Tony Collins's IT Projects Blog

A new era of official openness over on the NHS's National Programme for IT [NPfIT] began on 26 January 2007. On that date David Nicholson, Chief Executive of the NHS, spent a day listening to criticisms of the NPfIT and to proposals for putting the programme on the straight and narrow.

The event was called "The National Programme for Information Technology in the NHS: Facing the Issues, making progress." The audience of about 80 was individually invited. It included representatives from royal colleges, NHS trusts, the British Medical Association, the NHS Confederation, and suppliers to the NPfIT, BT, Fujitsu and CSC.

Some of the comments made by delegates that day were particularly important. One said safety lessons from implementations were "not being "systematically disseminated". Several delegates agreed that, for the programme to move forward, there needed to be an official admission of the strategic and local mistakes [not likely]. There was also agreement that the programme's objectives needed to be reprioritised.

And a white board was shown of eight challenges facing the NPfIT.

One highpoint of the first hearing of the Health Committee's inquiry into the National Programme for IT [NPfIT] on 26 April 2007 was an exchange between Martyn Thomas, who has called for an independent review of the scheme, and the committee chairman, Labour MP Kevin Barron.

Thomas made a good case for a review of the NPfIT and Barron appeared to remain sceptical throughout. Barron had not particularly welcomed his committee's deciding to hold an inquiry into the NPfIT.

Richard Granger, head of the NHS's National Programme for IT [NPfIT], when asked whether he supported the call for an independent review of the scheme, had made it clear that his door was open to critics whose comments were based on robust evidence.

But Martyn Thomas, visiting professor of software engineering at Oxford University's computing laboratory, emphasised the need for a review that was independent of the programme team

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing, Independent MP, Dr Richard Taylor, summed up the spoken evidence of the first group of witnesses, Richard Granger, Harry Cayton and Dr Gillian Braunold, as "bland platitudes".

These three witnesses had left the committee room after giving their evidence, without waiting to hear what the second group of witnesses - Martyn Thomas, Dr Paul Cundy and Andrew Hawker - had to say.

Speaking to Thomas, Cundy and Hawker, Dr Taylor, MP, said: "I am echoing David [David Amess, Tory MP on the committee]. It is so good to have you three after the bland platitudes we had from the first lot - absolutely refreshing. We were told user involvement was there from the beginning, and you said obviously it was not..."

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of the things that concerns me about the programme is that there is no definition of what is an acceptable level of security breach.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy was asked by David Amess MP: "Dr Cundy, is it a good thing that general practitioners will be offered a choice of suppliers for their electronic record system and does the decision to offer choice represent a change of direction by Connecting for Health and will it mean a less centralising approach to these issues?

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy said: "I know from my system in my practice is that there are times when I, quite frankly, do not have an immediate clue as to what is going on with a patient, and we have 20 years' worth of patient electronic records.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Richard Granger said: "...I would say with the time overruns that one of the problems with this programme is there was no financial contingency.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the first Health Committee hearing MP Jim Dowd asked Richard Granger: "When you say it [the NPfIT] has got more functionality than originally envisaged, is that because the original estimates were just wrong?"

Richard Granger replied: "I do not know of a large-scale IT enabled transformation programme in a complex organisation that from its starting point to its mid point has a direct correlation.

"I think it would be a fantasy to imagine. I know people write fantasies, but in the real world it would be ridiculous to imagine that halfway through a ten-year programme you would only be doing the same things as you set out five years ago.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing the chairman Kevin Barron asked Martyn Thomas why he was calling for an independent review of the NPfIT. Barron's view appeared to be that the facts independent reviewers would discover would already be known to the project team. So why have an independent review? In reply Thomas gave a sound summary of the benefits of an independent review over one commissioned internally.

Barron asked: "Do you think that people who are involved in the National IT Programme at the moment are aware and conscious of those facts, whether reviews have been published or not in terms of that? Do you think they are not capable of knowing that as something in their daily business, as it were? The programme is not without its problems. Are these people who are developing it not capable of being able to do that?"

Thomas replied: "I have reviewed a lot of large technical programmes over the years, and I want to stress, I am not asking to review this one personally, I am not for a second bidding for that job, but my experience of carrying out those reviews is that people get blinded by the fact that they are too close to the project and they get compromised by the fact that they cannot stand back and admit errors.

Connecting for Health, which runs the NHS's £12.4bn National Programme for IT, has responded to some our questions. These are its replies.

A team of people is working to stop medical information going missing after a software upgrade under the NHS's IT Programme led to hundreds of unwanted, incorrect and duplicate patient records being created every day.

The problem involves NHS sites in Greater Manchester and raises questions about how well some systems are being tested before going live as part the £12.4bn National Programme for IT [NPfIT].

Internal documents show that the duplicate patient records are incorrect. They have been created on the assumption that patients do not already have a record - even if they do. If these duplicates are left in place it could lead to clinicians seeing patients without access to important medical history.

To stop this happening, patent records have to merged with the duplicates quickly. If a backlog of unmerged records builds, hospital record libraries could send to clinics, days in advance of an appointment, the wrong patient file based on the duplicate record - which could be that of an entirely new patient.

Hundreds of unnecessary and incorrect patient records have been created daily as hospital appointments were booked on the National Programme for IT's Choose and Book system when linked to iSoft's iPM system.

It has come to light after an Maintenance Release 1 upgrade of iPM system over the weekend of 21/22 April 2007.

The problem means that when appointments are made on some Choose and Book systems in Greater Manchester where the MR1 upgrade has been installed, and the system cannot find the patient's correct identification number on the Personal Demographic Service of the National Programme for IT [NPfIT], it will create a duplicate record.

Connecting for Health, which runs the NPfIT, says that up to 400 duplicate records are being created every day. It denies there is any effect on the care and treatment of patients.

Internal documents show, however, that the problem is being categorised as a potential risk to safety. To avoid accurate patient data being lost in the mingling of correct and incorrect records, a team has been formed to merge the records carefully and safely.

Comment

When Computer Weekly began researching the cause of duplicate patient records at Manchester we contacted one of the trusts involved, the University Hospital of South Manchester NHS Foundation Trust.

The immediate reaction of a spokeswoman for the trust was to say that she had received a note about the incident a few days earlier from Connecting for Health, which runs the National Programme for IT [NPfIT].

"I am looking at it now," she said. "It is saying: 'if trusts have any press inquiries regarding the GM [Greater Manchester] Incident they should contact the Connecting for Health press office."

The note was dated 27 April 2007, several days before Computer Weekly contacted the trust. It seemed, therefore, that neither Connecting for Health nor the trust had issued any statement on the problem of duplicate records in Greater Manchester. They were prepared, however, to make a statement if a journalist rang. This may appear at first to be effective crisis management but it's not a good way to disseminate lessons.

The following are separate events reported as "Major Incidents" to NHS Connecting for the Health, which runs the NHS's National Programme for IT [NPfIT]. The particular incidents mentioned below were categorised as "Severity One".

After attacking the media for inaccurate reporting of aspects of the National Programme for IT [NPfIT], NHS Connecting for Health, which runs the programme, has accused some NHS trusts of "inaccurate reporting" of incidents that involve NPfIT systems.

An academic study of staff views of the progress of the National Programme for IT [NPfIT] locally has found that financial deficits and poor communication have hampered its implementation.

And the study found that continuing delays could constitute a growing risk to patient safety. The research was published online on 17 May in the British Medical Journal.

An extraordinary story reaches me which pushes back the boundary of what is acceptable in government communications - what some call spin.

Not even Orwell in 1984 had thought of this one.

In recent weeks there was a meeting in London where the NHS's National Programme for IT [NPfIT] was discussed. A record of what was said by the main speakers was kept by a reporter who worked for the meeting's organisers.

In 2000 the then Cabinet Office minister Ian McCartney, with the help of Intellect, the suppliers’ association, published a worthy guide on how to avoid IT-related failures.

The guide - successful IT - recommended that one accountable individual should supervise a project. That person should be called the Senior Responsible Owner.

It was a good idea, a corrective to flawed custom. Too often senior civil servants retired or were moved off projects as they began to understand its complexities. A senior responsible owner would see a project through from the time it was conceived to the point that the benefits became tangible.

The McCartney report said that reviews of successful IT projects in Singapore had found that in every case the scheme was sponsored by a senior manager, who was held accountable for its success.

