Tony Collins's IT Projects Blog

Financial uncertainty arising from the credit crunch is likely to lead to many outsourcing deals being re-negotiated, reduced in scope or terminated in 2009 - and they may go into dispute, warns international law firm Pinsent Masons.
 
The firm also says that long-term transformation projects may be delayed or terminated, in part because businesses will look to short-term cost cutting rather than to longer-term benefits.

When the government awarded the contract to ETS to process and mark SATs, Whitehall's press release was, as to be expected, full of praise for the supplier and the procurement process.

But the press release showed how the government, in awarding multimillion contracts, can be not merely at arm's length but miles away.

I said on the BBC Radio 4 "Today" programme this morning (approx 8.30am) that the loss of a memory stick by PA Consulting raises questions about why a private contractor had access to government data on 84,000 criminals. Does this mean private companies will also have access, on the quiet, to patient-identiable information under the NHS's National Programme for IT? I also said that there is so little independent scrutiny of the government machine, and so much secrecy, that the only time systemic failures come to light is when there is a, well, systemic failure.  

The Royal Free Hampstead NHS Trust is preparing for a possible compensation claim after a troubled go-live under the £12.7bn National Programme for IT [NPfIT]. 

The trust's staff have been struggling to cope with bugs and downtime since the go-live of the "Millennium" system from US supplier Cerner in June.

The trust's board has been told that all problems continue to be logged so that it is ready should a claim prove possible.

Barts and The London NHS Trust says it underestimated the impact on its operations of going live with the Cerner LC0 system under the NHS's £12.7bn National Programme for IT [NPfIT].

The problems have led to operating theatres and clinics being unused at times - despite a demand for them - because of difficulties in scheduling patients for appointments.

The trust is also funding from its reserves £930,000 for extra temporary staff, in part to cope with the backlogs of work following the NPfIT go-live. It is also facing a further £1.5m shortfall in income because it may not have enough accurate information on which to bill its local primary care trust for the patients it sees and treats.

PA Consulting has said sorry over the loss of a memory stick on thousands of prisoners as the Home Office terminated its £1.5m "JTrack" contract. PA's contract started on 1 June 2007 and was not due to end until June 2010.

It's ironic that the Home Office said at the time of awarding the contract that its length would provide "stability" to the JTrack system.

PA said in a statement yesterday [11 September 2008]:

"PA has safely handled sensitive government information for over 60 years and this is the first incident of such a nature that PA has been involved in. It is clear from the events of recent weeks that the challenge of managing necessary confidential information held by government, and in particular of eliminating human error, is industry-wide. We are engaged in dialogue with our clients and competitors to address, and find solutions to, this challenge.

Below is a transcript of my interview with Andre Snoxall, e-record programme director at Newcastle Upon Tyne Hospitals NHS Foundation Trust, which has broken away from the National Programme for IT [NPfIT]. The Trust is to implement Cerner systems from the University of Pittsburgh Medical Center. 

Snoxall spent much of the last 10 years as CIO for a number of trusts in New Zealand. He's Australian.

In the interview Snoxall talks about:

- Why in his view Cerner implementations in London and the south of England have gone wrong

- How Newcastle's plans to avoid some of these difficulties.

- Cerner's strengths and weaknesses

- The trust's biggest challenge - communications

- Why Newcastle's Cerner systems may be more advanced than those under the National Programme for IT [NPfIT]

- Newcastle's plan to minimise the use of the Cerner for reporting to the government on  patient activity

- Newcastle's plan to use its own Cerner system for seven years - by which time it hopes that local service providers under the NPfIT will have a replacement

Now the Labour Party's conference, which was held in Manchester, is finished, I've looked at the lessons and what went wrong on 13 large, government IT-based projects and programmes:

Is a promise or a prediction made by a supplier's sales team ever a representation? When is a representation, if that is what it is, ever a misrepresentation? If ever there is a misrepresentation, can it be held to be fraudulent if it is made thoughtlessly rather than deceitfully? What if the customer relies more on promises than representations?

Some of these were matters raised at the nine-month hearing between BSkyB and EDS - the most expensive High Court hearing the history of the IT industry.

One argument made during the hearing was that promises, predictions and opinions are not representations. So can they be held to be misrepresentations?

