IT equipment must be agreed by the Met Office Executive.”

The Met Office is one of IBM’s biggest customers. It says on its website: “We are now using an IBM supercomputer which can do more than 100 trillion calculations a second. Its power allows it to take in hundreds of thousands of weather observations from all over the world which it then takes as a starting point for running an atmospheric model containing more than a million lines of code.”

The Met Office reports that Young is responsible for the organisation’s IT strategy and ensuring that it adapts to support the business strategy.

Its website says that Young worked for IBM but does not make it clear he is still employed by the company while on secondment to the Met Office. It says that before joining the Met Office he “held a number of executive position within the IT industry, working for IBM, CSC and Siemens”.

Young’s Linked In profile says he is CIO at the Met Office and Director, System zStack and Mainframe Platform, Central Eastern Europe, Middle East and Africa at IBM.

In response to an FOI request by Dave Orr, the Met Office has released internal emails relating to Young’s recruitment and later appointment. Young is described in the Met Office’s Register of Interests 2010/11 as an “Executive, IBM UK Ltd (non-active)”.

The email exchanges show that the Met Office was keen and anxious to employ Young. Talks over Young’s recruitment, initially as Chief Technology Officer, began in July last year and took several months to conclude.

In August 2010 John Hirst, Chief Executive at the Met Office, wrote to Young mentioning, among other things, a ban on recruitment.

“It was good to talk to you on the phone this afternoon. This is to confirm that you are interested in joining us at the Met Office and we are interested in offering you a post.

“As we discussed there are issues of the recruitment ban, terms of secondment and security clearances amongst others but we have both declared an intent to try and get something organised between us.”

Also in August 2010 Diana Chaloner, the Met Office’s Director of Human Resources, emailed IBM on the costs and restrictions relating to the “possible secondment of David Young”.

Her email said: “I will need to get confirmation from John Hirst (our CE) before committing to the costs as outlined below. Whilst I don’t see it as a problem, I do also need to seek a way to overcome external secondee restrictions placed on us by central government recently. I will attempt to get this moving as quickly as possible at this end.”

In another email to IBM in August 2010, Chaloner referred again to the costs of seconding Young. She said:

“Following John’s earlier meeting with David (in his garden!) Alan Dickinson [then the Met Office’s Director of Science and Technology] and I met him last week. John has now spoken to David and is keen to try to progress a secondment. I know David is very keen too, but inevitably, with all the various restrictions placed on us, cost may be an issue, as will enabling the secondment contract to be approved.

“Whilst this might be quite challenging , I think there are usually ways to manage these things, so would really like to understand cost and timing…”

The following month, September 2010, Chaloner emailed Hirst on the need for Young’s appointment to be approved.

Her email has in the subject heading: “IBM Confidential: Secondment of David Young to the Met Office”.  Says the email: “At the moment we cannot give a precise date for David to start his secondment. I did mention in an earlier email that there are some added constraints across Government, and one of those is around recruitment and secondments…”

In October 2011 Hirst emailed IBM about a possible delay in appointing Young. “I am sorry this has taken so long and been more complex than anticipated but the rules of engagement have changed at least twice over the last couple of months and therefore keeping things moving forward steadily has been more difficult. I am still confident we can conclude this although I have suggested to David we might need a weeks (sic) delay in starting … the contracts are signed and sitting in my draw awaiting final clearance of the admin hurdles so there is no decrease in my intent to make this happen.”

On 29 November 2011 Chaloner wrote to Hirst saying that Young’s appointment needed the approval of the Secretary of State. “… The situation is looking very positive but we require final approval from Secretary of State. I was told that there seemed no reason for the secondment not to be approved, but it has to go through the appropriate channels. I can only apologise in the delay in David starting, and continue to nudge it from this end, almost on a daily basis.”

Young was appointed by the end of December 2010. The business case for a new Chief Technology Officer (which became a CIO role) says the secondment from IBM would finish on 31 October 2011. It says there is a “need to bring a professional IT expert into the organisation, to reshape the function in order to achieve greater efficiency in delivery of information technology, as well as ensure it is fit for purpose in the future, hence the need, at this time, to manage this as a short term secondment.”

