Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 60 - 79)



Siobhain McDonagh

  60. A lot more money has been earmarked for NHS IT and yet your Department says it does not track how the money is being spent on IT. How will you ensure that that cash does not get diverted to other things and that your Department's IT strategies are being delivered to plan and are achieving value for money?
  (Mr Douglas) What we have found over the last few years is exactly as you say, that people have diverted IT resource into other areas and because of that we are looking at a fundamentally different way of running the IT strategy now with a far greater centralisation of the money, particularly centralisation of the financial management and allocation, so where in the past we have put money into the general allocations and either hypothecated or earmarked an element of that, we will be setting aside specific central budgets effectively to fund the IT strategy direct. The key thing that we then need to sort out on that concerns the fact that that does not substitute for existing IT spend in the NHS because although we do not track the detail we would estimate at the moment that there is probably about £1 billion a year spent on IT in the NHS. What we are doing this year is what we call a baseline assessment to identify what is being spent now. We are doing a specific exercise to identify spend now to give additional monies that we will run through a central budget to ensure that it goes into the IT strategy.

  61. Has the budget been set to meet the 2003-05 targets?
  (Mr Douglas) We are in process at the moment of agreeing with the Secretary of State the overall disposition of money over the next three years. Clearly the IT strategy is going to be a major part of that.

Julia Drown

  62. I thought the Department was thinking it could not run everything from Whitehall and things needed to be devolved down and local priorities were important. Surely if somebody locally thinks something else is more important to be spent on than IT they should be allowed to?
  (Mr Douglas) It is absolutely that we want to devolve the main decision-making on the use of money for the NHS but with the IT strategy what has become quite clear is that unless some of this is driven from the centre it will not actually happen. Unless we have an IT infrastructure where people can talk to each other within the NHS, then we are not going to go through all the other changes that we require. We need the key elements of the strategy—an integrated health care record system, electronic booking and electronic prescribing—operating across the whole NHS. We cannot have them operating—

  63. What about foundation trusts, will they have the freedom to spend their money in this way?
  (Mr Douglas) We would expect foundation trusts to meet the same standards as any other organisations would have to within the NHS with the systems talking to each other.

  64. So you will be spending the money centrally for them?
  (Mr Douglas) We need to look at how we work out the spend for foundation trusts.


  65. What about the relationship with the social care "tribes" within the Department on this issue because it seems to me so obvious that the potential for IT right across the activity within the Department as a whole is quite incredible. If one visits other countries we are light years behind where they are on the use of IT. Mr Denham, have you any thoughts on where you are at in Social Services and how this relates to the Health Service in each locality?
  (Mr Denham) Of course we have got the Information for the Social Care strategy and we have been running a number of pilots over the last year, as well as asking local councils to develop their own strategies. The key thing here will be to make sure that as people develop their strategies they talk to each other, and many others are talking already with the NHS locally. We have got a number of care trusts. We have got extensive values and 160 Health Care Act flexibilities where essentially these services are having to talk to each other. I think the challenge certainly for councils will be to pick up what is happening in the NHS, particularly on these integrated care records, and to make sure that the social services information can be fed in. There are some issues I am aware of that we will need to sort out access to data, and I think that is the area that we will need to do work on over the next year or two in terms of councils, particularly staff of councils sharing data with the NHS and vice versa.

  66. Is there an issue in terms of confidentiality?
  (Mr Denham) That is what I am referring to.

  67. The areas that are shared with local authorities.
  (Mr Denham) We have had to begin to grapple with that and we have grappled with it locally around the development of care trusts where services have been brought together.

  68. Can I throw in a question of tele-health and whether we have any coherent strategy in that direction. Again, this Committee frequently receives very impressive information on development in other countries and the potential for tele-health within the United Kingdom. There is great frustration within private industries involved in tele-health that the NHS is so slow to adopt what in other countries is normal practice. Is that an area you are looking at? Is that somewhere where we will see changes in the near future?
  (Mr Douglas) I am not sure of the answer on that question, I will have to come back to you on that. I do not know the answer on that.

  Chairman: Would you mind responding to that because it is certainly an area this Committee is concerned about. I think our report on discharges made references to this.

Mr Burns

  69. Can you please explain the fall in the share of spending on geriatric services between 1991/1992 and 2001? Would it be helpful if I give you a figure reference?
  (Mr Douglas) Could you give me the table reference?

  70. Figure 2.1, D-G. When you find the figure I think you will see that there is a significant fall in real terms in spending.
  (Mr Douglas) Could I just look at that. I think that is probably the same information. This only picks up on services delivered by geriatricians and increasingly more of the care for the elderly is delivered by other specialists, it is a transfer of care to a more specialised consultant rather than a geriatrician and that would be the cause of that. I could not say that with certainty.

  71. If none of your colleagues have a view if you find on reflection that that is not right will you write to us to let us know, however if on reflection you find that is correct do not bother.
  (Mr Douglas) That is fine. I think that is the explanation.

  72. What are the main services affected by this fall in spending?
  (Mr Douglas) My assumption is that it is just geriatrician-led services.

  73. If you find on reflection that is not the case or there is more to it if you would be kind enough to write to us. If that is the answer to the question do not waste your time writing to us. Can I comment about care for the elderly. "Standards in wards for elderly patients has fallen in the last two years". Can you explain what that means and whether you agree with his assessment? I assume you will agree. It will be interesting if you do not.
  (Mr Douglas) I was not aware of that comment.
  (Mr Denham) I do not know what words he used. Where are you quoting from. I certainly think he has commented on the pace at which conditions are improving. In general his assessment of the National Service Framework for Old People has been on the whole reasonably positive. I think if you are referring to the article I think you may be referring to I think he has followed that up with a letter, which we can certainly let you have.

  74. The Tsar has fallen out of line.
  (Mr Denham) You will need to ask him. If you want us to give you a copy of the exchange you are referring to I would be happy to do so.

  75. Obviously you are familiar with this letter, as you are clutching it like a lifeline, perhaps you would like to share us with what the letter says, what the gist of the letter is?
  (Mr Denham) I do not have the letter with me.

  76. Yes, but you are answering my question by saying, he has written a letter where he sought to put the record straight, which suggests you must know what is in the letter or you would not use it to aid you in answering the question.
  (Mr Denham) I have not seen the article you are referring to for certain but if you supply me with the article I will check I am referring to the right exchange, if I may.

  77. Right. If you discover on reflection that you are not referring to the right article I would quite like to see the letter you are referring to. Would you send that regardless?
  (Mr Denham) I will send a letter that I think Ian Philp has written.

  Chairman: Mr Burns will let you have his article as well!

  Mr Burns: In due course.

Andy Burnham

  78. Can I refer Mr Douglas to table 3.3.1 which gives the allocations for this year. I really wanted to ask you about how the top-up elements of last year's allocations were arrived at, particularly the health inequality adjustment, which as I understand it that was extended last year. I would be grateful if you can explain what criteria determined how that figure was arrived at?
  (Mr Douglas) If I can double check on the changes to the health inequality adjustment, which was to take into account, I think, of the years of life lost for infants under one, I need to check the change that was made last year.

  79. Is there a recognition in the Department, obviously it was extended?
  (Mr Douglas) It was extended and what we are really trying to look to this year in changes is to bring in the overall formula rather than treat it as an off formula adjustment.

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