Whittington Hospital NHS Trust says it has accounted for four discs that went missing, which contained the personal details of 17,990 health service staff and former employees. The incident has cost the trust (taxpayers) about £25,000.

Police had been alerted, and the trust held 24 separate briefings for staff over four days, including one on Saturday, 20 September 2008, on the possibilities of identity theft. David Sloman, Chief Executive, wrote "individually" to the 17,900 staff at their home addresses to advise them of the missing data. The trust wrote to them again to let them know the discs had been accounted for. The trust also reported a Serious Untoward Incident. An enquiry had been set up and the Information Commissioner's Office was alerted. Staff were advised to keep a regular check on their bank accounts and statements.

Searches were carried out in all areas of Whittington hospital's salaries and wages office and the post room. The trust is based near the Archway tube station in London. There was also a search of the European headquarters in Warwick of McKesson, the intended recipients of the discs. McKesson runs the MAPS Manpower and Payroll system for the trusts. The Royal Mail was alerted.

A Ministry of Defence official says it is investigating with its contractor EDS whether a 1TB portable hard drive, which went missing from EDS's secure offices at Hook, Surrey, had an unencrypted download of the MoD's "TAFMIS" training and recruitment database.

When I put it to an MoD official that such are the security and audit mechanisms that nobody seems to know whether a large government database has been downloaded onto a portable hard drive which later went missing, the MoD official replied:

"We are vulnerable to that criticism, it would be fair to say."

The Mod is custodian for tens of millions of data records, according to an inquiry into a separate MoD data loss earlier this year.

In a statement on the latest incident, the MoD said it's possible that some of those serving in the armed forces "may have been compromised."

The MoD statement said:

"There is no indication that the data, if indeed it has fallen into unauthorised hands, has been exploited maliciously in any way; but it is possible that personal information on anyone serving or who has served in recent years in the Armed Forces may have been compromised."

In interviews on Friday [10 October 2008] the BBC asked me whether the possible loss of sensitive, unencrypted data on armed forces personnel, as a result of a missing portable hard drive, was the fault of the MoD's main IT contractor EDS.  I said not necessarily - it's unclear whether the MoD should be, or needs to be, passing sensitive government information into pass into the hands of private contractors.

It's remarkable that the MoD doesn't stipulate encryption for portable data stored in secure offices.

It's also remarkable that departments - not just the MoD - seem not to put any limit on how much government information - citizen information - they allow to be transferred to outsourced private companies. One question MPs should ask ministers is: how much control does the government have over the outsourced information held on millions of us? The government's honest answer should be: "We have no idea."

So much for internal audit. So much for the Data Protection Act.

Links:

Our interview with MoD over EDS missing hard drive - IT Projects Blog, 13 October 2008

EDS again? - Stuart King's blog

EDS loses personal details of 5,000 prison staff - Computer Weekly

Private data on armed forces goes missing - Silobreaker  

Sir Robert Fry, head of EDS Defence, has said that a portable hard drive which went missing had not needed to be encrypted under Ministry of Defence procedures because it was held in secure premises.   

Some in the IT industry may be surprised that portable MoD data does not require encryption if it is held in secure premises.

Fry said he was unable to rule out the malicious use of any data on the missing drive. But he said that "if it was intended for any malicious purpose, we would have had some indication that that was the case before now".

He was being questioned on BBC Radio 5's "Drive" programme, which included an interview with Computer Weekly. The presenter Anita Anand asked Fry: how secure was the hard drive?

He replied: 

"The hard drive was not encrypted but neither did it need to be, in terms of the protocols to which we and the Ministry of Defence work, when it sits inside a secure site."

The loss of the drive was discovered last Wednesday and reported by EDS on the same day. But it's not known when the drive disappeared. The Ministry of Defence said in a statement that the hard drive may yet turn up at another secure site. It conceded that the personal information of members of the armed forces might have been "compromised" by the loss of data on the drive.

The 1TB portable hard drive went missing from a secure EDS site at Hook in Surrey. 

MPs have criticised the loss of the hard drive, saying that a culture change is needed to prevent personal data going missing.

Health officials in London are working with BT, Cerner and IT specialists to rescue plans for integrated e-health records in the capital amid signs that the government's one-size-fits-all approach is disintegrating, Computer Weekly has learned.

