Not What I Expected

The "IT Upgrade" for the UK National Health Service that isn't

In this weekend's BBC and Financial Times sites, there's the latest on the disaster in the making otherwise known as the "IT Upgrade" for the National Health Service (NHS). The numbers are staggering. The Financial Times reports that the project is not only two years overdue on completion, but the costs have swollen from £6.2 billion to nearly £20 billion. And here's the phrase that pays from Lord Warner, the health minister who is overseeing this travesty:

The extra money did not mean the programme would cost more than expected, he said, but instead reflected the full expense of switching existing IT spending from outdated systems to the new ones. (Financial Times)

and

The delays to the electronic care record, which mean it may not be in place until early 2008, come in part because of delays in providing the software, which is being developed by iSoft and other companies. (Financial Times)

So, the schedule was under-scoped by years, and the true cost of the implementation was just sort of left out of the original plans?

And while the electronic records systems (aka, the customer database) is now over two years late, the same group has been rolling out and promoting the appointment system to GPs, with equally disastrous results. According to a survey by BBC's Radio 4, 85% of the GPs questioned said there should be "an independent review of the entire scheme by technical experts to check its basic viability." That's not having the same people who implemented it taking a look and saying that it looks fine to them. Even more telling regarding the appointment system--of the 80% of GPs who have access to the system, half said they either don't use it or rarely use it (BBC).

And the response on this? From Dr Simon Eccles, who's overseeing the project: "Our view is that we are already under enormous scrutiny, political financial and otherwise. We would be happy with further scrutiny, providing we don't delay the project further while answering yet more questions to explain why the project is delayed." (BBC)

Oh my--nothing like a veiled threat to make your customers feel like they are in the loop. Or maybe no a veiled threat, but a hope that the whole mess can be rationalized away by pointing to all the scrutiny that happened when the customers took a look around and decided that things weren't right.

Hands up, anyone who's thinking that the fox is indeed guarding the henhouse. Here we have a project that is overdue, over budget, without decent oversight, and the reaction of those responsible are to hand-wave around the numbers, and hold their client group hostage against any possible remedy.

So, what to do? The biggest problem is that there is a lot of money invested in this project as it is--if you decide to pull out, something has to be done about those funds. I'm not an expert on accountancy in the public sector in the UK, but I'll guess that depreciation of capitalized items may not be an option. In fact, when I see a statement like "full expense of..." that tells me that there's little to no capitalized funding going on. In one way, that's good--you don't have to play the depreciation tango with Finance. On the other hand, you get to take the hit all at once, and someone is going to be asking questions about all that money. And all that money is on the wrong side of the balance sheet. Even taking into account the difference between a British billion (100 million) and a US billion (1,000 million), that's like Bruce Chizen telling his shareholders that Adobe lost all of their sales revenue for the next two years in a botched IT expenditure. If you were a shareholder, which the residents of the UK *are* in the case of the NHS, wouldn't you be asking for a really good explanation of exactly what happened? And then voting the one in charge of the disaster out of office?

In any case, I'd be asking how all of this managed to spin out of control. Very rarely does a project of this size suddenly find itself over budget, late, and with unhappy customers. It had to get there somehow. This speaks for why a project of this size needs to have someone who knows about the technology, and in this case, the technology is customer databases, and someone who can act as independent oversight to the project. It's not evident that there were milestones for this project, nor were there "out of bounds" or "go/no-go" definitions and tracking available. In fact, I'd hazard a guess that there was a very helpful person with an MPP (Microsoft Project) files, happily showing progress in the coding until at some point the code needed to show up for some form of user acceptance. And that's when they found out that it didn't fit together in one large piece. In fact, it likely didn't fit together at all. And at that point, they saw how much they had invested in the project, and made the decision to throw money at it, as well as keep a forward momentum, with promises made that it all was just around the corner.

But that corner never came, and they had to release *something*. And that something was the scheduling software. And the reaction to that software led to questions, and those questions led to the realization that things were, indeed, two years behind and massively over budget.

And now they have to deal with it.

Theme Day!

I had a bunch of medical appointsments all end up on the same day. Some of this was due to planning on my part--why keep driving over to the medical center if I could get a couple of things done at once? And one, the *Return of the Epidural* just happened to get scheduled for the last slot that day.

First up, the nurse practicioner to review the current meds. I arrived to a parking lot in utter chaos, and when I came in the lobby, the place was crawling with people who just didn't seem to know where they should be. I knew where I should be, though, and headed upstairs.

After getting the usuals checked out, and getting the okay to move one prescription to nighttime, the NP asked me if I was going to get my flu shot that day. Aha! I told her not this week, because one, I was headed out of town later in the week, and the shots always make me sleepy for one day, and two, I had a quarterly blood test and epidural that day, and darn it, there's only so much fun one person can have!

She winced and wished me good luck.

Off to the blood taking. I have been asked by the nice people at Kaiser to please use one of the major facilities to get my blood taken. I usually need to have someone with experience in either pediatrics or geriactrics to properly hit a vein and get the multiple tubes. My current record for dry "sticks" is five in one session, which lead to a lab tech who was on the verge of hysteria, and my arms looking like someone had gone after me with a rubber hose.

So, 15 minutes later, I'm making the left arm available for this quarter's extravaganza. Then I noticed the needle. Wrong needle--adult gauge. I was pointing this out to the tech when he assured me he was going to hit a vein, and slammed the effing thing in.

Oh, he hit the vein all right. He tore it such a nice hole that the sub-skin seepage started immediately, and when he pulled the needle, the wound just kept on bleeding.

I always find it interesting when the lab tech acts like it's a personal affront that *I'm* bleeding and bruising. Hey Chuckles--there's a reason there are tabs all over my lab folder! It took about 10 min for things to settle down to the point where I was able to get up and leave w/o freaking everyone else out. But I already had the nicely spreading dark purple stain in the pit of my elbow, and it promised to be a lovely mess in a day.

So, a couple hours with repeats of the ice-gel bag, and it was time to go to the anesthesiologist for the epidural. He checked out my back, we went through what I was doing (everything is correct, it's just that the cartilage is a mess), and after a "oh, so spinal headaches are independent events for each epidural" discussion, it was time to bend over and get the beast.

No matter how much local you get on the skin and in the injection site, epidurals are painful. Amazingly painful. This from the woman whose tolerance for pain is legendary at Kaiser. But nothing to do but breathe and bite the effing pillow.

Then the "huh". Okay--what's up. I can feel everything (oh boy, can I), so it's not spinal related. Then he said--"stay still--you're bleeding, and I can't get it to stop". Okay, here's a problem--while I can put my arm up in the air to try and lessen the pressure on the veins in my arm, I can't exactly elevate my lumbar vertebrae independently of the rest of me. So, he's swabbing and swearing, and I'm trying to remember what colour underwear I had on that day (you think of the weirdest things--mine was I was *never* going to get the stain out if I wore something light). He then told me he was going to have to put some pressure on the injection point, and it was going to hurt. Any worse than the repeated Kyle McLaren butt-checks into the boards I'd just had? Bring it on!

Nope, that was just a "put a load of pinpoint pressure on a rapid expanding lower back bruise". The bleeding finally settled down, and he taped me up but good, telling me that I was going to look like I had major surgery on my back. I told him no worries--looked like it was a theme day, and showed him the large plum-coloured heaps o' fun in the pit of my left elbow, and pointed out that was just due to an adult butterfly being used.

At that point he changed his demeanor. I have to tell you, this doctor and I give each other large amounts of good-natured shit. And I understand his p-chem jokes. The guy basically deals with people in various amounts of pain for a living, so there's a lot of sick humour going down for those who are in that space.

But having a patient who he already knows has a connective tissue problem show an aspect of that in front of him, that's a different deal. And telling him that I've been here all my life, so I don't know anything different--that didn't do scads of good. He felt like he blew it. Given the size of needle you need to have for an epidural, it was a miracle nothing had been ticked before now.

So, an evening with the ice gel bag on my back and one on my arm (what, you thought I had only one?), and a week later, the worst of the discolouration is gone. I did find out that the injection point is still a little sensitive when I put some capsacin cream on the area. OMG.

Next time I'll spread out the fun over a couple of weeks instead of a couple of hours.