Feature

Published: 26/09/2002, Volume II2, No. 5824 Page 3 5 6

NHS IT is facing another period of turmoil.How is the rest of government getting on? Steve Mathieson reports

The past year has seen some big changes in the government's approach to IT. First, There is the money. Chancellor Gordon Brown has announced a 43 per cent increase in healthcare spending over the next five years, and the Wanless report, which accompanied the Budget, suggested healthcare IT spending should roughly double from the current level of£1.1bn a year.

More money, some of it explicitly targeted at IT developments, was announced for other central government departments at the end of the government's second comprehensive spending review.

Second, but less happily, the government has been extending its, already strong, surveillance powers - most recently in the Anti-Terrorism Act rushed through after 11 September last year. This strengthened the state's powers of electronic surveillance, which were already considered overpowerful by civil liberties campaigners because of the introduction of the Regulation of Investigatory Powers Act 2000.

RIPA allows the police, intelligence and other law enforcers access to telephone billing and e-mail traffic data - everything about a message except its actual contents. The Anti-Terrorism Act gives the government powers to force internet service providers to hold on to this data traffic for a year, rather than three months as was previously the case. The government has also refloated plans for ID cards.

However, there was a small retreat on the surveillance front when home secretary David Blunkett shelved a widely opposed extension of RIPA that would have allowed public bodies - including parts of the NHS - to demand communications data.

The biggest changes in government IT policy, however, have been taking place away from the headlines. Government IT has a reputation for high-profile failure.

In 1999, British Aerospace chief operating officer Peter Gershon wrote a report on government procurement that suggested setting up an Office of Government Commerce.He got the job of implementing his own idea.

In March, OGC negotiated a bulk contract between the public sector and the world's largest software firms. This should cut the cost of Microsoft's software by around£100m over three years, though it also encourages public bodies to consider Microsoft's (often cheaper) competitors.

But it is the 'gateway review' scheme for attempting to head off IT disasters by monitoring projects that is winning the most praise.

Gateway reviews are fairly standard practice in the private sector. A project gets formally and independently reviewed a number of times during its development, rather than being judged a success or failure after completion.

OGC has five standard gateway steps, plus another for the very start of higher-risk projects, a review called 'gateway 0'. Three to five assessors will take about four days to complete, and deliver, each confidential report.

The new NHS IT programme went through 'gateway 0' in May, though health service projects do not have to go through the gateway process.

Ian Johnstone, NHS Information Authority head of project governance, says: 'We benefited from both the review and from the experience the review team brought with them.'He feels the NHS 'will significantly benefit from implementing the gateway review process'.

The number of big government IT disasters seems to be in decline, and Philip Virgo, secretary general of Parliament-industry liaison group Eurim, thinks the gateway process is partly responsible.

'Those contracts are being thoroughly gone over.

The problems turning up are from old projects, ' he says. 'Very little has been agreed over the last year or so, as they are being subjected to very thorough review.'

But Mr Virgo feels government procurement could get even better: 'One of the things that is beginning to emerge is a clear swing against big projects, in favour of thinking big but starting small within an interoperability framework - then scaling up fast if works.'

Gary Barnett, IT research director at analyst firm Ovum, thinks any reduction in disasters has much to do with peer pressure, with contracts that pay on results and with projects in which some risk is shared. 'Some of the high-profile cases have certainly made people more circumspect, ' he says. This applies to the big suppliers, as well as to the civil servants. Suppliers seem happier than they once were.

'Broadly, government is going in the right direction, ' says Nick Kalisperas, e-government programme manager for IT suppliers' association Intellect. 'The inclusion of broad IT targets in the comprehensive spending review is very encouraging: it accepts that IT can be an important measure in a department's performance.'

'Any process that gives some rigour to the procurement timetable has got to be welcomed, ' adds Mike Turley, head of government practice at consultant PricewaterhouseCoopers, one of the few firms capable of bidding for big government projects.

Of course, the torrent of government spending means the vendors are unlikely to baulk at working with OGC. Private sector IT spending has collapsed after a spending boom during the dot. com bubble.

The public sector is the only growth area left. This in itself is easing one of the perennial problems of government IT: recruitment.

Despite the sudden availability of resources, one of the government's big IT targets - electronic government - looks to be in trouble. This requires all services, including those from local government, to be available 'electronically' - though this is an elastic definition. For example, it includes 'through a web-enabled call centre'.

'Lots of councils have websites, which is great, but if you ask a simple question like 'what are the schools like in my area?', It is very difficult to get an answer, ' says Mr Barnett at Ovum.

NHS Direct is invariably cited by ministers and e-government enthusiasts as a model transactional site. But most local NHS bodies have a long way to go - some primary care trusts do not even have their address on the web.

Meanwhile, research by the Society of IT Managers found that last winter just four of the UK's 467 local authorities had fully transactional websites, with a further 22 per cent reaching a secondary category.

The government is giving all local authorities£200,000 for e-government work.However, Glyn Evans, head of e-services for the London borough of Camden, one of the councils with a transactional site, says there will be a huge call on private sector capacity to meet the targets.

One move that may help is an increasing enthusiasm for open-source software. 'E-envoy' Andrew Pinder, the civil servant in charge of delivering e-government, recently backed this concept.

Much derided by companies like Microsoft, open source involves removing licence fees from software and encouraging users to collaborate on improving the programme's underlying source code.

