Sunday, 15 February 2009

Why The UK is short of Superbandwidth

Brown's Leadership self-delusions - Again
In 2003 Chancellor McBrown auctioned wireless bandwidth to the major Telco's who wanted to set up 3G mobile phone services. At the time McBrown thought he had got a good deal because the Telco's mortgaged their futures to the tune of £23bln. Unfortunately for them 3G has never really taken off and they have wasted most of the £23bln. Meanwhile McBrown has spent the £23bln. Now we hear that the UK is behind on installing megabandth width broadband and Wi Fi points in public places. This has to be due in part to the Telco's having mugged for £23bln and now being short of sufficient readies to invest in new services. Now guess what? McBrown has decided that through his visionary leadership new wi-fi and broadband capacity is needed and that he intend to make it happen. Is it too much to assume that if McBrown had not led the Telco's up the Primrose Path to 3G Auctions we might have had a decent broadband and wi-fi service for the UK already?

There's something odd about the NPfIT suppliers

Isn’t it odd that so many of the suppliers to NPfIT have troublesome financial records?
Firstly there is CSC which a year or so ago had trouble getting approval from the US financial authorities when closing its books, or it couldn’t actually close the books in time. Then there is iSoft which had an investigation into accounting irregularities in the UK two years ago. Note: iSoft is now owned by IBA Health of Australia and their shares have underperformed vs peers. IBA Health has also suspended dividend payments. Finally there is Allco in Australia, which owns 35% of IBA Health Group and they cannot get approval from the Australian financial authorities to divest a subsidiary. Also Allco’s shares have underperformed from some strange reason. Then there is BT that is losing its shirt, and mine, on Global Services.
Check these sites for more details:- http://www.capital-chronicle.com/2008/03/aussie-regulators-on-ball-as-always.html and http://www.healthtechwire.com/Projour-Singleview.206+M5d7e8fe4389.0.html
What’s going on with these companies? Is it the curse of NHS?

Something else to consider about NPfIT; With the exception of BT the entire programme appears to be being developed, and operated by foreign companies using mainly foreign labour and foreign software. This means the bulk of the £18bln will find its way into the profits of CSC and EDS – both based in the US. Accenture who cannily pulled out before their losses got too high – based in the US. Fujitsu – based in Japan. HP and IBM based in the US. Cap Gemini – based in France. IBA Health based in Australia. Microsoft/VMWare and the majority of the other operating system suppliers – based in the US. Indian sub-contract staff, 10’s of 1,000’s of them – based in India. No Buy British here then!
One assumes Prime Minister Brown and his Cabinet are satisfied with this result. Perhaps it is part of the master plan to help ‘Save The Global Economy’?

Thursday, 12 February 2009

BT Reports Fall in Profits - Again

Judging by the number of times BT has issued a profits warning it is more and more obvious that they did not and still do not know what's been going in their Global Services Division which is now declared to lose over £500mln. What a shocker! But perhaps not. It was widely known last Summer that BTGS was in trouble and that too many under priced contracts had been signed. In essence BT management acted just like the bankers who have been heavily criticised of late for dodgy deals and not being sufficiently contrite.
Questions to Mr Livingston, the boss at BT;
Why has it taken so long to understand the depth of the problem?
How long will the earnings hits continue?
What is being done to recover bonus payments made to those who over egged the earnings forecasts and signed up for the bad contracts?

Questions for The Secretary of State for Health, Alan Johnson;
If BT GS have over sold to their management the costs of IT for NHS what are the true costs going to be to the UK tax payer?
Will NHS IT have to renegotiate the contracts to ensure the losses sustained by suppliers like BT GS are not passed on?
In the light of continuing failure of suppliers to NPfIT will NHS IT be reviewing the capability of its chosen suppliers to continue to deliver before they fail or pull out?
As all public service contracts are subject to specific rules about offering accurate prices and not under bidding (which BT-GS seems to have done) have these rules been broken by BT?

Questions for the boss of Ofcom;
If BT GS obtained these contracts by under pricing their bids do their opponents in the bids have a case for malpractice?
As BT is legally obliged to bid for contracts within certain price parameters and seem to have ignored them to win business has BT broken Ofcom's own rules?

Question for the Prime Minister;
Is Mr Livingston still on the short list of knighthoods yet to be awarded?

Wednesday, 11 February 2009

NHS IT Strategy - Some Recommendations and Possible Solutions

Following my previous blogs in which I criticise NHS IT I guess it is only right that I should offer up some ideas and solutions to the problems. So here goes.

