May 2008 30

RobotdocThe recent termination of Fijutsu’s involvement in the NHS’s National Programme for IT (NPfIT) will mean yet more delays to this most ill-advised and expensive of government IT projects. Now almost three years behind schedule, and over £ 10 billion pounds over budget, delivery of the NPfIT is now likely to be pushed back further, and despite safeguards, costs are likely to rise too.

Fijutsu’s departure, following unsuccessful negotiations to resolve differences with the NHS over contractual obligations, provides further illustration – if any were needed – of the inevitable problems associated with government IT procurement. Following the disasters at the Passport agency, Magistrates courts, Rural Payments Agency and the Child Benefits agency, one would think that this government would have learnt some important lessons about the limits and complexity of massive IT programs. Some argue that lessons have been learnt from the past; the cost of Fijutsu’s departure should fall largely on the Japanese company and the decision to split the project over regions means that the project will not come to a sudden halt. But it’s unlikely that even these safeguards will deliver the protection to the taxpayer that they promised, and they don’t even begin to address the more fundamental problems
involved.

NPfIT is a perfect case study of how not to order IT; too many interests and people involved, leading to contradictory specifications. Suppliers complained that the governments lack of clarity about what it wanted, and unrealistic expectations about what can be delivered, led to inevitable disaster. This was matched by a notable lack of consultation with those who are set to use the system most, GP’s and
front-line hospital staff. And too compound the situation further, the program is overseen by a centralizing civil service which posses little or no experience in delivering complex IT systems, and so is easily mislead by private partners and contractors. 

It is the very volatility of politics that is perhaps most damaging to government IT projects though. Government priorities change over the duration of an IT project and the project is expected to change with them. No viable product ever emerged from such an environment. If for no reason other than this, the ID card project should be quickly abandoned. If not, it could take NPfIT’s place, maybe even the Dome’s, as Labour’s ultimate ‘big-government’ folly. 

May 2008 30

Texas_crime_mapping_2The Today Programme had an interesting piece on crime mapping this morning, which you can listen to here. I’ve written before about the TPA’s support for crime mapping – it’s a great way to make the police more accountable to the public they are meant to protect and serve, and to involve the public in making neighbourhoods safer.

The BBC’s Justin Webb presented an interesting and well-argued piece about his experience of crime mapping in Washington DC, where the map can inform personal decisions and business precautions. If you know particular crimes are common in particular places you can react accordingly. As Webb says, it does not necessarily address all of the root causes of crime but it does make you wise to potential threats.

Before I go on to address the criticisms that Evan Davis and Brian Paddick made of crime mapping on this morning’s programme, there’s an important question to ask: where on earth were the Conservatives?

Boris Johnson has pledged to introduce crime mapping in London, and the Conservatives have been supportive of the idea, so it beggars belief that they weren’t willing to put anyone up for interview to promote or defend the idea on the BBC’s flagship current affairs radio programme. By failing to put anyone up, they were empty chaired  and Paddick was given a free run at the idea, laying into it without anyone to argue in its defence. (It should be said that if Today are lacking someone to speak up for crime mapping in future, the TPA would be happy to stand in!)

The first query raised over the idea was the Information Commissioner’s concerns that publishing where crimes happen could invade the privacy of the victims – concerns which, incidentally, I can’t find online anywhere, but they were referred to by the presenter. This is easily solved by the methodology used. Where a mugging or assault happens outdoors you can map it precisely to the spot with no danger of identifying people. Where a particular house is burgled, damaged or invaded you map it within 100 yards or by street. Where there are extremely sensitive crimes you can map a wider distance if required.

Brian Paddick then raised the spectre of stigmatisation of particular areas. This is an odd argument – at the moment areas get bad reputations for crime levels simply by word of mouth, and such reputations are haphazard at best. Some areas get unfair reputations, which can stick for much longer than they are accurate. An accurate map recording the crimes actually committed means areas won’t be at the mercy of rumour any more.

If an area has high crime, people deserve to know before choosing to move there – that’s not stigmatisation, it’s informing people so they can choose how and where to live their lives. Would Brian prefer we tricked people into living in areas where they might be at risk by keeping the crime rates secret?

Nor is there any basis to Paddick’s suggestion that accurately reporting high levels of crime where it occurs leads to "victimisation". If anything, these maps will really drive home the seriousness of the crime problem in some areas and encourage people to demand that the police deal with it.

The former Lib Dem mayoral candidate also mentioned the success of the CompStat process in New York, which increased the internal individual accountability of different area police commands. He’s right, but why do the Met use a softer version of it? Shockingly, he said that

It’s not a very British thing to hold people publicly to account in front of their peers

It might not be very widespread in the Met, but that could explain why you are more likely to be stabbed in London than in New York, couldn’t it? Most organisations do exactly that – and public bodies should also hold managers to account in front of the taxpaying public.

Crime mapping is a great idea that holds a number of benefits. It’s just a pity that there was no-one on air this morning to give it a fair hearing.

May 2008 30

Last Friday, Matthew Elliott wrote here about the events of the previous seven days as "The week that taxes took centre stage". Opinion polls, speeches from Cameron and Clegg and then the Crewe by-election, fought squarely on the issue of tax, had put taxation at the top of the political agenda.

The last week has seen that trend continue, with some remarkable developments.

Perhaps most remarkable was Denis MacShane’s article in the Telegraph on Tuesday. The very fact that a Labour MP, and a former Minister at that, penned an article titled "The answer’s obvious: cut taxes and spending" is a notable change. MacShane points out that tax cuts are not only popular they are absolutely achievable, and signs up to the argument that tax has a harmful impact on relatively low income workers who are now paying an unacceptable amount of their earnings to the Treasury.

The article is a signal that the label of taxcutters is one that the main parties are now fighting to have, rather than fighting to avoid as they were a few years ago. MacShane argues that it is a Left wing thing to save money, that it is a Gordon Brown principle to be prudent and that it is Labour who recognise the financial troubles of ordinary people and the power of letting people keep their money to spend as they wish.

Readers will not be surprised to note that this is not simply a pure, ideological debate – after all, MacShane didn’t exactly display this taxcutting fervour when he was a Minister. There is of course a pragmatic motive, demonstrated in today’s YouGov poll for the Daily Telegraph. When asked

Taking all forms of taxation into account, do you think you pay too much in taxes, too little or about the right amount?

This was the result:

Too Much:  72%
Too Little: 2%
About right: 19%

That’s a massive majority, which has risen sizeably, and explains why MacShane is touting these ideas publicly.

Anthony King’s analysis in the Telegraph includes a remarkable figure, that 85% of people agree with the phrase

we have reached the limits of acceptable taxation and borrowing. With the rising cost of living, taxpayers can’t take any more

which is taken from Cameron’s speech of last week.

All this means that the message is clear: People want lower taxes and are willing to vote for them. For politicians, if they can tap that enthusiasm they will be well on the way to victory. For taxpayers, it can only be a good thing that the issue is riding so high and that the tide is flowing in the direction of tax cuts. Safe to say, we can expect to hear a lot more about tax cuts in the coming weeks.

May 2008 30

Policewestminster_2This study by Civitas looks excellent:

"The police, in their turn complain of central control and ill thought out government policies. All interviews were characterised by a high level of bitterness and frustration. Bonuses are paid to senior officers based on how they comply with targets. As in the NHS bad targets are coercing otherwise ethical public servants into unethical behaviour. Serious crime is ignored and minor crime elevated to the serious in order to satisfy the measurement regime. One office said: ‘We are bringing more and more people to justice – but they are the wrong people.’ Targets and increased central control are turning what should be an independent police force into what another officer described as, ‘an extension of the government.’ At the same time too much paper work sees officers spend only 14% of their time on patrol. Police numbers may be historically high but they are low compared to other countries while the ratio of crimes to officers is now overwhelming.

Targets miss the point of what the public wants. The Home Office judges each police force by how many crimes they detect and clear up. The public wants something different. They do not want the crimes happening in the first place. The absence of crime and disorder is not a target. As one constable wrote, ‘I remember when it was a matter of pride to come back after a night shift to find no crimes had happened. Now all we are asked is why no one was locked up.’

[...]

Unlike many other police forces, British police were not intended to be servants of the state but of the communities they serve. Their powers are personal, used at their own discretion and derived from the crown. This essential feature of British policing – policing by consent – is now in jeopardy."

Central targets are a dismally poor substitute for accountability to local communities.  The police are working for the politicians in Whitehall, rather than for ordinary people.  The politicians can’t see the day-to-day impact of crime across the country, all they can see are clumsy and often misleading statistics.  Police officers chasing ‘sanction detections’ can easily boost their numbers by chasing trivial crimes at the expense of serious offences and, with a bonus of £10-15,000 at stake, they have a powerful incentive to do so.

The police need to be made accountable to the communities they serve and freed from political management.

May 2008 29

Stethescope "Death rates of patients undergoing major surgery at NHS hospitals are to be published on the internet.

[...]

Death rates are expected to be at a disproportionately high level in hospitals where fewer operations are performed and surgeons have less opportunity to improve.

The government believes publishing the figures will mean badly performing trusts will have to improve standards or halt areas of surgery where they are lagging behind."

This, from a report in the Telegraph, is great news.  If patients can make an informed choice then that should put pressure on the acute trusts to up their standards.  In fact, this is long overdue:

An inquiry into the deaths of children at Bristol Royal Infirmary a decade ago showed how poor practice persisted because mortality rates were not disclosed.

The effect will be limited though as – within the NHS – patients only have a limited amount of choice.  While the trusts could compete with each other to a certain extent they are protected from new entrants to the market, a restriction that will severely limit the ability of patients to take advantage of this new information.

Beyond that, the structure of the NHS will restrict the ability of the trusts to respond to quasi-market pressures introduced by this new source of information.  The NHS is essentially a quango of quangos.  It is made up of a combination of the primary and acute trusts, strategic health authorities and a maze of central quangos.  In our report, Wasting Lives: a statistical analysis of NHS performance in European context since 1981 (PDF), we set out how the central quangos control many of the most important NHS decisions:

"The NHS has a large number of local bodies, the Primary Care Trusts, NHS Trusts and Regional Strategic Health Authorities.  However, these are all both legally non-departmental bodies answering to the Department of Health and effectively part of one organisation.  Most have only a very limited ability to act independently:

  • Their decisions over which drugs to buy are expected to conform to guidance from the National Institute for Health and Clinical Excellence.
  • IT expenditure is mostly handled by Connecting for Health which runs the National Programme for IT , the largest single information technology project in the world.
  • Staff pay, the largest item of expenditure,  is determined nationally by the NHS Pay Review Body.
  • Amounts of funding are also set nationally according to a weighted capitation formula.   This became very controversial in 2006 when the Government were accused of manipulating the funding decision for political advantage."

This information will be a valuable resource for NHS patients.  It would be so much more valuable if our healthcare system were liberalised more broadly.

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