Category Archives: IT-E-government

Data death/data lives

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Saw this report in today’s Guardian having just read the Connecting for Health 05/06 business plan. Surely if there’s one thing that would get the medical profession motivated about the benefits of C4H its that in a few years it will as a result (see Financial Times article on Monday) in an unparalleld national dataset on patient health which can be mined? But that opportunity will be wasted if the bureaucracy issue is not sorted:

“Tens of thousands of lives are being lost every year in the UK because medical researchers are hampered by bureaucracy in obtaining patient data, according to scientists. A report published yesterday by the Academy of Medical Sciences said that large population-scale medical studies are in jeopardy because of an “undue emphasis on privacy” by regulators.”

NHS Connecting for Health Response

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I was interested to read the NHS Connecting for Health response to the Medix survey of GPs on the progress to date. Perhaps CfH should set up a simple feedback site using Blog/Wiki technology, like Patient Opinion for patients, to encourage GPs to give their views? Also check out the Rod Space piece on this story.

“NHS Connecting for Health recognises that communicating with clinicians from a range of disciplines is essential. Our National Clinical Leads have been strengthening links with professional bodies representing clinicians through national clinical advisory groups, speaking at conferences, meeting with their peers and building networks. In addition, they have been ensuring that the views of the clinical community are represented to NHS Connecting for Health.

“Our own MORI research shows that NHS staff want to be engaged at local level. We have therefore been working through the Strategic Health Authorities to ensure that responsibility is shared and delivered at local level. For example, over a million leaflets went to NHS organisations last year to distribute to their clinicians and staff about the NHS Care Records Service. Further communications to NHS staff are planned.

“MORI work surveyed a range of NHS staff not just doctors and overall, the findings are positive:

  • Staff are supportive of what the programme is trying to achieve and consider it an important priority for the NHS.
  • Around half of staff are favourable towards the programme and around a quarter are neutral.
  • According to MORI, NHS staff awareness levels of NPfIT are as high as could reasonably be expected given that it is a relatively new initiative.
  • Staff agree on the benefits of the National Programme for IT (NPfIT) – that it will improve patient care, improve access to information and release more time to be spent with patients.

“It is well known that there is usually a dip in confidence in IT change programmes as early implementation gets underway – this is the phase that NHS Connecting for Health is in. Once people become familiar with new systems their confidence rises. For example, the Quality Management and Analysis System (QMAS) – delivered by NHS Connecting for Health – that enables GPs to get paid for the quality of their care is now ubiquitous and the survey shows that 75% of GPs think it is important.

“Media reporting tends to pick out the negative items. But there is much to be positive about in the full survey:

  • 59% of GPs and 66% of hospital doctors say that clinical care will be significantly improved in the longer term by NPfIT.
  • Over 50% of GPs and 40% of hospital doctors say they have had some / a lot of information about the NPfIT.
  • The majority of doctors are either neutral or think NPfIT will improve their working lives in the longer term.
  • The majority of doctors agree that NPfIT is a priority for the NHS.
  • Half of GPs and the majority of hospital doctors are neutral or positively supportive of NPfIT.

“However, the survey did not give doctors the opportunity to comment on some NPfIT services. For example 94% of GPs’ premises have had a new high speed, backed-up broadband connection installed at their surgery under the N3 programme. This is a foundation stone of NPfIT and the N3 programme is ahead of schedule.

“Concern was expressed on expenditure on NPfIT. However, the aggregated buying power via NHS Connecting for Health of the combined NHS has delivered huge savings over previous piecemeal approaches to IT procurement. Central purchasing of core systems will save the NHS an estimated £3.8 billion over ten years.

“We accept that the NHS has found it challenging to implement Choose and Book, due to the complex technical integration of old and new systems and the organisational and cultural change that is required. We have worked with the NHS to support their implentation efforts. Once people start to use it they become more supportive. Most importantly, Choose and Book is really valued by patients who have used it, they like the certainty of getting an appointment and when it suits them.

“A majority of doctors say there has not been adequate “personal” consultation with them about NPfIT. This is unsurprising given there are nearly 100,000 doctors in England. There has been significant consultation and discussion with doctors’ leaders and representatives and many, many clinical reference groups and user groups. In any case, 5% of responders are satisfied with the level of personal consultation. In aggregate this suggests some 4500 doctors have been personally consulted.”

Good news for patients

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Some good news – the national launch of Patient Opinion took place on 3 January:

There’s lots of official information about the NHS available on the Internet. You can find out which hospital got 2-stars and – if you’re persistent – what the MRSA infection rate is. But what people also want is to find out what other patients thought.

Patient Opinion, (www.patientopinion.org.uk) which launched nationally this week is an independent website where patients can do exactly that. It represents a revolutionary exercise in public feedback on health services that takes free-form patient stories about their experiences and creates structured data that can drive service improvement.  So a patient being referred to a particular speciality can review what previous patients at a range of hospitals thought about the services – for example did they think the wards were clean? And they can add their own experience to help future patients.

Patient Opinion’s founder Sheffield GP Paul Hodgkin says: “Although our start up funding comes from the Department of Health and South Yorkshire SHA, Patient Opinion is structured as an independent, not-for-profit social enterprise and we generate income by selling collated themes and reports to Trusts and PCTs. Subscribing Trusts also get the ability to direct data feeds of interest to relevant managers and clinicians.” He added it has been developed in support of the NHS Choose and Book programme in order to help patients decide where they want to be treated. It complements official NHS statistics and star ratings and as well as being independent, it is confidential and free to patients.

Livio Hughes, director of Headshift, the UK’s leading social software internet consultancy says: “We were determined to avoid turning the Patient Opinion site into yet another token ‘patient’ website. Instead, the communication model uses a range of social software tool and techniques – from patient weblogs to feed aggregation – to create reliable patient-generated reputations for individual departments and services, and shares these with prospective patients at the point when they are choosing a provider.”

The site’s system is simple, easy to use and requires patients just to tell their story in their own terms – it uses a specially-designed social tagging system to learn from the informal language used by patients, rather than forcing them to use official medical and healthcare terminology. Patients are given a treatment diary and the system will help them prepare for consultations with doctors. It is also the first major application to achieve real-time web service integration with NHS.UK to ensure information is up-to-date and relevant.

E-Government comes to the fore

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A few developments appear to be bubbling up in E-Government, starting with the Adam Smith Institute publishing a report critical of UK efforts to date:

“The UK’s e-government strategy is fragmented and producer driven, says Andrew Lomas, and will never deliver its full potential benefits to the public. By contrast, tiny Estonia has re-thought its government systems around the new technology – resulting in much higher online access to government services and great public satisfaction.” It calls for an IT minister to be given Cabinet level status.

Secondly, I understand that Tony Blair is going to grasp the E-Government nettle this month and launch a major policy initiative.

Of course all this gets covered in comprehensive detail in William Heath’s www.idealgovernment.com/ site.

Tony’s Tea

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Just came across this interesting snippet on Kablenet on Tony Blair’s webcast:

Tony Blair wants to follow up on his ‘day in the life’ website broadcast with similar online projects despite criticism that the video amounts to a propaganda exercise.

The video, released on the Number 10 website at the beginning of January 2006, was put together by an in-house production team which followed the Blair around “for some days”, a spokesperson for the prime minister told Government Computing News.

The slick three and a half minute film is claimed to offer the public an insight into the prime minister’s daily routine, but opposition MPs have criticised Blair for using a government website for issuing a political statement.

Among the clips, the video shows Blair holding a mug of tea as he addresses reporters, standing next to various world leaders and listening to home secretary Charles Clarke during a Cabinet meeting.

Transformational Government IT strategy

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There’s promising proposals in ‘Transformational Government’ for small innovative suppliers, despite explicit mention of their potential contribution being dropped from the draft. Note that in the final supplier management section it refers to the encouragement of standardised contracts etc in the belief that: “This should allow departments to incorporate additional products and services from other suppliers including SMEs.”

In particular the two items from the key vision which focus on a move to design IT-led services around the needs of citizens and business, and for the Government to move to a shared services culture, bodes well I believe for social software specialists who can deliver innovative and value for money on both counts. For example within a section on shared services, looking at information management, the document looks at collaborative working which would be greatly assisted by wiki-based systems.

It will also be interesting to see how the role of Customer Group Directors work out, charged as they are with leading “the transformation of groups of services to customers, especially for those which cut across organisational boundaries”. As it is one thing to talk about reducing silos and another thing to make that happen as anyone with real-time experience in public sector project management will confirm. Nevertheless in conclusion it recognises the ambitious scope of the strategy “but with strong foundations laid in the next few years it should be entirely achievable”.

To respond return comments by Friday 3 February 2006 to: itstrategyprojectteam@cabinet-office.x.gsi.gov.uk

The Brazilian connection

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I had a very pleasant journey back to London in the company of Nicholas Wood-Dow who was at the conference to promote open source software. We touched base on a few topics including Brazil and the connection between the Brazilian ambassador’s wife Lucia Flecha da Lima and Princess Diana, open source software of course (the best example in the public sector being its use by the German Government), and even the Cambridge connection (him Cath’s & me Christ’s). I mentioned I had worked briefly for Linux User magazine (which also included contributions from Dr Douglas Carnall), and said I thought an article on how NASA has used GNU/Linux could motivate key policy makers who love shuttles and space stations and all the rest.