Organisational Reform Is Needed: Firstly assuming that NHS continues with its current structures and remit one has to make do with what’s in place and perhaps make some changes in the various established groups that are part of the UK Health sector. I refer to The British Medical Association, The Colleges of Dentistry, Nursing, Mid-Wives, Surgeons and other similar groups. These should be asked to take on the skills and quality management side of each of the professions, and if there are not similar organisations for para-medics, ambulance drivers, and hospital management, they should be sponsored and set up. These groups, which I would call Guilds, should not do anything that intrudes into the area of Trade Unions as the support and championing of the workers (cleaners to surgeons) should be via Unions whereas Guilds would champion quality and skills. Currently the BMA, for example, gets too involved in trade union type work while trying to ensure clinical excellence. This creates a conflict of interest which is never properly resolved and hence service, and the patients, suffer.

Understand That Our Health Is Part Of The State Of Our Being: It is not something managed for us by the government. Neither is it apart from how we live. It should be seen as part of the whole of life. Which means that our health systems must be integratable with our other life systems like; email, calendars, iPod, mobile phones, Facebooks and the like. Thus health systems have to be as user friendly and based on open standards and architectures which allow integration and assimilation. This would enable easier usage, and thus greater usage and uptake, leading hopefully to better health.

Empower The Health Sector Staff; by ensuring they are consulted and included in decisions and solutions design. Give them a part of the £18bln to spend within their team. In the previous blog I facetiously said it would be possible to give each person in the NHS £10,000 to spend on their personal IT and still have £3bln change left over for central solutions. If this £10,000 were pooled by team, or task force and all the members of the team voted on the best way to spend it, it is almost certain that this will give better solutions and value for money than the current Big-Brother-knows-best approach. After all – it has been shown that Big Brother most certainly does not know best as he has over spent by a factor of three and is late by 5 or 6 years in providing a solution. Can you imagine a team of ward sisters over spending their budget by such a factor, or waiting six years for their new IT to work for their wards?

Create More Openness and Support Empowerment; by publishing every statistic available on the components and participants in health. The Guilds could play a role of ensuring that stats are accurate and meaningful and auditable. But first publish everything that is to hand and deal with the inevitable entrenched power groups who prefer to keep information to themselves. Too often we hear that the public can’t be trusted to understand the information given to them. This is patently wrong. In every instance where the public are given the correct information they enhance their lives by making the right decisions appropriate for them and thier families. The statistics could be easily available via something like Swivel.Com which is now the universal repository for statistics and graphs. This would make it cheap and easy to do. The benefit would be that anyone from anywhere could look at the NHS performance, and query the results, offer suggestions for improvement and use the best ideas which deliver best performance. It would thus demystify NHS reporting and create support for it.

Address Only Specific High Priority and High Profile Items: rather than trying to be all things to all people and creating a universal messaging and record tracking system, beloved of apparatchiks and bureaucrats – which is where most the IT spend is currently focused, the NHS IT strategy should be enabling strategy which allows multiple solutions and applications to communicate across a common open back bone, ie the Internet. As many people die from infections picked up in hospitals why not focus an entire set of solutions on this problem, which seems to start from infected patients bring in the infections to staff and visitors spreading them? For instance simple monitors could be attached to disinfectant hand sprays located at entrance doors to see how they are used and to ensure they do not run out of disinfectant by flagging up empty bottles. For patients when first entering hospital there should be a monitoring system used to ensure they are checked and what the results are. Once outbreaks occur graphic map over lays of the hospitals could be used to show the extent and depth of infections. This information could be made available to all hospital staff to keep them informed and alert. Another area that consumes a lot of time and money is the movement of non-mobile, normally old, patients to and from hospitals. From personal experience I know of examples where; 80 year old people spend an entire afternoon in an ambulance moving around London in order to get home from a morning appointment, or where ambulances have turned up to pick up a patient with insufficient staff to help move them, or the right equipment or the driver does not have the right directions. Thus many patients miss or are late for appointments or are traumatised by the experience. In addition too many ambulances travel too far from base to pick people up. Instances of 200+ mile round journeys happen all too often. Most of the scheduling is done via telephone and recorded on pencilled log books, leading to many mistakes of recording, transcription, and interpretation. A fleet management system would pay huge dividends. The list of issues goes on. An empowered work force would be able to come up with the most important ones to act on, assuming someone listens to them. Start with the people – not their quasi unions.

