Electronic Health and Social Care Records funding – amendment

I laid an amendment on behalf of the Public Accounts Committee seeking independent scrutiny of the decision to provide £650k to the Health and Social Services Department to complete the EHSCR project. The big guns were against us that day, not wanting to be scrutinised. It is funny that members can often be heard saying that the Public Accounts Committee should review something that doesn’t involved them, but when it does, can be very defensive!

Sir,

The Electronic Health and Social Care Records project began in 2006 and since that time there has been no update provided to Members by way of a States report as to how it has been progressing.

The original Billet d’État of December 2006 stated that the cost of purchasing a full EHSCR would be £9.7m over the 10 year life of the contract and that capital costs would be £3.9m, with the balance in terms of maintenance and department’s implementation costs, funded from revenue. Members were advised that the revenue costs would be derived from savings, which were estimated would be around £9.65m.

The project board was to be supported by an implementation team drawn from health and social care professionals under the direction of a project manager and supported by the States ICT Director.

The design and implementation stages were due to be completed by 2009 after which the number of staff involved would be reduced to provide ongoing support for the remainder of the contract term.

The project was sold on the basis that it would improve the way clinical care is delivered in Guernsey whilst also yielding much improved health and social care information to support operational management, the quality of clinical services and strategic planning of future health and social care delivery. It was evident at the time that the systems in place were inadequate and out of date and members were advised that there would be financial and non-financial benefits of implementing the system.

HSSD are now requesting a maximum of £650K, or to be more accurate £600k per paragraph 76 and £650k per the proposition,in order to implement the ePrescribing and Children’s Information database. I suspect there are few here who would question why these modules are needed. Indeed these could be key to releasing benefits both of a financial and non-financial nature.

However, the Committee is very concerned that this Assembly is being asked to delegate authority to T&R to undertake a project assurance review without any independent scrutiny. Indeed we have issues in terms of the proposals generally in relation to the role of T&R so far as overall scrutiny  is concerned and I will highlight these in general debate, for now I will focus on this particular bid.

 

Firstly, I would like to thank HSSD members and staff for the presentation that they gave the other week, which was very informative even if it did raise more questions for me that have resulted in this amendment.

So what are the concerns? Well 3 are of a nature relating to the funding itself;

The first it that at the presentation we were advised that GPs records, a stated benefit in the 2006 report would not happen as the GPs did not want to be part of it. Not only does that mean a key deliverable won’t be achieved, but that should in theory have been some savings in project implementation costs.

Secondly, the 2006 report stated that the project implementation costs would be derived from revenue, whereas we are now being asked to give delegated authority to T&R to take the funds from Capital.

Thirdly, the project according to the 2006 report allowed for a contingency which was included in a figure of around £1.2m, including, confusingly, hardware costs.

Such concerns prompted my email to the T&R Minister recently and I would like to thank his  Department for their detailed response. However, the comments made to do not allay our concerns. In particular, the fact that it is made clear that the project has clearly gone over budget.

Those more seasoned members of this Assembly will recall the implementation of the Social Security Benefits system which took 8 years to complete from 1998 to 2006. It too resulted in a key deliverable not coming to fruition i.e. it only delivered the benefits system not contributions system. The total cost of the project was calculated at £9.232m against a budget of £6.187m. PwC were commissioned by the then PAC to report on the project and they provided 30 recommendations for similar IT projects the vast majority being applicable States wide. One such recommendation related to the fact that all costs of particular projects should be identified at the start and specifically ring fenced.

Now this project commenced before that report was published and before significant  improvements were made to the project management process and which are set out in the report we are debating today, together with the latest proposals to improve it further. And it is already evident from the T&R Department’s response that all costs had not been identified or ring-fenced.

In addition, Members may well be aware of the news from Jersey about a similar project that has gone horribly wrong. My counterpart there is quoted as stating;

It’s intention was to digitise and integrate health and social services patient care records but the programme came up short. Moreover, information given to the States Assembly was so poor that States Members may have had little or no idea that the programme came up short.

Does that sound familiar?

The Chair also stated that 2015 would see its HSSD ask for another £12m to finish the job. If and when that request is made, she urged the States, and I quote, ‘to satisfy themselves that project management standards have improved before allocating any more public money’.

Now members might say, fine but T&R say they are going to do an assurance review, that will be ok then. The Committee would like to point out that T&R have been intimately involved with this project from the start with a number of political members on the Project Board since 2006, as well as having the States ICT Director on the implementation team, to name just 2. It is for this reason that the PAC believes that there should be independent oversight of the project assurance review.

Usually the Committee only gets involved in projects after they have reached practical completion, through the commissioning of Post Implementation Reviews. Indeed, as I mentioned 3 weeks ago we will be producing a report on capital projects arising from the findings of these reviews since 2010 in the next few months.

However, given the above reasons we believe that there are sufficient warning signs that the Committee should take some involvement now. We also believe that Members should know the outcome of the review. Whilst it is encouraging that HSSD are asking for £650k and are stating that this is all they will need to reach completion, given the department’s recent track record in relation to financial management, I do believe we need assurance that this is in fact the case and that they will not be coming back asking for more.

I hope Members see the logic of this amendment. Again, I would say we are not questioning the merits or otherwise of implementing the 2 modules but that this should be done with eyes wide open and with some degree of assurance that what the HSSD says it needs, is in fact the case.

 

 

Repeat that the Committee believes that it would add value in two specific ways: firstly through the independent oversight of the project assurance review and secondly, through making Members aware of the outcome that review and our findings.

No, it is not the intention of PAC to ‘undertake’ the review – we understand that there may be other already established groups within T&R and/or the governance of the Project that will be in a positon to do that.

Rather, PAC should be involved in the scoping of the Review, considering the Report once completed and then making public our findings.

Given the length of this project, the fact that similar projects have not gone to plan, the recent experiences in Jersey and the involvement of T&R throughout the life of the project I believe that independent oversight is essential and hope that Members will support this amendment to enable just that.

 



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