The original plan which was announced in 2002, in a document "Delivering 21st Century IT Support for the NHS", was for the National Programme for IT [NPfIT] in the NHS to deliver "ruthless standardisation". In London a single database to support electronic health records for eight million people was to be rolled out to all trusts and other NHS sites.

That plan turned out to be too ambitious - and was watered down when officials and the NPfIT local service provider in the capital, BT, decided to install in NHS trusts different releases of the US-based Cerner "Millennium" system to support e-records.

Now that plan, too, has run into trouble. BT, NHS IT specialists and Cerner have ended up customising LC1, the standardised smartcard-based Cerner system, for one London trust, the Royal Free, after it ran into serious problems.

Some long-term users of the Cerner Care Records Service - which is due to be rolled out to hospitals across the south of England - have "little confidence in the information generated", according to an external, independent audit report.

The criticisms by users at Weston Area Health Trust in Weston-super-Mare, North Somerset, are despite nearly two years of intensive remedial work on the Cerner Millennium system.

The difficulties at Weston show that problems arising from an e-records go-live under the NHS's National Programme for IT [NPfIT] can last years, despite claims by the Department of Health and NHS Connecting for Health that problems with Cerner installations in the south of England are only teething.

It's not just in England where health staff are trying to minimise delays for patients after the go-live of e-record systems. 

A US website reports that a prototype room includes a system that scans employees' badges when they enter a patient's room and automatically displays patient information as appropriate.

1) Fujitsu to withdraw from the NPfIT - what happens now? 

Summary: Only a week ago a deal aimed at rescuing the NHS's National Programme for IT in the south of England seemed imminent... But at what one NHS official said was the "59th minute of the eleventh hour" Fujitsu informed Nicholson that it was withdrawing from the negotiations...All that the NHS had been relieved to negotiate in the contract re-set has evaporated... It will be of little comfort to the Department of Health and ministers that Computer Weekly warned them in 2002 and 2003 that the NPfIT was too ambitious to be achievable, and that the programme incorporated some of the biggest mistakes of the past. For this warning ministers and some parts of the media branded us doom-mongers.
We still hope our critics will prove us wrong. But it's six years since the NPfIT was announced. How much longer do they need?

2) SAP go-live leaves 18,000 unpaid bills at Europe's largest local authority - what went wrong

[Not the shortest of headlines]

Summary: The lead for Birmingham City Council's IT-based transformation programme said of the unpaid invoices after go-live with a SAP-based financial system: "What has led to a larger backlog than we originally anticipated is a combination of all these factors. We probably anticipated every one of them but what we didn't take into account was the cumulative effect."
**
The lead for an IT transformation scheme at Europe's largest local authority, Birmingham City Council, has expressed "regret" after the troubled go-live of a SAP-based system left a backlog of more than 18,000 unpaid invoices.

Each NPfIT contract for the local service providers is nearly one metre high with the schedules and appendices.

Clearly the national programme has been good for some (loggers) even if it hasn't been welcomed so enthusiastically by some hospital boards. When Tony Blair, a former barrister, personally approved the NPfIT perhaps he subconsciously had in mind the real beneficiaries.

PS The amount spent on lawyers' fees since the inception of the National Programme in 2002 to 30 November 2006 was £31.5m.  That was before the year-long negotiations over Fujitsu's contract re-set, the termination of its contract and the continuing talks with BT to take over Fujitsu's work in the south of England. And negotiations have been continuing for about nine months over CSC's contract re-set, much longer than expected.  

This is a summary of some of the most important parts of a hard-hitting report by the Public Accounts Committee on the Windows-based £7bn Defence Information Infrastructure [DII]  project 

The DII is not a failure. Given its complexity and over-ambitious timetable it's surprising more hasn't gone wrong; and parts of it have gone well: the MoD has a strong relationship, for example, with EDS which leads the Atlas consortium, the main DII contractor.

Still, progress has fallen well short of expectations and in the first three years of the programme the MoD spent more than 90% of the original budgeted costs of the first stage but received fewer than 50% of the terminals and software it had expected. Core software such as word processing, email, internet access and security should all have been available in June 2006, but less than half of the requirement had been delivered two years later in June 2008. The report criticises the MoD and Atlas for "severe underperformance".

