Granger says he is 'ashamed' of some systems provided

Tags: Accenture Agfa Cerner CfH Choose and Book CIO consultant Fujitsu Granger HIS IBA iS iSoft London Millennium Nicholson NPfIT Quality South

10 Jul 2007

The departing head of the NHS IT programme Richard Granger has said he is ashamed of the quality of some of the systems put into the NHS by Connecting for Health suppliers, singling Cerner out for criticism.

Going further than he before in acknowledging the extent of failings of systems provided to some parts of the NHS - such as Milton Keynes – the Connecting for Health boss, said "Sometimes we put in stuff that I'm just ashamed of. Some of the stuff that Cerner has put in recently is appalling."

He said a key reason for the failings of systems provided was that Cerner and prime contractor Fujitsu had not listened to end users. "It really isn't usable because they have building a system with Fujitsu without listening to what end users want. They have taken some account but they then had to take a lot more. Now they are being held to account because that's my job."

The latest remarks, quoted in an interview in the current issue of CIO magazine, appear to make a nonsense of Granger's June statement that unless agreement was reached between Computer Sciences Corporation and iSoft over its acquisition by IBA Health, Cerner could wind up as the system used across the whole of the English NHS.

In December 2005 Nuffield Orthopaedic Centre became the first NHS site to go live with Cerner Millennium under the NHS IT programme. It has since suffered a string of problems ranging from missing appointment records, to inability to report on wait times. The Millennium system – now installed at six NHS locations in the South – remains unable to directly integrate with Choose and Book or meet 18-week reporting requirements.

In April, 79 members of staff from Milton Keynes NHS Trust signed a letter outlining their frustrations at the Millennium system, stating: "In our opinion the system should not be installed in any further hospitals.

CfH said there had been some "unacceptable problems" with the new system installed at Milton Keynes. The hospital trust was subsequently visited by Granger and NHS chief executive David Nicholson to learn of the problems first hand.

At the end of June, David Wrede, a senior consultant at Taunton and Somerset Hospital NHS Trust, exasperated by almost a dozen cancelled go-live dates, gave vent to his frustrations with the version of the Millennium system on offer from Fujitsu the local service provider in the South.

Speaking at the BMA's annual representative meeting on 29 June Wrede said: "We should have a public inquiry. The people who made the original Cerner contract should be brought to book and as Cerner Millennium R0 [release zero] is not fit for purpose…" The motion calling for a public enquiry was passed.

The first Cerner installation by BT, the NPfIT contractor in London, is scheduled to go live at Barnet and Chase Farm NHS Trust within the next week. The trust is understood to be due to recieve the same release zero version of the Millennium software that has so far been used in the South. Later sites in London will use London-specific versions of the software.

Granger also cast further light on Accenture's departure from the NPfIT programme at the end of 2006, describing their relationship with sub-contractor iSoft as a failed marriage, in which they had failed to realise their co-dependency. He contrasted the relationship with iSoft with Accenture's performance on Picture Archiving and Communication Systems with Agfa as its sub-contractor. "When they work with a mature, high quality vendor that recognises Accenture as in charge and they're doing it their way, you get a quite good deal and they'll do the job."

The CfH boss goes on to state that he has been careful to avoid Stockholm syndrome -identifying with suppliers' interests rather than those of the NHS - as problems have mounted.

"One supplier asked for an extra £500m to deal with cost overruns. He received a succinct refusal but there are many places where the response would have been different; where threats of bad publicity and contract disputes would persuade an organisation to start bunging millions of pounds a month in addition to the existing contract, just to cover up," says Granger.

Elsewhere in the in-depth valedictory interview carried out ahead of Granger announcing his resignation, he rounds on critics and erstwhile colleagues, saying. "Either people are really stupid or evil. It's difficult to be compassionate with people who claim that suppliers are going out of business because they are not getting paid or they were withdrawing from wishing to do business with the NHS. At the same time, they are saying they [the suppliers] have been bunged millions of pounds that weren't budgeted for. It's stupid or wicked."

He reserves particular ire for so-called experts. "There is a little coterie of people out there who are alleged experts and who worked on this programme. They were dismissed for reasons of non-performance or in one case, for breach of commercial confidentiality.

