Select Committee on Public Accounts Minutes of Evidence



Part of a letter to the Chairman of the Committee from the Chief Executive, NHS Executive

I am writing to follow up my appearance before the Committee on 29 March.

  During questions by Mr Nigel Griffiths it was evident that a consultant at the Royal Shrewsbury Hospital had written twice to the Committee in detail about the hospital's CALM information system. I did not receive copies of these letters until the hearing was over and was therefore left on the back foot when Mr Griffiths questioned me about them. I thought this was a lost opportunity for the Committee to hear a full account of the system.

  You will recall that Mr Griffiths' questions focused on whether or not the NHS Executive had taken active steps to roll out CALM to other NHS Trusts, and whether PAS-linked or stand-alone systems in other Trusts were delivering similar benefits.

  CALM is a piece of decision-support software designed to be linked to hospital Patient Administration Systems (PAS). Its design and development are described in Mr Hay's letters. As I understand it, intellectual property rights are now in the hands of a private company (ISL) with close commercial links with the SEMA Group, who are PAS suppliers. CALM is DOS-based and therefore not the most up-to-date technology. I understand that SEMA are working to upgrade and integrate CALM into their own PAS system, but do not intend to make CALM available separately for integration into other PAS systems.

  A key feature of the success of CALM in Shrewsbury is that it operates in a setting which also has the other vital ingredients needed for effective bed management; viz:

    —  in-depth understanding of the dynamics of the local scheduling/booking/patient management and discharge systems;

    —  key players, especially the clinicians, buying into the system and giving up personal control over admissions and discharges;

    —  committed staff, trained to use the facilities and their and others' experience;

    —  reliable and up-to-date in-put information;

    —  an operational PAS.

  I made the point at the committee that a successful bed management system depends as much on people, knowledge, commitment and local circumstances as on particular technology. The necessary ingredients do not exist in equal measure everywhere in the NHS, nor with sufficient regularity to make it sensible to specify a single technical solution. It is the job of the NHS Executive to promote good practice and we believe the most appropriate way to do this is to inform both product and outcome specifications. Our experience suggests that it is unlikely that the answer to effective bed management lies in a single technological solution.

  I am sure that the Committee would also accept that I have to be very cautious about actively promoting a product that commercially benefits one firm when there are other equally good alternatives on the market. I therefore stand by the line we have taken on Shrewsbury—holding it up as an example of what can be achieved by targeting the right resources, including technology, but stopping short of requiring other NHS Trusts to apply the same technological fix.

  All main acute NHS Trusts now have a core PAS and the ability to develop a bed management system as admissions, discharges and transfers are devolved to ward level. Many NHS Trusts will be market-testing or procuring PAS systems as part of the move towards implementing the Electronic Patient Record. The IM&T Procurement Review will address how to make best use of the experience and market position of the NHS and to ensure lessons are shared through the service. Inpatient planning and bed management systems will certainly be a part of that process. Specifications will be informed by CALM and other similar projects but it will be up to suppliers to demonstrate value for money and tailored solutions.

Sir Alan Langlands
NHS Executive

9 May 2000

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