Some years ago my GP's surgery moved to a new, purpose built building and my doctor proudly informed me she was in charge of the new IT system. "Prescriptions will be generated by computer; test results will be much speedier as hospital administrators will email them instead of snail mail; I'll be able to make immediate specialist appointments with local hospitals," plus a series of other wonderful innovations I don't recall.
More than 10 years on only two of her forecast have come to pass. Prescriptions are computer generated and test result are only slightly faster - about a day. The specialist appointment dream she had hasn't come to pass and I remember once asking why. The problem appeared to be with the NHS IT system and nothing to do with the surgery's software.
It comes as no surprise to me that a series of botched government IT projects has left taxpayers with a bill of more than £26bn (yes billion) for computer systems that have suffered severe delays, run millions of pounds over budget or have been cancelled altogether.
Parliament's spending watchdog has described the projects as "fundamentally flawed" and blamed ministers for "stupendous incompetence" in managing them.
Further evidence has emerged over the failings of the mammoth £12.7bn IT scheme to revolutionise the NHS. Just 160 health organisations out of about 9,000 are using electronic patient records delivered under the scheme. The vast majority of those were GP practices. Millions of pounds have been paid out in legal fees and the taxpayer has footed a £39,2m bill for "legal and commercal support" for the National Programme for IT (NPfIT).
We were supposed to have access to our health records online by 2005 but the Department for Health is still "years away" from fulfilling the pledge.
A project that was meant to save the Department for Transport about £57m eventually cost £81m and workers at the DVLA were forced to brush up their language skills when computer systems gave them messages in German.
The Department for Environment, Food and Rural Affairs paid £350m to allocate subsidies to farms but left British farmers more than £1bn out of pocket.
The MoD's Defence Information Infrastructure project is running £180m over budget and 18 months late and is now set to cost £7.1bn.
The list goes on. I reiterate what was said in one of yesterday's posts:
Based on evidence from 60 senior civil servants, analysis published today from the Institute for Government, an independent charity which aims to improve government effectiveness, points says the office of the British premier has more concentration of power than any other developed country.
“In contrast,” it adds, “the fragmentation and lack of coordination at the centre of the civil service – the Treasury, No 10 and the Cabinet Office – leads to an administrative centre that is relatively weak. This curious situation has created a strategic gap at the heart of British Government, which inhibits the ability to set overall government priorities and translate them into action.”
The government is in chaos. The only answer they seem to have to any problem is to throw money at it. Will the tories reduce this extravagance? I won't hold my breath.
"To err is human - but to really bugger things up, use a computer"
.... who are the big businesses behind the contracts that make money out of these unlearned lessons in futility - or perhaps I'm being naive, as the real lesson being learned is how to fool politicians and management that a computer system (the more expensive the better - obviously)will magically solve problems?
So sad, so true. These programs seem to originate in Government with people,including Ministers, whose only idea of IT is the last Science Fiction movie they saw, and they believe the computers in it are real.Beyond that, IT is a closed book. Based on what they think they know, contracts are issued, and signed by people who know IT but have only a hazy idea of the hazy idea that the Government thinks it expects of the system.The company thinks that it can develop and deliver what the Govt thinks it wants, but did anyone think to consult with the real customer, the people who will actually have to use the system 24/7 and do a job with it?
No. Of course not.can't do that!
So the first the workers know is being introduced to a system designed by people with a grand idea but not a clue of the real needs of the operators of the system,built by people who thought they could make it work.The whole thing complicated by ad hoc alterations to the contract,and vital pieces cut out to save a few thousand, which will cost millions in extra work when the system goes live and it has to be used!And then its discovered that there is not enough bandwidth between sites, so the system runs as fast as cold treacle, and operators spend half the day waiting for the screen to update.
You can understand this happening once, but not every damned time.
And remember that every computer will currently have a copy of M$ windows whatever as the operating system, at a unit cost of about 130 quid,why not use open source operating systems virtually for free?
A re-think of the whole procurement system is needed, and make sure people making decisions are qualified to make them, and that especially includes the politicians. Getting the best possible advice means nothing if the person being advised can't understand, or worse still totally ignores it, which seems to be the current situation.
This waste has been going on for 12 years Clarinda. You would have thought at least civil servants would have realised by now when they're being conned.
As for the politicians all they want the contractors to do is say a system will work. They don't have to believe them anymore than we believe politicians.
Apogee, I can see you've had experience of this whole fiasco.
Your last paragraph says it all but I do think this government has been far more irresponsible with our money than any other in my lifetime.
It was my impression that the NHS IT fiasco was England-only. I thought that Scotland had gone for interlinked small systems.
Hospital Computing and the Costs and Quality of Care:A National Study
David U.Himmelstein,Adam Wright,Stefie Woolhandler
American Journal of Medicine
CONCLUSION: As currently implemented,hospital computing might modestly improve process measures
of quality but does not reduce administrative or overall costs. Based on a survey of 4000 hospitals
If we were to dig we would discover IT companies full of ex-civil servants.
IT consultants that I have asked "why are gov IT schemes so rubbish" tell me that it is generally because they go for the cheapest offer and then try to get it to do something bigger than it was designed for. That is certainly the case of NHS Connecting For Health which is why Fujitsu walked out on it a couple of years ago.
To be fair, a while ago I tried 'choose and book' for a specialist appointment and it went very well; not that there was much to choose because there is only one unit dealing with my condition within 50 miles.
Morning SR: I have a great solution. Let's leave the UK and set up on our own!!
Seriously, I'm was overawed when I had an Xray in one hospital and saw it on a computer screen in another hospital an hour later. I took longer to get there than it did. So I suspect that teh Scottish system may be a lot better than the NHS one.
Certainly the farming situation was better in Scotland. I understand that the EU allowed 2 systems for compensation payment, and all the countries chose one of them, and England chose the other....
It possibly is mainly an English matter Brian but I do know my doctor's surgery spent a great deal of money on a system which took years to connect to the main NHS Scotland one.
Also they still can't make an immediate specialist appointment while you're sitting in the consultation room.
That's what my doctor was thrilled about. She's retired now and the promises which were made are still to come to fruition.
That wouldn't surprise me in the least OR.
Ah banned, good for you. We don't have that system here as yet as far as I know.
It doesn't surprise me in the least banned what your IT folk say. Having spent the morning listening to Geoff Hoon speaking at the Iraq Inquiry, I've decided politicians are wingers. All of them. The more intelligent listen to the advice of the informed but many are so in love with their own egos they can't even do that.
Aye they're doing quite a good job here with test results too, especially scans and Xrays.
I didn't know about the farming situation. Interesting. Could it be worth you doing a post about that to emphasise the difference between here and the rest of the UK?
Tris - your well-observed impression of proficient interlinking and discrete radiology systems was possibly due to the fact that Consultant Radiologists were involved in the choice and design of clinical IT that actually fulfils their criteria and not some isolated management fantasy in a NHS procurement office.
Well researched information and figures Rosa; but where do you start, to explain this phenomena of vanity stretching to absurdity.
Generally I argue that there is no reason or principle why a publicly run organisation should be any less efficeint in its management and performance than a commercial operation; but its obvious from your examples that practice has been customised to make the commercial bidder the predator and the public sector the fatted bovine.
First off, no commercial operation would have entered into these contracts without first reviewing their objectives and auditing the price with the envisaged savings. It would take too long here to go into the clauses than need to go in to invitation to tender documents and specifications.
Suffice to say the customer doesn't need to know how it will work - that's up to the contractor - but he has to know how he wants it to work and what he wants it to do and have a reasonable idea of what the benefits are against the costs.
What the customer mustn't do is give the contractor the impression or leeway to believe he can take advantage of the bovine and turn it into a cash cow.
IT systems, Edinburgh trams or war- mongery. it's obvious the public bovine's have neglected their brains and over developed their udders.
I'm a bit busy at the moment, but give me £10m and 12 months and I'd reduce the NHS admin costs by at least 33%, half of which I'd invest in the medical staff and back up and leave the rest for the Treasury.
Systems, IT or otherwise, are all well and good, but get the core of the organisation, whether it's commercial or country, firing on all cylinders first.
For that you need the wisdom of Solomon harnessed to the energy and commitment of Hercules and somehow I just can't see that criteria being met by Westminster or Whitehall.
Or does it happen because of a heap of brown envelopes?
Now that is interesting Clarinda. We other areas of speciality involved or did they show no interest?
'Suffice to say the customer doesn't need to know how it will work - that's up to the contractor - but he has to know how he wants it to work and what he wants it to do and have a reasonable idea of what the benefits are against the costs.'
Crinkly, I think Clarinda has explained to Tris part of the reason for the problem. If the Scottish NHS Consultant Radiologists can involve themselves in the development of their sector of IT, why did others appear to do nothing? Were they disregarded by their superiors or was their attitude one of apathy?
Were they even asked their requirements?
The Army Pay Corps IT system was one which caused many problems for rather a long period. I understand the IT provider involved was given full information regarding the requirements yet the government refused to fully fund the necessary software. This resulted in an ineffective system which required a great deal of extra money thrown at it to even ensure it was workable.
Apogee is spot on.With over twenty years in the cooncil, my experience is that it's always done on the cheap, the frontline workers complaints are fobbed off with assurances that it's all in hand, and they then have to cobble together a system which works(sort of)just to do their job.
The bosses have to substantiate their pay now Conan, let's be fair. Then they can say they've made 'efficiency savings'.
I'll see if I can find out when it was SR... It was compensation for something, but I can't remember what, and I'm not sure when ... a couple of years' ago I think.....
I just remember thinking that all the countries of the EU, including Scotland did it one way, and the English did it the other way. All the farmers of the EU, including Scots farmers were paid timeously, and the English farmers were not....
Maybe some other reader remembers...?
Rosa - you provide the contractor with a specification. That's why it's necessary to know comprehensively what you want.
When he submits his tender you check it covers all the bases then draw up a contract that relates performance to price.
In your Pay Corp example, if the IT provider was provided with the full scope of the demands on the system and the software requirements were part of it, then the cost should be borne by the contractor - he hadn't met the spec.
If on the other hand the software were designated by the government as a separate cost centre then it comes back to bovine dis-jointed thinking. For a system to be a system it must work - no use having renewable power generation in the Pentland if it cannot get into the grid sort of thing.
The radiographers is an example of how it can work but, and here I'm surmising, they were probably asked because of the technicalities involved in their speciality - transmission of x rays - scans etc.
For the rest of the NHS I doubt if they were asked to contribute to the systems requirments
Rosa, if you decided you wanted an extension on to your house, you would have a fair idea what you wanted it for, where you wanted it to be and what you wanted it to look like. You wouldn't just ring up a builder and ask him for a price for so much square feet of an extension, then watch as he builds it where you don't want it?
Stupid illiterate contracts are where the contractor turns up every month with a wheelbarrow to collect his variation to contract gains. Government contracts seem to be of that persuasion.
Was it the mad cow outbreak Tris? I remember something then around the time Brown became PM.
Crinkly, if my memory serves me well that did happen (the Pay Corp giving the spec).
The software company quoted the government and the government said it was too expensive. Thus the Pay Corp received a system which could not do what was required.
After many add-ons etc the whole system had to be revamped at tremendous cost to the taxpayer. The hoohaa was well covered by labour spin merchants at the time and of course the military couldn't say much.
I've also heard certain other contractors were incompetent although given the jobs. Makes you wonder.
A link sent to me. Pinch of salt springs to mind:
SR: I don't think it was Mad Cow; that was a mainly English thing; this was a Europe wide thing, and I heard a lot about it on "Farming Today". I think it was in the time of Hilary Benn being the Secretary of State. I'm sorry I can't come up with it. It's a poor argument that you can't sustain with a link, or even remember the subject. All I remember thinking was trust Labour to get it all wrong when every single one of the rest of us got it right!!!
It was payments and they were mioles behind. Rnglish farmers were having to go the bank and ask for overdrafts because the payments were so late. Scottish payments were on time! (Just as well, as our banks have bugger all money to lend!!)
I'm sure someone will come up with the solution!!!
Tris I think Westminster tied us in the their Mad Cow policy for a long time although I think Richard Lochhead did some negotiating because there was none here.
I'll keep thinking.
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