Nick also mentioned the fact that another Nick – Nicholas Negroponte – chairman and founder of the MIT Media Labs, has produced a sub-$100 PC  to run on Linux  and as I found out is aimed at children in Brazil, as well as China, Egypt, Thailand, and South Africa. It was launched at the the World Summit on the Information Society earlier in November.

eAccessibility’s 70% failure rate

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The last session titled ‘No Citizen Left Behind’ focused on the complex issues of exclusion from e-services, a feature of all EU states. Kevin Cullen, of the Work Research Centre, summarised the usual solutions to bridge the digital divide from possible policy measures like universal service through to targeting excluded groups (indeed there is a service for older web users in my local inner city community centre which maybe I should take a look at).

On the important issue of accessibility Barry McMullin of  Dublin City University launched the eAccessibility of public sector services in the European Union report. A long title for a study which found that 70% of the 436 sites (around 305 sites) surveyed failed to meet the basic Level ‘A’ standard. Not surprisingly it also found that there was a significant correlation between states with strong policies supporting website accessibility and accessibility of those sites. I was hoping the worst offending EU websites would be revealed by Barry but of course for the purposes of the study this information was anonomised. However, Barry did tell me that the detailed data has been provided in confidence to each of the members states so they can locally do whatever further they think is appropriate. So look out public sector web managers if your’s is one of the 70%!

 

Time for the E-Government Conference

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Now that I’m sort of recovered from last night’s footie and post-match drinks, I’m here to distill some highlights from the E-gov conference. So far liked the mention of ‘co-creation’ as an engine of change from William Heath from Kable. Also enjoyed Sean Smile from Accenture pinpointing the value of customer group directors who will take charge of customer groups as part of the new IT strategy.

Of course there are plenty of familiar themes, in particular the stress of the benefits and risks of sharing vs protecting individual’s information for example. This was highlighted by the chair of the Soham Enquiry Sir Michael Blancard, who also emphasised the need for cultural change within organisations to go alongside new technology to effect the glittering prize of ‘transformation’. Specifically that staff need to feel they occupy an environment in which they feel confident they are be able to pass on ‘bad news’ without needing to go into further detail.UK Information Commissioner Richard Thomas added that unpublished research from the ESRC had picked up on substantial public uncertainty about data sharing.

Simple AND complex

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Looking at the project focus and listening to the talk at yesterday’s complex science meeting, the focus of the EPSRC project is on the large scale: “Such systems and the organisations in which they are situated are becoming ever larger and more complex and need to interoperate. Large complex systems have also exhibited emergent and unexpected behaviour.”

My response to this ‘large’ emphasis was to be reminded of the value of seeing the role of the simple and the small scale in complex systems and the like. (folk sayings such as ‘for want of a nail’, recognise this fact). But it’s my experience this is easily missed in the culture technology design, though of course usability attempts to overcome this.

Or to put it another way the importance of the simple in design needs to be taken a little more seriously. Let’s here I would like to quote the words of Murray Gell-Mann who specially coined the phrase ‘plectics’ to recognise this importance: “It is important, in my opinion, for the name to connect with both simplicity and complexity. What is most exciting about our work is that it illuminates the chain of connections between, on the one hand, the simple underlying laws that govern the behavior of all matter in the universe and, on the other hand, the complex fabric that we see around us, exhibiting diversity, individuality, and evolution. The interplay between simplicity and complexity is the heart of our subject..”

Wow, big stuff. OK, so what’s the practical value of this? Well consider the direction of the Government’s IT strategy published in early November as scrutinised in the Guardian:

“The drafts contain the phrase: ‘Many of the government’s suppliers have a patchy track record on delivery.’ In the published document, this is watered down to: ‘The public perception remains that many of government’s suppliers have a ‘patchy’ track record.’ Another draft clause, which seems to have been cut, reads: ‘Small, innovative suppliers continue to press for easier participation in government business.’

“Together, these two phrases hint at a different way of doing things. That, rather than handing over IT projects in their entirety in billion-pound deals, the government parcels out work in small chunks, none mission-critical, on a scale that small firms can bid for. Although there will still be cowboys – more, probably – they are less likely to wreck a project. Significantly, this is standard practice in Canada, acknowledged as the world’s leading e-government.”

The moral of this story is that understanding the value of the small and simple also connects with the value of involving small innovative players in delivering public sector IT projects. It’s based on both good science, and good business. For example why not divert some of the UK’s health service IT spend in this direction? As the third largest organisation in the world after the Indian State Railways and the Chinese Red Army the NHS could do with a bit more counter-intuitive thinking?