Documenting Past Failures: (2) NRF and Dr. Foster

The Dr. Foster episode is one that always will be close to my heart, not only because it demonstrated everything that was wrong about the Neighbourhood Renewal Fund (NRF)/Better Neighbourhoods Initiative (BNI) programme, but also because it had a surprising kick in the tail, and one that was highly gratifying to me.

The story is as follows – and I apologise for the minutiae, but as will become clear, they are necessary to expose the scale of the duplicity that occurred.

In late 2006, LBWF’s Local Strategic Partnership (LSP), chair Cllr. Clyde Loakes, paid Dr Foster Intelligence (DFI) £47,150 from the BNI budget to produce a report which would focus on the most deprived areas in the borough, analyse their patterns of ill-health, identify those constituent households at risk of coronary heart disease and cancers, and recommend ‘appropriate interventions based on the research carried out, and previous experience, including required timescales and funding’.

 DFI began work on 1 September 2006 and presented its findings on 29 September 2006, meaning that it earned at the rate of £2,400 per working day. Its report, Understanding the health needs of Waltham Forest’s Neighbourhood Management Areas, was 140 pages long, and consisted of 53 pages of double-spaced text; 24 pages of maps; 63 pages of appendices, including much generic material; and an electronic annexe, in the form of a spreadsheet, ‘[p]roviding postcode level data of all those lifestyle types at greatest risk of the targeted conditions’.

When the Cann Hall Neighbourhood Forum found out about what Dr. Foster was up to, it was immediately concerned. We had recently paid for consultants to produce a health strategy for the area. The PCT published data on disease down to ward level. It was well known that poorer areas in LBWF suffered from high rates of coronary heart disease and cancer. What added value could yet another study provide? Moreover, was the idea underpinning the report – that you could go round knocking on doors and telling people they had a good chance of getting cancer – in any way sensible?  Accordingly, I began to investigate.

In answer to my initial questions, I was assured that the new report represented a vital step forward. Thus, after I had raised the matter at the relevant LBWF Scrutiny Committee, an officer told me: ‘The findings of the [DFI] report underpin the entire Household Health Improvement work undertaken by the BNI Household Health Improvement Managers [HHIMs]’.

Shortly afterwards, on 17 July 2007, I met face-to-face with Ms.Tracey Thompson (Head of the BNI) and her boss, Mr.Colin Moon (LBWF Head of Housing), and was given a rather less rosy assessment, though also advised that there were mitigating circumstances‘CM explained that using Dr Fosters [sic] had been an innovative approach…but that as is often the risk with a new approach, it had not worked as well as expected. TT confirmed that the HHIM’s [sic] had struggling [sic] to get referrals through the door-knocking approach originally envisaged’.

However, as I soon discovered, both of these comments were rather misleading.

The first fact that I established was that the DFI report in fact had been effectively shelved, certainly never used as intended. LBWF’s response to a Freedom of Information Act inquiry, dated 8 August 2007, made this abundantly clear. The DFI report, it stated, had been studied as part of ‘background research’, but it had not been employed ‘to fashion or operationalise practical interventions’ – the very reasons, of course, why it was commissioned in the first place. So much for the assertion that the report underpinned ‘the entire Household Health Improvement work undertaken by the BNI Household Health Improvement Managers’!

Very concerned by this, I then began – with a colleague – to look more closely at the report’s contents. What we found was shocking. The report was littered with typographical errors, and illogicalities. It was opaque about its methodology. It included statements that seemed perverse (to give one illustration of the latter, DFI claimed that the deprived neighbourhoods had below average rates of coronary heart disease – something that was contrary to both intuition and expert medical opinion). And finally, there were also obviously major problems with the postcode analysis. For when we used the Post Office’s own data base to check the 207 post codes that the consultant claimed covered Cann Hall and Cathall wards, we found that no less than 80 – or 38 per cent – came up as void.

Prompted by these revelations, in October 2007, I made a formal 12-page complaint about the report to the Dr. Foster Intelligence Ethics Committee, a related but independent company, chaired by the eminent scientist, Dr. Jack Tinker, which fulfilled a watchdog role in relation to DFI’s functioning (for those who are interested in the intricacies, I have posted my report in the documents box to the left).

Happily, this proved efficacious, and in a judgment of 6 December 2007, the Ethics Committee upheld my complaint in its entirety, ruled that DFI was in breach of its own code of conduct ‘in relation to the accuracy clause’; instructed DFI to review the report in order ‘to amend the inaccuracies, to investigate the omissions, and to ensure that editorial systems are reviewed’; and placed a record of this decision on the DFI website (to my amusement, it is still there, see ).

The question that remained to be answered was how and why the DFI report had been commissioned in the first place, and the answers here were rather more illusive.

One problem was that, when it was initially being considered, this project did not seem to have been refereed properly. Another was that the procurement and tendering process appeared to have been demonstrably flawed. LBWF rules for contracts valued at £5,000 to £75,000 stated that: ‘A minimum of three written quotes are required including or in addition at least one local supplier [sic]’. Yet when I asked a mid-ranking officer if this had actually happened, I was informed in writing as follows: ‘As the amount involved was less than £50k, the then Health Manager prepared a specification and sent to [sic] three similar organisation [sic] for written quotes. Dr Fosters [sic] was one of them, they responded and were selected.  The other two – one (professor Adrian Renton of the Institute of Health and Human Development – University of East London) wanted a joint bid with Dr Foster, the other (John Eversley of PPRE [sic] could not bid because they [sic] would not be able to complete the project within the stipulated time. Two of the three organisations invited to bid are based in East London – unfortunately no suitable Waltham Forest based organisation could be identified’.

Significantly, the officer did not seem very familiar with the Council’s tendering rules. But the story she told was clear. And if it was true, it put the DFI contract well outside of the regulations.

To clarify matters, on 13 August 2007 I wrote to the LBWF Chief Executive, Roger Taylor, presented the evidence, and asked him to investigate. On 29 November 2007, an extraordinary 78 days later, he deigned to reply, writing as follows: ‘In respect of the procurement procedures employed in the case to which you refer, I am satisfied that this matter was dealt with appropriately in that, in accordance with the Council’s rules, three tenders were sought. As a matter of working practice, both here and in many other places, if not all the tenderers choose to reply, officers proceed quite properly to determine the matter on the basis of those who have tendered.In respect of the matters you have raised in relation to Dr. Foster’s methodology, I understand that Dr. Foster has undertaken a review of the methodology employed in this case and will inform us of the outcome in due course’.

It was notable that Mr. Taylor’s comments about the tendering process, though forthright, appeared confused – not least because of course merely seeking three tenders did not satisfy LBWF rules.

On 18 December 2007, the chief executive wrote to me again, apparently modifying his earlier opinion that ‘this matter was dealt with appropriately’. He now admitted that three written bids (including one from a Waltham Forest supplier) were indeed required (as opposed to be just ‘sought’); reported that ‘at least three organisations were invited to submit written quotations for this contract’; added that of these, ‘one responded to state that they were unable to fulfill the contract within the required time-scale’ and a second ‘asked whether they might submit a joint bid’, an approach that was rejected; and pleaded mitigating circumstances, writing: ‘it is not always possible or practical to insist that rules are followed to the letter, in order to get the job done and in time (for example, where bidders withdraw). In these circumstances, it is sometimes necessary to take a pragmatic approach, and to award the contract to the most suitable remaining bidder. In these circumstances, it is expected that records be kept, for audit purposes, to show that efforts have been made to follow the procurement process, and to meet the requirements of the Procurement Rules correctly’.

To clear matters up, once and for all, on 21 December 2007 I asked LBWF under the Freedom of Information Act to provide me with hard copies of ‘all letters that LBWF sent to outside parties regarding any aspect of the tendering and bidding process for the “Working with at risk households” project [the formal pre-tendering name] during 2006 and 2007’, as will be noted, a fairly broad request.

On 15 January 2008, LBWF’s replied, telling me that all it held on this topic were two e-mails, dated 16 and 19 July 2006, which showed the London consultant PPRE expressing interest in the project, but then being turned down by the LBWF Public Health Improvement Manager because ‘the timescale for the work is four weeks’. In short, LBWF possessed no written evidence that ‘at least three organisations were invited to submit written quotations for this contract’ (as Mr. Taylor claimed); that one organisation ‘asked whether they might submit a joint bid’ (as Mr. Taylor claimed); that a local supplier was involved; or even that – amazingly – DFI was in fact one of the bidders!

Finally, in a letter to Iain Duncan Smith MP of 8 February 2008, Mr. Taylor came clean, writing: ‘With regard to the procurement, the Council’s Internal Audit Team investigated the issue. The procurement of the DFI report did not fully follow the Council’s Contract Procurement Rules. The appropriate processes to seek authorization and record decisions were not followed, but Audit did not find any evidence of fraud. This is bad practice and we have taken steps to ensure that all staff are fully aware of the need to follow procedure and the consequences of failing to do so’.

The contrast with his statement of 29 November 2007 (reproduced above) could not have been starker.

The sting in the tale that I referred to followed. Out of the blue I was passed an e-mail allegedly sent by ‘Sam Gauntlett P.A.’ from ‘’ to a low level officer in LBWF which read as follows: ‘The Ethics Committee Report is attached, following their meeting on 17 January. The Chairman reiterated that although there were errors in the report, this did not detract from the overall findings or the vast majority of content’.

This seemed like a ruse to pretend that, at bottom, it all had been a fuss about nothing. What is more, I discovered that this e-mail had been copied to several senior officers, and also brandished by Mr. Taylor in front of Cllr. Loakes’ LSP, where he referred to it as first ‘from’ and then ‘on behalf of’ Dr. Tinker.

Sensing a rat, I wrote to Dr. Tinker seeking clarification, and almost by return received the following reply: ‘Thank you for your letter of July 24th.The Ethics Committee judgement is the final word on the matter.The comment attributed to me is not correct and I expressed surprise when I saw it. The Ethics Committee did therefore not share this view and I never gave Sam Gauntlett permission to communicate with LBWF on my behalf. I hope this clarifies the matter’.

Subsequently, I went back to both LBWF and DFI about the identity of the mysterious Ms. Gauntlett, and the reasons why the e-mail had surfaced, but by now the shutters were well and truly down, and no further information was forthcoming.

And that basically was that. DFI deserved little credit for its initial report, though at least its mechanism for fielding complaints had proved independent and fair.

As to LBWF and Mr. Taylor? Well I leave the assessment of their behaviour to the reader. What’s clear is that £47,150 of our money had gone straight down the drain…

PS inevitably, the Waltham Forest Guardian provided good coverage, see for example: