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Suppliers tell parliament NHSIT stories

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Pantomime villain.pngSo why did you take this undeliverable £multi-billion IT project on?

The Boo-Hisssstems Integrators were up before parliament again this week. MPs on the Public Accounts Select Committee wanted to know why the computer systems they've been building for the NHS are so expensive, so late and so not working.

Committee chair Margaret Hodge wanted to know why BT and CSC why contracted to do the work when it had clearly been undeliverable from the outset.

It's a good question. The government had in 2002 offered the entire administrative health IT market and payments of billions to what was then just five suppliers. The Department for Health would effectively banish the existing health IT market. It's five favoured suppliers would each get a ready-baked regional monopoly.

No matter that it was unfeasible. The Boo-Hissstems Integrators couldn't lose, as has become apparent now the programme is running seven years late and the government shows no sign of ceasing to subsidise their failure.

The healthcare presidents of BT and CSC, sole remaining suppliers of patient systems for the NHS IT programme, tried to persuade the committee Monday they had got the sprawling project under control. They claimed they hadn't finished the job till now because users' needs had changed.

Had they not taken so long over it, the system would have been delivered before the world had moved on. So here we are, 10 years later, and Margaret Hodge is having to ask them if they will ever finish the job - which she did.

She didn't get a straight answer.

Just how cushy these suppliers have had it under their NHS contracts became apparent when the committee turned its attention to Patrick O'Connell, president of BT Health. (See from 16.30 minutes in).

Both execs behaved as though they had the largest pensions in the room. But O'Connell showered the committee with patter not heard since Terry Thomas graduated from the School for Scoundrels.

Hodge was livid over BT's having charged £20m-a-site for patient records systems. Was this what BT called value for money?

BT at PAC - 23 May 2011.png"I think the benefit the systems' producing are equivalent to the value for money you started out [with] before it was rearranged into a different setting that will not only produce value for money, it will produce more value for money going forward," said Terry - sorry, Patrick.

He made a mockery of the inquiry when Ian Swales, the mild mannered MP from Redcar, took the gavel.

Swales, clearly a decent man, started out well enough. The software's simple to produce, so where has all our money gone: surely its a failure of BT management?

But he started flapping. His question became babble. It was as though there was something withering about O'Connell's stare.

"You mean BT management?" asked the BT president reproachfully. A condescending smile fluttered near the corner of his mouth. Ho, you little worm. So you think you can spar with me?

Ian Swales on PAC - 23 May 2011.pngDuel

Swales was going to spar, yes.

"The software costs are trivial," persisted the MP.

"A teenager in their bedroom can automate an email from one system to another."

And so the contest was on.

O'Connell wrestled like a Hydra over this simple question of how much of the billions wasted on NHS IT had been hoovered up by BT management.

He played dirty. He swatted at Swales with a suggestion the MP was doing a poor job. Then he described just how significant were the forces at his own command, running as he was, or claimed to be, the largest such public IT system in the world.

He finished with some smug sales patter.

The combination of a threatening tone, belittling look, a put down and a puffed chest had been enough in the space of just a few moments to cause the MP to sag like a classical hero in the jaws of defeat.

Swales began mirroring O'Connell's patter about the size of his IT project, repeating it as though it was a question from the committee. All seemed lost.

"So were we wrong to ask for it then?" was all Swales could manage.

It was a wilting repetition of the claim made by Boo-Hissstems Integrators that customers were at fault for public sector IT failures because they asked suppliers for the wrong thing in the first place.

Hodge stepped in like Hercules' faithful charioteer, and Swales got back to his feet, a little unsteady.

"So can you answer my question?" the MP blurted.

But he was weak from all the flapping. He asked how much BT and NHS management were to blame for the mess in NHS IT. It gave O'Connell a way to slither round the question.

BT at PAC - 23 May 2011 - 2.png"I don't think that's the issue," said the BT exec, setting up his misdirection.

