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However, just 0.1 per cent. of all prescriptions issued in the NHS in December 2005 were issued by that method.
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Although the latest available figures show that in the week to 28 May 2007, 5 per cent. of all prescriptions were issued using the electronic prescriptions service—that is a better measure than the one paraded in an earlier intervention and in the Government’s amendment—figures uncovered by us show that less than 2 per cent. of those prescriptions were downloaded by pharmacists for dispensing. So much for the boast in the Government’s amendment! Despite even this very low take-up rate, NHS Connecting for Health still insists that,

We witnessed the sight in Woolwich as recently as 25 May of the incoming Prime Minister saying in his campaign—against nobody—to head the Labour party that

However, this is the very Chancellor who presided over a Treasury that explicitly provided the money, which he announced in his Budgets, to be spent to achieve all this by 2005. What monumental incompetence caused him not to know where that money had gone and that it had failed to achieve its stated goal—so much so that he had to announce that goal as the very first of his new ideas? The system was meant to have been in place for more than 18 months now.

Speaking of monumental incompetence, I shall leave the subject of the parallel scandalous failure of the Department to implement successfully the medical training application scheme for junior doctors to my expert colleague who will wind up for us today—the surgeon commander, my hon. Friend the Member for Westbury. [Interruption.] Yes, surgeon commander, and to be respected.

Today we are calling for a full zero-based independent review of the programme. To date, rather chippily, that has been ruled out by Ministers and by the chief executive of the NHS, yet the latter has acknowledged the “clash” between a national programme and the need for it to be delivered locally. He described the programme as

and referred to the “bunker mentality” that Connecting for Health has built around it. I cannot argue with his critique of the programme as far as it goes, but when are the Government going to make the necessary U-turn and devolve complete power to local hospitals? One of the original architects, Lord Hunt, who is now back in post, said just last month —[Interruption.] Ministers might like to listen to this. Their own colleague who is now back in post and in charge, said that now is the right time

That is what we have called for all along—local contracting, with nationally set interoperability standards.

Mr. Andrew Lansley (South Cambridgeshire) (Con): We said that five years ago.

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Mr. O'Brien: Indeed, and look what has happened in the interim. The Government have failed on the job. Above all, that is what the users—doctors, be they consultants or GPs, nurses, therapists and managers—really want. Then, they will buy into this and use IT to improve health care for patients. Only a full, zero-based independent review can bring us to that point, and the Minister should now have the grace to accede to having one.

It is in the interests of patients and our constituents, and of the morale and professionalism of the wonderful and dedicated staff in our NHS, that I urge the House to vote for the motion.

1.16 pm

The Minister of State, Department of Health (Caroline Flint): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

It is laudable that the Opposition support, as the hon. Member for Eddisbury (Mr. O'Brien) acknowledged today, the aims of the national programme for IT. However, it is deplorable that they continue to condemn the delivery of this programme and the necessary investment to achieve the aims that they so loftily support. It is noteworthy that when the Conservatives were last in government, the NHS was one of the last bastions of garage-built computer and paper systems. Despite the Labour Government’s inheriting from the Conservatives in 1997 an NHS that was spending approximately 2 per cent. of its overall budget on computer systems, the one thing that unified almost all the systems bought for the NHS by that Conservative Government was their incompatibility and their inability to pass information from one site to another.

It should be noted that, despite our having led the world in the computerisation of GP practices, the one thing that we could guarantee patients was that their electronic records within a GP practice could not be transferred electronically to another practice—even between systems bought from the same vendor. That lamentable state of affairs is now viewed with a quaint 1950s nostalgia by Opposition Members as being more desirable than the successes delivered by this Government through the national programme for IT.

Far from being a “hasty conception”, the NHS’s national programme for IT learned from the mistakes that a Tory Government made. In 1998, we launched a
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well thought through four-year programme to develop pilots of electronic records. The electronic record development and implementation programme, known as ERDIP, led to a number of small-scale yet successful local installations. The key issues that contributed to this programme’s not being sustainable in itself were the need for it to be taken up on a national basis and to deal with the unaffordability created by this local development. Such affordability issues were driven by significant cost inefficiencies as a consequence of small-scale local procurements and a high degree of variability in the software from one NHS location to another. During 2001 and 2002, it was with these lessons in mind from the preceding three years that we established a strategy group under the auspices of Professor Sir John Pattison, then director of research analysis and information at the Department of Health, in order to pull together a strategy that we published in 2000, entitled “21st Century IT for the NHS”. It is therefore an act of gross revisionism to suggest that the Government hastily conceived the national programme under my noble Friend and Minister, Lord Hunt.

