Examination of Witnesses (Questions 60
- 79)
MONDAY 21 OCTOBER 2002
MR RICHARD
DOUGLAS, MR
ANDY MCKEON,
MR GILES
DENHAM, MS
MARGARET EDWARDS
AND MR
ANDREW FOSTER
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.
Chairman
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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