From the report [my sub-headings]:

Did the MoD mislead Parliament in 2006 by understating DII's full costs?

"The Department originally forecast that the Programme would cost £5.8bn ...This cost is greater than the £2.3bn that the Department had previously reported to Parliament. The Department stated that it had provided Parliament with the value of the contract that had been awarded to ATLAS at the time, which is its usual practice, but subsequently acknowledged that this could have been explained more fully.  The Department now estimates that the cost of delivering the DII Programme will be £7.09bn ...

Conservative MP Edward Leigh, Chairman of the House of Commons' Public Accounts Committee, has issued a statement on a report of his committee today on the Defence Information Infrastructure. He said:

"The Ministry of Defence's ambitious new £7 billion IT system, designed to replace hundreds of ageing existing systems, was badly planned in important respects. No proper pilot for this highly complex programme was carried out and entirely inadequate research led to a major miscalculation of the condition of the Department's buildings in which the new system would be installed.

"In addition, the ATLAS consortium implementing the project - led by EDS ... underestimated the complexity of the software it had agreed to create. For over two years, it was unable to deliver a system that could safely handle Secret material.

Analysis and comment

The National Programme for IT in the NHS was launched with the best of intentions - to use technology to help doctors, nurses and other health professionals make better decisions in the interests of patients.

The NPfIT is also aimed at helping patients make better decisions in their own interests.

But good intentions have taken some hospitals on the road to hell.

The Chief Executive of Rotherham NHS Foundation Trust has explained why his board is to buy a patient record system on the open market without waiting for the "free" Lorenzo software which is due for delivery under the NHS IT scheme.

Interviewed by Computer Weekly, Brian James said his board is expected to make a decision on a supplier of patient administration and clinical systems shortly, having run an open competitive tender.

 Health officials sought to discourage a foundation trust from buying systems outside the NHS IT scheme by threatening to charge for national software even if the trust bought an alternative system, Computer Weekly has learned.

The threat, if carried out, could have left Rotherham paying for two hospital systems when it needed only one.

John Black, president of the Royal College of Surgeons, says the Choose and Book system "purports to offer greater patient choice" but "has had the opposite effect".

Black's comments will not make it any easier for NHS Connecting for Health to persuade doctors to use Choose and Book. Many like it and some refuse to use it. A few doctors complain that they find it difficult to finalise a booking on the system because of technical problems. But Black's criticisms are of the way the system works rather than the technology.

Black told BBC Online:

"Using the latest technology to increase the efficiency of the health service and measure how patients' lives are improved is vital. But this must be sensitive to the individual patient and must retain personal professional judgement.

"The current system in the NHS is forcing patients and doctors apart and I believe the delivery of care is poorer without those personal relationships. "

But responding to Black's comments Whitehall officials have pointed to a blog post by Helen Evans, of "Nurses for Reform" who calls on doctors to embrace Choose and Book.

On its front page today - and in a two-page spread inside - The Times has published a joint Times and Computer Weekly investigation on government IT including an opinion piece from us.

The articles refer to IT-based projects, programmes and contracts which have exceeded the original announced costs by more than £18bn.

MPs are fed up with failures of some large government IT-based projects and programmes - as are the government IT professionals, civil and public servants, and contractors who are achieving success on very limited budgets and find their work is overshadowed by the project Chimeras which have unrealistic time-frames and budgets.

The opinion and the analysis in The Times make it clear that we're not attacking government IT people but the way projects are approved without enough Parliamentary or external challenge to assumptions.

After The Times yesterday published the results of a joint investigation with Computer Weekly over government IT projects - contracts have cost at least £18bn more than first announced - a public sector employee has emailed to ask me why there was no mention of IBM.

IBM was the prime contractor on one of the projects mentioned in The Times - the Scope system for the intelligence services. But IBM's name was not mentioned.

As The Times says, the government is secretive about its IT contracts. Sometimes the government does not want Parliament or anyone else to know the name of the main IT contractor. This is despite the fact that Scope is on the list of the government's highest-priority "mission-critical" projects.

I understand from separate sources that IBM is the Cabinet Office's Scope system contractor, though neither the Cabinet Office nor IBM will comment.

