Mathew Swindells, the interim chief information officer for the NHS technology programme, has left the organisation to join a private sector consultancy. Swindells replaced Richard Granger, the UK's highest paid civil servant, who was running the project. He left in January. Granger said at the time he was leaving because the …
"...if the long-term interests of NHS patients and taxpayers are to be protected"
A change of direction then. The interests of neither of these groups have been of concern up 'til now. Just the shiny technology and its soundbite potential.
And no, I can't think which faceless civil servant might be next with the poisoned chalice.
Let's do an Apprentice
Get Alan Sugar to muster together a few likely CIO candidates and put them through their paces on TV.
This would make the NHS look interesting, and could even help fund the new CIO's salary.
What an apt name seeing as we've all bee Swindelled!
They should appoint Paris, even she would do a better job :-)
Action at the HIGHEST level?
"Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected."
Come on. Stop trying to "sort out" the problem by just replacing the people at the top. The people at the top don't matter, because they don't know enough to make useful decisions. At the midlevel, get a group of people who actually know what they're doing to specify the project and hire a decent firm to do the actual work, not the usual idiots who get the contracts.
Having said that, I haven't heard about an Accenture account since their work at RPA where...oh wait, they were shockingly crap again. Try actually getting decent people to do the job for once, and don't believe the rest (Crapita) when they tell you they can do it faster and cheaper. They can't.
Here's a thought...
This job seems to be a revolving door to the outside world...
Why not instead of getting another internal NHS flunky looking for their exit plan, etablish a board of I.T. directors from the private sector who on a voluntary basis act a the steering comittee for this entire project. That way you will have access to professionals who have handled large system integration activities, vendors and their shenanigans and actually have intelligent articulate people providing oversight.
Too good an idea?... all right I'll get me coat...
It's the civil service, stupid
As with other public IT sector projects the contracting firms are not directly the problem. Their competence is demonstrated by the relative success with which they carry out private sector IT projects (without which they wouldn't be the size they are). Sure they screw things up in the private sector, but not to anywhere near the degree that every public sector project goess off track.
The real problem is with the lack of competition in the public sector which makes a successful IT project more dangerous to its employees than one that fails. If something goes well then the IT system may well make large numbers of admin jobs redundant (this, after all, being the big advantage of well planned IT resources). If everything goes badly then civil service jobs are secured and, with no competition to the NHS, there's no risk of going out of budgets being cut due to incompetence (quite the reverse, in fact).
Of course, these thoughts would be disastrous to make public and so the civil service engage in endless project reengineering and scope changes to ensure that no contractor has a clue what's expected. They reward these contractors handsomely on a per diem basis to ensure that they're happy to take the money and shut up and long-term silence over the incompetence/active malice of the civil service in these projects is ensured by keeping the same big suppliers on every project no matter how badly the project goes as long as they agree to keep quiet about where the blame really lies.
Until that side is fixed we'll get an endless cycle of 'EDS/Accenture win big project. Big project fails altogether after years of going disastrously over budget. People demand investigation. Investigation doesn't happen. EDS/Accenture win another big project.'
Externally sourced project management with clear lines of control and pay related to project completion would go a long way to solving it, but clarity isn't a government strong suit.
Been Contracting in and out of the NHS for years you meet the same Management on different NHS sites no matter what cockup they've made so you can garuntee it'll be another job for one of the old school ties
a view from the coal face
I've worked at Connecting for Health for a few years now. My observations from the coal face are thus:
- Permanent staff are not always managed properly e.g. many don't have annual objectives or development plans. There are many hugely skilled CFH staff but their efforts are not always formally recognised. A culture of absenteeism and "flexible" working has developed with the result that attendance is not managed properly if at all. Together, these things serve to erode the enthusiasm and commitment of the very members of staff CFH should be trying to retain / keep motivated.
- CFH represents a very difficult operating environment for permanent staff and suppliers. Clinical leads are often constructive, insightful and supportive but this is not always the case. It's hard to engage some clinical leads due to their busy diaries and trips to conferences overseas with the result that programme teams don't always get the input they need when it's needed. This results in assumptions being made by people who don't want to see programmes slip any more and Clinicians in the NHS sometimes slating people's best efforts when they've tried to keep things moving in the absence of timely input from subject matter experts.
- There's too much complexity. The scale, ambition and delivery timetables for programmes means that it's often difficult for CFH staff (and suppliers) to get definitive answers to questions. This can lead to confusion and a reluctance by suppliers to do the right thing where doing the right thing significantly increases their delivery schedule and the associated costs.
- The plurality in the provider / supplier model leads to inefficiencies. Work packages are given to different suppliers and new teams each time. This means that time is wasted getting new supplier teams up to speed on basics, when retaining suppliers / teams that already have the basics would ease the pressure on CFH staff and reduce risk of non delivery.
- CFH often itself overlooks the challenge of the programmes being delivered. CFH staff (and most of the time its suppliers) work very hard and seldom get any recognition (not least due to the constant slating in the press). CFH could help by making more of a deal out of the CFH permanent staff who do a great job in often very trying circumstances. The leadership of CFH is strong, but not always visible - this would also help matters.
Here's what I'd do:
1. Implement proper annual objectives, line management and attendance management. There's too much sickness absence, coming in late, going in early, or in some cases, just not turning up at all.