"If you are talking about NHS staff, we have found them to be perfect, dedicated, committed, and have worked extremely hard to advance health care in a very evolving and changing environment."

O'Connell mocked a little choke of emotion as he spoke.

He ended with a little laugh. This was childs play. He thought he had the day.

But Swales would not give in.

He might not have had the wherewithal to handle the BT exec's deceits. But he was a representative of the people. He lifted his last question like a great, blunt sword and whacked it over O'Connell's chuff about the poor, offended NHS staff.

"The delays are all down to your companies, then?"

O'Connell lost his poise. Did this pipsqueak MP not know when he was outclassed? He got tetchy, the last recourse of the playground bully.

He starting blaming users again.

What users wanted today was different to what they wanted 10 years ago. Every NHS Hospital Trust wanted its own internet domain nowadays. He concluded with a feeble cad's flourish: "I don't know if you know what a domain-per-trust means?"

Hodge called order, noting that what NHS users wanted today was exactly what they wanted 10 years ago - a working system.

BT at PAC - 23 May 2011 - 3.pngDefeat

Now it was O'Connell's turn to babble. His game was up.

Richard Bacon, the heavy-hitting MP from South Norfolk, asked him about the trouble the National Audit Office had trying to reconcile numbers submitted by BT with those from the Department of Health.

O'Connell tried to claim there were no such discrepancies.

He started flapping. BT's numbers did reconcile with those of the DoH, he said. He suggested the government auditors had got their numbers wrong. His heavy gold jewelry flashed for the video cameras.

Bacon was trying to find out why BT was charging £9m per site for a records system that should cost under £2m.

"That's part of the numbers we are trying to reconcile," said O'Connell, drawing laughter from onlookers at the back of the committee room.

The committee was none the wiser on the numbers. And it won't be till it can open BT and CSC's books. But it did get a measure of these Boo-Hissstems integrators.

Spanner jams data centre mergers

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Mosquito up close.pngThe Cabinet Office dropped a stinker in Parliament this week, admitting it's data centre consolidation programme is lacking fundamental intelligence.

The Public Administration Select Committee asked Cabinet Office how many of the 220 data centres used by central government were actually owned by private suppliers. How on earth can you consolidate 220 data centres, the question implied, when most of them are owned by different suppliers and operated under different contracts.

Don't know, said the Cabinet Office in written evidence to the committee.

We don't know how many central government data centres are privately owned, it said. We don't actually know what contracts we have across government either. And while you're at it, neither have we any idea what the average cost of a desktop computer is in the public sector.

Look closely and you might spot a pattern here. Government has tried and failed for 10 years to get decent benchmarks on IT spending. It meanwhile has to beg suppliers for the numbers: tell us how good a deal you are giving us because we don't know.

Suppliers reckon they're giving good head. And then you hear the Department of Health has spent £2.7bn since 2003 on a nation-wide patient records system suppliers still haven't delivered.

So where does all the money go? Two point seven billion pounds to knock out a patient database: it can't all go on second and third country homes for overpaid wide boys and team-building weekends in Grouse season. Can it?

Pantomime baddies

As for data centres, the Cabinet Office thought a year ago there were just 130 of them in central government. Even then it should have known what it was talking about. A posse of boo-hissssssystems integrators brought the consolidation proposal to Cabinet Office on a plate in 2009. Counting data centres is not rocket science, even for these bozos.

But by late 2010 Cabinet Office found 90 data centres had fallen down the back of the sofa. Central government had 220 data centres it had to consolidate, not 130. And now, two years after busty trade body Intellect dreamt up the whole idea, Cabinet Office still doesn't know which Intellect members actually own them and, one would assume, just how good their offer to consolidate really is, or indeed how it might work.

Think of it like this. If a posse of 10 boo-hissssystems integrators came knocking on your door proposing a way to drastically reduce the amount of money you had to pay them for data centres, you wouldn't think it a bid odd, would you? No, you'd take their plan and present it as a data centre consolidation programme toot suite.