The Times reports today that the National Audit Office is likely to investigate Whitehall's biggest computer projects and contracts after disclosures that their costs had exceeded the announced figures by more than £18 billion.

Edward Leigh, chairman of the Public Accounts Committee, said: "As a result of The Times's investigation I am going to immediately ask the Comptroller and Auditor-General [the head of the NAO] to investigate the whole matter of government IT spending and in particular the contracts highlighted in the paper."

The NAO, although independent of the government and Parliament, produces reports and briefings for the Public Accounts Committee and will usually agree to the committee's request for an investigation. The NAO has reported to the committee on several of the individual projects listed by The Times in its joint investigation with Computer Weekly but an aggregated report could point out common factors, problems and lessons.

Links:

Government IT projects will cost taxpayers £18bn more than expected - Computer Weekly

Watchdog to investigate how government IT projects overran - The Times

Something must be done to break cycle of IT failure - CW Opinion piece in The Times  

£18bn Government IT scandal - 3 pages in The Times today

Secret deals that cost taxpayers billions  

Cerner beat Wall Street expectations, reporting an adjusted fourth-quarter profit of $53.6 million, or 65 cents a share, reports the local paper where the supplier is based.

Meanwhile at least two UK Foundation Trusts are considering buying the Cerner system from the University of Pittsburgh Medical Center - Newcastle Upon Tyne Hospitals NHS Trust has already bought it. 

But it's unclear whether having an indirect relationship with Cerner will prove any more successful than having BT as an intermediary. BT supplies and installs the Cerner Millennium system in London as part of the NHS's National Programme for IT.

Homerton in London made a relative success of Cerner - but the trust signed a contract directly with Cerner and has been able to make the changes it wants - unlike other Cerner users.

Links:

Kansas City Star - Cerner's local paper

Rotherham set to announce EPR contract - E-health Insider

MPs visit e-record sites in Canada and US as part of NPfIT investigation - IT Projects blog

Interview with CEO of Rotherham break-away trust - IT Projects blog   

Roll-outs in the London area of the Cerner LC1 Millennium Care Records Service are due to resume, Computer Weekly has learned.

The resumption makes it less likely that BT and the Department of Health will part company over the supplier's £1bn contract as London's local service provider under the National Programme for IT [NPfIT].  BT will be relieved to go to its financial year end with renewed activity on the London Programme for IT.

But the risks remain.

Editorial to be published in Computer Weekly next Tuesday

Number one in the list of Computer Weekly's top tips for project managers is advice that's supposed to be humorous, even slightly cynical.  It says that projects with realistic budgets and timetables don't get approved.

But reality trumps our satire: big projects keep being approved on the basis of unrealistic estimates of their cost and time to completion. 

One government project executive has told Computer Weekly that budgeting in government is a game: if the Treasury and the department in question want the scheme approved, they turn a blind eye to irrationally low initial estimates of the cost and the timescales

We - and others including Robin Guenier - said in 2002 that ruthlessly centralised IT systems could not be foisted on NHS trusts which take their own decisions. But Downing Street and the Department of Health went ahead anyway with the ruthlessly-centralised National Programme for IT [NPfIT]. Now David Nicholson, Chief Executive of the NHS, is repeating Guenier's warning:

"The idea that you could, by attrition, drive a national programme into an NHS that was unwilling to accept it, simply is not deliverable."

David Nicholson February 2009, Public Accounts Committee, in response to a question from MP Richard Bacon.

And once Nicholson has retired - with the inevitable knighthood - the lesson will doubtless be forgotten.  

Link:

Why good NHS technology is so badly needed - Johnson King

Now that the central spend on the NHS's National Programme for IT [NPfIT] has officially exceeded £5bn - even without local and some other costs - Computer Weekly is publishing here for the first time a Government document which put the total lifecycle cost of the national programme at £5bn in 2002.

The Office of Government Commerce's 4-page Project Profile Model was expunged from the published version of Delivering 21st Century IT Support for the NHS, a Department of Health document which marked the launch of the NPfIT.

GM bankruptcy fears - it's probably unwelcome news for EDS which used be owned by GM and remains one of EDS's biggest customers. With EDS in its fold, HP commands about a third of GM's $15bn technology budget.

