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April 2002 brought the Wanless report, which recommended that IT funding should be doubled and ring-fenced. By June, the national programme for IT was launched by Ministers with the title Delivering 21st century IT support for the NHS. The published version of that omitted both the high-risk scoring and the costs estimate included in the draftthen £5 billion, a figure brilliantly unearthed by my hon. Friend the Member for South Norfolk (Mr. Bacon),
whose forensic and relentless work in that area has been, and remains, parliamentary scrutiny of the highest order. I pay tribute to him. Can the Minister tell us why that £5 billion cost estimate was left out of the document? I look forward to the answer.
actual expenditure at £654 million (estimated outturn) spent against expected expenditure of £1,448 million, reflecting the slower than planned delivery.
In April 2006 problems began at supplier iSOFT. In September, Accenture pulled out of the NHS IT programme, booking a £240 million provision for expected losses from the work. In March 2007, even the downgraded 90 per cent. choose and book target was missed, just as the electronic patient record pilots began. Pilots for care records were due to be in place by 2005.
Mr. Todd: I thank the hon. Gentleman for belatedly giving way. He has moved on from the point that I wanted to ask him about. If you allow me, Mr. Speaker, to catch your eye later, I will expand on some of the issues relating to proper management of information technology in both the public and private sectors, but I was concerned at the hon. Gentleman's rather naive view that the private sector is innocent in the matter. Has not he represented any constituents who use British Gas services and who are currently plagued by some of the difficulties arising from its change programme?
Mr. O'Brien: No doubt we look forward to the speech that the hon. Gentleman will make, if he catches your eye, Mr. Speaker, but this debate focuses on proper procurement and delivery, with the use of taxpayers funds, in the public sector of something that is really important: the health of our constituents and health care services. We must understand how the problem came about.
The only consultation to take place after the publication of Delivering 21st century IT support for the NHS in June 2002 looked at the care records element of the programme, and that was a consultation not on the substance of the programme, but on the technicalities of care records. There was no consultation on the other elements of the programme, namely choose and book, the electronic prescriptions service, the N3 broadband network, smartcard access, telecare, and the picture archiving and communications system, known as PACS. The latter and the N3 broadband network are the only bits so far that have been successful, so let us give credit where it is due. [Interruption.] As I have just said, PACS has been successful, if the hon. Member for Ellesmere Port and Neston (Andrew Miller) will listen for once. As Professor Peter Hutton said to the Public Accounts Committee during its review:
key decisions were taken in the early period without proper clinical input.
Dr. John Pugh (Southport) (LD): I think that we would all accept that PACS is successful, but that project went on for some time before NHS Connecting for Health got going. Therefore, it is a pre-existent project.
Mr. O'Brien: The hon. Gentleman makes a valid point. It has often been confirmed by our local expert, the surgeon commander on my right, my hon. Friend the Member for Westbury (Dr. Murrison), that that system was working perfectly satisfactorily and did not need to be hugely improved under the current system. However, there are still other systems that must be brought up to standard.
One of the major concerns with the NHS IT programme, and one which an independent review must address, is the seeming lack of an evidence base for it. In a recent British Medical Journal article on the subject, one trust director was quoted as saying
One of the things they haven't done very well is to clarify some of the benefits...I haven't seen a good list of benefits.
Cost-benefit analysis is basic to any capital project, let alone one of this scale, costing billions, and especially when it is taxpayers' money. The paucity of the evidence base testifies to the hurried planning and procurement of the programmes. With at least £12.4 billion of taxpayers money being committed, some cost-benefit analysis should have been done, and a robust business case established.
The growing cost of the programme has been the inevitable and wholly avoidable consequence. The programme was launched with the putative cost, as we know, of £5 billion, which was excised from the document. Once the contracts were signed, the ministerial line was that it would cost £6.2 billion over 10 years, although Lord Warner admitted on Newsnight that
the full cost of the programme was likely to be nearer £20 billion.
The NAO put the figure of £12.4 billion on the programme, and the PAC has suggested that even that massive sum may be surpassed. To October 2006, only £918.2 million-worth of that sum had been delivered.
Despite the highest paid civil servant being in charge of Connecting for Health, the programme has suffered from a lack of leadership. In two years, there were no fewer than six senior responsible owners of the NHS IT programme at Richmond House. Lack of leadership was one of the key themes of this weeks PAC report into Government IT. It highlighted the failure of Ministers across Government to meet the senior responsible owners of mission-critical and high-risk IT programmes, or to take a grip by meeting them sufficiently regularly. It also highlighted the low profile and high turnover of chief information officers and the lack of clarity about their roles.
To all of that we must add that one of the design flaws of the NHS IT programme has been its massive centralisation. The programme structure has, in effect, established several regional monopolies through local service providers. From the original four, there are now three providers serving five regions: the CSC Alliance
in the north-west and west midlands, the north-east and the eastern clusters; Fujitsu Alliance in the southern cluster; and the Capital Care AllianceCCAin the London cluster. CSC took on two clusters from Accenture when it pulled out of the programme in September 2006.
Hospitals have been forced to accept the IT imposed on them by those local service providers, or in some cases have had to invest in costly interim solutions due to delays in the programme. A recent BMJ study into the implementation of the programme suggested that the Connecting for Health software is more expensive than software on the open market. One medical director said:
A lot of things are being sold to us at a much higher price than we would have been able to get if wed been in a real market situation, so the total costs to the NHS have been very high indeed.
Those regional monopolies have caused serious supply-chain concerns. The exit of Accentureat an estimated loss to it of £250 millionwas a big blow to the credibility of the programme. The supplier that has been most in the public eye is iSOFT. Its share price has plummeted twicethat is public informationand on 6 April the shares fell a further 40 per cent. It appears that iSOFTs previous accounting policy, which it has now had to abandon, was based on its receipt of letters of credit, centred around advance payments from NHS Connecting for Health. In evidence to the PAC on 26 June, Richard Granger of Connecting for Health stated that it would make an advance payment only when covered by a letter of credit from a bank. That is nice work if you can get it. [Interruption.] That completely undermines the Departments claim that suppliers get paid only when they deliver. [Interruption.] But as the Minister cannot be bothered to listen, she will not understand that.
iSOFT is now looking for a buyer. Its main customer, CSC or Computer Sciences Corporation, has opposed a bid by an Australian firm. [Interruption.] The Minister says from a sedentary position that she finds what I am saying boring. The trouble is that she is so bored by IT that she has not bothered to have regular meetings, or to supervise or take a grip of the process. She needs to listen to a proper critique of where the Government are wasting taxpayers money, and to take control for once of a programme for which the Government are deeply responsible.
Mr. Stewart Jackson (Peterborough) (Con): My hon. Friend is making a strong case. Is not the real issue that on a day-to-day, week-to-week basis Ministers do not know what they are doing? In May 2006, the Minister advised us that the programme was
already the focus of regular and routine audit, scrutiny and review.[ Official Report, 24 May 2006; Vol. 446, c. 1877W.]
In the same month, her colleague, Lord Warner, said that the likely costs of the project would be not £2.3 billion as originally envisaged, but £20 billion. Does that not sum up the Governments mismanagement of the programme?
Absolutely. My hon. Friend makes a valid point, although the Minister would no doubt
immediately say that the £20 billion was meant to encompass the total expenditure on IT across the NHS and not only the Connecting for Health programme. Either way, it is monumental incompetence to double ones costs in a short period.
As I have said, iSOFT is now looking for a buyer. Its main customer, CSC, has opposed a bid by an Australian firm, IBA Health. It was announced yesterday that iSOFT is beginning legal proceedings against CSC; and CSC today said it was continuing to review its options
and does not exclude the possibility of making an offer for iSOFT.
The programme has been a masterclass in how not to do procurement. I expect that the Minister will stand up and crow about the speed of the procurement, which was begun in February 2003 and completed by February 2004, but what has it led to? Suppliers are leaving or collapsing, and the system is both dysfunctional and late, with costs burgeoning against minuscule deliverydespite the statistics in the Government amendment, which are, in any event, not measured against their own targets, showing that they dare not do that.
Rob Marris (Wolverhampton, South-West) (Lab): The hon. Gentleman mentioned iSOFT and the role of the private sector. Following on from the remarks of my hon. Friend the Member for South Derbyshire (Mr. Todd), may I caution the hon. Gentleman about IT projects in the private sector? IT projects across the piecein both the private and public sectorsare notoriously difficult. This project comprises several programmes and we are all aware that it has not gone smoothly. However, it is wrong to have a rose-tinted view that things go smoothly in the private sector. The difference is that the private sector hides things. Moreover, when iSOFT was booking revenues and declaring them against future revenues, which is very dodgy accountancy practiceit has been caught doing thatthe chair of its audit committee was that private sector champion, Sir Digby Jones.
Mr. O'Brien: Whether or not things were hidden or inefficient in the private sector, at least scrutiny was exercised by both competition and shareholders. It appears in the public sector that the Government have also been seeking to hide things. Why else have they not had a debate on this subject on the Floor of the House? The Opposition have had to secure this debate. Furthermore, taxpayers money has been used and the Government have created a series of monopolies for delivery, and they are not exposing that to the true test, which is competition. Competition is one of the best ways of making sure that things are not inefficient and not hidden.