Tameside council, the first local council to produce a 'transactional'website, has made the structure for its site freely available to other authorities through the government's Pathfinder scheme for sharing council expertise.

The big problem, for the public sector as for the private sector, is that computers merely make improvements possible. Getting the full benefit requires 'business process re-engineering', jargon for changing the way an organisation works.

'A lot of government departments are putting in electronic service provision which is not necessarily connected to the rest of the organisation, ' says Mr Turley at PricewaterhouseCoopers.

He knows of departments where a response to an e-mail enquiry takes 15-20 days.

As a result, there is increasing government interest in knowledge management systems - software that stores and retrieves an organisation's intellectual capital and so helps to complement fast communications with faster decision making.

Team working New Labour is determined to make public services focus on their users as consumers.

Since public services are now large and, from the user's perspective, fragmented, this requires IT.

In the NHS, for example, care is increasingly delivered by teams. But patients often feel shuttled from one part of the system to another, generally at the convenience of the staff involved.

IT has the potential to smooth the patient journey by giving the team - and even the patient - access to the same records and information.At the same time, it reinforces the concept of teamwork and so forces change.

IT projects across the public sector are starting to emphasise electronic records and modern communications that both aid customer service and encourage new ways of delivering it (see box, page 5) - a trend already familiar from the private sector.

Companies in direct contact with the public have become increasingly reliant on computers as they have closed down local stores and offices - the demise of the bank manager is an obvious example.

Call centres only work because staff can instantly retrieve the information held on customers when they dial in - great for dealing with quick and simple queries, but less good for long-term relationships.And the majority of public services fall into the latter category.

The consensus view on Labour's IT performance is rather on the lines of its slogans from the last two elections. In 1997, with confusion over policy and a string of poorly procured projects heading for collapse, things could only get better. In 2002, a lot has been done - but There is a lot more to do. l Comprehensive victory: the criminal justice system Criminal justice was the single biggest IT beneficiary of July's comprehensive spending review.

Chancellor Gordon Brown allocated more than£600m of extra funding over three years towards a unified case-file system, due in 2005, boosting the project's total budget to£1bn.

The funding followed an admission from prime minister Tony Blair in June that 'many of our criminal-justice IT systems are still in the Dark Ages'.

The Audit Commission believes that delays in criminal justice cost£80m annually, partly due to IT-related problems.

The criminal justice IT programme plans to implement a secure e-mail system between the police, courts, Crown Prosecution Service, prison and probation services by the end of 2003.

This will be followed by a central data exchange, allowing police officers on the beat to transmit and receive photos, along with data from the police national computer.

Court officers will have similarly comprehensive access to case information.By 2005, victims too should have online access to the progress of their cases.

Sounds familiar? 'There are a lot of parallels between criminal justice and health, and their need for common records across organisations, ' says Trevor Patchett, head of consultant PricewaterhouseCoopers' health practice, who spent 18 years as an NHS administrator from the 1960s to the early 1980s.'Both groups involve sets of 'silos' that do not have a good track record of collaborating.'

Law and order has a reputation for nightmarish IT projects that rivals, and may even exceed, that of the health service.The CJIT programme, which aims to bury this legacy, is similar to the NHS's multi-billion pound IT development programme.

The NHS already has a secure e-mail system in the shape of NHSnet, but is similarly set to try and build new structures around electronic records.

'In some respects, the NHS is ahead, ' says Mr Patchett.'It already has NHSnet, and is going for renewal, but it needs to beef up its bandwidth.You have electronic patient records in some trusts.

'But what the NHS hasn't tried to do is scale it all up, to see if it can work for the whole population.'

There is an obvious difference in scale between the criminal justice system and the NHS.

Relatively few people are 'clients'of the first, while the whole population may use the second.

But the state of their records is similar.

'The data is held by a number of agencies, some on disk, some on paper, ' says Jeremy Barnett, chair of the IT panel at the Bar Council.Rationalisation will be 'a vast undertaking'.

Mr Barnett identifies two main issues - both of which also haunt the NHS: 'There is the harmonising of standards for data and resolving access rights.'

Brychan Watkins, head of IT for the City of London police and head of the Society of IT Managers'police group, says that a secure e-mail system is vital.

'If a policeman sends an e-mail to a solicitor, then the solicitor has to know it is from that police officer, and only that solicitor can be able to read it, 'he says.'This is something that has to be done nationally - you can't have lots of different authentication schemes.'

Mr Watkins does not think the system's full implementation will save much beat-officer time.

'They may provide information through a workstation rather than a typewriter, but they will still have to provide it, 'he says.'I think it will have an effect on the back-office administration, reducing the number of staff just handling paper.'

Neither does Mr Watkins think data sharing will improve the efficiency of the justice system - at least, not on its own.'This is something that has to be done, because without it, a lot of other process changes can't happen, 'he says.'But in itself, it will not fundamentally change things.'

Eventually, however, the system may change working practices. For example, Mr Watkins says, it could enable the CPS, which uses the evidence gathered by the police in court, to work more closely with police officers.

Mr Watkins says the CJIT project is only now a realistic prospect.

'We have now reached a point when internet technologies, such as XML [a very widely-used data standard] and PKI [encryption], mean we have the necessary technology. I do not think this was possible five years ago.

'There is been an enormous increase in standards, driven by e-commerce.We have a fighting chance of making this work.'