An unpleasant side-effect of media coverage of IT-related project failures is that people have come to expect a decline in an organisation's service at and after the installation of a large system.

Failure has become acceptable, in the same way as the public has become accustomed to lost information about them on CDs, memory sticks and laptops.

Below is an email from the well-meaning and energetic Chief Executive of Somerset County Council, Alan Jones, who writes to staff a week after the go-live of a SAP system on 1 April 2009. Jones refers to "weeks of turbulence".

On BBC R4's Today programme on Monday I spoke of how IT suppliers successfully lobby for new work, with the result that ministers and their advisers are kept busy with proposals for new surveillance schemes such as the one to monitor all emails, phone calls, and use of social networks including twitter and facebook.

As Fujitsu departs the NHS's National Programme for IT [NPfIT] there will be three competitions for the supply of Care Records Service systems to most trusts in the south of England.

BT and CSC, as the two remaining local service providers under the National Programme for IT [NPfIT], will have to compete with other suppliers for orders from southern trusts.

NHS CIO Christine Connelly said at HC2009 at Harrogate that three strategic health authorities in the south will hold competitions under NHS Connecting for Health's Additional Supply Capability and Capacity [ASCC] framework. 

Each SHA will choose a supplier from a list of about 10, which includes BT and CSC.

A post on NO2ID points out that Barts and The London has more patients waiting in excess of 30 weeks for inpatient treatment than any other trust listed in Department of Health statistics. The Government promises patients a maximum wait of 26 weeks.

The statistics are for the month of February 2009.  

Barts and The London and hundreds of its patients have ended up as victims of a politically-charged implementation of the Cerner-based Care Records Service a year ago.

This is an article on the NPfIT to be published in Computer Weekly print edition

If the NHS IT scheme, the NPfIT, were a jumbo jet, its frequent crashes would have put fear-of-flying courses out of business.

But because the NPfIT is not an aircraft crash, there is no wreckage. The damage is not visible. The Trust's undiagnosed, sick, or injured patients have been on a hidden waiting list,lost in the systems. As delays in their treatments are below the perception of the general public they don't seem to matter.

The disorder we've highlighted this week at Barts and The London NHS Trust, a year after it went live with the NPfIT Cerner Millennium Care Records Service, is the most serious problem to afflict the national programme.

The trust's managers are uncertain who among their patients have gone untreated within the government's 18-week target. They have been trying to reduce a backlog of more than 2,100 patients on their 18-week waiting list.

Some of the trust's patients have been discovered months after they should have been treated. When patients go untreated they are likely to get worse. A spokesman for Barts insisted yesterday that his Trust was certain that no patient's health has deteriorated because of delays in their treatment. But we cannot see how they can be certain.

An unscientific poll of a very small number of end-users of new Windows-based systems being installed as part of the £7bn Defence Information Infrastructure indicates that 31% of them rate the new technology as better than what they had before.

The poll is on the Army Rumour Service which has hosted a long-running and generally well-informed debate on progress and problems with the DII network.

Some of those taking part in the debate have been employees of the EDS-led Atlas consortium, which is helping the Ministry of Defence to deliver the DII. Their comments on the Army Rumour Service, if true, are enlightening.

The total votes on whether the DII systems are better or worse than existing systems is only 110. This is a tiny sample given that the number of terminals being installed in the DII project runs into tens of thousands. Still, it's a qualified vote of confidence in the Atlas consortium.

Glyn Hayes, chairman of the Health Informatics Forum at the British Computer Society, gave a brief but frank assessment of NHS's National Programme for IT [NPfIT] at a Westminster forum this week.

Hayes is leading a review of the NPfIT for the Conservative Party.

With Guy Hains, President of CSC's European Group, Hayes spoke about the NPfIT to an audience of Parliamentarians, IT specialists, clinicians and others at the Conservative Technology Forum at Portcullis House, Westminster, on Monday evening.

One of his main messages to an incoming government is not to assume that an IT-based modernisation of the NHS is easy.

"Would a changed government want to cancel the programme? I think the plea is to understand one thing more than anything else: it is very difficult to implement IT into healthcare anywhere in the world and it is even more difficult in England than a lot of other places.

