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21 Mar 2007 : Column 1018W—continued

The departmental figures relate to national research programme expenditure. They do not include expenditure in the areas of human health concerned from the research and development allocations made annually to national health service providers. That information is not held centrally.

The Medical Research Council (MRC) is one of the main agencies through which the Government support biomedical research. The MRC is an independent body funded by the Department of Trade and Industry via the Office of Science and Innovation.

NHS: Drugs

Mr. Lansley: To ask the Secretary of State for Health how many medicines were reclassified from prescription-only status to over-the-counter status in each year since 2002-03; and whether it remains her policy to aim for 10 such reclassifications to take place in any given year. [123131]

Caroline Flint: The NHS plan committed the Government to making more medicines available over-the-counter, where it is safe to do so. In response, the Medicines and Healthcare products Regulatory Agency (MHRA) implemented a new streamlined reclassification procedure in April 2002 and took forward an agenda on switching to encompass not just acute, short term, self limiting conditions but to new areas of chronic disease management.

Over-the-counter medicines include both those supplied by a pharmacist and those on general sale (GSL) available through outlets such as supermarkets. The number of marketing authorisations where the legal status has been changed from POM (prescription-only medicine) to pharmacy or from pharmacy to GSL for each complete year since 2002-03 is presented in the following table. It is noted there may be more than one new switch application for the same substance. Also many applications follow on from the initial change of legal status of the medicine.

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POM to pharmacy Pharmacy toGSL Total

















Recent significant switches into new therapeutic areas include the first statin (simvastatin) to reduce risk of heart disease, a triptan (sumatriptan) for migraine, and an eye drop treatment (chloramphenicol) for infection. A consultation to extend reclassification to the eye ointment has also completed, and there is progress with new consultations into further therapeutic areas.

In February 2007, the MHRA led an important initiative to move forward the debate on widening access to medicines for women's health. A seminar supported by stakeholders and experts in the field of women's health explored the benefits and challenges associated with switches in this area. An important consultation on the reclassification of tranexamic acid for treatment of heavy menstrual bleeding was announced at this meeting.

It remains Government policy to promote widening the availability of medicines within the patient choice agenda, recognising the challenges ahead with moves into new areas, and the aim for such classifications to take place each year is reflected within the MHRA business plan.

Derek Conway: To ask the Secretary of State for Health what (a) drugs and (b) treatments are not available on NHS prescriptions in England that are available in other parts of the UK. [123590]

Caroline Flint: English general practitioners are able to prescribe any drug/treatment on the national health service unless it is listed in Schedules 1 or 2 to the national health service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004.

These lists are replicated in Parts XVIIIA and XVIIIB of the drug tariff, copies of which are available in the Library.

Northern Ireland, Scotland and Wales have similar arrangements backed up by their own legislation. A detailed comparison of the content of the respective lists could be possible only at disproportionate cost.

When a patient is being treated in hospital a consultant can arrange for the supply of any drug or other substance, even one not normally available on NHS prescription, provided the primary care trust or NHS trust: agree to supply it at NHS expense.


Mr. Stephen O'Brien: To ask the Secretary of State for Health what statutory responsibilities (a) she and (b) the NHS Director of IT has in the sale of (i) any NHS IT supplier and (ii) iSoft. [119555]

Caroline Flint: There are no specific statutory responsibilities attaching to the role of Director
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General for National Health Service Information Technology (NHS IT). Those of my right hon. Friend do not extend to the sale of commercial information technology companies.

However, contracts let under the national programme for IT, for which the Director General for NHS IT is responsible within the Department, contain contractual rights covering, for example, adverse changes in control which allow the NHS to refuse to continue to use those services if the purchaser of an existing NHS IT supplier were deemed inappropriate.

Through the national programme contract with its local service provider CSC, these provisions also apply in respect of iSoft as a subcontractor to CSC. The position of iSoft is being monitored both directly and in concert with CSC.

These provisions represent a considerable improvement on historic contracting arrangements for protecting the interests of the NHS in its procurement of IT goods and services.

Mrs. Dorries: To ask the Secretary of State for Health which clinical specialists have been removed on a temporary basis as options on the Choose and Book IT system for general practitioners in Bedfordshire in the last 12 months; and if she will make a statement. [122827]

Caroline Flint: The information requested is not held centrally.

Andrew George: To ask the Secretary of State for Health pursuant to her statement whether her Department has had to revise any of the (a) costs incurred and (b) total expected contract cost over five years of the choose and book computer systems referred to in the answer of 8 May 2006, Official Report, columns 63-64W, on the choose and book system. [123753]

Caroline Flint: The expected core contract costs have not changed, and no revision has been required. The total of costs incurred naturally increases over time as the choose and book system continues to be rolled out across the national health service. As at the end of January 2007,these were £34.6 million for core contract system development and related service charges. A further £39.7 million has been spent on the additional services and additional functionality that the original choose and book business case envisaged were likely to be required as the system is rolled out.