The two most controversial elements of the programme are the care records service and choose and book. Under the care records service, the patient record was supposed to have been fully rolled out by December 2005. The first pilots went live only in March this year, and we are still awaiting a timetable for full roll-out. Above all, widespread and deep-seated
anxiety about patient confidentiality has troubled many as they come to appreciate the Governments design for their private and personal information.
The Government made a notable U-turn when they decided in December last year to allow individuals to opt out of the summary care record: we welcome that option. However, serious concerns remain. The Government insist on saying that
only basic data will be held on the summary care record.
However, that includes information about prescriptions, from which, as any doctor will confirm, any illness or range of illnesses being treated can be fairly easily extrapolated. Will the Minister remove prescription data from the summary care record, or at least stop using the word basic, which is deceptive in this context?
Moreover, when the Government announced the opt-out, they failed to make it clear that it is still not a full opt-out. Patients can opt out of having their medical details uploaded to the spine, but they still cannot opt out of having their demographic information updated, such as name, address, date of birth and NHS number. Will the Secretary of State come to the House to state that that will be made clear in the literature going out to patients at the pilot sites? Furthermore, the Government have not yet come clean on whether they intend to join up their identity cards programme with the NHS IT programme; this debate gives the Minister the opportunity to clear that up, and I hope that she will do so.
Finally, we have not yet received the assurances we need about the security of the system. The Minister might stand up and rehearse arguments about legitimate relationships, role-based access, smart cards and audit trails, but we know that smartcards are shared in hospitals, and an audit trailif it worksmerely tries to shut the door after the horse has bolted.
We must also not lose sight of the fact that the vast majority of people who go to hospital are at least lightly conscious even if they are very ill or seriously injured, and even if they are unconscious, doctors will still follow proper professional diagnostic procedures, rather than tap away at a laptop next to the patient to find out what has been wrong with them in the past. There seems to have been no consideration of that reality. If a proper business case had been submitted and consultation with front-line staff had taken place, the fundamental need for this type of IT base might have been reconsidered.
The choose and book service was supposed to be 100 per cent. delivered by the end of December 2005. When the Government missed that, they set a target of 90 per cent. delivery by March this yeara target they have missed by miles. A mere 38 per cent. of bookings are being made through choose and book, with some primary care trusts achieving rates as low as 8 per cent.
In an interview on Newsnight about the national programme for IT, broadcast a year ago, Lord Warner, the former Minister responsible for NHS IT, said that he would resign if choose and book was not delivered by this March. He got out well in advancelast
December. So no Minister has taken responsibility for the delay, andsurprise, surpriseto replace Lord Warner the Government have re-appointed Lord Hunt, who designed the thing in the first place.
In addition, it transpires that half these bookings are done by patients themselves on the phone. Their doctor gives them a list of hospitals and their telephone numbers, and it is up to them to go home, choose their preferred hospital and try to make the booking, instead of its being done at the doctors surgery, as it should be. Choose and book, where it is working, is rarely working properly.
Mr. Hunt: Does my hon. Friend agree that choose and book might have been a lot more successful had there been proper consultation with key stakeholdersnamely, the GPs who use the system? They complain frequently that one of the main problems with choose and book is that they can book appointments only at particular hospitals and not with individual consultants. However, many GPs want to book an appointment with a consultant whom they know is particularly good at a given task.
Mr. O'Brien: My hon. Friend is absolutely spot onsuch consultation is precisely the issue. Moreover, patients want choice as part of their freedoms and opportunities. At the same time, they want to continue to engage the expertise of those upon whom they rely.
So we have to ask, is choose and book, which is not yet working fullyfar from itas currently designed really the improvement in services that patients are crying out for? When will the Government give a proper timetable for choose and book, if it can be delivered? If it cannot, when will they abandon it?
Margaret Moran (Luton, South) (Lab): To hear the hon. Gentleman speak, one would think that choose and book is a complete disaster. However, are not nearly 98 per cent. of GPs using live choose and book? Moreover, and as the hon. Gentleman has just indicated, surely the issue is whether the service to patients is effective. For example, are not hospital records, which were previously turned around in two to three weeks, now turned around in two to three days? Does the hon. Gentleman not count that as a success?
Mr. O'Brien: I am surprised to discover that the hon. Lady has not been listening, because that is certainly not what I said. Anybody relying on that 98 per cent. figure will discover on examination that even a doctor who has used choose and book once and found it to be totally useless has been included in that figure. The true figureas shown in a parliamentary answer given by one of the Ministers own colleaguesis about 38 per cent., although it might have gone up by one or two points since that answer was given. So the hon. Lady should rely on facts, rather than on the Whips handout.
by 2005 for 50 per cent. of all transactions, with full implementation by 2007.
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