"It is one of the most difficult areas of human existence to put systems into. One of the major problems with the national programme is that politicians at the time thought that if they threw money at it, it would happen in a couple of years.

"It couldn't because it is so difficult. Can they [an incoming government] please remember if it is difficult; and can they please remember there is no magic bullet."

Whenever I've asked BT in the past whether its £1bn contract as a local service provider in London has been profitable and, if not, why it has not announced any losses, the reply has been to the effect that all is well, and that the contract will prove profitable over its lifetime.

Today's Financial Times reports:

"Of £1.3bn in writedowns at [BT] Global Services, £1.2bn was down to two contracts, one of which is to provide IT services to NHS hospitals in London. BT estimated the entire value of that contract, for 10 years and signed in 2003, was £1.1bn."

When civil servants defend the failure of an IT-related project they usually say that the problems are in the past and all is well now.

Last week Edward Leigh, chairman of the House of Commons' Public Accounts Committee, was ready for that answer.

Dr Jonathan Fielden, chair of the BMA's Consultants Committee, said the value of electronic patient records had been established, but that the National Programme for IT in the NHS [NPfIT] was taking too long to deliver them. "At what stage do we cut loose from this spiralling disaster?" he asked.

The EDS/Oracle Joint Personnel Administration [JPA] used by the MoD to pay servicemen and women, and their expenses and allowances, is gaining credibility among some users, says a report published yesterday by the National Audit Office. 

The report which was published yesterday [20 July 2009] says: "Despite the weaknesses in the JPA system, the Army has recently reported that the reputation of the system is improving."

But the NAO also reported that suspected fraud using the system is increasing: a lack of control over claims made on the system makes expenses fiddles possible.  

The two things are definitely not linked. 

NAO report 

Computer Weekly article on the NAO report

Writing in today's Guardian, Vic Lane, a visiting professor of health informatics at London South Bank University, responds to an article by Andy Beckett [system failure?]. Lane says that Beckett's article on the £12.7bn NPfIT was "too negative".

Lane writes:

"...'Should the IT project be scrapped?' No! Let's keep the gains, such as 'Choose & Book', which patients like because it allows them to organise their first hospital appointment.

"President Obama has recently committed $19.2bn for EPR systems in the US. The Americans appear to think it is worth striving for aims similar to those in the NHS project.

"[Richard] Granger resigned two years ago, leaving a good foundation. Perhaps the new management can bring the IT programme to a successful completion. 'No other country has managed to connect up its health-care systems,' says Beckett. Can England be the first?"

Lane's article

Homerton rejects NPfIT FOI request - IT projects blog

"Aspire has been fully engaged with IMS [information management solutions - part of HMRC] trying to meet the three Quantum objectives since early April.

"During [this] time the nature of the challenge and potential for solutions has clarified.

"Aspire is absolutely committed to continue the journey to deliver success for HMRC on Quantum.

"We're light years ahead of where they were five years ago" said iSoft's Gary Cohen, speaking in Auckland, New Zealand.

"Over the next one to two years, we will see a major transformation ... It's a very political process. It's not true that it [the NPfIT] hasn't delivered."

"...We remain convinced that Fujitsu's position is not symptomatic of a broader decline at the top end of the UK IT services market. Recent good progress from other major players such as IBM (£265 million - National Identity Scheme), HP/EDS (£1 billion - Aviva), Capgemini (12.7% growth in 1H09) and CSC (£385 million - National Identity Scheme) show that there is still life in the market for big deals in both the public and commercial sectors...

Below are excerpts from the iSoft's annual report, which is published today [1 September 2009] in Australia. IBA Health in Australia acquired iSoft and has now adopted its name.

The annual report is upbeat about iSoft's Lorenzo, the much-delayed software which is at the heart of the NPfIT, the National Programme for IT.

Lorenzo is due to be installed by local service provider CSC in three of the five regions into which the NPfIT scheme in England is split.  

iSoft describes itself as the "world's largest healthcare information technology company in terms of our global footprint".

These are some of the statements in the iSoft annual report. They're by iSoft or Gary Cohen, who's Executive Chairman and CEO of iSoft Group Ltd.

"Today, having succeeded beyond our expectations, iSoft can truly take its place
as a global leader in healthcare information technology.