Ask around, and it becomes apparent government's lack of intelligence about what it pays its ICT suppliers to do might inhibit the consolidation programme's aspirations.

Dr Richard Sykes, a data centre consultant, reckons suppliers only proposed data centre consolidation because they got wind of mega-data centres run by the likes of Amazon and saw their number was up. What an old cynic.

At least, he says, central government's estate of data centres had "grown like topsy". As each department realised it needed a data centre, it got one - and got one of its own on the advice of an oligopoly of ICT suppliers.

Now they're all over the place and thank Christ someone noticed what a killing these suppliers were making because poor Mrs Harris didn't get on too well this winter and she's wondering if her winter fuel allowance will see her through next year what with the wide boys having pissed her pension up the wall and all our taxes having been wasted on all these bloody redundant data centres.

By the time the consolidation plan had become the G-Cloud Vision, and the Cabinet Office had fleshed out proposals in consultation with SMEs, people like ex-CIO John Suffolk started saying how government intelligence about its own IT expenditure would always be one bob short as long as systems were not implemented using agreed standards.

The government wasn't getting straight answers from its suppliers. It's tempting to think of them as self-serving parasites. That would probably be unfair. But when the Cabinet Office says the problem with public sector IT is government has not been an intelligent customer, that is only half the story. It's tantamount to saying, blame the victim.

So how do you find out how many central government data centres are owned by the private sector if you can't trust their answer?

You could order them to open their books. It might not be necessary for something as simple as data centres. But there's a few other riddles you could answer while you were at it. Like where did that £2.75bn of NHS money go? Can we have a line-by-line breakdown submitted to the National Audit Office, please?

NHS IT system condemned

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NHS Surgery.pngIn a jaw-dropping condemnation of the NHS National Programme for IT, the National Audit Office has exposed a white elephant in the final stages of collapse.

In what read as a final pronouncement, the NAO reported that after nine years and £2.7bn, the NHS has failed to deliver its primary aim of an electronic care record for everyone in the country.

The situation looks so dire the system might continue leeching money from the NHS for another decade if the whole scheme and all its software is not seized by state liquidators.

The NAO was confident DoH had saved the day. But it had done so by turning the systems architecture on its head. The National Programme had been all but abandoned. The NAO all but called time on it once and for all.

"There is a compelling case for the recently announced Whitehall-wide review to re-evaluate the business case for the Programme to determine what should happen now to safeguard against further loss to public value," said the NAO's Update report on the NHS IT Programme's care records systems, published today.

Yet the NAO couldn't simply move on. It was being held back by its multi-billion pound contractual obligations to failed suppliers BT and CSC.


Ian Watmore, the Cabinet Office head of government IT, told the Public Accounts Committee Monday the oligopoly of suppliers was to blame for the mess in government ICT. But the government couldn't simply ditch their contracts when it was so hard to prove where the bucked stopped in a court of law.

So, the NAO reported, DoH had commitment to honour its existing contracts for the failed delivery with BT and CSC. The total, with implementation and delivery fees, would cost another £4.3bn to 2016.

Might suppliers do the honourable thing now and resign, apologize, and hand what software they had over to the public?

DoH had abandoned the original scheme's aim of storing all NHS information in a single system spanning thousands of separate NHS organisations. It had effectively scrapped the system. It had opted instead for one set of rules so that disparate systems could share what information they had. This proposal was on the drawing board when the DoH first embarked on the scheme in 2003.

Oh dear

NAO had a scrappy report card for BT and CSC, who had already been paid billions but failed to deliver systems across the country.

DoH had spent £6.4bn on the entire programme to date. But masses of hospitals, ambulance crews, mental health units, community care teams and doctors surgeries were still waiting for working computer systems.

The Department was trying to handle the system requirements in a more flexible manner, in keeping with the agile mode in systems development. But NAO was pressing it to stick to the original contracted specifications as a measure of success. The new mode was "overly positive" when the cogs of the system were stuck in the mire.

DoH had permitted suppliers to deliver fewer systems without getting a commensurate reduction in price. Costs appeared still to be going up. There was no end of it and matters were only becoming more complicated. The state of the core patient system was enough to induce a mortal gag.

"Although some care records systems are in place, progress against plans has fallen far below expectations and the Department has not delivered care records systems across the NHS, or with anywhere near the completeness of functionality that will enable it to achieve the original aspirations of the Programme," said the NAO report.


"The Department has also significantly reduced the scope of the Programme without a proportionate reduction in costs, and is in negotiations to reduce it further still. So we are seeing a steady reduction in value delivered not matched by a reduction in costs.

"On this basis we conclude that the £2.7 billion spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of £4.3 billion will be different," said the NAO.

Deadlines had been repeatedly missed. When systems had gone in take-up of care records was poor. DoH had compromised its original requirements.

The report painted a most unpleasant picture of CSC, which had delivered care records systems to just four out of 97 hospitals in the North, Midlands and East of England.

The NAO said CSC would likely fail to deliver the rest before its contract runs out in 2016. DoH had been in dispute over its contract with CSC for 18 months, trying to claw back some of the £5bn it had promised the supplier.

DoH had meanwhile been forced into technical modifications of the one-size-fits-all software systems being delivered by the suppliers because they did not fit the slots they were being put in. Costs of these modifications were uncertain, but were £220m to date.

Delivery costs were going up, funding was going down. Additional costs were being incurred by trying to make health systems from outside the Programme compatible with those inferior systems delivered by BT and CSC.

Little was certain. BT and CSC were in such a slough they could not even agree with the Department of Health in numbers submitted to government auditors. NAO had been unable to clarify the discrepancies.

And so on...

On top of that, the NHS was facing reorganisation under the coalition government. The NAO report gave no impression these lumbering suppliers would need anything less than another 15 years after they fulfilled their current obligations to redesign the system to work in the new NHS organisational structure.

"Of the 4,715 NHS organisations in England now expected to receive a new system under the Programme, 3,197 are still outstanding. The current CSC contract alone requires delivery of 3,023 GP systems and over 160 deliveries of Lorenzo by July 2016," it said.

The ongoing saga is an embarrassment for the UK, for tax payers, for the government. Any embarrassment suffered by the scheme's suppliers has been sated by the billions paid to their shareholders, the billions more they are contracted to receive, and the hundreds of millions more still to be allotted in contracts not yet let.

It is an insult to the Cabinet Office Open Source and Software Re-use Action Plan launched in 2009 by then minister Tom Watson and it is an insult to the coalition government's repetition of its aims, both before and after the 2010 general election that brought it to power.

Were Watson and now Maude's plans to get control of public computer software ever feasible when the commercial world has such a death grip on public ICT?

Watson's plans for software re-use dared to imagine a time when public software was public property. Any work suppliers were paid to do would contribute to the public good. And that good would be stored in the form of software on which any agency, or any one from the the wealth of local health systems providers who flourished before this débâcle, could contribute improvements.

The National Programme is in such a state, the government has nothing to lose if it is serious about its Open Source Software and Re-use policy: it could become the first great public open source system.

Cancel the NPfIT says motion to annual BMA conference

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The British Medical Association's Annual Representative Meeting, which starts today in Brighton, will hear a motion from the Northern Ireland Council which says:

"This Meeting believes that there has been little demonstrable benefit to the National Programme for IT for the NHS with an unacceptably high cost to benefit ratio and poor value and therefore, in the current time of financial constraint in the NHS, demands that the government cancel the National Programme for IT and divert the monies into frontline direct patient care."

It's also likely that the BMA ARM will hear a call for it to abandon its acceptance of the "opt-out" model for the summary care record scheme.

Trisha Greenhalgh on Summary Care Record - where does the truth lie?

