Reduce the power of the centre

Gordon Brown’s attitude to the NHS IT programme and its critics is appalling. He demonstrates a casual disregard for facts and reason.  He is more interested in what is politically expedient than what is good for patient outcomes.  He does not recognise what can and has gone wrong.  The public purse is his to plunder, redistribute and waste.

The bizarre aspect of this is that he could have reasonably blamed his predecessor, Tony Blair, for instituting (and rushing) such a huge project during one of his infamous sofa sessions.

(It seems telling, by the way, that the NHS IT programme’s successes were not part of the original brief.)

Q60 Mr Leigh: So how are you going to maintain the pressure now on efficiency?

Mr Brown: Because departments now have very tough targets that they have to meet in relation to efficiency for the future. You chose a number of high profile projects. I disagree with you about the NHS computer. I think it is a necessary project. I think the fact that it is a difficult project does not mean to say that it is not —–

Q61 Mr Leigh: £12 billion spend, four years late, Fujitsu having pulled out, Lorenzo only working in one ward in primary care trusts. Do you think that is a great achievement, Prime Minister?

Mr Brown: And patients are getting electronic prescriptions now, people are being able to book their hospital appointments from their computer. You cannot say that that is not an advance, for all the huge problems that a huge project like that has created.

That reminded me of Seamus Milne: “For all its brutalities and failures, communism in the Soviet Union, eastern Europe and elsewhere delivered rapid industrialisation, mass education, job security and huge advances in social and gender equality.”

Likewise, one cannot say that Iraq’s improvements in literacy rates was not an advance, for all the problems created by Saddam Hussein’s ‘learn how to read or go to jail’ policy. 

[Gordon] You want to abolish it. I say that that is a necessary —-

Q62 Mr Leigh: I do not want to abolish it. I want it efficiently.

Mr Brown: No, you do want to abolish it, and I think that is a necessary —–

Q63 Mr Leigh: When have I said that?

Mr Brown: Your party has. I am glad we have now found that he disagrees with his party.

In fact the Conservative party has not said it is going to abolish it, so that is a falsehood.  They said they are reviewing it (an independent review chaired by a Dr Glyn Hayes).

Q64 Mr Leigh: My last question is that you are going to rely —–

Mr Brown: I just say that with something like the NHS computer it is easy to say it is of no use to anybody 

No-one has said “it is of no use to anybody”, therefore Brown is being dishonest (in using a straw man).

but actually it is providing the electronic prescriptions, doctors’ records are being kept, at the same time as providing a means by which people can book hospital appointments.

 

For tens of billions of pounds…  and we still haven’t got a working system.

Now, no-one (as far as I know) is saying that these are undesirable goals – what people are saying is that such projects could be handled better.

Including, by the way, the National Audit Office and the Office of Government Commerce.

Fine, don’t believe me, or the NAO or OGC.  What about the Chief Executive of the Royal Free hospital in Hampstead, London?

The head of one of the first hospitals to trial the new NHS summary care records system has apologised for the “heartache” the system has caused staff and said the disastrous implementation cost his hospital £10m.

Andrew Way, chief executive of London’s Royal Free Hospital, said he still supported the concept of electronic records, but that his staff have been let down by what they were given.

“I think it is very disappointing that the work we had to do as a trust has caused our staff so much heartache and hard work,” he said.

“I have personally apologised for the decision to implement the system before we were really clear about what we were going to receive. I had been led to believe it would all work.” …

Or Nigel Edwards?

… director of policy at the NHS Confederation, which represents over 90 percent of NHS organisations in the UK, also criticised the roll-out.

“This isn’t the first hospital to have very significant problems with implementation and in particular this issue that it doesn’t quite fit local systems..,” he told the BBC.

“Hospitals need to be able to tailor what they’ve got to their needs rather than being given this one-size-fits-all solution.“

(29 related articles)

Once again, directing at this level from the centre leads to serious problems – and, in the case of medical systems, this can risk not only the public purse but perhaps more importantly the health of patients.

But Gordon & co. do not care.  Their way is the right way.  Their critics are all wrong.  Even when the evidence suggests we are right.  The NHS and healthcare are politically too important for the centre to decentralise or devolve.

Tony Collins at Computer Weekly:

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. …

I do not normally stray into commenting on such things (except for my page on Government IT Gone Wrong).  But to me this is symptomatic of the general malaise with this Government: everything must be dictated from the centre; but when something goes wrong it isn’t the centre’s fault, or at least no-one resigns; lessons are not learned; Ministers aren’t competent or experienced within their portfolios (only one Health Minister is a former frontline healthcare worker, for example); there is a lack of scrutiny and accountability; … need I go on?

According to the NAO and OGC, what are the common causes of government IT project failure?

1. Lack of clear link between the project and the organisation’s key strategic priorities, including agreed measures of success.
2. Lack of clear senior management and Ministerial ownership and leadership.
3. Lack of effective engagement with stakeholders.
4. Lack of skills and proven approach to project management and risk management.
5. Lack of understanding of and contact with the supply industry at senior levels in the organisation.
6. Evaluation of proposals driven by initial price rather than long term value for money (especially securing delivery of business benefits).
7. Too little attention to breaking development and implementation into manageable steps.
8. Inadequate resources and skills to deliver the total portfolio.

The NAO and OGC see these same problems time and again, and it is the taxpayer (and patient, in the case of the NHS) who bears the brunt of the results.  With the NHS IT programme for example we hear that the frontline healthcare workers were not properly (if at all consulted).  Isn’t its a ridiculous state of affairs, when a frontline healthcare workers are not properly consulted about a healthcare system that they are going to have to use?

I suspect there are similar problems in non-IT related but nevertheless ‘large’ projects or policy changes directed from the centre.  They are simply too ‘big’ and complex to micro-manage from the centre, and the wrong people have influence on them.  That is not to say things can not or must not be changed – but they must be handled in a more appropriate way.  We also, as I mentioned above, have Ministers who are not competent or experienced within their portfolios or the work they have taken on / been ordered to do.   There is also an interest in leaving a ‘legacy’, and then there are are the factors involved in Parkinson’s Law:

1. An official wants to multiply subordinates, not rivals;
2. Officials make work for each other.

With medical records, for example, they could have agreed (with healthcare workers and patients) a minimum standard for how medical records should be stored (the minimum required fields in the database, e.g. name, allergies, current medication), and any number of companies (as opposed to five) could have then competed to develop the best software to meet those requirements.  Alternatively we could have followed the example of some other countries and stored the information on cards that the individual becomes responsible for carrying around.  

Of course that would mean they wouldn’t have a treasure trove of medical data to trawl.  I’m reminded of the LSE’s alternative to the National Identity Scheme – in short, all the data would not be stored on one central database, but on the individual identity card (backed up by trusted third parties, such as banks, chosen by the individual).  Rather less objectionable (although I would still object to it) than the Government’s scheme, which by the way is no longer based on Blunkett’s one new gold standard database, but a meta-database based on the DWP’s Customer Information System and the Passport database, to be trawled by the police, security services, and (probably) council staff.

And of course there is always the alternative of doing nothing.  But then, if politicians chose to do nothing we might question the justication for their existence…

There seem plenty of alternatives to micro-managing from the centre and starting huge, unwieldy projects and policy changes, and it seems well past time that we started exploring them. One benefit of this is that having a number of different solutions would enable us to see what happens in practice.

But sadly (and dangerously, in relation to healthcare) we will not see this Government exploring any other alternatives.

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