Sunday, 8 February 2009

Why NHS IT Won't Work

Let's look at some basic facts about NHS to see there is anything there that explains why the IT Strategy has gone very wrong.
1. It is the largest single IT project anywhere in the world.
2. It is charting new waters and just like Starship Enterprise, goes where no one has gone before.
3. The NHS with its more than 1.5 million employees is the single largest employer in Europe. Only the Chinese Peoples Liberation Army, Indian Railways, and Wal-Mart employ more people.
4. With one exception there is not a single country in the world that uses the UK's NHS model of providing health services. This exception is not Russia (even Stalin wouldn't inflict the NHS in his people) he had the gulags to help deal with them. Mind you given the death rates in some of our hospitals, passe Maidstone General, we might want to reclassify them. It is not Japan, where centralised management and pulling together is a strong ethos. Neither is it any of the socialist Scandinavian countries. It is in fact that country well known for creative management and a people centred view of life; North Korea, which is hardly a role model that anyone would want to boast about. But there you go.
All the above tells us that this is going to be high risk, high spend, slow and very difficult. Yet as the single biggest project in the UK government the NHS IT is not reviewed regularly at any depth by the Cabinet.
So, without a wholesale restructuring of NHS it looks like a recipe for failure to me. Do the English and Welsh have stomach for restructuring? Is there a politician out there capable of articulating what needs to change? Without such a person I am afraid NHS will continue to fail, the IT project will never succeed, and all the investment will be wasted.
As we all know neither the Labour Party not the Liberal Democrats can bring themselves to ever have a frank debate about NHS's issues. Anyone who says anything mildly critical is given pariah status. It is probably left to the Conservatives to come up with something. But as a 'contaminated brand' and 'health pariah' anything they do will always be suspect, no matter how sensible it may be. They also have the problem that Andrew Lansley MP, Shadow Health Secretary, has had a charisma bypass and is almost invisible to the public. What does he stand for? What will he do to improve matters when in power? Is he just waiting for Labour to fail and is keeping quiet because he has so little to add, confining himself to unambitious tinkering at the edges of NHS. It's not a very inspiring picture is it?
I have now drifted away from IT to the much bigger and more complex problem of what to do about the delivery of health services in England and Wales. See further blogs over the next days for some thoughts.
Meanwhile back to NHS IT:-
Let's now discuss the chosen solutions. The one based on iSoft is the place to start. This package was originally designed work within the precincts of a health practise and by all accounts worked quite well. The problem is that it was decided by the solutions providers, CSC and others, to base their solution on this product. Smart move you might say. But unfortunately as anyone with experience in IT will tell you, taking a small scale system and stretching it to a wider geography, across multiple locations, with hundreds, if not thousands, more users, is doomed to failure.
Accenture who should know better had this very experience when they rebuilt a small scale shop application more suited to a local corner shop than to the core of a solution for a stores chain, British Home Stores. That failed and Accenture bailed out once they saw it wouldn't work and would not make money for them. Just like they have done in NHS, and who can blame them! In essence scaling iSoft up to mega health region size is rather like taking a tug boat design and turning it into an aircraft carrier. It might float but will it be fit for war?
In addition, there has been the problem that many of the iSoft founding management left as fast as they could once they cashed in the share options based on an inflated share price due to iSoft being part of NHS IT. Thus we have a complex, overly political customer taking on a much amended and stretched solution. Which is where we are today.
The technical solution to all this is supposed to be Lorenzo. The next version of iSoft's solution. Now what odds am I offered that this will work on time too? How about 100-1?
Those are long odds you say, and given that iSoft has built up all this experience they can surely get the version right. Ok then, let's build on the tug boat analogy. SS iSoft was built in a local boat yard on the Isle of Wight, and now the builders have to move operations to Clydeside to design and build a Nuclear Submarine, something they have never done before, just as the boat yard owners and managers have taken their cash and emigrated to new villas in the South of France. Does 100-1 sound too long now? I don't think so.
But surely the systems integrators with the NHS contracts can make it work? Unfortunately they have found out they have bitten off more than they can chew. As mentioned before Accenture a world class systems integrator has cut and run. Others will almost certainly follow soon. Those left struggling to make this work (which interestingly includes CSC who picked up the failing BHS stores solution from Accenture several years ago) have probably found they have invested several times more than they bid and are suffering cash flow problems as a result. They have also put a huge amount of management focus on getting iSoft up and working (much of it with subcontractors in India) and thus have not spent sufficient energy, cash, and management time to turn their cobbled together HMS iSoft aircraft carrier into a Lorenzo nuclear submarine. They have also got a dysfunctional client to deal with and are not totally to blaim. But they are culpable.
Where does this all leave us? It leaves us with £18bln spent on IT that won't work or won't be used because the client has decided to buy elsewhere, and with NHS trusts who are going to commision their own solutions. Which is where this should have begun. What an expensive lesson?
You know it would be cheaper to give each NHS's 1,500,000 employees £10,000 to buy their own IT to help do their job better, and it would leave £3bln spare.
See later blogs for ideas on NHS IT.