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               "The National Programme for IT: it's time to acknowledge the elephant in the room"

Professor Trisha Greenhalgh OBE is Director of the Healthcare Innovation and Policy Unit at Barts and the London School of Medicine and Dentistry, Queen Mary University of London. She led the independent evaluation of the Summary Care Record Programme.  

The evaluation cost taxpayers more than £723,000, and there is no sign that the Department of Health and NHS Connecting for Health will take seriously the concerns the report raises. 

The views expressed in the article that follows are Trisha Greenhalgh's:

"Last week, I asked a packed conference hall of general practitioners if any of them had ever seen a Summary Care Record. Not a single hand went up.  

"Yet 30 million people in England have received a letter saying that a Summary Care Record will shortly be created for them from their GP-held medical record.

A pantomime-style clash? 

"Here is a clash of narratives that would sit comfortably in a pantomime. 

"Does the Summary Care Record exist? Oh no it doesn't, say some pundits, except in the dreams, manifestos and business plans of politicians and policymakers. 

Microsoft launches HealthVault - your personal health record?

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Microsoft is today launching HealthVault in the UK, a personal health data repository which has the implicit support of the Conservatives

John Coulthard, Senior Director Healthcare and Life Sciences at Microsoft, says:

"According to research, 13% of the UK population are actively interested and engaged in looking after their 'wellness' - i.e. they do things such as exercise regularly, look after their diet, monitor their weight, take their temperature and blood pressure. Many of these people record this data in a variety of places - from apps on their phones to scraps of paper.

"Today, with the launch of Microsoft HealthVault in the UK, we are offering those people a central repository for that data, where information can be entered manually by an individual for themselves or their family - or automatically from a range of compatible devices including weight scales, blood pressure monitors and pedometers.

Any need for Summary Care Record?

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           - "The SCR was based on an unresearched and unverified need."

           - It will be "next to impossible to keep SCR database accurately synchronised" 

Roz Foad, an NHS informatics expert, has responded to the excellent report by Trisha Greenhalgh and University College London on the NPfIT summary care record scheme.

Foad  is chair of the BCS Primary Health Care Specialist Group, and former IM&T Service Manager at Hertfordshire PCT.  

She says:

"What has not been examined to date are the alternatives to pushing data into a single database.

Clinicians may not access summary care records - today's UCL report

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An evaluation of the summary care records scheme by researchers at University College London has concluded that:

"Benefits of centrally-stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale."

BMJ summary of UCL report: 

Will Summary Care Records do more harm than good?

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The Summary Care Record must be abandoned for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights, says Professor Ross Anderson of Cambridge University.

He also says today that the SCR "brings very few benefits and has the potential to do serious harm".

Ross Anderson, professor of security engineering at the University of Cambridge Computer Laboratory, argues that the national database of national electronic database of patient records is not fit for purpose and illegal.

In the British Medical Journal his arguments go head to head with those of Mark Walport, a director of Wellcome Trust, who believes that the SCR will make valuable contributions to better care.

Their arguments come as a final report of University College London's evaluation of the summary care record scheme is published. A summary of the report is on the BMJ's website. 
Anderson says that a digital medical record system that shared information when appropriate between care providers, and was dependable and safe, would be of "great value". He adds:

"However, the summary care record isn't it. It must be abandoned - for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights.

Report to reveal danger to patients posed by NHS IT database?

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Alex Deane, Director of Big Brother Watch - a campaign fighting intrusions on privacy - says of tomorrow's report by University College London on the NPfIT NHS Connecting for Health Summary Care Record scheme:

"This report reveals that there are serious and potentially irrevocable tensions at the heart of the Summary Care Record.

"Many GP practices aren't equipped to handle the technology and medical staff are suspicious of the data found on the system.

"We were told that the SCR would make our lives easier; this report shows that this insecure, inaccurate database is fraught with problems that pose a real danger to patients."


The coalition has performed a disgraceful u-turn on summary care records - Big Brother Watch

Highlights of confidential UCL report on summary care record scheme - IT Projects Blog

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