"He actually sent our financial model to a supplier and that's why we suspended him. He then resigned which is an answer in itself."

Granger continued: "Who contributed evidence to the public accounts committees? For just about every figure quoted as an expert in this programme, I've got HR files on them. They generate a piece of opinion that often substantiates their world view."

Link

The full CIO article can be read at

http://www.cio.co.uk

Readers Comments

Somebody else's fault ...

10 Jul 07 10:01

Jim Collins, the US management guru, suggests that when things go wrong great leaders look in the mirror (rather than out of the window). I think it's a sound principle.

Who selected Cerner

10 Jul 07 10:47

Surely Mr Granger there must have been a process of specifying what the NHS wanted and then measuring the capability of Cerner to deliver this. Equally surely you must have involved coal face NHS staff in this process - clinicans and admin staff alike. If so – this is clearly a failed procurement process in selecting a duff system. If not – you cannot blame the supplier for a non rigorous selection process. Bottom line is that the NHS has given you and your team responsibility for selecting fit for purpose, best of breed systems – and it is this failure I think you should be ashamed of.

Who's Fault

10 Jul 07 11:13

Perhaps if Granger had listened to users in the tendering process a system fit for purpose would have been purchased. If he had listened to other trusts who had purchased these systems before NPfIT then they would have gone with other suppliers.

So blaming suppliers for not listeng to users is a bit like the "pot calling the kettle black".

Choice of Systems

10 Jul 07 11:21

Given the fact that isoft continues to be the major supplier after all the controversies its been involved with, the CfH doesn't seem to have too many alternatives left on the table.

"Stockhausen Syndrome"

director@doctors.org.uk

10 Jul 07 12:30

“One of the things I’ve been careful not to do in the NHS is create the supplier Stockhausen syndrome.”

Interestingly, in the orginal article, it is referred to as 'Stockhausen' rather than 'Stockholm' syndrome. What an apt description of the degree of harmony currently prevailing between CfH, its suppliers and its users!

Accenture

10 Jul 07 13:58

Can we assume that the one supplier asking for an extra £500m was Accenture?

"Stockhausen Syndrome"

10 Jul 07 14:47

For those not familiar with this diagnosis, a useful definition is given at http://hellbox.org/archives/001022.html

Stockhausen Syndrome Noun. A psychological state in which the victims of overly complex music and/or art develop an irrational relationship with the work. This solidarity can sometimes lead to absolute defense of the work, outside of pragmatic and realistic views. If the defender says that it is just their opinion, this is not a sufferer. If the defender claims that you are wrong, they are right and anybody who disagrees with them is out to get them, then this is probably a sufferer.

Accenture ?

10 Jul 07 16:44

Why would anyone assume it was Accenture who asked for the extra money - Isoft were the only supplier who were in financial difficulties as far as anyone is aware

Who chose Cerner? Who approved RO (and iPM) as fit for deployment?

11 Jul 07 00:09

Cerner failed to win any of the LSP contracts they directly bid for, but they were the software sub-contractor for the LSP in the South (and later London). One of the key criticisms at the time was that neither iSOFT nor Cerner had a product to demonstrate to the NHS - I recall the term vapour-ware was used extensively.

However bad Mr Granger may think the Cerner product is, it somehow passed the many test criteria set by his organisation and was approved by them as fit for deployment. If he really does think this is an appalling product, he should be asking who was ultimately responsible for it being pronounced as ready for operations in the first place. He should also ask whether any untoward pressure was put onto Cluster, SHA or Trust staff to sign off the first of type deployment as having passed the contracted deployment verification criteria. If he doesn't know what these were (and he should), he could try putting into Google and choosing from one of the many sites which carry this detailed information (including some maintained by CfH).

Once he has done this, he should perhaps consider whether his own position is tenable.

Holding Cerner to account isn't his job. As he has told us so many times, it is the LSP's job to hold their contractors to account. His job was to ensure the LSPs delivered fit for purpose products to the contracted timetable. Anything else is simply remediation.

Just for the record ....

11 Jul 07 07:34

It's interesting to hear that Mr Granger's organisation has been diligent in maintaining its HR records. Meanwhile, millions of taxpayers must be wondering about the lack of progress with the health records it was supposed to deliver for them! Not that I'm implying for a moment that any of this is NPfIT's fault (of course).

