Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 160 - 179)

THURSDAY 1 DECEMBER 2005

SIR NIGEL CRISP, MR JOHN BACON, MR RICHARD DOUGLAS AND MR ANDREW FOSTER

  Q160  Chairman: We have been led to believe that there is. It just struck me, in terms of forward planning as a politician and arguing about health matters, that we should be able to get some sort of measure?

  Sir Nigel Crisp: It is specifically classes of drugs you are talking about.

  Q161  Chairman: Various classes of drugs, yes. The number of NHS prescriptions for various classes of drugs. It is not about the individual drug, which somebody may feel is commercially confidential or not in terms of probably a manufacturer or producer of drugs, as opposed to just seeing what the general trend is in prescribing to see whether or not initiatives are working in terms of healthcare?

  Sir Nigel Crisp: Let us look at that again. I am sorry; I would not want to mislead you by guessing.

  Q162  Chairman: Could I move on to the issue of the national programme for IT. We hear or read on quite a regular basis now that the cost of this is approximately £6.5 billion. Is that what is thought?

  Sir Nigel Crisp: I can ask Mr Bacon to answer in more detail, but the contracts we let were for £6.2 billion. They were let at the beginning of last year.

  Q163  Chairman: Is that the full cost if implementing it locally and nationally?

  Mr Bacon: As Sir Nigel has said, the £6.2 billion, which is the value of the national procurement programme, includes both the products themselves and provision for local implementation and training in some respects. We would expect, and, indeed, the Wanless Report, I think, made this point quite clearly, that the overall expenditure on IT in the NHS would progressively increase because we are progressively a more information dependent service, not just for management but, much more importantly, for patient safety and for the convenience of patients using a flexible service. We do expect that number to increase. The NHS currently spends, and it is quite difficult to track actually and forgive me for elaborating slightly, but we track the spend on administrative IT but much of the IT is built into scientific and technical machines that we do not track specifically, so it is quite difficult to get an exact figure, but of the order of a billion a year is spent now by the NHS on IT and progressively that will transfer into support for the national programme for IT. I know we have talked at this Committee and in other places about the overall costs of the national programme in the past. It is not that we are evasive, it is because it is quite difficult to track all the transfers of costs that will happen over a ten-year run, but, to confirm your point, the central contracts are at £6.2 billion, as Sir Nigel mentioned.

  Q164  Chairman: Is that paid for directly centrally?

  Mr Bacon: Yes, the £6.2 billion is managed by a central programme which I am the senior responsible officer for, and the contracts are let at national level.

  Q165  Chairman: Some of the things that are being paid for now on this annual £1 billion in the NHS, it is vital that that equipment has the ability to talk to anything that has happened nationally. How do you check that that is the case?

  Mr Bacon: Again, part of the national contract, which is called local service providers—there are five clusters across the country—over the life of this programme progressively the local systems will be replaced by standard systems coming through the LSP contracts which, of course, will be compatible with other aspects of the programme. We will have, we admit, a very difficult transition period where because historically the NHS has not had a centralised approach to this, we have many suppliers all of whom have had their system tailored to local use, so the transition period is very difficult and many of the difficulties you read about are explicit in the ones you have mentioned where we are having to interface systems to existing system, and that will progressively ease as we are implementing the new local service provider contracts.

  Q166  Chairman: Is this the secondary user service?

  Mr Bacon: The secondary user service runs off the back of the core standard; so this is not actually the secondary user service, no, that is a data service which uses the data we collect for the management of patients and the management of the service for other purposes, which Richard Douglas, I am sure, could explore with you more.

  Q167  Chairman: That is not the product of this?

  Mr Bacon: No.

  Q168  Chairman: Have you any problem with that service?

  Mr Douglas: There are a number elements to the secondary user service. One of it is called secondary user service PBR—without getting into too many initials it is SUS PBR—which is the system to help Payment by Results work. It effectively sends data from providers to PCTs by HRG at its simplest. We were planning to use that effectively for the second half of this year to manage the introduction of PBR. We are not using it, not because of problems with SUS PBR itself but with the data that is going into it. The quality of the data currently going into SUS PBR is not sufficiently accurate to support Payment by Results. What we have got is local systems, effectively, that will be allowed to operate for the next four months until the next financial year. We will run those in parallel with a shadow SUS PBR and then have the full system operative when Payment by Results is extended next year. It is later than we hoped, but it is not to do with the system, it is to do with the data quality issues.

  Q169  Chairman: Are any PCTs or other providers going to suffer financially because of this current situation?

  Mr Douglas: They should not suffer because of it. We should have arrangements in place in all the SHAs effectively for fall-back systems that allow them to operate without SUS PBR working. I have been through this in quite a lot of detail with the Strategic Heath Authority finance directors at my last meeting with them, and what they are all doing is looking at managing their own local systems to operate this, so it should not lead to a significant problem in any PCT.

  Q170  Chairman: My last question on this one is in relation to the issue of Choose and Book. It first went live in 2004. The uptake was extremely low and remains so. When are the numbers of patients using this system going to reach the original levels that were predicted for the system?

