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House of Commons

Tuesday 24 April 2007

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

NHS Information Technology

1. Mr. David Jones (Clwyd, West) (Con): What recent assessment she has made of the effectiveness of the use of information technology in the NHS. [133172]

The Minister of State, Department of Health (Caroline Flint): The digital technology being delivered through the national programme for IT is already being used widely by clinicians on a daily basis, and 91 per cent. of general practitioners have made a booking through choose and book. Most importantly, it is bringing benefits for patients by improving their care, safety and experience, and by improving the efficiency of services across the NHS in England.

Mr. Jones: The Minister will be aware that the British Medical Association’s working party on information technology is concerned about the non-compatibility of the IT systems of the four home countries, and in November it wrote to the director general for IT in the NHS to express that concern. Will the Minister please say why it was not thought appropriate to design compatibility into the systems from the outset, and what effect does she think that lack of compatibility will have on patient safety, particularly in border areas?

Caroline Flint: Of course we are working with our colleagues across the borders of England to set standards and to consider issues of interoperability. For example, although the devolved Administration in Wales have chosen to adopt different approaches to the development of IT in relation to the health service in Wales, we are in discussions about how we can facilitate the migration of existing NHS shared administrative services, so that the NHS care record service data spine can be used. We are working together, and I am pleased to say that across England, we can prove that we can work with the system to produce results daily. Choose and book is rapidly being taken up across the country, and we are making progress on electronic prescriptions and many other measures. I am sure that that is something that the devolved Administrations will want to consider.

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Angela Eagle (Wallasey) (Lab): Will my hon. Friend take this opportunity to congratulate the managers and staff at the Clatterbridge centre for oncology, which several years ago introduced an innovative IT scheme enabling its nine new Linux scanners, which deliver radiotherapy, to be chosen and booked by people who are expecting treatment? That ensures that there is huge productivity, and waiting lists for radiotherapy, which used to be very long, have now plummeted. People are getting their cancer treatment at the time of their choice, much faster than ever before.

Caroline Flint: Exactly. Our ambition is to provide better and safer services, quicker than ever before, and innovative clinicians are working with managers in the health service, and are co-operating with us, to do exactly that. I pay tribute to those people at her local hospital, who are making a difference to the lives of the patients whom they serve.

Mr. David Ruffley (Bury St. Edmunds) (Con): The April Public Accounts Committee report on the national programme for IT reported that the care record service is running two years behind schedule, with no firm plans for deploying the necessary software. Clinicians do not have faith in the programme. Four years after its start, there is uncertainty about the costs for the local NHS, and one of the largest suppliers, Accenture, has bailed out. Why is it that under Labour management, the NHS appears to be in the information super lay-by, when it should be on the information super highway?

Caroline Flint: We acknowledge the PAC report, but it happens to be a year out of date, and it is based on a previous National Audit Office report— [Interruption.] Let us just hear what the NAO has to say about our programme for improving technology in the NHS. It says that the NHS connecting for health programme

and that

It also says:

On the electronic patient record, it is important that we take time to get it right; that is better than speeding ahead and getting it wrong. [Interruption.] The Tories had 18 years to get on top of the technology, and not a lot was done. The question was asked—

Mr. Speaker: Order. I call Martin Linton.

Martin Linton (Battersea) (Lab): Has my hon. Friend made any assessment of the switchover from X-ray to digital imaging at St. George’s and other hospitals, and on the roll-out of packs in that regard?

Caroline Flint: I thank my hon. Friend for raising that important point. We are moving from old-fashioned X-ray films to digital images, which will transform the NHS. Over 170 hospitals are already using the system, and all NHS hospitals will have it by the end of the year. I congratulate St. George’s hospital
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on its commitment to providing the best possible service. On top of all that, within the first year we expect to save £40 million.