Mr. Todd: Bearing in mind what the Minister has said, I doubt she will be surprised that the mental health trust in Derbyshire has, certainly until recently, operated with 19 separate information systems and that it is virtually impossible to obtain appropriate management information in such a fragmented systems environment.

Caroline Flint: My hon. Friend is right. We are trying to catch up with the fragmented communications in the NHS, large as it is, and the essential requirement behind change is patient safety and better services. That might mean some inconvenience for staff, but that has to be faced if we are to put patients at the heart of our health service.

Dr. Pugh: Will the Minister give a guarantee that software provided by the various local service providers—quite a few of which are still left—is all interoperable?

Caroline Flint: We are obviously trying to ensure that. I am happy to write to the hon. Gentleman to clarify that point, but we need to achieve step-by-step change. I shall come to how we have had to take stock of development and its timetable to ensure that we get it right.

The Opposition’s failure to recall the extreme difficulties that they experienced in government in specifying systems, many of which never went live and were a gross misuse of public money, contrasts sharply with this programme, which has been tightly managed—as endorsed by the National Audit Office. I will concede that there are unavoidably a number of users who have not been consulted, but during the four-year pilot process the NHS Information Authority, and predecessor organisations such as the information management group, undertook extensive consultation with end-users about the content of the national strategy. We now have a system in place through a rolling programme of service implementation, led by a veteran NHS manager, Richard Jeavons, to ensure that before the implementation of systems all users, especially those on the front line, are satisfied with what they are receiving and how it will be implemented.

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Unfortunately, I have to tell the hon. Member for Eddisbury and his supporters that the Opposition’s activities in fuelling negative media coverage often prejudice the opinions of end-users prior to their receipt of systems. Connecting for Health and the Government have had to answer misinformation provided by the Conservatives and others. Day by day, however, more and more staff are recognising the value of the new system and putting it into practice.

Mr. Stewart Jackson: Opticians must be doing well because the Minister is wearing rose-tinted spectacles. What unique insight into the programme has been missed by the Health Service Journal, the BMA, GPs, 23 eminent IT specialists and parties in this House? It is not only the Opposition who question the implementation and efficacy of the programme; it is all those experts, who have all been disregarded by the Minister and her colleagues.

Caroline Flint: Nobody is being disregarded. We recognise that there have been delays because we need to be sure that what we are trying to achieve and the practical implementation of the programme are understood. I make no apology for that. I would rather spend a little time getting it right than do it wrongly. There is a difference between constructive engagement and that based on no real evidence but on speculation and misinformation put into the public arena. I will give specific examples on particular groups later.

The national programme for IT in the NHS has established a number of well respected national clinical leads, and recently appointed a full-time clinical director. It has also established user forums for live systems and continues to improve these systems in line with feedback from users. Perhaps the greatest example of the way in which the national programme for IT does listen to its end-users relates to the picture archiving and communication systems, or PACS. Today in London, every NHS hospital is now equipped with that type of system. That means that patients wait significantly less time for reports and follow-up consultations, that films are no longer lost and that care is delivered more safely and efficiently. Picture archiving was not part of the programme when the contracts were let in 2003. Those systems were added to the contracts in 2004 in direct response to feedback from front-line clinicians and groups representing patients, so the system has been updated and remains as flexible as possible to take account of new IT developments.

Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): I have seen PACS in operation in the Homerton hospital. It had its teething problems, but it is now very welcome in London hospitals. I have a more personal point to make, which is that patients in Hackney who have an appointment with a hospital or a community service now receive a text message to remind them of their appointment. If we are to bring health care into the modern world, that is an improvement that should be welcomed on both sides of the House.

Caroline Flint: I agree. Would it not be wonderful if the media and other commentators talked more about where the system is working well for people? Then people in other parts of the country could ask their
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health chiefs and officials for the same service. That would be community engagement and patient engagement, which is what we want for people all over the country.