Mrs. May: To ask the Secretary of State for Health (1) when the national programme for IT in the NHS will be launched; [123970]

(2) what projection she has made of the total implementation cost of the national programme for IT in the NHS. [123117]

Caroline Flint: The first elements of the national health service care records service, to provide a transaction messaging service, a personal demographics service, a spine directory service and secure access controls via smartcards, went live on time and to budget in July 2004. Since then very substantial progress has been, and continues to be, made and the NHS is already effectively
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dependent on systems and services delivered through the national programme for the diagnosis and treatment of patients. Over 38 million patients can now benefit from Choose and Book, and over 2.7 million bookings have been made to date, with daily bookings now exceeding 18,000. Over 13.5 million prescription messages have been issued electronically, with the daily count exceeding 100,000. 73 picture archiving and communications systems have been implemented, and around 160,000 patients are treated each week using the technology. Through the new national broadband network (N3), 98 per cent. of general practitioners practices now have a broadband connection. NHS mail currently has over 230,000 registered users, each with an email address for life, sending a million e-mails per day.

The national programme is being delivered by the Department's NHS Connecting for Health agency. The value of contracts let for the core components of the programme amounts to £6.2 billion over 10 years. The National Audit Office have calculated that the full gross cost of the programme including national contracts and legitimately approved additions, other central expenditure, and local implementation costs is some £12.4 billion at 2004-05 prices. However, this figure does not take into account anticipated savings in the price paid by the NHS for information technology goods and services due to the central buying power of NHS Connecting for Health, or in NHS staff time saved through using the programme's systems and services. The National Audit Office also acknowledge an independent evaluation that confirms that £4.5 billion has been saved by central rather than local procurement, and also acknowledges a further £860 million of savings achieved through centrally negotiated enterprise wide arrangements.

Norman Lamb: To ask the Secretary of State for Health how many NHS trusts have bought new computer services outside the NHS national programme for IT during the last 12 months; and if she will make a statement. [123989]

Caroline Flint: The information is not collected centrally. In addition to the clinical systems and services being delivered under the national programme for information technology, national health service organisations have always been responsible locally for meeting their wider information technology (IT) needs, including for non-clinical services such as human resources and finance IT systems.

Systems deployed under the national programme are, however, already in place in every NHS trust, supporting access to care when and where it is convenient, reducing the numbers of failed appointments, improving the accuracy and handling of prescriptions and facilitating the capture, storage and transmission of X-rays and digital images so they are available to clinicians when and where needed. In addition, over 16,000 local systems, with well over 300,000 users, have now been delivered across the NHS by the programme’s five local service providers supporting accident and emergency units, hospital theatres, mental health and pathology services, and many others.

Norman Lamb: To ask the Secretary of State for Health what the costs of (a) the Personal Demographic Service, (b) the Personal Spine
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Information Service, (c) the Transaction Messaging Service, (d) the Secondary Uses Services, (e) the Clinical Spine Application, (f) the Spine Directory Service and (g) the access control framework; and what the projected costs are in each year until implementation is complete for each. [123997]

Caroline Flint: The spine is the colloquial name given to the national database of key information about patients’ health and care. It forms the core of the national health service care records service (NHS CRS). It also supports other key elements of the national programme for information technology, such as choose and book, the electronic prescriptions service (EPS), and 'GP to GP' record transfer, each of them using the spine’s messaging capabilities as part of their own services.

The contract to set up and operate the spine under the national programme for information technology in the national health service is held by BT. Accounting information does not separately identify costs incurred in respect of the individual spine applications, and the information requested could be provided only at disproportionate cost.

Up to 31 December 2006 total expenditure under the contract amounted to £310.7 million, made up of £232.8 million in set-up costs, and £77.9 million in revenue costs. Set-up (capital) costs are incurred in phases as functionality is added to the spine through staged software releases over the implementation period. The ongoing service (revenue) costs average around £45 million a year, although this will fall in a range between £30-60 million in any particular year. These sums are in line with the contracted value of the work concerned, which is some £620 million over nine years.

On a typical working day the spine database is accessed by around 50,000 authenticated unique users, and processes; approximately 1.3 million personal demographic service queries, 16,000 choose and book bookings, and over 100,000 electronic prescription messages.

Growth in these volumes is rising dramatically with the increase in functionality across the NHS CRS and continuing roll out of the various elements of the system. The spine is already the world's biggest structured healthcare messaging system whose cost represents an investment of no more than about one pound per NHS patient per year over the life of the contract.