The Job Description, which is headed “Management in Confidence”, says the IBM secondee will “lead the IT function in the effective delivery of 24/7 IT services and enhance our world leading supercomputing and infrastructure capabilities to secure achievement of future corporate objectives.” The main responsibilities will include directing and co-ordinating 300 information technology, programme/project management professionals, and support staff…”

The job also involves overseeing the “selection, acquisition, development and installation of major information systems”. It further includes the need to “determine and manage all outsourced  external IT service provision as appropriate to meet service level agreements.”

Comment:

There is nothing wrong with the Met Office’s decision to hire an IBM secondee except perhaps that it underlines the reliance of the public sector on its major suppliers.

It’s clear that the Met Office has struggled hard to employ David Young because of his expertise. Nobody would understand the Met Office’s IBM systems better than IBM.

But we have seen evidence from the National Audit Office that suppliers all too often understand customer installations in the public sector better than the civil servants know their own systems. In the case of the NPfIT, auditors had to rely on suppliers to explain what they had been paid and why.

It’s time for the civil service to build up its expertise so that it ceases to rely on suppliers that dominate government IT.

CityCamp events set to bring hacking-like innovation for family-based local government services

By David Bicknell

Last week, we asked whether US-style public service coding could be used to build mutual apps for local communities.

Now it seems such a scheme is underway. CityCamp Families will be held in November. There is more about it here

There is also going to be a  CityCamp event in Manchester in mid-September.

DH puts case against cancelling NPfIT contracts

By Tony Collins

The Department of Health has put a detailed case to MPs for not cancelling £4bn worth of NPfIT contracts with local service providers CSC and BT.

Among the points the DH makes is that “the NHS cannot continue without replacing the systems now covered by these contracts” – which refers to the NPfIT contracts with BT and CSC.

The DH also says that CSC and BT “have been clear that they are not willing simply to talk away”. Legal advice to the DH is of a “significant” risk that BT and CSC may, if their contracts are ended, work with Fujitsu in a unified legal action against the Department. Fujitsu and the DH are in a protracted legal dispute after the Department terminated Fujitsu’s NPfIT contract in 2008.

The Department’s memo to the Public Accounts Committee is published today in the PAC’s report entitled “The  National Programme for IT in the NHS: an update on the delivery of detailed care records systems”.

The report is highly critical of all the main parties to the NPfIT including:

– CSC which the report says has delivered only 10 of 166 of its ‘Lorenzo’ systems in the North, Midland and East. The PAC report calls on the Government to give “serious consideration to whether CSC has proved itself fit to tender for other Government work”.

– BT, the other main supplier to the NPfIT, which has “proved unable to deliver against its original contract”, says the report.

– Sir David Nicholson, the Chief Executive of the NHS who is senior responsible owner of the NPfIT, who is criticised by name. It’s rare for the committee’s MPs to personalise their criticism. It says there has been “weak programme management”  and adds: “We are concerned that, given his significant other responsibilities, David Nicholson has not fully discharged his responsibilities as the Senior Responsible Owner for this project. This has resulted in poor accountability for project performance…”

– The Department of Health and NHS Connecting for Health which cannot be trusted to give reliable or complete information on the NPfIT, even to government auditors.  The report says: “Basic information provided by the Department to the National Audit Office was late, inconsistent and contradictory… This occurred despite the fact that Connecting for Health, the NHS organisation responsible for managing the Programme nationally, has 1,300 staff and has spent £820m on central programme management.”

– The Department of Health over its poor ability to re-negotiate contracts with BT and CSC. The report says that the Department ended up “clearly overpaying BT to implement systems …BT is paid £9m to implement [RiO] systems at each NHS site, even though the same systems have been purchased for under £2m by NHS organisations outside the Programme.”  This “casts the Department’s negotiating capability in a very poor light”. The report adds: “We are worried that the Department will fare no better in its current negotiations with CSC …”

– The Department of Health for leaving NHS trusts in a mist of uncertainties. Trusts with NPfIT systems will not know the costs of supporting them after the BT and CSC contracts expire in 2014/15. It’s also uncertain how individual trusts will manage CSC and BT NPfIT contracts when the supplier agreements are held by the Secretary of State for Health.

– The Department of Health for leaving CSC in a controlling position to supply trusts with upgraded interim iSoft systems that were not part of the original contract. Says the PAC report: “It is important that CSC, particularly given its proposed purchase of iSoft, does not acquire an effective monopoly in the provision of care records systems in the North, Eastern and Midland clusters.

“This could result in the Lorenzo system effectively being dropped as the system of choice and many Trusts being left with little choice but to continue with out-dated interim systems that could be very expensive to maintain and to upgrade, or to accept a system of CSC’s choice.

“CSC should not be given minimum quantity guarantees or a licence to sell a product other than that procured and selected by the Programme within the Local Service Provider contract.”

But in its memo to the Committee the Department is unrepentant. Indeed the self-justifying detail and tone of the DH memos, which include selective, apparently corroborating quotations from a KPMG consultancy report that the Department has never published, suggest that, while the NPfIT has changed, the zeal with which DH officials defend the scheme, whatever its problems, has changed little since the programme was announced in 2002.

The DH’s case for not cancelling the contracts with CSC and BT was prompted by a written question from Richard Bacon, a Conservative MP and long-standing member of the Public Accounts Committee who has taken a close interest in the NPfIT.

Bacon asked:

What are the maximum payments to which NPFIT would be exposed for contract cancellation of the detailed care records systems, for each of the LSP providers [CSC and BT]?

The DH said that if the contracts were cancelled for convenience the maximum payments could be [DH italics] in excess of the currently anticipated costs to complete the BT and CSC contracts. If the DH were to cancel contracts for acute hospitals only, the maximum payments may reduce by 50%, said the DH.

The DH adds:

“These costs do not include the deployment or operational costs of any new systems that the NHS would need to procure. The NHS cannot continue without replacing the systems now covered by these contracts.”

Cancellation costs 

Cancellation costs could involve, said the DH:

– Contractual costs: The minimum amount the supplier is allowed to receive under the contract.

– Damages This would include covering some of the suppliers’ unrecovered costs to date and pre-accrued claims at the point of termination

– The costs of providing the ongoing services after termination. It is likely that suppliers will seek to increase these ongoing costs in an attempt to improve their financial position. The Department claims that Fujitsu increased its service charges and claimed it would turn systems off if outstanding sums were not paid.

– Costs of replacing systems, plus support and development of live services.

– Legal and professional fees for terminating, transferring work and investigating the facts around termination.

But the DH makes no mention that the Department would have a strong negotiating position if contracts were terminated because any dispute could cause the Cabinet Office to lose confidence in that supplier, which may affect the ability of the company to win further government work.

Would any major supplier want to fall out with government as a whole, rather than just one department?

Coalition changes mean that government considers itself as a single customer when reviewing the reputation and credibility of individual suppliers.

MPs don’t trust the DH’s information

Many of the points made by the DH in 15 pages of memos appear to have been largely discounted by the committee, partly because MPs did not trust what the Department said.

Comment

The Department of Health has a history of quoting selectively from consultancy and legal reports to support the argument it is making.  This is what tabloids do at times. Indeed the DH  never publishes the consultancy and legal reports it quotes from, so should we trust its arguments that point to keeping the NPfIT contracts with CSC and BT?

There may be good arguments for cancelling the contracts that have not, and are unlikely to be, mentioned by the DH.

Some benefits of cancelling NPfIT contracts

Cancelling could end the uncertainties for trusts that would otherwise be pressured to take NPfIT systems. It could also end the uncertainties for trusts that have yet to buy NPfIT systems and may face punishing costs to keep them running, and in step  with changes within the NHS, after the contracts with BT and CSC expire in 2014-2015.

If Campaign4Change were advising the coalition we would suggest it commission a genuinely independent review of the pros and cons of cancelling the NPfIT contracts.  The review  should not be commissioned by the DH or Connecting for Health because their lawyers and consultants will tend to tell the department what they think it  wants to hear.

One of the messages that comes loud and clear from today’s report of the Public Accounts Committee is that the DH cannot be trusted to make the right decisions on behalf of taxpayers and the NHS. The DH cannot even be trusted to tell the truth to judge from the PAC report.

The Cabinet Office needs to take control of major DH IT spending. Perhaps the sooner the better.

Public Accounts Committee report on NPfIT detailed care records systems.

NHS must consider scrapping NPfIT – MPs.