Ageing: What do People Need?

Ageing impacts everybody in civil society.  We all grow older; we observe the ageing process with mild disinterest until it affects us personally. Who are the key stakeholders in sustaining a reasonable quality of life for our ever increasing ageing population?

• Older people living independently
• Relatives, who may live many miles away
• Carers providing voluntary or commercial services
• Local Authority Social Services officers
• Voluntary Sector advisors

At the Health Technology Forum (November 20th, 2013), Mike Clark informed us that there are 1.5 million people employed in the Social Care industry.  In addition, there are about 5 million more providing unpaid care to relatives, friends or via voluntary work.  Before may years have passed, more then 9 million of the UK population will be personally involved in providing social care.   It is beginning to have a major impact on UK productivity with so much time and effort being deployed in caring. Technology enables people to do more, with less effort, improving outcomes in health and wellbeing.

Before rushing into a care technology solution, Quarkside recommends taking stock of what each stakeholder group needs, with answers to simple questions for each group:

• What are the benefits of monitoring activity in the home?
• What are the risks?
• How much activity should be monitored and stored, if any?
• How much data should be shared, and with whom?
• What are the critical privacy requirements?
• What is affordable?

These questions are being posed at Kent County Council (November 23rd, 2013).  The results should should inform any care ecosystem design for the technology products that will largely have to be self-funded.  The State will not provide for things that only provide peace of mind and improved levels of wellbeing of older people and their relatives.

MLF supports open standards: Open Care EcoSystem?

Martha Lane Fox understands the case for open standards; from her speech in the lords:

“I am not talking about expensive and costly top down nhs IT projects but instead about better use of data, open standards, more agile development and a more digitally minded culture in our healthcare sector….

 … the Department of Health (DH) believes that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services. Implemented effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on long term NHS costs and improve people’s quality of life through better self-care in the home setting.“

The NHS can potentially save so much money, they should consider giving financial support to organisations working on preventative care.  Here’s Quarkside’s idea.

Elderly people living independently could have their homes fitted with activity sensors and wear health monitors eg blood pressure.  Data is collected continuously, via the Internet, and analysed to create an individual’s unique, normal, behaviour pattern.  Deviation from normal patterns, displayed to family members or carers, alerts them of potential health problems and they can provide valuable data for GPs or hospitals.

Early medical intervention could improve outcomes for people with chronic conditions, eg diabetes, loss of cognition eg Alzheimer’s and recently discharged from hospitals.  Each could be worth £billions.

An ecosystem of open standards makes sense.  We need standards for::

• Home activity sensors, eg smart meters
• Health monitors, eg heart rate
• Safety alarms, eg carbon monoxide levels
• Time series data for all types of home and health monitors
• Display of analytical information for individuals, families, carers and health professionals
• Information governance of digital identities and data sharing

Standards like this, developed coherently in the public sector, would encourage innovative SMEs to enter the market and vastly improve health outcomes.  It could be a world leading industry, helping the UK economy.  This open ecosystem should be supported by multiple stakeholders.  It crosses the boundaries of Government departments of Business, Innovation & Skills, Health, Education, Communities & Local Government, Work & Pensions  and Local Authorities with responsibility for Social Care.

Any Government and Trust funding for the development of an Open Care EcoSystem will help the transformation from a reactive public health service to a preventative health culture in private citizens.

Is ten years too ambitious?

7DIG: Time needs more than philosophy

The Time component of the seven dimensional information governance (7DIG) framework was of little practical interest.  The spatio-temporal paradigm may hold the philosophical high ground, but a treatise on Gantt charts would have been out of place.  Serendipity has revealed a practical product, which is free, and is based on a philosophy of teams doing the right thing at the right time.  It brings together the People who have to do the information governance with the Process that sets Objectives and uses Assets to achieve the desired Outcomes.  And it has a Risk register.

It is project based – ideal for setting up an Information Governance process and should be adaptable for continuous monitoring. Look at some of the features:

1. People from any department or supplier
2. Assets, such as an information asset register and documentation, as a sharable resources
3. Objectives, as part of the textual description including a breakdown into areas of interest or phases of work
4. Process description in the form of tasks, which can be repeatable, taking us through the identification to deletion cycle
5. Outcomes by the way of documented completion of tasks and compliance with targets
6. Time charts, calendars, milestones and the possibility to export to your favourite Gantt chart tools
7. Risk register, very simple to input and understand but good enough in most Information Governance régimes

The openness is especially encouraging.  It is completely Web-based and viewable from your iPod, iPhone or iPad.  Even the name is encouraging – Teamwork.

Quarkside wondered why such a simple product has not popped up in the radar previously.  Maybe it has only been promoted within the systems development community – and not yet reached public sector ICT managers.  Another job for Socitm?

Plant the Flag: Think about outcomes

Dedicated followers of Socitm will know that the five year forward strategy is called “Planting the Flag”.  It was published in May 2011 and yesterday was a timely review in a joint meeting with the local CIO Council.  Progress is being made on “Planning the Routes” and “Driving the Routes”.  The diversity of size and responsibility of Socitm members is such that one size cannot possibly fit all.  The documents can only be considered as frameworks for action.  As one speaker pointed out, best practice is backward looking, and less important if we are trying to encourage innovation and transforming business processes.

“Planting the Flag sets out three core principles (collaborate, redesign and innovate), six strategic capabilities (leadership, governance, organisational change, strategic commissioning, shared services and professionalism) and six key issues around information and technology that are key to redesigning local public services – faster, cheaper, better – delivering better for less in ways citizens want. “

One group, consisting mainly of CIOs, pointed their problem is communicating the messages to their chief officers and members.  The the names of the stages are a metaphor of planning a trek into the high peaks of the Alps.  That’s fine for invigorating a live audience – but it gets in the way of releasing budget for doing things differently.  Most concerning was that the strategy does address the practical problems of delivering IT enabled services to citizens – it is not driven by the outcomes that are at the forefront of delivery agencies’ agenda.

Everybody in the room bought into those principles and capabilities – but they are essentially inward looking to the ICT profession.  They are not the issues that attract support from democratic or service leadership.  When CIOs go back to their patches, they are faced with translating the strategy and briefing notes into something digestible for supporting business cases for change.  The advice has to fit into the local political agenda.

Nobody is saying that is a simple job for Socitm – but there is a need for a simpler message for a broader range of stakeholders.  Neither should it be just for local authorities; it has to go out to health, police, emergency services, transport and innumerable voluntary sector agencies.

IDs for a UK Citizen Account

Quarkside has just heard of a way to solve the following problems:

• Benefits costs
• Under employed people
• Education maintenance allowance
• University living costs
• Basic pensions
• Enhanced pensions
• Recovering money for fines
• Health costs

It requires setting up a citizen account (UK citizens only) for EVERY citizen, including children. For sake of an abbreviation, we will call it the UK Citizen Account (UCA). The following rights are given, they are paid from taxation, without exception, into a freely spendable account (FSA).

• 0-16 child allowance, spendable by nominated parent or guardian
• 16-18 youth allowance, spendable by the young person
• 19-24 tertiary education allowance, spendable by the citizen
• 24-67 working age allowance
• 67-80 first pension
• 80+ second pension

Alongside the government input is personal input which is a proportion of taxable income.  This is a protected endowment account (PEA).  The main aim is to build up a personal fund that can be drawn down as housing, pension, health and mid-life education.  The nearest analogy is Singapore’s Central Provident Fund (CPF).  It is a colonial legacy: ” When the Japanese Occupation ended in 1945, Singapore became a British colony again. Life was hard. People struggled to make ends meet. To ensure that workers could take care of themselves in their old age, the Central Provident Fund was set up as a compulsory savings scheme. ”

The benefits to the government are:

• Simplicity of administration – entitlements are universal, every citizen independent of other income
• Means tested benefits cease, such as housing benefit.
• Personal National Insurance (NI) contributions are paid into the PEA, like a compulsory personal insurance.
• Employers NI contributions are paid into the PEA as a percentage of taxable income.
• Debts to the government can be taken from the fund, eg fines, unpaid taxes.
• Choice by the citizen for medical treatment.  The tariffs are well documented.  A percentage is taken from the PEA for every access to NHS services – lower percentage for basic services (10%) – higher percentage for more expensive, private care provision (90%).
• Funding for infrastructure from accrued savings
• Funding for low cost housing by giving loans from accrued personal PEA savings
• Choice to use the PEA for adult education and retraining for new skills.   The Working Age Allowance is always paid to provide some basic income.

The benefits to the citizen are:

• Guaranteed untaxed income throughout life, whether working or not.
• Working will always be better than not working.
• Protected Fund, built up by work, for spending on housing, further education, pensions and health.
• Additional contributions from employers (including self-employed), interest on account and profits from fund investments.
• Opportunity to obtain a mortgage from funds accrued – commercial interest rates will be charged.
• Opportunity to pay for adult education or re-training.
• No risk of bankrupt or stolen pension funds.
• Choice to pay for care at home or residential homes.
• The residue on death forms part of the estate – not taken by the government.

The details can be sorted out, but it avoids the costly mistake of Universal Credits.  Such a total restructure of the welfare state means sacrificing sacred cows. Singapore now has a handle on social welfare costs, unlike the UK.  They have a successful economy.  Rationing of health costs is left to citizens and their families.

And the governance issue is: – citizens will need to have a trusted Identity,  without too many duplicates.  Perhaps this will be good enough to allow them to vote, too.

A Framework for Frameworks

Whilst reviewing a worthy document on leadership in ICT, it seemed to lack structure.  The contents were fine, but left an uneasy feeling that not everything had been covered.  Was the advice MECE?  This led to a Leadership Model, reminiscent of one used by Quarkside before (7DIG).  The seven primary dimensions were Direction, Stakeholders, Resources, Action, Outcomes, Time and Risk.

The Expanded Leadership Model is probably a reasonable Framework for many ICT organisations.

It triggered an idea of a Framework for Frameworks. A self-help tool that gives a structure for all MECE dimensions.  It starts with seven generic concepts.

1. Context:  the business environment and constraints
2. Subjects:  People who are involved in processes
3. Verbs: Words that denote action by people, Process
4. Objects:  Things that are resources to be consumed or created
5. Outcomes: Desired results from the process actions
6. Time:  When things are to be done
7. Risk:  What can disrupt the Process – and how to manage risk

The diagram may help some people.  Let us know if it has helped you.

Let the organisation decide the next level down.  They know the trigger points and politics that will enable changed behaviour or transformation of processes.  For many purposes, this simple framework for frameworks should be more effective than McKinsey’s famous 7S framework for changing organisations.

Liam Maxwell: One year later

It is more than a year since Liam Maxwell’s  “Better for Less” was published.  What has been achieved from the 69 pages of ideas? It obviously made the right impression because he is now working in the Cabinet Office in a one year appointment from September 2011

He did ask “WHAT WILL SUCCESS LOOK LIKE?

Our goal should be to deliver to the online population frontline public services with minimal, possibly zero, administrative cost, freeing up cash for more effective, intermediary-based, service delivery for those not online, and also as savings. This is already happening in some areas of local government and driving taxes down. It is happening in other countries, making service delivery better. It is time the biggest component of the British economy, its bloated state, started to learn these lessons.

How does it work? 5 principles underlining all IT in government We base our approach on a small number of core principles

1) Openness

a. Open Data – government data must be transparent
b. Open Source works – its concepts should be applied to processes as much as to IT
c. Open Standards will drive interoperability, save money and prevent vendor lock-in
d. Open Markets – competition creates efficient market-based solutions.

2) Localism – the centre may set the standards, but local deployment is best.

3) Ownership and Privacy

a. It’s our data, government can have access but not control over personal data.
b. Government should be accountable for data protection and proper use.

4) Outcomes matter more than targets.

5) Government must be in control of its programmes, not led by them.”

Let’s look to see how successfully the principles have been incorporated into the Government ICT Strategy.

1. Open data, open standards and open source are clearly stated objectives. And open markets are part of the procurement objective.

2. Localism does not get a mention, according to word search. This is a gaping hole, but perhaps Liam will explain this when he speaks at the SOCITM conference in November.

3. Alarmingly, neither privacy nor data protection are words within the strategy.  The objective for “Risk Management Regime” has implied elements for both, but the metrics concentrate system security – not anything based on citizen data protection.

4. Outcomes are potentially the most important gap in the strategy. There’s too much concentration on internal, central government processes. The four objectives for “using ICT to enable and deliver change” are not really focussed on citizen outcomes.

5. Governance of programmes is an implicit role for the “Public Expenditure (Efficiency and Reform) Cabinet sub-committee (PEX(ER))“. There are twelve senior people named, with representatives from MOD, MOJ, HMRC, HO, DoH, DWP and Cabinet Office.   That  should be enough people. However, Quarkside thinks that UK plc should also have representation from departments with responsibility for improving the ICT skill base of the country. Shouldn’t DfE and BIS have something useful to contribute? And if localism is really important, why doesn’t DCLG have a place on the high table?

Quarkside gives “Better for Less” 40 marks out of a possible 100 for influencing the agenda. In the old days, this was a ‘Pass’ at A level. So not too bad. However, it would not have secured you a place in one of the top universities.

Recipe for Rip-Offs – Quarkside Dunnit

How encouraging that Quarkside produced the strapline for the PASC Report Government and IT — “a recipe for rip-offs”: time for a new approach.  The author was quoted in paragraph 102.   It was taken from a longer statement  made in January.

“Complete outsourcing is a recipe for rip-offs. “

It even made the morning BBC news bulletins.  More importantly, it has been open and frank with criticisms and  recommendations.  There is little to cause negative comment from Quarkside.  Just read the full report.

The only area for improvement would be to link the concept of outcome based commissioning in paragraph 75:

“The Government must stop departments specifying IT solutions and ensure they specify what outcomes they wish to achieve, within the broad technical parameters to ensure interoperability.

with the discussion on Waterfall versus Agile Development.

The model in paragraph 81 does not mention outcomes.  Outcomes are the starting point of Quarkside’s Seven Dimensions of Information Governance (7DIG).  This is a nice example of using 7DIG to test validity of governance plans.  Agile is also seen as experimentation.  That’s fine, but the scientific method creates research goals.  These goals can be set at each iteration and possible future goals reviewed – and the outcomes must be re-visited.

Framework for Change: Technology Enabled

The public sector can now start making use of a useful standard has crept out of the OASIS (Organization for the Advancement of Structured Information Standards).  The title is not in fashion,  “Transformational Government Framework Primer Version 1.0”, and hides that it can help technology­‐enabled change.

This single diagram shows all that most people need to know.

TGF Diagram

It may not be perfect in every case, but it is a far better starting point than the blank piece of paper that initiates most shared service programmes.  Not only does it comply with Quarkside’s Process, Governance and Technology philosophy, it highlights the need for critical success factors (CSFs).  CSFs are a fundamental part of the framework roadmap already published by Quarkside.

Give it a try – or just publicise its existence.  Perhaps LeGSB has a role to play.

Thanks to Mick Pythian for this link

QA may madden Maude

The 2011 Government ICT strategy preaches standards.   Tick box = Good.  People who bore for standards preach, ‘to do it properly you must define the standard and check later that the standard has been followed’.  This blog compares the strategy against a standard (standard with a small ‘s’) – in this case against the same set that was used to review the SOCITM ICT Strategy, released in draft last month.

The target for all public sector ICT is established in the introduction:

“6. Information and communications technology (ICT) is critical for the effective operation of government and the delivery of the services it provides to citizens and businesses. It offers key benefits by enabling:

• access to online transactional services, which makes life simpler and more convenient for citizens and businesses; and
• channels to collaborate and share information with citizens and business, which in turn enable the innovation of new online tools and services.”

Everybody must agree with this, and observe that sharing information across multiple agency boundaries is critical for citizens, businesses and agencies.  It has led to much discussion about shared infrastructure, shared services and the benefits this will bring.  Fortunately, we can use a standard for quality assuring the Strategy and highlighting any gaps that need to be addressed.  It has nine dimensions for assessing multi-agency information sharing partnerships.

• Business Scope and Plans
• Governance
• Legal Issues, Policies, Rights and Responsibilities
• Information Sharing
• Identity Management
• Federation
• Transactions, Events and Messages
• Infrastructure
• Sustainability

Overall these can be summarised into Process, Governance and Technology – the Quarkside mantra.  A quick traffic light assessment against the standard dimensions is as follows:

• Business Scope and Plans: Amber

The reasons are good and there is an aggressive, but risky timeplan.  Dependence on on word ‘Agile’, is a recipe for systemic obscuring of progress.  It provides opportunities for hiding problems that only emerge when the end-users in multiple location are expected to change time-honoured processes, and new systems are not interoperable with old systems.  The needs of 450 local authorities must not be ignored.

• Governance:  Amber

A structure has been developed, but it omits the input of local delivery agencies, such as local authorities.

• Legal Issues, Policies, Rights and Responsibilities: Amber

Apart from the Policy, other issues are not raised

• Information Sharing: Amber

Use of open standards and APIs will help at a programmatic level, but additional useful services, such as Master Data Management and systems interoperability standards are not mentioned.

• Identity Management:  Red

Avoidance of a cross public sector strategy for citizen, employee and agent identity management risks complete failure of the strategy and policy objectives will not be met.

• Federation: Red

Federated trust by all involved agencies is vital for both accuracy and efficiency.  Nowhere is this mentioned or implied.

• Transactions, Events and Messages:  Green

Operational systems usually find technical solution for inter-system data transfers.  The use of Web services on the Cloud should help.  Channel issues are addressed

• Infrastructure:  Greenish

The overwhelming weight of the document is technology and infrastructure, there are eleven actions planned.  However, one suspects that the thought process has ignored local government and external agencies in the calculations.  Are local authorities expected to reduce ICT costs by 35%?

• Sustainability:  Red

The standard means to ability to sustain a shared service for operation over many years, not reducing carbon usage.  Most shared services fail because of the inability to agree funding for operations, and all the development investment is wasted.  Central Government must agree a sustainable funding model at the very beginning of every information sharing project.  The Cabinet Office should feel responsible for the whole of the public sector, not just central government departments and agencies.

So how do you react to 3 Reds, 4 Ambers and 2 Greens?  It is low on Process and Governance and higher on Technology.  Quarkside thinks it is good enough for a first draft to get the ball rolling.  But if Francis Maude thinks this document is going to deliver all his policy objectives, then I fear that he, or his successor, is set for a big disappointment and some explaining to do.