Andrew Miller: My hon. Friend correctly referred to the way in which PACS was added on the basis of consultation with end-users and clinicians. Will she also confirm—to correct misinformation from the Opposition—that the technology involved in PACS is such that it could not have been rolled out on a mass scale under the previous Administration or indeed before we did it?

Caroline Flint: Absolutely. We had to have national oversight and direction, as well as the resources to make that wonderful development happen. Money is really important. It is interesting to hear from the Opposition about how they want to stall the national programme—

Mr. Stephen O'Brien: On the contrary.

Caroline Flint: Well, another inquiry would bring progress into question. The Opposition have never told us what they would have been prepared to spend to provide the service that is benefiting patients and assisting NHS staff. There is a difference between talking the talk and walking the walk and making the services that we should expect as a matter of course in the 21st century something that everyone can experience.

I acknowledge that in some cases we have had to take stock, delay implementation or adjust our thinking based on what we have been told by those on the front line. I am also willing to acknowledge that some of the systems that have been implemented under the programme have not proved popular with end-users as they introduce benefits to patients that may not be to the convenience of NHS staff on all occasions. One such example is the choose and book system. It benefits a patient nearly every second of any day. However, the additional work required by GPs to deliver this improved service to patients has been controversial and I recognise that the early versions of the software have been improved as a consequence of direct feedback from doctors.

Several hon. Members were present at an event hosted by Computer Sciences Corporation—CSC—last night in Portcullis House. They would have heard from Dr. Angela Rowland that far from the systems being unresponsive to the needs of end-users, her work environment as a doctor has now been radically improved as a consequence of the delivery of these new systems.

Andrew Miller: I stayed at the CSC event throughout because I am interested in the work that it has done on picture archiving at the Countess of Chester hospital and I was concerned to note that, despite invitation, not a single Conservative Member turned up.

Caroline Flint: That is an interesting piece of information. The Conservatives obviously like to listen to people only if they are saying what they want to hear.

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Angela Watkinson (Upminster) (Con): What advice can the Minister offer my constituent, Mr. Pegler, whose GP decided that he needs an urgent appointment as he has a family history of cancer? He was advised to use the choose and book system and given the telephone numbers of four hospitals, yet it has proved impossible to get an appointment from any of them. He subsequently contacted the patient advice and liaison service, but is still waiting for a response. Mr. Pegler has been trying to get an appointment for nine weeks. I do not know whether Hackney hospital was one of the four to which he was directed, but I should be grateful for any advice the Minister can give him.

Caroline Flint: I am very concerned to hear about that situation. If it had happened to one of my constituents, I should have been knocking at the GP’s door to ask what was going on. I shall be happy to take the information away and look into the matter because we know, and I hope the hon. Lady acknowledges, that the access times for diagnosis and treatment of cancer have improved enormously over the past 10 years. However, I am happy to talk to her about how best to represent her constituents.

It is the case that in some aspects of the programme extended consultation with end-users has led to some delays from the original timetable, which was established in 2002. One such example is the summary care record, where an extended consultation exercise with members of the public and professions working in the NHS was led by Harry Cayton, the national director for patient involvement at the Department of Health. It resulted in modifications both to the requirements and the consent model from what was proposed in 2002. Far from regretting that aspect of delay in the programme, I think it was a prudent course of action. In our opinion, to have proceeded hastily with the delivery of the system, in the absence of consensus for the consent model and the content of the summary care record, would have been ill advised.

With regard to front-line clinician support for the summary care record, I refer the House to coverage on BBC Radio Manchester on 31 March, when Dr. Natha of Kearsley medical centre in Bolton stated that patients would benefit greatly from the summary care record. For example, any doctor outside a GP practice who makes an emergency visit to a patient in the middle of the night would have an up-to-date and accurate summary of the patient record in front of them without having to put questions to an elderly patient who may or may not know the answers, or even be in a position to give them.

A point was made about the medical training application system. My right hon. Friend the Secretary of State for Health has already answered questions about MTAS and we have expressed our regret for the difficulties with the system. However, it should be noted that the security and end-user assurance arrangements within the systems deployed by the national programme for IT—at this point, about 19,500 systems used by more than 350,000 front-line NHS staff—have to date prevented such difficulties from occurring. We have avoided hostages to fortune through the provision of cast-iron guarantees in that respect.

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