Date: 06 Nov 92 16:51:00 GMT From: Lord Wodehouse Subject: London Ambulance Compter System >From Computer Weekly Thursday 5th November 1992 85/ 92 17:87 GLAXO GROUP RESEARCH INFOSYSTEMS N0.991 Ps Ambulances revert to paper based back-up (Jason Hobby) LONDON Ambulance Service (LAS) this week reverted to a paper back-up system alongside computers until problems with its 1.1 million pound computeraided despatch system are ironed out. Last week the system failed to operate effectively - prompting an external inquiry called by Health Secretary Virginia Bottomley. It also emerged that Systems Options, the company supplying the main part of the software for the system, had no experience in designing despatch systems for ambulance services. LAS uses Systems Option's Wings Geographical Information System (GIS) for Microsoft's Windows, in eonjunction with automatic vehicle location specialist Datatrak's vehicle tracking system. The system runs on networked PCs and file servers supplied by Apricot. Details of 999 calls are entered into a PC and the data sent via a local area network to an allocator faced with a PC displaying a map of a given area, and the location and availability of ambulances. Crews, in touch via radio, can receive messages and updated data on mobile data terminals. The Wings system has a facility known as dynamic data exchange which means another program can send in-formation such as vehicle lo-cation to Wings in real time. McDonnell Douglas, which already has systems in nearly a third of UK ambulance services was upset that it lost out to Systems Options, while other suppliers have, questioned why the LAS failed to consider tried and tested systems. Keith Green, managing director of Bleasdale Computer Systems, which has supplied hardware for several ambulance services, says West Midlands has successfully run its own in-house developed system for over three years. "They have two systems linked together by Ethernet in a fault tolerant nature. The software has been extremely robust. An awful lot of dry running, four to five months, was put into the system and training of people. It's a matter of life and death for a ; computer system in sin, tions like these." [The system has again failed and is depending totally on the backup system now. One ambulance was delayed about 30 minutes. The main comment made here in my office was that the management simply switched from the old system to the new, without *any* period of pararell running of both systems. If this is the actual case, we see an example of faith in an untried system, and cost-cutting requirements, triumphing over common-sense!] Lord John - The Programming Peer mail - w0400@ggr.co.uk fax - +44 81 423 4070 tlx - 8951942 GLXPRI G ------------------------------ Date: Thu, 5 Nov 1992 17:09:19 GMT From: Brian.Randell@newcastle.ac.uk Subject: Re: London Ambulance Service [Today (5 November) both The Guardian and The Independent have carried lengthy articles on this ongoing saga. The Guardian article is in the Computer Section of the paper, and gives more technical detail than I have seen before; the Independent article is a page 2 news article describing the latest developments. Both are quoted here in their entirety. Brian Randell] THE GUARDIAN - Thursday November 5 1992 London's computer aided calls system for ambulances has failed. Why? This is an emergency Jason Hobby Last week the London Ambulance Service (LAS) for the second time admitted defeat in its attempt to install and operate a computer-aided despatch system to cope with the 2,300 emergency calls it receives daily. After numerous 999 calls were lost in the (pounds)1.1 million system, the resulting furore cost its chief executive, John Wilby, his job. When Wilby took over at the LAS he inherited a command and control system that simply did not work. The system, based on four large Data General Eclipse minicomputers should have gone live in 1990, and did not. Two experiments designed to test its ability to cope with peak 999 call rates failed. Costs had tripled from (pounds)2.5 million to (pounds)7.5 million. All of this culminated in LAS suing the supplier, a BT subsidiary, International Aeradio Ltd and subcontractor computer systems house CGS. The need to get a working computerised despatch system up and running was by now so great that the service went looking for an "off the shelf" solution. What happened next raised a few eyebrows among the established suppliers of systems to ambulance services. LAS gave the contract to Systems Options of Aldershot, a little-known supplier of geographical information systems (GIS) to local authorities and the BBC, but not ambulance services. Why didn't the LAS look at systems up and running elsewhere? How about the West Midlands Ambulance Service, with 1,100 emergency calls a day, the next biggest in the UK after London? It uses Unix-based fault-tolerant hardware supplied by Bleasdale Computer Systems and software written in-house. Unlike London, the West Midland has a second, back-up system, which has had to be used only once in three and a half years, when an engineer accidentally pulled out a cable. McDonnell Douglas, which has a 30 per cent share of the UK market for despatch systems, was incredulous at losing the contract to Systems Options. But there was no surprise about the other main contractor for the project: Datatrak, the automatic vehicle location specialist. Datatrak's system was being used successfully by other services, notably Surrey Ambulance, and by Securicor. Datatrak works by using locators, based on 32-bit microprocessors fitted to a vehicle, and connected to an antenna. The locator receives signals from the Datatrak radio network and establishes the vehicle's direction and speed, accepts status information from other outside sources if needed and sends it via the Datatrak network to the user's control room. Datatrak points out that its part in the LAS system is only in transmitting location details. The computer hardware consists of 4080486 DX/33 workstations and four FT DX/25s fault tolerant servers supplied by Apricot, running Novell Netware. When a 999 call is made, a receiver takes the call details and enters them on to a PC. The data goes via a local area network to an allocator, who also sits in front of a PC. The allocator should be able to see a map of the given area showing the location and availability of ambulances, which are constantly in touch via radio. If crews are at base they pick up written details and instructions. If manning their ambulance, a mobile data terminal, supplied by Solo Electronics, flashes up instructions. The main software part of the system, supplied by Systems Options, is a version of its Wings geographical information system (not the Wingz spreadsheet) for Microsoft Windows. Wings allows the user to view data records on-screen in their correct geographical context against maps of the areas displayed. Using Windows' DDE (Dynamic Data Exchange) facility, another program can send information (eg vehicle location) to Wings in real time, thus providing real-time map updating. Windows lets the user view maps overlaid with his or her own data in one window, while looking at other applications. It all sounds fine in theory but in practice last week the LAS had to revert to a partly manual system after the first full operational test revealed problems. But until the inquiry, set up by Virginia Bottomley, establishes the facts behind the debacle, it won't be possible to apportion blame. Jason Hobby has covered the LAS story for Computer Weekly since April 1991. ------------------ THE INDEPENDENT - 5 November 1992 Ambulance service computer fails for a second time By Susan Watts - Technology Correspondent The London Ambulance Service abandoned its controversial computer system early yesterday after the second bout of problems within 10 days forced staff to revert to paper and pencil. Early last week the LAS witnessed what one union official described as "the worst 48 hours in the history of the ambulance service". On the Monday and Tuesday serious difficulties with the (pounds)1.5m computer system are said to have cost between 10 and 20 lives. Yesterday the LAS claimed nobody was seriously affected by the breakdown. Staff noticed the system was "slowing down" apparently at the same time as data was being automatically stored. They tried to bring in "back-up" computers, but this approach failed. At 2 am yesterday the system became so slow that operators went back to the manual system they have used "since the year dot". They tracked calls logged in the system to make sure ambulances had been sent out. All but one had gone ahead. The one "lost" call meant a delay of 25 minutes in sending an ambulance, the LAS said. The ambulance arrived 9 minutes after the call was spotted and the patient reached hospital safely. Martin Gorham, acting chief executive, said he would not bring the computer back into service "until [the LAS] is satisfied that these problems have been solved". Yesterday, a leaked letter to Virginia Bottomley, Secretary of State for Health, from ISL Consultancy Services, revealed claims that it had warned the LAS about potential problems. ISL Consultancy Services raised the alarm after it lost out in the bid to supply the LAS system. The contract went to Systems Options, an Aldershot-based company. The letter from ISL claims that other more experienced companies were overlooked. In the letter, Ian Lund, a senior partner at ISL says his company had a proven track record in command and control systems of the type the LAS was seeking. He says the Metropolitan Police used his company to check similar computer systems it had installed. Mr Lund claims the LAS asked his company to review the quality assurance aspects of the chosen system. But he alleges that the ambulance service failed to acknowledge the review, which highlighted potential hazards, despite his repeated attempts to speak to the person who commissioned it. Yesterday's difficulties came at a quiet time. Last week an unexpected flood of calls exacerbated the computer problems. The extra calls came just after the system had been switched into an automatic mode and three separate divisional systems combined to cover the whole of London. Operators yesterday said management should have heeded their warnings that the Computer Aided Dispatch System was not up to scratch. They said the half-computer, half-manual approach adopted after last week's crisis meant lives were still at risk. They wanted the computer shut down completely. Systems Options refused to comment on the latest problem with its system yesterday. Details of yesterday's breakdown will be passed to the external inquiry into the LAS, full details of which are expected to be announced tomorrow by Mrs Bottomley. ------------------------------ Date: Thu, 5 Nov 92 13:09:07 GMT From: Chris Welch Subject: Re: London Ambulance Service Computing, 5 November 1992 LAS on sick list before collapse (by Douglas Hayward) Computer systems at the London Ambulance Service were already under fire before last week's events. Staff at LAS, led by the public sector union NUPE, say the system that allegedly plunged the service into chaos last week and may have resulted in up to 20 deaths, was already responsible for up to 48 deaths which the union has linked to the system since it went live in January this year. At the centre of the storm is a small Aldershot-based software company, Systems Options, that won the initial 1.1 million pound contract for the troubled LAS dispatch system in June last year. LAS had scrapped a previous development from BT subsidiary IAL at a cost of 7.5 million pounds in October 1990. Time was running out when Systems Options came on the scene, substantially underbidding established supplier McDonnell Douglas. The problems of a small software house working against the clock were compounded by an atmosphere of hostility and poor management at the LAS. Suppliers dealing with the service have spoken privately of disorganisation, as well as low staff morale and severe problems between management and employees' representatives. Staff at Systems Options are known to have been unhappy with the way the project was managed. Other observers agree that things went badly wrong. Dave Embleton, chairman of software house IPL, which supplies safety-critical software to the aerospace and ambulance market, said: "It's very strange that a system of this importance should go live and fall over so quickly. It seems insufficient attention has been paid to the need for thorough testing." Following the chaos of Monday and Tuesday last week, the system has reverted to a halfway house, with the computer allocating jobs but control room staff taking details from printers and contacting stations and crews by radio. Mike Smith, systems manager at LAS, said: "One thing that did not fail was the computer. What seems to have gone wrong is that the people working on the system were flooded with exception messages - we don't yet know why. We may have lost local knowledge by breaking up sector desks at the weekend." Other LAS officials responded to NUPE's criticisms with oblique references to deliberate non-cooperation by staff threatened with new technology. However, crews and control rrom staff received a boost last week from one of the suppliers that tendered for the contract. Michael Page, managing director of software house Action Information Management, attacked the fundamental architecture of the system, which uses rule-based and geographical information software to automate ambulance dispatch. "The rule-based, analytical approach used by LAS cannot deal as well as an experienced operator with the small minority of difficult cases. The system wrongly reduces the influence of the operators," Page said. ======================== Box attached to article COUNTDOWN ========= May 1987 LAS start 3 million pound computerisation project after a year's delay. October 1990 LAS scraps computer aided dispatch module after it fails tests. February 1991 LAS seeks damages from IAL over faulty dispatch module. July 1991 Systems Options, Apricot and Datatrak selected to write the new dispatch system. January 1992 Phases one and two begin live trials. March 1992 Phase two trials temporarily suspended following claims of fatal delays caused by system errors. October 1992 Phase three terminated after two days of chaos. LAS chief John Wilby quits; independent enquiry announced. ------------------------------