Examination of Witnesses (Questions 55-59)
PROFESSOR IAN
PHILP, DR
FELICITY HARVEY,
PROFESSOR TOM
WALLEY AND
SIR CHRISTOPHER
O'DONNELL
3 MARCH 2005
Q55 Chairman: May I welcome our second
group of witnesses. We have an empty chair at the present time.
We understand that Professor Philp is stuck in a traffic jam with
a minister—we are not sure which minister he is lucky enough
to be stuck with—but he hopes to be here within the next
quarter of an hour or 20 minutes. We will make a start because
we hope to complete this session in round about an hour. Could
I ask our witnesses to introduce themselves to the Committee briefly.
Dr Harvey: I am Dr Felicity Harvey
and I am Head of the Medicines, Pharmacy and Industry Group within
the Department of Health. Within my remit I cover the sponsorship
of the devices industry; indeed, it was my part of the Department
that was working very closely with industry in the Healthcare
Industries Task Force work over the past year.
Professor Walley: I am Tom Walley.
I am Director of the Health Technology Assessment Programme on
behalf of the Department of Health. I am also Professor of Clinical
Pharmacology at the University of Liverpool and a Consultant Physician
at the Royal Liverpool University Hospital.
Sir Christopher O'Donnell: I am
Chris O'Donnell. I am the Chief Executive of Smith & Nephew,
which is the largest producer of medical devices and technology
based in the UK, one of the 10 largest companies in the world,
and we contribute particularly to healthcare technology research
and innovation as a key part of our activities.
Q56 Chairman: Could I begin by referring
to some of the evidence that came out in the earlier session.
I am not sure whether you were present and heard the evidence
but one of the points that was raised related to the difficulties
of services being organised and viewed in silos. One of the issues
that particularly concerns me—and you probably heard the
example I gave of the effect on the National Health Service of
telecare solutions preventing a broken hip—is that the budgetary
crossover is not there, so the investment, possibly by social
services or, indeed, the individual into those telecare solutions
in their own home, does not in a sense relate to the savings that
are made in the health service. I wonder, Dr Harvey, how you would
respond to that concern, in particular the concern that increasingly
the service is devolving decision-making to a local level; and
is there any strategy you might favour nationally? It is, in many
respects, down to those local people to drive it forward, and
it would appear in many instances that they are not driving it
forward.
Dr Harvey: Chairman, quite an
element of this Professor Philp would be in a very good position
to speak to when he arrives. He, as you know, has the brief for
older people's care, both from the health and social care perspective.
In terms of silo budgeting, from the primary care trust perspective,
as you are aware, they now have budgets—they have about
80% of the NHS budget now. That allows them to develop services,
working closely with social care across the health/social care
interface, and through the Payment by Results mechanism that we
have, which was referred to earlier, with the intention through
that to unbundle what we have as the groupings of services within
the HRGs that lead to the tariff, this will allow Primary Care
Trusts, working with their local authorities, to look more carefully
at how they deliver services locally. It is down to local decision
as to how they do that but, as you are aware, there is quite a
lot of movement now from care that would have been delivered within
a secondary or tertiary care setting to looking at delivering
that in different ways in a primary care and a primary care/local
authority/NHS way. I think there are now more mechanisms, particularly
as Payment by Results develops. Also, I think one needs to remember
that Primary Care Trusts, although in the past they have had annual
budgets, have since 2003-04 been given a three-yearly budget.
Some of the concerns that have been raised have been around short-termism,
and therefore primary care thinking about just one year. Now we
are looking to a longer horizon, to say that Primary Care Trusts,
working with their local authorities, should be looking over a
longer period of time. Therefore some of these benefits, around
the sorts of treatments that they might deliver that would have
efficiency/cost-saving benefits or whatever, and, most importantly,
benefit patients more, are now far more within the capability
of PCTs to deliver in terms of this new mechanism that we have
in place.
Q57 Chairman: Why do you feel we are
so behind other similar European countries in introducing telehealth
and telecare within the UK? I mentioned in the first session that
it always strikes me very strongly when we go to other European
countries and elsewhere in the world that we frequently see they
have made these quite remarkable advances but often using British
technology that we do not see in use in our own country.
Dr Harvey: I think there are two
issues. One relates to where we got to in the Healthcare Industries
Task Force about how we get innovation into the NHS, but the other
is possibly a more practical immediate one, and that is that,
in terms of telemedicine—telemedicine requires the possibility
of transferring data, transferring digital images, etcetera—it
needs quite a lot of capability within the system. The National
Programme for IT is actually rolling out a broadband based network
and service between primary, secondary and tertiary care. This,
if you like, gives a platform to allow the telemedicine aspect,
which is very much around the clinician and interfaces between
the clinician with the patient. If you look at the telecare element,
and even telemonitoring, where, as one of the witnesses was suggesting,
you could send data down the telephone line—you do not require
broadband for that, you can just do that through an ordinary telephone
line—there is therefore the possibility for doing telecare—and
we have already heard there are some examples of that, although
possibly not as many as we would like to see in the future—and
also there is a possibility for telemonitoring, of patients transferring
data into hospitals. I think the National Programme for Information
Technology allows us the platform to develop that further in the
telemedicine context. In terms of the telecare context, Professor
Philp will be able to say a bit more about what is happening in
terms of strategies to move that forward, but I think it is very
much supported by the Healthcare Industries Task Force recommendations
which are very much around: How do we get new innovation into
the National Health Service? We accept the fact that the NHS has
not been very good at getting new technology in. I think there
were quite a lot of environmental issues, particularly working
towards the target within the National Health Service Improvement
Plan around a maximum of an 18-week wait for treatment from referral.
To deliver that—which means diagnostic services have to
fall before that 18-week maximum—we have to move to far
more innovative methodologies for both diagnosis and treatment
mechanisms. I think that gives us the sort of impetus, along with
the mechanisms that we have been trying to set up through HITF—the
implementation of which Sir Christopher O'Donnell as well as Lord
Warner will be overseeing—to catch up with those other countries,
whose innovation and entrepreneurial culture is possibly indicated
more in terms of how they deliver services now.
Q58 Dr Naysmith: Are you implying that
a lack of "good enough" IT systems in this country up
until now has been one of the factors inhibiting the growth of
telemedicine?
Dr Harvey: In terms of telemedicine,
the fact that you do need more of a broadband based basis—and
I am not the expert on this, but we would be delighted to give
you further details—does actually mean that for things like,
for example, the Picture Archiving and Communications system (PAC's)
which are now being introduced and will be introduced by 2008
(for example, for diagnostic radiology and scans), unless you
have a networked facility—
Q59 Dr Naysmith: Yes, I understand that,
but are you saying that it is because of a lack of the ability
to transmit images of sufficient quality that that is inhibiting
that? Then the question is: Why did they manage it in the Scandinavian
countries 10 years ago?
Dr Harvey: I think it may be the
lack of a national capability for doing it. There are various
pockets within the country where they can, they have, and they
are doing it, but in terms of a national capability to do that,
the National Programme for IT gives us the platform from which
to think about that nationally, rather than just local investment
in local particular areas where they have decided in the past
that for them it would be of benefit.
Chairman: Could I go along that tack?
I am interested in you calling it a platform because that implies
it is just a start and you can jump off it into all sorts of directions.
Chairman: Or fall off it!
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