Examination of Witnesses (Questions 140
- 159)
MONDAY 23 MARCH 1998
MR ALAN LANGLANDS, MR FRANK BURNS, DR JAMES READ AND MR DAVID BIRD.
140. I am going to ask Mr Frank Burns, have
you carried out a proper cost benefit analysis of this system
and, if so, do you think it will be in operation by the year 2000
properly and how much extra money will need to be spent per annum
between now and the year 2000?
(Mr Burns) I think as the Chief
Executive has said we have agreed, as suggested by the NAO Report,
that we will do this independent evaluation of the Code.
141. When?
(Mr Burns) Again as the Chief Executive
has reported to the Committee we are drawing up terms of reference
for doing that.
142. When will it be completed?
(Mr Burns) We expect it will be
completed by the end of this calender year.
143. Yes.
(Mr Burns) In so far as the next
two years is concerned I can only reiterate the Chief Executive's
view that we have to have a commitment in the National Health
Service to modernise our information systems. This is not only
Government policy but it is an absolute inevitability in a service
as important and as complex as the NHS. Therefore, we must make
a commitment over the next two to five years to modernise our
information technology systems. We have to deliver the objective
in the recent White Paper to establish electronic communications
between all hospitals and all general practitioners. We know as
an absolute fact that we cannot deliver electronic communications
between hospitals and general practice without an agreed standard
clinical vocabulary.
144. You are the Head of Information and
Management Technology.
(Mr Burns) I am, yes.
145. When will that system be in operation
in your view?
(Mr Burns) Well, if we take as a
given that the NHS must modernise its information systems; if
we take as a given that we must invest in the clinical systems
that will support the capture and use of clinical information
in hospitals and in general practice; if we take as a given that
we must use the technology that will allow communication electronically
between hospitals and general practitioners; if we take as a given
that we would want to do that over the next five years then we
have to take as a given that the NHS must be using a standard
clinical vocabulary such as has been produced by this project
in order to support all of that.
146. Is that standard vocabulary currently
agreed? The Chief Executive said we have got wide agreement cross
clinicians, so has that standard vocabulary now been agreed?
(Mr Burns) Yes. In so far as Version
3 is concerned the project was to produce fit for purpose terms.
147. If it is agreed why is it going to
take another five years for you to implement it? It has already
been on the blocks since 1991.
(Mr Burns) The project for Version
3 to produce the terms was concluded in 1994. The vocabulary,
such as is necessary to support work in hospitals, has only been
available since 1994. It is a very complex and important piece
of clinical development. We need to be certain that the vocabulary
is fit for purpose because it will be used to support clinical
communication and we need to be absolutely certain that clinical
communication is precise, especially when we move that communication
on to computers. This is why it has been so necessary to do the
extensive bench testing that has been done and this is why it
is necessary to properly pilot the use of this vocabulary in a
live situation.
148. I am getting the red card from the
Chairman but the answer is if it was already in operation in 1994
it amazes me that not more clinicians are using it in hospitals.
Can I ask you one final question. How much money have you allocated
in your budget line to this project over the projected life for
the next five years?
(Mr Burns) The amount of money we
would need to spend both to develop these Codes and to put them
into operational use in the NHS is linked directly to the amount
of investment that it will be possible to make in the development
of clinical information systems in the NHS. That is a matter that
is currently before ministers in their consideration of my information
strategy.
149. How much money have you provisionally
allocated in your budget line over the next five years for this
project?
(Mr Langlands) Can I help, Chairman.
It may sound as if we are being evasive on this.
150. You are.
(Mr Langlands) No, let me finish.
The answer is we cannot commit money over the next five years.
The Government is currently undertaking a Comprehensive Spending
Review and as part of that Comprehensive Spending Review it will
determine both the capital and revenue resources that are to be
available to the health service between 1999-2002. We do not know
the outcome of that discussion and we will not know the outcome
of that discussion for some time. One of the things that has been
looked at in the Comprehensive Spending Review is the need to
improve and update the way we handle information in the health
service in line with the Government policies. We cannot sit here
today and make five year projections which we have no basis for.
151. Chairman, can I crave your indulgence.
We are not getting clear answers to clear questions here. You
have a budget line for this year and next year at the very least.
Can you give us those figures[21]?
You must have a provisional budget line for the following three
years after that. 16
(Mr Langlands) We can certainly
do two things. One is provide a note for the figures for this
year and next year to ensure that they are entirely accurate.
We will do that immediately. The second thing I think we can do
is set out for the Committee some of the issues that are currently
being considered in the Comprehensive Spending Review[22].
It is not our place to have provisional plans for n years ahead,
it is our place to advise ministers who will determine public
spending in the NHS against their other priorities. We will do
both of these things if it will be helpful to the Committee.
Mr Williams: We look forward to receiving
it.
Mr Page
152. Mr Langlands, I think everybody accepts
there is a desperate need to have a clinical IT system running
throughout the NHS, but here we are just considering Read Codes.
How many other systems were looked at before the Read Code was
decided to be adopted?
(Mr Langlands) In 1988 eight different
systems were looked at. These were all systems, as indeed the
Read Codes were, that were in pretty minimal use as far back as
1988. Only ten per cent of general practices, for example, were
using the very early versions of the Read Code. That figure is
now 80 per cent. Only a handful of hospitals were engaged in this
discussion and there are now 150.
153. So you examined eight and you chose
the Read one as the best one?
(Mr Langlands) The NHS Executive
at the time-this started in general practice-advised by the Joint
Computing Committee of the GMSC, that is the GPs' committee on
the BMA, and the Royal College of General Practitioners, chose
from eight and they chose this one as being the most suitable
for development.
154. So the answer to the question is eight?
(Mr Langlands) The answer to the
question is eight, yes.
155. If I can take you to page 21, paragraph
1.31, according to this the Executive-and sometimes I will say
you when I mean the Executive but I realise that you were not
necessarily there at the various times and I apologise if I get
them muddled-in the proposals were not fully evaluating the likely
costs and benefits of the Code. Are you saying the Executive went
ahead with this project without doing a cost benefit analysis?
(Mr Langlands) That is correct.
156. I think I will leave that there. I
do not think I can take it any further.
(Mr Langlands) What they did do
was review the very thorough report from the Joint Computing Group
which did identify in some detail the benefits and did analyse
with some rigour the eight options that you identified in your
first question.
157. However, there was not a full cost
benefit analysis taken, you would agree?
(Mr Langlands) There was not a full
cost benefit analysis undertaken by the NHS Executive. They accepted
the recommendations of the Joint Computing Group.
158. Dr Read appears to have run the Centre
as his own bailiwick. Could I ask what advice in setting up the
Centre was given to him by the Executive on how he should run
the Centre?
(Mr Langlands) I have no real knowledge
of that. As far as I can determine that advice would have been
given by his line manager at that time and I think it is absolutely
clear from the Report that there was confusion about accountability,
confusion about where the locus was on key employment issues.
159. Mr Langlands, with respect to what
you are saying, there was not confusion at all. Dr Read ran this
as his own bailiwick. I suggest that he is not experienced in
the requirements of public service and the stringent rules and
regulations that govern our lives. So do you not think the Executive
would have been playing fair with Dr Read if they had actually
given him some advice and not said, "Off you go, run this
centre"?
(Mr Langlands) I think the Executive
was remiss in not being absolutely clear about the lines of accountability,
about his responsibilities and the sort of standards that were
required in relation to personnel issues and financial and probity
issues.
21 Note: See Evidence, Appendix 1, pages 24-25 (PAC
264). Back
22
Note by Witness: These are percentages of general practices which
are computerised. Back
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