The Experts

11 Jul 07 10:28

"There is a little coterie of people out there who are alleged experts and who worked on this programme."

Anyone who is in business will tell you that success or failure is a product of the people you employ. Therefore the most important task a leader has is to gather the right people. Granger doesn't seem to realise that the failure of the people within the project was his responsibility. He either was involved in the employment of these people and is therefore culpable, or worse he wasn't involved and is therefore more culpable for ignoring the most important aspect of a project.

It seems evident in his every word that Granger isn't a team player. Throughout the many years we have observed Granger criticising just about anybody he comes into contact with. Weather you are a husky or a privacy fascist you were always going to fall into one of Richard's little black groups who he sees as ranged against him.

A final point I would like to make to Richard, knowing full well he wont listen, is that he made a grave error in side lining the huge talented resource of experts he had at hand. I am talking about the hundreds of IT and information managers up and down the country, who were largely ignored, forgotten or at worse denigrated. Richard failed completely to understand the roll these people would take in implementing these systems. As a result he lost what could have been his greatest asset.

Non-performing little coterie

11 Jul 07 10:28

In his CIO magazine interview Mt Granger says that some of his little coterie of critics were dismissed by him for non-performance. Two thoughts about this: 1. From what I hear every day his coterie of criticis is not small, it is colossal. 2. If he dismisses people for non-performance then surely, by the same token, he should be seriously considering his own position.

Ashamed, and so he should be

11 Jul 07 12:11

Fascinating.

Dismissed staff for non-performance. Is that why the SRO was changed so often so that this couldnt happen at the top ?

CfH as the overarching supplier to the NHS should own their failures. We are all products of our experiences, but as to keeping HR files on all your enemies, is that the mark of a healthy organisation ?

What next?

11 Jul 07 12:32

With Blair and Granger gone or going. Will the delivery in the present structure going to continue?

Will the NHS revert to local suppliers giving help on a local level?

For what I can see this whole excerise is the reason I tell clients never buy vapourware and never take the first delivery of any product..

Granger has failed miserablily. He tried to spin products from iSoft and Cerner as 'bottom up' products built by the users. This has not happened and what has been left has been less than nothing.

Back to the drawing board. I would suggest if they really want to go forward look at iSoft and Cerners involvement to end. Their is two choices: 1. Local acredeited suppliers connected together by a national spine. 2. Large Enterprise solution from companies WHO HAVE EXPERIENCE in dealing with these type of implementations.

The first one is simple enough, run the already bought and paid for national spine and connect a scatter of smaller implementations which conform to standards. Competition would keep the prices and varity of products in check.

2. The second looks very much like what has already been tried but where I would differ is in using products already on the market and leverage into the area. Health is a customer industry and if you approach the corporate world and ask them how they manage the customer experience. They would answer Customer Relationsip Management software. CRM software has been used for the last 15 - 20 years. There products are use to hold information and process actions for the customers. They are multibillion organisations like Oracle, SAP, Salesforce... They have huge applicationns and massive experince in the Enterprise space

Who was in charge?

11 Jul 07 15:01

Every time someone leaves a senior appointment in the NHS, they seem to claim that someone else was in charge! Mr Granger is sending out all these criticisms now, but seemed to criticise us for making exactly the same points a year ago about CERNER. If he did not know that it was all going wrong, and said good progress was being made on CERNER, then who was in charge? Or if he was in charge, why did he not listen to us all a year ago?

I do not follow - was he the boss?

11 Jul 07 15:06

Surely if Mr Granger was "boss" then it was down to him to make sure that CERNER etc were "OK". I recall many of us being criticised for saying exactly what Mr Granger says now. We were branded as if we were Luddites, not responsible, wise clinicians.

Perhaps he could at least say "Sorry" to us and "Thank you" for not just letting NPfIT roll on in to our Trusts.

I had ot resort to a letter to the Chief Medical Officer about CERNER to make my conscience clear - I could not stand by and let it roll on into hospitals and take them out of the business of caring for sick people.

Experts

12 Jul 07 08:31

'Experts' are only useful if you listen to them and then draw the correct conlusions. There have been many who have not minced their words as to the process and suitability of the products, who have been crushed and unfairly discredited. This man now stands and starts to blame those around him, oh and he has kept records! (is he entitled to this info since he has left as surely it was confidential?)- its a bit rich! I always thought that the buck stopped at the top, but once you reach the top it would appear that mushroom management principles apply.

How not to win hearts and minds

12 Jul 07 13:11

I find this article and the ensuing thread of comments very telling as it seems to illustrate a total mismatch between Richard Granger's managerial approach and the culture of the NHS environment in which he has attempted to deliver. For a complex and ambitious programme such as his (repeat HIS) to succeed, lessons from countless other initiatives have repeatedly shown that real commitment to the programme from users, suppliers and many other stakeholders is the key to success.

The rather menacing approaches reported ("shooting huskies", "I've got HR files" etc) are- at best - likely to foster dutiful compliance (along with some seething resentment, I'd suggest).

You reap what you sow...

(post edited by EHI)

Not professional

12 Jul 07 21:57

Surely the NHS hold the contract and are in charge of Change Control. Therefore it is they that should listen to users and put forward the relevant changes requests. Mr Granger is only criticising himself and the NHS NPFiT hierarchy. If he felt like this then why did he not do something about while he was in power rather than making comments like this. It only goes to make life harder for those trying to implement the offering.

What could have been...

13 Jul 07 09:21

had the I4H programme continued, many trusts would now be in their 3rd year of running with clinicall-rich electronic patient records. OK, they wouldn't have been so well linked as NPfIT proposes (though some I4H solutions were regional), but so far there's little clinical value from NPfIT except for PACS. And this is only working well at local stand-alone level. Image sharing between institutions is a technical and IG hotch-potch, and links with the clinical record systems are hopeless. A good local record system would have delivered more clinical benefit to patients than a poor but well-distributed system. NPfIT seems to forget that the aim of all this is to provide clinicians with a tool to improve patient care. Not as a vote-winning strategy to give glitzy impressions of bells and whistles that only contribute trivially to patient care.

Just One Mistake

13 Jul 07 10:29

Mr Granger only made one mistake, he chose the wrong strategy, probably through ignorance, inexperience of the NHS and because of bad advice. Those of us who were around in the early/mid 90s and learnt from previous NHS systems catastrophes were sidelined for a new breed of Granger's yes men. They must share some of the blame.

Leadership

13 Jul 07 11:02

"First rule of Leadership: EVERYTHING is your fault"

When I was with IDX, the version of our software installed and running at Chelsea and Westminster had literally HUNDREDS of man years of development over and above the core US product in order to be usable by an NHS Trust. But at least we had a product, with clinicals, in USE in the NHS.

Deployment and local configuration of a new Hospital site typically takes 12 months or more.

For any US supplier like to think that it could realistically use core US product and have it be usable for a UK Trust is IMHO a grave mistake. To think that an inexperienced new UK deployment organisation could take a product and install it in less than 12 months was also a big mistake (e.g. BT's plans typically called for a 3-month deployment plan).

All along the prime contractors and suppliers have been forced into setting unrealistic targets and unachievable goals by CfH leadership, in a culture of fear, uncertainty and doubt...

(post edited by EHI)

Confusing costs and benefits?

13 Jul 07 12:17

I note from the CIO Interview that Richard Granger said "cost is ordinarily defined in this environment with benefit having been subtracted. That is, net cost; net benefit." So that is it is it? Claiming benefits when they haven't yet been delivered/realised. IMHO this short phrase sheds some considerable light onto the whole programme and perhaps helps to explain why no one seems able to agree on how much the programme should cost let alone what benefits it should be delivering. I mean by benefits real tangible benefits that should have been included in the original business case and should be being tracked thoughout the life of the programme culminating in demonstrating that they have been delivered/realised.

What next? 2

nhstechie@btinternet.com

14 Jul 07 10:58

" ... look at iSoft and Cerners involvement to end"

Let's not throw the baby out with the bathwater and at least take a look at the new iSOFT product which has been so long in development and has had at least some NHS input into its functional design. I can't comment on the Cerner product as I've never seen it.

The one thing we need in the post-Blair/post-Granger era is an objective appraisal of the options for the NHS as a whole and NPfIT in particular. Some monumental mistakes have been made - constant reorganisation, PFI, alienating frontline staff and miscalculating software development timescales. That said, it isn't too late to salvage something useful on which to build now that the two most unpopular protagonists are off the scene (though let's not gorget that RG IS still with us till October).

SRO?

14 Jul 07 11:01

"Is that why the SRO was changed so often so that this couldnt happen at the top ? " - NO these SROs were all Granger's boss and they reported to Downing Street!

Re: What next 2

colin@clinformation.com

16 Jul 07 09:30

IMHO, the monumental mistake was the centralised NPfIT approach. There is no baby in a bath: maybe a dinosaur egg in a primordial soup! The centralisation experiment was a complete volte-face from the 1998 Information for Health strategy and it has not delivered anything like the end-user functionality that was expected (even with pessimistic estimates of progress) from IfH's plans delivered locally with support from NHSIA.

"Salvaging something useful" has an air of desperation. What is needed, I'd suggest, is a new strategy that moves us from where the NHS is now (way off-target and with some contractual arrangements that might need unpicking) to where a well-informed planning exercise determines that the NHS needs to be. I'd be surprised if that didn't look something like the IfH vision from almost 10 years ago!

Retrospectoscope

keith.foord@esht.nhs.uk

16 Jul 07 09:34

There is a marvellous instrument in medicine called a retrospectoscope. Some of us had used this following prior IT experiences but were ignored. At least we go PACS for every hospital in England out of this, even though intially the whole concept was not in the programme (!) but even then once beyond the proven products NPfIT have not beeen able to make them join up properly! For other clinical IT many of us are now years behind where we would have been without this benighted programme.

Desperation?

nhstechie@btinternet.com

16 Jul 07 23:45

""Salvaging something useful" has an air of desperation. " You bet it does - I still work in the NHS!

In my part of England most of us have already implemented iPM PAS and there isn't a viable alternative to making the most of it. I haven't yet seen the beta of Lorenzo - I'll willingly suspend my disbelief until I have. We don't know what's hidden in the bathwater - it could be a baby or it could easily be a turkey.

Either way, we can't turn the clock back. IfH had a great vision but no money (except non-existent hypothecated funding) CfH had lots of money, but at best blurred vision.

Granger Legacy

17 Jul 07 10:02

Here are some questions about Granger's legacy: 1) Has NPfIT/CfH encouraged a programme of research into health care IT? And has an electronic patient record been defined? 2) Has NPfIT/CfH the capability to deliver the software systems the NHS needs? Is a centralist model appropriate to an NHS consisting of a large number of substantially independant institutions linked by contracts? 3) Has NPfIT/CfH encouraged clinical and IT professionals to develop the skills necessary to support health care IT now and in the future?

Re: Desperation?

colin@clinformation.com

17 Jul 07 11:12

In my earlier posting, I wasn't suggesting that the NHS purposefully reverts to its 1998 plan. I was simply pointing out that - given lack of progress and the imminent departure of the programme's director - now looks like a good time for a major refresh of the NHS IT strategy. Looking at the lessons from NPfIT, more local ownership seems inevitable (I think this has already been acknowledged in the LOP) as well as more meaningful stakeholder engagement. And it's hard to imagine how, at this stage, better clinical buy-in can be achieved without a sharper focus on meeting local clinical priorities.

If you take all this into account, any resulting strategy is likely to bear more than a passing resemblance to IfH! I also think it likely that, if a fresh round of strategic planning started, many people might quickly begin to regard NPfIT as a legacy programme and - rather than being resigned to "making the best of it" - actually rise to the new challenge of moving forwards with more ownership of their local agendas.

Desperation

17 Jul 07 18:09

Something like 3 years ago I chose the username Desperado for postings to this site, though that does not appear on posts.

I am concerned that whilst NLOP pays lip service to local decisionmaking, the contracts, and those at SHAs, commit us to continuing to implement the turkey in the bathwater.

NLOP

01 Aug 07 10:10

I attended a CfH workshop last week and in discussions with one of the facilitators, he advised that the acronym stood for 'No Longer Our Problem'.