Andrew George (St. Ives) (LD): Among the large number of answers that I have received from Ministers is one from 4 September last year in response to a question about what information the Department collects from primary care trusts, acute trusts and strategic health authorities on the allocation of budgets for choose and book, as well as information returned about assessment. The answer was “None”. How can the Minister, in response to earlier questions, suggest that the Department is satisfied that it can make an assessment about the choose and book system if it is clearly not collecting any kind of information from people who are using the system?

Caroline Flint: We regularly collect information in different ways on the choose and book system and how it is working. I was pleased to visit a GP practice on Monday, and I talked to the GP about how it was working in that area. One thing is true: the IT to support choose and book has been delivered; the IT to support electronic prescriptions has been delivered; the broadband network has been delivered ahead of schedule; and digital X-ray machines have been fully deployed across London and the south of England. That is what is happening, and it is transforming lives. We will collect information where necessary, but we would rather provide the facility and ability for the local health service to get on with the job and produce the results.

Mr. Stephen O'Brien (Eddisbury) (Con): The Minister says that everything has been delivered, but the blunt truth is that twice the Government have set a target for choose and book, and twice they have missed it. Last year, Lord Warner promised to resign if choose and book was not delivered this March; in December he scuttled off on a fix-up job and is now blaming GPs and MPs for his failures. David Nicholson has criticised the bunker mentality of connecting for health, and today—

Mr. Speaker: Order. The hon. Gentleman should ask a question.

Mr. O'Brien: Very quickly, I should like to ask a question. When will the Secretary of State admit that that is a missed target, come clean and deliver something that is worth while?

Caroline Flint: We are delivering connecting for health on time and on budget—but perhaps the hon. Gentleman’s question was written by Professor Ross Anderson, who is an independent adviser on IT to the Select Committee on Health. Among a number of suggestions for Conservative party policy, he proposed a fresh look at IT policy, suggesting that in each civil service department there should be a chief information officer at grade 1 and that

based on their IT advice. If that is the best advice that the Opposition can obtain for operating a modern Government using the modern technology necessary for our public services, so help them.

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Cost Shunting

2. Robert Key (Salisbury) (Con): What recent assessment she has made of the extent of cost shunting between NHS hospitals and local authorities. [133173]

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Delivering high-quality social care and health care in every area while securing maximum value for money can be achieved only by NHS bodies and local authorities working together to make the best use of the available resources. We have made it very clear that cost shunting is not acceptable.

Robert Key: Can the Minister confirm that 17 per cent. of NHS capital resources are locked up in that problem? Does he agree that it does not matter whether we rebrand bed blocking as delayed discharge or cost shunting, because we are dealing with some of the most vulnerable people in our community, many of whom suffer from dementia? It is not just embarrassing, it is shameful that no Government Department is prepared to get a grip on the problem, whether it is the Department for Communities and Local Government funding local authorities, or the Department that runs the health service. We cannot go on with wards full of people who should not be in hospital and need not be there, because it is all down to accountancy.

Mr. Lewis: Some very specific things have been done to bring local authorities and the NHS together at the local level. Local area agreements bind them together through shared objectives and targets, joint appointments are increasingly made between the health service and local government at local level, and the Local Government and Public Involvement in Health Bill requires a duty of partnership for the first time from local government, primary care trusts and other health bodies. I have to say to the hon. Gentleman that Members on both sides of the House remember when winter crises were an annual event under the Conservatives, so we will not take any lectures on bed blocking from him.

Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): Does my hon. Friend agree that one issue for social services has arisen because of the success of the NHS in dealing with more patients and discharging more patients? With that increased throughput, many such patients have more intense needs, so will my hon. Friend look at developing more intermediate care schemes in which health and social care departments can work to discharge people into the community, but with more support so that they can go back into their own homes?

Mr. Lewis: My hon. Friend is absolutely right. That is at the heart of the debate about re-engineering services away from the acute end of the national health service into community-based health services and social care. That leads to more investment in early intervention and preventive services, and it increasingly gives people what older people and their families tell us they want—care so that individuals can be supported to continue living at home for as long as possible. It is shameful that the Opposition automatically present all those changes as cuts, not as changing services to meet people’s needs.