In keeping with Australian Accounting Standards, iSoft's annual accounts, which are published today [1 September 2009],  include "certain critical accounting estimates".

These estimates take into account iSoft's contractual arrangements with CSC to supply the Lorenzo system. CSC is the main NPfIT local service provider to NHS hospitals in England, outside of London and the south.

Where the annual accounts have involved a "higher degree of judgement or complexity", or "assumptions and estimates are significant to the financial report" these have been disclosed in Note 2 [on page 82 of iSoft's annual report].

The note refers to the "Consolidated Entity" which comprises the iSOFT Group Limited, its subsidiaries and interests.

It says that if the arrangements between CSC and the Consolidated Entity are terminated, because of, say, material disputes regarding obligations, including the scope of delivery or payments, this could affect iSoft's accounts.

The Consolidated Entity's largest customer contract is the CSC contract in relation to the deployment of the National Programme for IT (NPfIT) for the National Health Service in England.

The CSC Contract contributed approximately 23.5% (2008: 19%) to the Consolidated Entity's total revenue in the year to 30 June 2009.

- Most clinicians and IT managers don't want the National NHS IT Programme abolished - they want it reformed

- Large majority against letting private firms - such as Google or Microsoft - manage NHS patient records

- Strong support for DH to continue development (currently suspended) of HealthSpace, its own personal health record system

"On day one the Trust went live with a single clinic using the system; as confidence has grown, this has increased in just three weeks to around 15 users operating the system. The plan is to complete training of the remainder of the clinicians in order for the whole Department to be using Lorenzo by the end of October 2009."

iSoft sees opportunities in a UK change of government, says its CEO Gary Cohen

"We have taken evidence on cases of poor decision taking and weak project management on many occasions. The same lessons have still not been learnt, making the management by the National Offender Management Service (NOMS) of C-Nomis a prime example of how not to develop a project."

"From the outset those responsible failed to identify the modifications required to the
software to meet NOMS' needs. The Home Office assessed it as broadly meeting the needs of the prison service, but as a North American product the software needed to be adapted for UK legislation.

"In respect of probation, there was a serious failure to understand the magnitude and cost of the changes which would be needed, even though the Home Office recognised at the start that the software met only 29% of the needs of the Probation Service.  The estimated cost of developing the C-NOMIS application rose from £99m in 2005 to £254m by July 2007 due to customisation."

"The programme team running C-NOMIS reported that the programme was delivering on time and to budget, when it was not."

"In May 2005, as part of the C-NOMIS project approval process, the Home Office's
Programme and Project Management Support Unit certified the C-NOMIS project as not suffering from the eight common causes of project failure. Subsequent analysis of the underlying causes of the costs increases and delay by the National Audit Office indicated that C-NOMIS suffered from four of the eight common causes of project failure in full and three in part."

"Planning for the C-NOMIS project was unrealistic, in part because of an over
optimistic 'good news' culture which was not challenged with sufficient rigour by
senior management with in-depth knowledge of the business."

"The first Senior Responsible Owner and other senior people involved with C-NOMIS demonstrated a remarkable lack of insight and rigour, coupled with naivety and over-optimism."

"As a Government we will continue to support the delivery of the national programme for IT in the NHS." Ivan Lewis, Health Minister, House of Commons, June 2007

"The NHS had a quite expensive IT system that, frankly, isn't essential to the frontline. It's something that I think we don't need to go ahead with just now."  

My pick of the best parts of yesterday's debate in the House of Commons on the NPfIT is below. Several things struck me:

-  £600m in savings is less than the increase in the costs of the central NPfIT contracts, which have risen from £6.2bn to about £7.5bn. 

-  Andy Burnham, the Health Secretary, refused repeatedly to answer questions about the added costs of varying the contracts with the local service providers BT and CSC to achieve some of the announced savings.

- Why did the Chancellor Alistair Darling say the that the NPfIT was not essential to the frontline while Andy Burnham gave the opposite impression? Is it simply that the Treasury has a negative view of the costly NPfIT and the Department of Health is defending its biggest project? [One MP says the NPfIT cuts are a way for the Government to remove from the Tories any scope for using savings from the NPfIT as as means to fund a new Tory proposal in the run-up to an election.]  

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From yesterday's debate: