Examination of Witnesses (Questions 120
- 139)
MONDAY 23 MARCH 1998
MR ALAN LANGLANDS, MR FRANK BURNS, DR JAMES READ AND MR DAVID BIRD.
120. So as far as you are concerned these
payments that have been listed, the incompetence, the paying people
off, were not evidence of failure to manage the finances properly,
you are happy with that track record?
(Dr Read) I think the finances were
managed carefully with the enormity of the projects that we were
trying to manage.
Mr Hope: My time is up. Thank you
very much.
Mr Clifton-Brown
121. Mr Langlands, good afternoon. According
to your biography you are a very eminent man. You hold a Diploma
of the Institute of Health Services Management and you are an
Honourary Professor of the University of Warwick Business School.
So you should have a reasonable grasp of how IT systems should
be implemented. You were also appointed to the Department of Health
as Deputy Chief Executive in 1993. Three years later on 8 May
1996 you appeared before this Committee and many of the questions
that have been asked this afternoon were the same sorts of failings
on the hospital information support systems. Did it not occur
to you after that hearing on 8 May to go away and look at the
implementation of these Read Codes and, if so, what have you personally
done to ensure that they are being implemented properly and that
public money is being spent wisely?
(Mr Langlands) Not as a direct result
of the Committee hearing but as a result of the likelihood of
significant change in the health service and the need to improve
our use of information and IT in the health service in June 1997
we set up a major review of information management and technology.
That review has been carried out by Mr Burns, who is on my right,
who has been the driving force behind an excellent system that
uses all the principles of Read Codes and security, the unique
patient number, all the building blocks that we need for good
information management technology in his trust at the Wirral Hospital.
His advice has been given to me. We are working at the moment
with ministers to consider how we take that forward and how we
use it to promote the Government's policies that have been set
out in the recent White Paper.
122. Do you recall in answer to the Chairman,
answer 11, this was in answer to questions from the Chairman about
the integrated computer systems, you said: "In the period
between now and the year 2000 it will be increasingly difficult
for hospitals to function without this system"?
(Mr Langlands) Yes.
123. Here we are in 1998 and you have already
admitted in answer to Ms Eagle substantially this system is not
working in any reasonable number of hospitals. If your answer
was correct then how are we now going to progress towards 2000?
(Mr Langlands) We have to progress
in a whole number of ways. There is no single bullet solution
here. Providing health care to every individual in this country
is a complicated business. Providing information management systems
that support the way in which health care is provided that can
be used properly and effectively by clinicians in their day-to-day
work is a huge task, a task that every developed health system
in the world is having to deal with at the moment.
124. That is the sort of answer you might
have given on 8 May 1996.
(Mr Langlands) I think we have made
considerable progress since then.
125. You have not been able to give a definitive
answer this afternoon to show us how you have made progress since
1996. There has been a lot of waffle but we have not really heard
anything positive about how you have made progress since 1996.
(Mr Langlands) I think we have made
progress in developing Read Codes and I reject the notion that
Version 3 does not work. I think we have made progress, and there
is documentary evidence to support this, further progress in integrated
clinical systems in different hospital settings. We have reached
a very detailed agreement with the medical profession in this
country about how we are going to handle our security and questions
of patient confidentiality in these clinical systems. We have
been managing the roll out of what is called the unique patient
identifier which gives every member of the population a unique
number for use in health records. Every other country in the world
regards these as major achievements. These are the essential building
blocks of good clinical systems that ultimately will improve patient
care in this country and in that endeavour we have strong support
from the clinical community, but we should not kid ourselves that
these are simple matters.
126. Mr Langlands, you have given me a lot
of long answers. I would be grateful if you would keep your answers
fairly brief. I am going to ask you a series of questions on costs
now. Can you tell me what the estimated annual savings from the
Read codes systems have been over the last ten years?
(Mr Langlands) No.
127. Could you give us a note on that, please.
Can you tell us what the accurate development costs have been[15]?
I know you have given the figure of £19.8 million [16]
in the Report, but is that figure accurate?
(Mr Langlands) I think it is £19.5
[17]
in the Report, but I am not sure. That is an accurate figure.
The figure that I have been using this afternoon in relation to
Version 3 is just over £3.8 million. The sum in relation
to medical staffing issues is £2.7 million, in relation to
the professions supplementary to medicine, £138,000 and in
relation to nurses, health visitors and mid-wives, £1 million,
so it is just over £3.8.
128. In addition to that there is the money
you have paid to Dr Read's company, Computer Aided Medical Systems
Limited, is there not? Can you give us an idea since the purchase
from him of the copyright of this system how much have you paid
him for distribution?
(Mr Langlands) I cannot give it
to you now but I would be happy to provide a note[18].
129. Can I give it to you? In answer to
a Question from Roger Morgan MP on 18/12/97 it looks as though
the total figure is about £13.8 million. So in addition to
almost £20 million of developing the system you have paid
his distribution company £13.8 million.
(Mr Langlands) I would need to check
that figure and I would also need to be clear with you that some
of these --
130. Let us ask Dr Read. Is that a correct
figure?
(Dr Read) I have not got the figures,
I am sorry.
131. Let me give you a breakdown of the
figure. The figure for 1995/96 was £1.6 million. The figure
14for 1991 to 1996 was £7.4 million. It is likely that payments
at this level will continue for the expiry of the CAMS contract
in 1999 suggesting further payments of £4.8 million. If you
total those together that is £13.8 million. Do you accept
that that is the sort of figure that your company will be paid
until the termination of the contract?
(Dr Read) I would have to check
that, but it sounds not far wrong.
132. You must have some idea of how much
money your company has been paid for the distribution of this
system up to date and between now and the end of the contract
in 1999. That seems a fairly fundamental figure.
(Dr Read) It is something like £1.5
million a year which is to cover the costs of CAMS for servicing
its contract.
133. Either the answer given in the Parliamentary
Question on the 18/12/97 was correct or it was not correct. What
is the answer, Mr Langlands? I am quoting from the answer.
(Mr Langlands) I do not have the
figure in front of me, but I certainly would stand by --
134. You would stand by the figures.
(Mr Langlands) -- the figures and
I would be happy to provide the Committee with a note[19].
There are other costs to the Health Service. For example, GPs
and others themselves, the users, pay a licence fee as well. I
think rather than give you partial figures we will give you a
comprehensive picture.
135. Can you give me an idea of the amount
of clinicians' time involved in the development of Read 3 and
what that cost would amount to?
(Mr Langlands) As far as I know
it has not been quantified. It could only be quantified by measuring
the time that the group of people in the 55 working groups spent
at meetings, but, of course, a lot of the work would be done back
in their own hospital setting. We could try and estimate that,
but it is an extremely difficult thing to get at.
136. These 55 speciality groups have been
working over a two- year period. Somebody who is reasonably knowledgable
in these matters has estimated that it might have involved 200
hours of clinicians' time at a cost of £50 per hour. That
would involve a total figure of some £20 million. Do you
think that is in the right ballpark or not?
(Mr Langlands) I think I would like
to check based on the actual experience of the people who ran
the committees.
137. You can see we have got almost £20
million for developing it. We have got £13.2 million paid
to Dr Read's company. We have got some £20 million-worth
of clinicians' time involved in developing it. We are getting
to some pretty massive figures. Could you give the Committee,
Chairman, with your agreement, please, a detailed note of the
total costs involved in purchasing, in developing and any other
associated costs with the Read systems 2 and 3 to date so we can
see how much money has been spent in total? Would that be possible?
(Mr Langlands) That would certainly
be possible[20].
If I may, Chairman, suggest that alongside some of these costs
we should try and identify as far as possible in monetary terms
some of the benefits as well because I think we are in danger
of looking only at one side of the equation.
138. I think that would be very helpful.
The Chairman has already referred to a Report commissioned by
CCC in 1996 from a consultant called Mr David Markwell(?). He
indicated that the costs might be nearly £100 million. This
is getting to be a very significant sum indeed. I refer you to
Ms Eagle's question: is it not now time to consider abandoning
Read 3 altogether with these types of costs involved?
(Mr Langlands) It is time to carry
out the independent evaluation and we have agreed to that. To
abort this project which potentially is of huge importance to
the NHS is something that I could not commit myself to. I think
that would have to be a decision for ministers, especially given
the strength of our clinical support. These may seem like huge
sums of money, they are huge sums of money, but the Health Service
is a very big organisation and we will have to spend, even to
meet the priorities that have been set out by the government so
far in this area, very substantial sums of money to modernize
the computing and IT kit in the NHS. There is no doubt about that.
139. One has got to look at this thing on
a pragmatic basis. This thing has been going since 1991. It has
cost many tens of million. We do not know yet exactly how many
but one estimate has put it as £100 million. If you come
before this Committee in two years time where, realistically,
do you think we will have got to? You have told us it may or may
not be working in three acute hospitals, it may or may not be
working in 11 or 12 other hospitals and it may or may not be working
in 80 per cent of GP practices. How much more money has the taxpayer
got to put in to a system that may or may not finally work?
(Mr Langlands) The system is only
going to work if the clinical systems, the host systems that are
needed to run this are put in place. There are a great many issues
to be tackled in the NHS in updating clinical systems. There are
a great many issues to be tackled in the NHS in advance of the
year 2000 to deal with the problems of the millennium bug, and
we are going to have to look very carefully over the next two
or three years at the total expenditure in this area. It is only
when the money has been devoted and when ministers have agreed
what that total expenditure should be, and we have an agreed IMG
strategy which ministers are looking at at the moment, that I
will be able to compare the two and give you some indication of
what progress we can make in a two-year period. The whole thing
will depend in part on resources, in part on expertise and in
part on the policy directions that ministers take.
15 Note: See Evidence, Appendix 1, pages 23-25 (PAC
264). Back
16
Note by C&AG: The figure in the report is actually £19
million. Back
17
Note by C&AG: The figure in the report is actually £19
million. Back
18
Note: See Evidence, Appendix 1, pages 23-25 (PAC 264). Back
19
Note: See Evidence, Appendix 1, pages 23-25 (PAC 264). Back
20
Note: See Evidence, Appendix 1, pages 23-25 (PAC 264). Back
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