Friday, 27 March 2009

How Many More Mid Staffs around the UK?

It is now emerging that many whistle blowers went to various authorities over the years to report the disaster that is Mid Staffs NHS Trust. None of them were listened to. Nothing was done, and patients continued to die or suffer great pain. It was only when Central NHS saw the relative health care statistics produced over a period of years that somebody actually took notice and decided to investigate, and then take action. Thank goodness this was done – BETTER LATE THAN NEVER.
But why did it take so long to spot something so glaringly bad? I submit it is because there is not a proper scientific and business like management of health metrics service that regularly monitors what is going on in the NHS monolith. As a matter of urgency the NHS management together with its new IT management team must prepare systems of data gathering and metrics reporting at all levels of the service. There are health service benchmark software companies or Total Quality Management companies out there who can almost certainly provide a basis to build what is now being shown to a very crucial need for NHS and indeed the citizens of the UK. See blog posting on 11th Feb
The metrics should be more than just for finding out failures, their proper use has to be to learn about best practices and solutions, and to spread them across the NHS thereby driving out the need to look for failures as there won’t be any. If done correctly, in the right spirt with the right tools, there would in future be only places in the service where a business-as-usual tuning, or upgrades and improvements would be made to make health better for all. Now that’s something to look forward to.

Are NHS Hospital Group Managers and Governors Brown's Lemmings?

The news this week continues to report many failures in NHS and flaws in NPfIT that should worry us all. The latest includes The Joseph Rowntree Reform Trust report on government data bases. This claims that many NHS databases among which are; Detailed Care Records, and CRS Secondary User Services, should be scrapped or redesigned. As mentioned in previous postings to this blog, insiders were reporting a long time ago that the design of the technology and the management procedures are fatally flawed leaving many openings for non-authorised users, usage, and corrupt records.

There is also the news that three NHS Trusts are not using all of NPfIT. In fact Rotherham has actually signed up for Meditech’s solution, while many others are sounding out McKesson’s, another IT solution which many of them already have, to see if they can extend the contracts. So there you have it. A solution where security is not good enough, data management is not good enough, and delays continual while some users are backing away from it and actively looking at extending the life of what they already have. Not bad for a £13bn spend is it?

What is astonishing; is that with so many problems with NPfIT across all Health Trusts,that so few trusts have chosen to exit the programme. The governors of these bodies should ask themselves why they are continuing with this disaster. Are they Brown Lemmings?

Sunday, 22 March 2009

How NHS Can Do Better - More Thoughts 2

Sorry for the length of this post - there's a lot to cover.
Following this week’s report of the early deaths caused by neglect at a major hospital group in Staffordshire anything any the IT critics and bloggers can say on this subject would be inadequate. We can comment, criticise, warn, and offer ideas for improvement; but can’t do much to stop a sickening catalogue of shameful events like those in Staffordshire from happening. They were not caused by lack of training, or by lack of funds, or lack of IT, or by force majeure. These deaths and the suffering of many patients were caused by bad leadership and that alone. On TV News the other night a Labour Party Health Minister, Ben Bradshaw, showed little if any remorse for their leadership and its role in the deaths. He blamed the local health authority and other quangoes. What a creep. Now read his Wikipedia comments NHS IT: “On the subject of the National Programme for IT, a scheme dogged by cost overruns, failing public confidence, delays, and doubts over its benefit to patients,[6][7] he commented: "Our use of computer technology in the NHS is becoming the envy of the world. It is saving lives, saving time and saving money. If you talk to health and IT experts anywhere in the world they point to Britain as example of computer technology being used successfully to improve health services to the public.” This shows his lack of consideration, and an ability to live in a parallel world to rest of us who have to be treated within his NHS or have to pay for his NHS IT system. Just like Gordon Brown he is denial of the obvious.
So; what can NHS IT do better? This piece will look at non-urgent ambulance services – my term for ambulance services that are used to take out patients from home to hospital for booked treatment. As touched on previous postings; this service, at least in London is dreadful. Let me explain from personal experience.
A semi-invalid old man who needs to help to get down to street level from a 2nd floor flat to be driven various appointments, gets up at 6am to prepare for an 8:30 pick-up. The ambulance arrives at 11:00 with one driver who refuses to help him down the stairs with the words “No one told me I was to help you, it’s not my problem”. Or, the ambulance arrives late at the hospital, which means the appointment is missed and has to be rebooked for some months in the future. Or, the patient arrives on time at the front of biggest hospital in London and is 80 year old wife is left to find a wheel chair to wheel him herself to the clinic as no staff can or want to help. Or the ambulance arrives at the wrong entrance and goes away with even trying to telephone for instructions. Or should two ambulance staff turn up they drive round London spending two hours plus with old and frail patients being jostled about while they do a’ bus tour’ to various hospitals. The same occurs on the way home. So a 30 minutes consultation at mid-day can require that a patient start the day at 6am ending it at 6pm after spending upwards of 4 hours sitting in an ambulance and 8 hours in waiting rooms. Even the youngest of us would find it hard to survive this sort of treatment.
What does all this poor service do? It requires ambulances to drive on long wasteful journeys which cost extra money on wasted fuel and staff costs. For the Greenies it also adds to UK’s carbon footprint. It means appointments are missed and therefore NHS capacity is wasted adding to costs. It means that a shortage of ambulances occurs; requiring emergency crews to drive from East Coast or South Coast towns to fill the gaps. All this leads to yet more wasted time and money and bigger carbon footprints. Above all it means that patients who are in a frail condition are stressed to breaking point, probably making their conditions worse.
What’s needed to sort this mess out? Apart from some motivated management and staff, i.e. The Culture Thing mentioned before.
It needs IT systems in which ambulance bookings can be entered to ensure the full needs of each patient are logged. Currently each hospital, each ambulance station uses pen and paper to record and transcribe appointments.
It needs ambulances equipped with GPS devices for routing and location tracking.
It needs ambulance crews equipped with hand-held type pc’s for managing their service just like modern home service companies who service washing machines, or carry parcels.
It needs links for hospital doctor pa’s to have access to ambulance bookings to enter their patient’s needs.
It needs, above all, leadership willing to put their political rhetoric to one side and consult with and listen to staff and patients (not trades unions or quangoes) to ensure solutions are developed from which all can benefit.
Sadly I cannot see Gordon Brown, Alan Johnson, or Ben Bradshaw having the courage to admit their past is wrong and that a new future, not one based on NpfIT, is needed.

Wednesday, 18 March 2009

IBA Health Rights Issue

I must be a bit thick when it comes to understanding how rights issues work as this particular one seems to be a circular process. Let me explain. IBA Health which is 35% owned Allco Equity Partners (AEP) also owes them A$60mln, and in the middle of AEP collapsing (don't take my word for it read the Oz business press or this bloomberg posting IBA asks current share holders, which presumably includes AEP, to fess up with cash to pay for the rights issue.
On top of this there are bad stories emerging from the UK where it looks the new NHS IT management are about to reconsinder the decision to use Lorenzo, IBA Health's flag ship new product which several years behind schedule and massively over budget.
Question 1. If IBA Health's biggest customer, UK NHS, pulls the plug on Lorenzo what happens to IBA Health earnings and this rights issue?
Question 2. If AEP does not buy into the rights issue who will?
Question 3. Who gets the A$60 mln or part thereof that IBA are going to pay back after the rights issue.? Is it AEP or the administrator?
Question 4. If AEP is collapsing it ought not be able to buy into the rights issue. But you never know with banking and finance laws or rulings, these days they seem to defy common sense. Perhaps they can buy into the issue in which case AEP has a new asset to help defray losses.
Question 5. It looks to me like the collapse of AEP and this rights issue will cause a major change in IBA Health's ownership with perhaps one or two companies holding majority stakes. What does this do for the customers, partners, and minority shareholders?

As all this looks decidely odd. But you never know it might all be business as usual. Can anyone out there in financial analyst land enlighten me?
Am I worrying about nothing?

Sunday, 8 March 2009

Perhaps a basis for better services management for NHS is in sight.

Capita’s announcement on 19th February that it is acquiring CHKS Ltd. is interesting and fascinating as well being in my opinion an astute move as it bolsters Capita’s capabilities for the measurement and hence management of health services. As discussed in previous posts the management of metrics and their analysis to define problem areas, and potential improvements is sadly lacking in many areas of the NHS, particularly the non-clinical ones like cleaning services, procurement, materials supply, theatre scheduling, appointments, and non-critical ambulance services. One hopes that the NHS trusts can make greater use of services management analysis for the benefit of all.

Note: I have to register an interest in that I own shares in Capita.

The Curse of NHS Again

IBA Health
Let’s have a look at recognition of revenue which is always a ‘sensitive’ issue for IT Services or Software companies. IBA Health’s results statement says; “The National Programme for IT contract in the UK is a product delivery arrangement with a phased release of functionality enhancements over the period of the arrangement. Any licence revenue is recognised as the elements of the product are delivered. Implementation and service revenues are recognised upon the provision of those services.” It seems that the ‘product delivery arrangement’ is one in which licence revenue is recognised as elements of the product are delivered? This indicates that IBA Health’s revenue growth as claimed in the results is in part based on revenue for which no invoice has been raised, or the product is actually paid for, i.e. IBA Health has the money in the bank. Just how much of the claimed revenue is actually in this category is difficult to see. One can also see from: Notes to the FinStats no 8 (p58) and no 9 (p59) there is $35.4m of Past due receivables, and $58.7m of Accrued Revenue (ie not yet invoiced).
All this lack of clarity always worries and as clarity of results should benefit all parties surely it should be more clearly reported in the results? Until they are more searching questions are necessary.

Here is more detail on CSC’s restated results for FY97 to FY07 which caused announcements of results throughout 2008 to be continually late - as referred to in a previous post. Apparently the restatements are in the light of the FASB Interpretation 48 re Uncertainty in Income Taxes. The restatement coincided with an IRS investigation of CSC's US tax returns. The investigation concluded: “Under the settlement, which is evidenced by a Form 906 representing final resolution, CSC and the IRS have agreed to certain adjustments, the collective effect of which include a net operating loss carryover, research and foreign tax credits and charitable contribution carryovers, and other adjustments relating to amortization and depreciation deductions. The company will not be subject to penalties from matters covered by the settlement.” See the full text of the announcement on CSC’s web site here: . Perhaps it is this complex tax and statement situation which has led CSC to make some significant assignments within its Investor Relations department.
It is strange though that few if any other major US corporations seem to have had to restate earnings to this degree.

Thursday, 5 March 2009

IBA Health half year results - what do they tell us about the health of this business?

IBA Health results – Are They Good or Are They Bad?
On 17th February IBA Health published half year results to 31st December 2008. A cursory look indicates that things are looking good. Revenue is up, profit is up, new business signings are up. But note; cash flow is negative at -$ 12.9m while Debt is up by S66.6m. Together these show that money is flowing out of the business.
As mentioned; new and renewed business signings look good. However if the average contract duration is 2.2 years and 36% are for 3+ years then the other 64% of new contracts are for an average 1.5 yrs each, which to me looks pretty short. Imagine trying to sign up deals fast enough to keep the business fed with contracts? It’s a task which would require Super Salesman to step forward and deal with.
The results presentation has suppositions about the world health market for IT, quoting healthy growth in gross terms with no mention of the fit with IBA’s products. This is rather like stating that China has a growing population who will all ride bikes and we intend to sell them all cycle shorts. The market volume to be based on the number of bikes per head when no one knows how many people would wear the shorts. A recipe for failure I think.
There is no mention of the many issues with NPfIT in UK. i.e. ‘It’s Late’, ‘It is not fit for purpose’, Health Trusts are backing out and doing their own solutions. The press and pundits are all over this programme. As indeed is UK’s Parliament. See the following from the proceedings of The Public Accounts Committee:
"Trusts in the largest of the regions covered by the national programme, the North, Midlands and East, are using an interim system because of major delays to the Lorenzo system which should have been deployed there. At the end of last year Lorenzo was being used in only one primary care trust, and in no acute trusts.
It recommends that before the new arrangements for the South are finalised, the Department of Health should assess whether it would be wise for trusts in the South to adopt these systems. In particular if either of the local service providers takes on additional work in the South, the department should assess the implications for the quality of services to trusts their existing areas of responsibility. "
Edward Leigh, chair of the committee, said: "The original aim was for the systems to be fully implemented by 2010. The truth is that, while some are complete or well advanced the major ones, such as the care records systems, are way off the pace."
Yet IBA Health does not acknowledge the problems in anything I have seen from them. IBA Health talks up the product set even though many deadlines appear to have been missed. Are they being entirely honest with the audience and investors?
Read this interview with Gary Cohen CEO of IBA Health in which he manages to not mention any of the problems seen by the UK Public Accounts Committee who represent his single largest customer.

All the above notwithstanding if Obama does a Blair/Brown toss-money-at-health-IT-programmes-to-see-if-it-sticks then IBA Health could be getting some handsome revenues from the US, assuming the US Government can bring itself to buy products from non-US companies. Its track record here though is very poor.

Chairman Brown and NHS IT - NPfIT

Ignore McBrown’s refusal to apologise about missing the debt ridden mistakes of the banks under his purview (he’d rather die than admit to a mistake) – instead ask why even a self evident failure like NPfIT does not receive an acknowledgement from him it is failing right now when there are many experts telling him so. Perhaps as it is an English only solution and the Scots are staying out of it (smart move that) he feels it will do for anyone without a Mc/Mac prefix to their name.