  Mr Bacon: We appeared before the Public Accounts Committee on this subject about three weeks ago, and we can confirm the issues that were raised there. We do admit that the implementation of Choose and Book as a system, largely because of the integration issues that I mentioned earlier, not because the core system does not work, it does, are about a year behind. This will not, as we said to the PAC, threaten our ability to deliver our actual promise, which is to enable individuals to choose a hospital from initially a minimum of four and to book their appointment remotely. What it does mean is that we will not be able to use the best technology to do it at the time we made the promise, which is from 1 January. What we expect to have done is to have caught up with this by a year later, i.e. next December rather than the current December. What is encouraging is that we are seeing really quite rapid growth now in the number of bookings having taking place. We are now up to over 7,000 a week from a position where, I think, the total we have done in August this year was about 250—we are now rattling through over a thousand a day—so we are seeing real progress in the implementation, but I would be the last to say this is not going to be a difficult implementation for all the reasons I have mentioned earlier and also for some of the individual data issues around accuracy of data in existing systems that we need to correct. So, good progress in the last three or four months, but we confess, as we did recently, that we are about a year behind on the overall implementation of Choose and Book as a system.

  Q171  Dr Naysmith: Can we move to targets for a minute or two? One of the things I want to ask is since introducing the 13-week target for maximum out-patient waiting time performance seems to have slipped a little bit?

  Sir Nigel Crisp: On the 13-week?

  Dr Naysmith: Thirteen week, yes. Do you expect to meet the December target?

  Chairman: It is 18 weeks.

  Q172  Dr Naysmith: No, it is 13 weeks.

  Mr Bacon: We have two waiting list targets. We have two headline waiting list targets in the general sense, and then some subsidiary targets in specific specialties, but I think the point you are referring to are the two December 2005 targets of a maximum 13-week wait for out-patient and a maximum of six months for in-patient. We are, as we have done with every other of our waiting list targets in recent times, tracking that down very closely week by week over the whole health system, and we are confident because the numbers and the way we track it suggests to us that we will be as near as damn it to the target. Inevitably when you are talking about literally tens and tens of thousands of these, there may be the odd one or two that slip through, as has happened in the past, but we are pretty confident now, because we are close enough and we can see the numbers. If the Committee will forebear with me for a moment, we track this on what is called a targeted list basis: so not only do we track the number we know are waiting now we track the people we know we have to treat by the end of December in order to hit the target, and so we are tracking that, as we have every other one, and we are confident that we are going to make that target.

  Q173  Dr Naysmith: I do not have any problems with targets as some people do, as long as they are sensible, they make sense, and they are relatively easy to measure. As Mr Bacon said earlier with sexual heath, they have chosen the target that was easiest to measure in working out what was happening to all the money. Which brings us to the question of why, when you were accounting the 18-week target from GP referral to start of treatment, did not the officials and ministers realise that no definition of that target existed. At the time that you set the target there was a lot of confusion about what this target actually meant?

  Mr Bacon: That is true. Since we set that target we have done substantial work. We knew broadly what the target would be, so it is not true to say we had no idea. We knew the basic elements of it and we worked through very carefully in the planning process both the deliverability of it and the financial consequences of it; so that is built into our planning assumptions. What we have been doing over the last year or so is to work through the minute detail in the definition sense, when the clock starts for certain things.

  Q174  Dr Naysmith: When the treatment actually starts, so it is not just an estimate of something and then six months after that?

  Mr Bacon: Yes. I do not know whether the members of the Committee will remember, but in the early days of the in-patient and out-patient waiting list targets we had similar definition problems. As we move into this 18-week from GP referral to treatment target some of these definition issues are much more complex. We have had a very extensive process over the last year of engaging with the NHS on the best definition of some of these things. We have just gone out with a document which sets out our proposals and asks for comments so that the service has a chance to think about the way in which we define these targets so that we can refine them before we actually have to deliver them.

  Q175  Dr Naysmith: You have definitely got a draft definition now?

  Mr Bacon: Yes, it is out for consultation.

  Q176  Dr Naysmith: Can we see a copy of it?

  Mr Bacon: Absolutely, yes. By all means.

  Q177  Dr Naysmith: Have you got a deadline for finalising this?

  Mr Bacon: I have not got the exact date. It is early in the New Year. We have asked for responses. When we send you the document I can give you the deadline date, if that is helpful.

  Q178  Dr Naysmith: Finally on this area, do you know how well the NHS is currently performing on a rough 18-week target?

  Mr Bacon: No, is the straightforward answer, and I can tell you why that is.

  Q179  Dr Naysmith: It is a bit worrying?

  Mr Bacon: There are three components to the 18-week target, the first of which is the out-patient appointment, and we have not to date collected anything other than statistics of people waiting over 13 weeks, but we do know what the cohort of people in total is below 13 weeks. We know precisely what the in-patient waiting dimension is, but the bit in the middle which we are introducing as part of this target, which is the diagnostic phase, we have never collected statistics on; so the bulk of the work here in looking at definitions and what statistics we should collect has been concentrating on that phase. I can give you numbers for the first element and the third element, but what I do not have, because we have not collected them in the past, is that middle element.


 
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