But the McCartney recommendations have become, in the main, a tick-box exercise. Leon Trotsky said that ideas that enter the mind under fire remain there securely and for ever. At the other extreme, there is the Office of Government Office which doffs its hat and asks those running departments and agencies whether they would, if they wouldn't mind, consider taking seriously the idea of senior responsible ownership.

And so, this is what has happened since the McCartney report was published:

- The Office of Government Commerce, which is part of the Treasury and which oversees good practice, complaisantly asked departments and agencies to appoint senior responsible owners of IT projects.

- Sir Humphrey shuddered involuntarily at the idea of one person being held accountable for any IT-related failure.

- Expediency or self-serving reactionism prodded the heads of some departments and agencies to appoint, as senior responsible owners, civil servants who were due to leave or retire before the project had been completed.

In May 2007 Gordon Brown said in a speech: "Government must be more open and accountable to Parliament".

But Computer Weekly has learned that government action to try and stop publication of reports on the £12.4bn National Programme for IT in the NHS, and the £5.3bn ID cards scheme, could stall the release of the information for years - despite rulings by the Information Commissioner that the documents should be made public.

It was known that the Treasury's Office of Government Commerce was to go to the High Court under the Freedom of Information Act to try and stop the publication of early Gateway Reviews on ID cards. Gateway reviews are independent assessments on risky IT schemes at various stages in their lifecycle.

Computer Weekly has now learned that the High Court case is unlikely to take place before June 2008. This is nearly two years after the Information Commissioner Richard Thomas ruled that early gateway reviews on ID cards should be made public.

These early gateway reviews are already ageing - they were written in 2003 and 2004.

A political documentary to be broadcast on Monday evening, 24 September, on Channel 4 was filmed in part at the offices of Computer Weekly.

Channel 4’s “Dispatches” documentary on Monday 24 September 2007, to which Computer Weekly contributed, questioned whether the guardian of public spending, the National Audit Office [NAO], is too close to some of the departments and agencies it audits.

Labour MP David Taylor, an auditor by profession and former computer manager, told the programme:

If the US military accidentally destroyed some small buildings in Nevada it would be illogical if it countered critics by saying that its explosive experts successfully left thousands of other buildings in America untouched.

If Her Majesty’s Treasury managed to flush £300m in cash into London’s sewers it would be illogical if its defence for public relations purposes was that the money represented less than 0.1% of the government’s annual spend.

The HM Revenue and Customs [HMRC] is using the same peculiar logic – spin - to trivialise its mistake in issuing up to 14,000 incorrect penalty notices, of £400 a time, to companies that have filed annual returns on time. This is the third year running that HMRC has accidentally and automatically issued incorrect penalty notices.

HM Revenue and Customs [HMRC] said this afternoon [9 October 2007] it is cancelling incorrect penalty notices to employers centrally and is writing to companies to let them know.

It's also saying that the number of incorrect penalties is fewer than six per cent of the 202,000 notices issued on 24 September, so fewer than 12,120 companies are affected, it claims.

It's still investigating the cause and so it's unclear how HMRC knows how many companies are affected.

The Revenue has a reputation for playing down its mistakes and persuading the National Audit Office to do the same in its reports on the department's finances and administration. So we're not sure whether its assurances on the number of employers that have received incorrect penalty notices are based on fact, extrapolation from samples of incorrect penalties or wishful speculation.

After being contacted by Computer Weekly HM Revenue and Customs confirmed on its website that it has issued incorrect penalty notices. Thousands of employers are affected. I then asked its press office: “How did it happen? Will HMRC be publishing a full report on how it happened and the lessons learned to assure employers it won’t happen again?

HMRC replied with commendable speed.

MP Richard Bacon, a member of the House of Commons' Public Accounts Committee, says that new passport holders will still have to pay for an ID card, even though the new passport will carry broadly similar data.

HM Revenue and Customs [HMRC] says it will sue US-based services supplier EDS unless the supplier steps up compensation payments for failures in its IT support for tax credits, which led to tens of millions of pounds in incorrect payments to claimants.

The Revenue’s chairman Paul Gray says his officials have carefully archived “millions of relevant documents” in preparation for a court case he hopes will not happen.

The tension between the two sides comes after they signed a unique deal in November 2005 in which EDS agreed to compensate HMRC over tax credits by paying £71.25m with £26.5m of this contingent on EDS winning new UK government contracts.

By the end of 2006 EDS had paid less than £250,000 of the £26.5m – and at that rate it would have taken more than 100 years to pay off the full amount.

HM Revenue and Customs [HMRC] gives the impression it would enjoy its work more if it could avoid communicating with the world outside.

The problem is not its people. The senior civil servants at HMRC I have met have been genial and intelligent. But beneath the feet of HMRC’s finest runs a thick sediment that keeps them from advancing. Worse, they accept the organisation's reputation for poor communications as an orthodoxy that shouldn't be opposed.

This is an example.

Sir John Bourn, head of the government's spending watchdog the National Audit Office, is to retire on 31 January 2008 after coming under pressure to quit.

The Liberal Democrats earlier this month called for his resignation after he ran up large bills for foreign travel and some meals.

Analysis

A former Whitehall official has revealed that he and his colleagues were given 10 minutes to make the case to the Prime Minister over what became the world’s biggest civil IT-based modernisation programme.

The disclosure was made by Sir John Pattison who was headquarters director of research and e-champion at the Department of Health. He was speaking on BBC Radio 4’s “Wiring the NHS” documentary on the £12.4bn National Programme for IT [NPfIT], to which Computer Weekly contributed.

HM Revenue and Customs has struck a deal with its IT supplier Capgemini that cuts the annual technology spend by hundreds of millions over the life of the contract. The agreement compensates the company with a contract extension worth more than £1bn.

I've posted on this blog answers to questions I had put to two senior executives who are running the £5bn contract for a new Defence Information Infrastructure [DII]. They talk about the scheme’s progress, problems and lessons learned.

It’s difficult to avoid making a comparison between their openness on the DII and the defensiveness of officials over the NHS’s National Programme for IT [NPfIT].

Both are huge IT-based programmes. Both schemes have a one-size-fits-all approach. And on both projects those with old technology welcome having it upgraded, though others complain when their advanced systems are replaced with something that does less in the interests of all.

But there’s a big difference in the way the MoD and the Department of Health confront dissidents.

In this blog entry the two leaders of the £5bn Defence Information Infrastructure contract [DII], who represent the Ministry of Defence and the Atlas consortium of suppliers, led by services company EDS, answer our questions about progress and challenges, and the lessons learned.

Their defence of the DII follows a joint investigation of the DII by Computer Weekly and Channel 4 News. Bob Quick, the MoD's programme director for the scheme, and Howard Hughes, Chief Operating Officer of a consortium of suppliers, Atlas, did not deny there have been problems but said the scheme was on a sound footing.

**

Why was there a need to change the DII contract in December 2006? [The Atlas consortium was awarded a DII add-on contract, increment 2a, worth an extra £750m, in December 2006. The first increment was worth £2.3bn to Atlas. Under increment 1 about 70,000 systems should have been delivered by mid-2007. Today only about 16,000 terminals have been delivered.]

Bob Quick said:

“The contract wasn’t changed. We did add at the end of 2006 another increment. It’s an incremental contract to de-risk the delivery. At the end of 2006 increment 2a was added which is a further set of UADs [user access devices such as desktop systems and laptops]. The programme has had some challenges as we have rolled forward.

“As of today we [have] in the order of 16,000 UADs and about 56,000 account holders. The early part of the programme very much concentrated on the delivery to the users who had some of those older systems because we needed to get the infrastructure out there to support the HR applications, both civilian and military, and some of the other defence change applications coming through.

“So we certainly were not rolling out the volume of UADs that we anticipated at the time of contract award. But we have now done about 400 of the 600 sites in increment 1 so [we're] about two thirds of the way through in terms of sites. The number of terminals we are now rolling out has ramped up over the last few months and we are regularly rolling out 3,000 and 4 ,000 a month which will assist in getting the programme back to the combined plan for [increments] 1a and 2.”

The two leaders of the £5bn Defence Information Infrastructure contract [DII], who represent the Ministry of Defence and the Atlas consortium, which is led by services supplier EDS, have spoken about progress and challenges, and the lessons learned.

Ans