Norman Lamb: To ask the Secretary of State for Health what assessment has been made of the compatibility of the new NHS IT system with hospitals' present IT systems. [124000]

Caroline Flint: Existing national health service information technology (IT) systems and databases are typically incompatible with each other. They have frequently been designed around the specific requirements of individual NHS organisations, and therefore do not support the transfer of information, sometimes even within a single trust, or elsewhere in the NHS. These shortcomings can result in clinical decisions taken on the basis of incomplete or inaccurate information leading to suboptimal quality
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of care, avoidable inconvenience to patients and doctors, and additional administrative costs.

By contrast, the defining characteristic of the national programme for IT is provision of fully integrated systems that are interoperable, and ensure transmissibility of patient data across organisational boundaries. The national infrastructure will also speed up and make more certain the processes of identifying and contacting patients. This is becoming increasingly important as care becomes de-centralised from hospitals and takes place closer to, and in, patients’ homes.

More than 50 existing systems from a range of care settings—general practice, acute hospitals, independent sector providers, and community pharmacies—have already been accredited to interact with national programme services such as choose and book, the electronic prescription service, the secondary uses service, and the general practice electronic records transfer system. The necessary development and upgrading of these existing systems has been coordinated by the existing systems programme of the Department’s NHS Connecting for Health Agency.

Norman Lamb: To ask the Secretary of State for Health what estimate has been made of how long it will take hospitals to transfer all information from their present IT systems onto the new NHS IT system. [124001]

Caroline Flint: Deployment of new hospital systems under the national programme for information technology involves several key stages between initial preparation for implementation through to go live, during which a number of important organisational and technical activities have to be completed, including planning, training, testing and clinical safety assessments. All the stages in the run-up to completion of go live involve some transfer of data from legacy systems to local service provider systems, though legacy systems remain live and in service until the process is complete. These arrangements are quite typical of major information technology systems deployments in both the public and private sectors.

The process will normally take several weeks, involving anything between 0.5 million and up to 10 million records. The time scale in each particular case is dependent on a number of factors, largely to do with the size of the trust and any complexities identified during data migration. These might include difficulties in collating data from legacy systems, or the need to incorporate specific local requirements late in the process of implementation.

Systems deployed under the national programme are now in place in every acute trust, and in some 98 per cent. of general practices. Almost 17,000 systems have now been delivered with around 330,000 national health service users. New systems are supplied every week to support one or more of patient administration, theatre management, accident and emergency and mental health unit, ambulance services, pathology services, and many more.

Norman Lamb: To ask the Secretary of State for Health what proportion of their budget each hospital is expected to spend implementing the new NHS IT system; and what assessment has been made of the impact of implementing the new NHS IT system on hospital budgets. [124002]

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Caroline Flint: There is no specific numerical target for year-on-year spending by national health service organisations on local implementation of the national programme for information technology. Each NHS organisation is free, and expected, to use its resources in the way that delivers the best possible value for money. However, evidence from the Department’s most recent (2006) survey of investment in information management and technology in the NHS shows that the combined total of current and predicted future local NHS and central spending reflects significant progress towards the level anticipated in the 2002 Wanless Report “Securing our Future Health” as being necessary to deliver the breadth and quality of healthcare services envisaged in the report. Detailed information from the 2006 survey is available in the Library.

Any costs associated with implementation of the national programme locally are very significantly outweighed by the savings accrued from participation in the programme. Most notably, an independent industry analysis has concluded that some £4.5 billion has been saved by aggregate central procurement rather than local procurement, a figure confirmed by independent industry analysts. In addition, savings have been achieved in the prices paid by the NHS for information technology goods and services due to the central buying power of NHS Connecting for Health, as well as in NHS staff time saved through using the programme’s systems and services. The National Audit Office have acknowledged savings of £860 million achieved through centrally-negotiated enterprise wide arrangements.

The national programme was not mentioned among a list of possible factors contributing to NHS deficits in 2004-05 in the June 2006 joint National Audit Office/Audit Commission report on financial management in the NHS.

Norman Lamb: To ask the Secretary of State for Health (1) what assessment has been made of alternatives to a central database for storing patient records; [123999]

(2) whether an assessment has been carried out of (a) the implications and cost of removing the NHS spine system and (b) the impact of doing so on existing (i) patient care and (ii) patient records. [123998]

Caroline Flint: The alternative to a central database for patient records has existed and continues to exist in the status quo prior to the inception of the national programme for information technology. It is characterised by information technology (IT) that does not support the transfer of information between systems, encourages the creation of multiple records for the same patient within a single organisation, tolerates the loss and delay of records during their slow transit by hand, the unavailability of key information when needed, and the compromise of security and confidentiality of patient data. These shortcomings regularly result in clinical decisions taken on the basis of incomplete or inaccurate information, suboptimal quality of care, avoidable inconvenience to patients and doctors, and additional administrative costs.

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