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Julia Goldsworthy (Falmouth and Camborne) (LD): To what extent will greater co-operation and accountability be introduced by pooling budgets? Is the Minister aware of Cornwall county council’s local government review submission, which proposes exactly that? Are any discussions taking place at a cross-departmental level to encourage that?

Mr. Lewis: I have a great deal of sympathy with what the hon. Lady says. We need to move from a notion of partnership between local government, the NHS and the voluntary sector to a notion of integration in every local community. We must move away from health care and social care being provided separately, so that local government and the health service locally truly secure the health and well-being of the local population, strongly focused on the needs of individuals, older people, disabled people and their carers, and families.

David Taylor (North-West Leicestershire) (Lab/Co-op): Is there not some risk that the discussion will develop into blame shunting, as David Stout, the newly appointed director of the PCT Network, has suggested? Local people do not know who runs what, and if organisations blame each other, public confidence in both sectors will deteriorate. How can we restore the momentum towards co-operation between social services and the NHS that my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) set in train all those years ago?

Mr. Lewis: I agree entirely with my hon. Friend. We must break down the Berlin wall between the NHS at local level and local government. No longer is the prize simply the integration of health care and social care. The full range of services that local government provides make a difference to the quality of life of older people, disabled people and vulnerable people. Local area agreements, a statutory duty of partnership, guidance on how services should be commissioned in an integrated way—all these matter, but so does the culture at local level. We expect leaders in the NHS and local government to provide leadership. We expect professionals to put aside their professional prejudices, organisational boundaries and historic enmities and focus on the needs of the people who require services.

Acute Hospital Services

3. Michael Gove (Surrey Heath) (Con): If she will make a statement on the future of acute hospital services. [133174]

The Secretary of State for Health (Ms Patricia Hewitt): The future of acute hospital services increasingly lies in high-quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman’s constituency.

Michael Gove: The Minister is aware that accident and emergency units in hospitals that serve my constituents are threatened with closure. What she may not know is that the so-called clinical evidence base justifying these cuts on medical grounds has been drawn up by someone who is not even a doctor, and the officials executing the cuts refuse to make improving
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clinical outcomes one of the aims of their work. Is it not clear that the cuts have nothing to do with helping people in pain and everything to do with ministerial mismanagement?

Ms Hewitt: The hon. Gentleman is talking absolute nonsense. Hospitals are changing because medicine is changing, and there are discussions going on in Surrey and other parts of the country about how to improve services—in some cases by giving more treatment closer to patients’ homes in health centres, community hospitals or GP surgeries, but also about how to ensure, for instance, that for people who have suffered a heart attack or stroke, specialist life-saving care is available in specialist centres. That will not be the case in every single local hospital—but no formal proposals have been made yet on service improvements and changes in Surrey. They will be made in due course, and consultation on them will not start until the summer. That is the appropriate time to have a debate about how services in Surrey can be improved to give people better care and a better chance of having their lives saved.

Keith Vaz (Leicester, East) (Lab): The Secretary of State knows that there has been a promise of new money for Leicester—£700 million for the pathway project. Although there will be a delay in the application for foundation status, will she reiterate the Government’s full support for the rebuilding of the hospitals that was promised under pathway, including refurbishment of the Leicester general hospital, so that in Leicester we can provide the best possible care in the best hospitals in the country?

Ms Hewitt: My right hon. Friend and I have taken a close interest in this matter over several years, and I am delighted to say that last year the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who has responsibility for reform and delivery, announced a private finance initiative rebuild across the three hospitals of the University Hospitals of Leicester NHS Trust. My understanding is that, following some discussions with the private sector partner about the cost, a review is taking place, but I have no doubt that that investment will continue for the benefit of people not just in Leicester but across Leicestershire and other parts of the east midlands.

Dr. Richard Taylor (Wyre Forest) (Ind): Does the Secretary of State agree with the Department of Health document “Keeping the NHS local: a new direction of travel”, which in referring to smaller acute general hospital reconfigurations states:

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