2. Clinical leads need to be better managed and work the same days each week.
3. CFH needs to manage knowledge better for the benefit of staff and suppliers
4. Look at the way suppliers are engaged / managed / integrated into CFH programme teams
5. Get the CFH leadership team to celebrate success and individual achievements more frequently.
n.b. Paris - because she'd brighten the place up a bit and give us all something to laugh at.
didn't see this one coming
the NHS has never treated IT as part of core business. The only way that this project is going to work is if it is headed up by a doctor who has the professional respect of healthcare workers, together with an IT team.
Anyone who has done this sort of work knows that buy-in is crucial to success, but the problem is that the only clinicians who are involved in this monster cock-up are the Nu-Lab Apparatchik moths who cluster round the flame of doom. Unfortunately this analogy does not pan out, as the moths don't get a horrible roasting death. But here's hoping.
If there wasn't already an OS highly proven system from the US Veterans Affairs, all this might be excusable. As it is, it is a fuck up on a par with Iraq, with similar costs and likely death toll, which could have been easily and cheaply avoided.
What happens next?
Is he bailing out, who is going to clean up the mess? Or are the little ones going to pay the price again?
Surely we need some long term accountability from people who starts IT projects and bail when its tanking thanks to their incompetence.
swindells--nomative determinism at work
Hmmm... first this week, we had a certain Mr. Brands advocating a global ID scheme. Now we have Mr. Swindells leaving the NHS. I wonder will we have a Mr (sick as a) Parrot replacing him...
You don't have to look towards the US for a proven medical system, again like the US it military related - UK Defence Medical Services has it.
So, you are a senior civil servant and get this job. A vendor comes up to you and offers you a consultancy job if you ensure they are awarded a large chunk of this pork barrel. You go with a nice golden handshake to a job where you don't have to do anything and nobody gets to pin you with the blame for the fact that you were shockingly incompetent and wasted tonnes of tax pounds.
Of course that's probably not how it happened but you can't help wondering.
Dare we say Deming? Of course we do.
Would the combined prospect of reduced costs, fewer mistakes and greater job satisfaction be a step too far? Or would you be Daft enough to challenge what has already been done, and will be done again? -Toyota, spring to Mind, though they are by no means the only company.
Extensible Quality Philosophies, to be adapted as needed with all 42 Gain -all dimples and smiles, not pimples and smiles -which would be a most Healthy and Heartily Wellcome Tonic?
CFH needs to show it is working for end (l)users
Speaking as one of the 'health professionals' (no not a doctor or nurse - there are other clinical professionals in the NHS) CFH needs to engage with end users. Most do not see any advances in IT *which bring any improvements to the way they do their job*! A few regular small working improvements would improve the image of IT among the ward/clinical department users. As one of those hated departmental developers who produce small projects for their department, I find that CFH has promised urgently needed projects but in my case - we would have been waiting since 1997 for one project (displaying at ward level if discharge prescriptions have been received and if completed). This saves the equivalent of one wte each day answering the phone! Our trust IT was completely uninterested in the project and has disparaged it at every turn. But it does something which people need and use.
CFH from our point of view suffers from
1. those who are/seem incompetent - never leave and treat anyone else as computer illiterates
2, those who are competent, get hiked off to so-called 'strategic projects' and are never seen again
3. competent and leave to join private business at much higher salaries
4. IT projects which are promised in 3 yrs and delivered in 13 or more years (I've been in theNHS 22 yrs so I HAVE seen this)
5 projects delivered only to find that clinical practice has moved on on the intervening 7+ years and the delivered project is not easily upgradeable
So NHS staff ARE disillusioned with IT - no wonder why - I have no doubt there are talented people in NHS IT - just cannot seem to see them.
PS - my profession is a level 3 part of CFH so I'm told. At this stage there is apparently NO date to even START any specification! Judging by delays at the first level I will be retired by the time our specialty is recieving its component of CFH
TUX because I only use Win98/2k/XP for games (or writing those 'hateful' projects...)
Deming, constancy of purpose, etc.
Trouble with the Deming approach is that although it's largely proven to be effective in many parts of the world, it's largely incompatible with top level management dominated by clueless accountants, lawyers, and the like, especially when the corporate goals never last longer than 18 months before there's another round of cost savings.
Other than that it's good stuff.
Bernard, those who work for the NHS are not civil servants.
Also, the idea that EDS/Accenture/Fujitu etc are blameless is wrong. They were eager to take the money and apparently happy to be involved in a succession of IT failures. If they know it will fail, because "civil servants" will sabotage it, and they have professional standards, why do they keep signing up to these things? Because they make big bucks out of it regardless of the final result. To me that makes them complicit.
Its a sort of drug pusher - user scenario. Which is the pusher and which the user? That depends on your perspective, but neither are innocent of blame, and both are tainted by the relationship. For one side it is about the money, for the other, the need.
Re: Let's do an Apprentice
I don't know about you, but Amstrad was a by word for cheap tacky electronic goods that fell to pieces.
Hey son, here's you new hifi. Gee, Dad you shouldn't have bother, really you shouldn't have bothered.
Ill Do it!
Looks it gona go tits up so putting me in charge wont hurt!
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