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We take patients’ concerns about the confidentiality of their records extremely seriously. We have established
a consent model in the NHS in England that respects the wishes of patients to control the flow of their information, while establishing an arrangement that is administratively efficient and pragmatic. Although much may be heard within the confines of Westminster about the public’s concerns about confidentiality, it is the case that less than 0.2 per cent. of patients in the early adopter communities for the summary care record have so far expressed a wish to opt out of the summary care record as it is launched.
It would be wrong for Opposition Members to suggest that arrangements they oversaw in the NHS, which relied on post, faxes and phone calls, were something that a 21st-century Government would want to perpetuate. It is a necessity on the grounds of efficiency and safety that the NHS move from those islands of electronic information and a dependency on paper into the 21st century, with information moving on a secure basis to support patients as they are cared for in numerous locations.
Meg Hillier: My hon. Friend will acknowledge the excellence of the City and Hackney primary care trust, one of the top seven of the 32 in London. However, although that excellent PCT welcomes the community support system—the RiO system—which will, for example, track childhood immunisation and is vital in tackling public health, it says that it is “a massive task” and that we shall have to find lots of extra resources to support it. Can my hon. Friend expand—if not now, perhaps in writing—on how NHS IT services can help PCTs that are already as good as mine to ensure that we have decent public health IT systems as well as the acute systems that she has been describing?
Caroline Flint: I thank my hon. Friend for that contribution. As the Minister responsible for vaccination programmes and public health, I am concerned to ensure that we have joined-up systems in terms of vaccination. There are clearly real issues in London in respect of the movement of families from one side of the city to another. I have taken them up by holding meetings with Connecting for Health and Department of Health officials responsible for immunisation so that we can tackle some of the problems and make sure that the systems are fit for purpose. The issue is complex and it is a challenge tracking the movements of families with children, especially those who may be vulnerable and not in a steady residential situation. If my hon. Friend wants to talk to me further about the circumstances in her neighbourhood, I shall be happy to meet her.
We have put in place security standards known as e-GIF—electronic Government information framework—level 3, which provide the highest level of civilian security around users accessing systems. Furthermore, all staff in the NHS are bound by professional codes of conduct, and the wide area networks being used between NHS sites are, by civilian standards, secure. Clearly, it would be misleading of me to offer the House an absolute, cast-iron guarantee that there will never be leaks of information, but we have taken all reasonable precautions to ensure the security of information being stored and transmitted within the system. We take it very seriously if any member of NHS staff makes inappropriate use of their access to information.
Mr. Todd:
Given the existing Lloyd George record system, which despite the incredible professionalism of
NHS staff can only be described as extraordinarily vulnerable in security terms, it is worth bearing in mind the different context. In that system, the exposure to risk is within a relatively limited environment, whereas once information is placed on a network the exposure to risk is much wider. Can my hon. Friend expand on how that problem will be tackled?
Caroline Flint: We are of course looking at exposure risks in the networks—at issues relating to access, PINs and smartcards—as well as the offences that are appropriate if individual members of staff misuse their security access and clearance. Any organisation, whether in the public or private sector, faces such challenges when dealing with information about customers, patients or users, but I am pleased to say that we are operating at the highest standard of civilian security in terms of data—probably the highest anywhere in the public sector. In many respects, the national IT programme has learned from previous Government IT programmes; that is acknowledged and the system is being driven forward in a way from which other public and private sector systems could learn.
I am sure that Opposition Members will join me in congratulating NHS Connecting for Health, which was commended even in the recent Public Accounts Committee report on IT projects. The outgoing chief executive of the Office of Government Commerce, John Oughton, said:
“I think the procurement process for Connecting for Health was an exemplary example of procurement. It was run to a very tight and rapid time scale; it started when it was intended and completed when it was intended; and it produced a very good result. I do not think any of the suppliers were disadvantaged in that process.”
Furthermore, I am sure that Opposition Members will also join me in commending NHS Connecting for Health for what was described by the NAO at the conclusion of its 18-month investigation into the national programme as
“a very positive report, which confirms that the programme to modernise the NHS computer systems is...much needed...well managed...based on excellent contracts...delivering major savings...on budget...has made substantial progress”.
Far from being badly run and over budget, the national programme for IT has been independently reviewed already by the NAO, which found that the
“previous model of IT procurement was haphazard”
“programme has the potential to deliver substantial financial, safety and service benefits for patients and the NHS”.
I am sure that Members of the Conservative Opposition are familiar with the content of the report because it was laid before Parliament on 16 June 2006. I am sure that they do not rely only on the opinions of such people as Tony Collins of Computer Weekl y, who has, I understand, provided briefings solely to members of the Conservative party and produced material for publication by Conservative party think-tanks.
Mr. Bacon:
It is interesting that the hon. Lady says that Mr. Tony Collins of Computer Weekly has provided briefings solely to the Conservative party. I happen to know that David Nicholson, the chief executive of the
NHS, invited Tony Collins to a seminar, which he agreed to attend. How can that be consistent with what the Minister just said?
Caroline Flint: Does that not demonstrate that we are open to listening to all voices in the debate? We do not approach this from a narrow, partisan point of view. I suggest to the hon. Gentleman that it is useful if people are transparent about who they are providing advice to and the parties for which they are writing IT policy.
In our opinion, it is lamentable that a programme that is focused on the delivery of safer and more efficient health care in the NHS in England has been politicised and attacked for short-term partisan gain when, in fact, it is to the benefit of everyone using the NHS in England that the programme is provided with the necessary resources and support to achieve the aims that Conservative Members have acknowledged that they agree with.
Owing to delays in some areas of the programme, far from it being overspent, there is an underspend, which is perhaps unique for a large IT programme. The contracts that were ably put in place in 2003 mean that committed payments are not made to suppliers until delivery has been accepted 45 days after “go live” by end-users. We have made advance payments to a number of suppliers to provide efficient financing mechanisms for their work in progress. However, it should be noted that the financing risk has remained with the suppliers and that guarantees for any advance payments have been made by the suppliers to the Government. That contrasts sharply with the policy of the Conservatives when they launched the now abandoned policy of financing IT projects through the private finance initiative. The national programme for IT in the NHS has successfully transferred the financing and completion risk to its suppliers.
It is untrue that there is not a firm timetable for delivery. It is sadly the case that extended consultation and a knock-on effect regarding delays in specification led to two years’ delay in the delivery of the summary care record functionality. However, each software delivery from BT, the contractor concerned, has been on time for more than 12 months. Similarly, the quality management analysis system for GP payments was delivered on time. The picture archiving system is on time. The core software for choose and book and the electronic prescription service has been delivered on time, and the network underpinning all those applications was delivered—[Hon. Members: “On time?”]—early.
I find it perplexing that Conservative Members have suddenly developed a deep relationship with some struggling IT suppliers. Are they suggesting that the Government should indulge in a little bit of dodgy state aid, or perhaps bung a few tens of millions of pounds to failing suppliers as a consequence of a supplier’s failure to fulfil its obligations? It would be interesting to hear what the Public Accounts Committee would think about such a policy.
Rob Marris:
My hon. Friend is absolutely right and underscores the fact that the official Opposition do not
really understand the computer industry. I do not claim to be an expert on it, but I spent some of the previous Parliament as a member of the Work and Pensions Committee, which produced a report on computers. The Conservative motion calls for a “full and independent review”, but the NAO has already carried out a review. Given that the nature of the industry is such that there are few suppliers, where on earth would the Conservatives get an independent body to conduct such a review? It does not exist. If there were a big enough body with sufficient expertise to carry out a review, it would certainly be in the system of government already.
Caroline Flint: I agree with my hon. Friend. The review is a red herring and part of the attempt constantly to undermine the good progress that is being made under the national programme. The Conservatives are trying to build in more stalling mechanisms, instead of constructively engaging on delivery.
When the Department of Health published the principles of the procurement arrangements for the national programme in January 2003, it stated clearly that it intended to transfer financing and completion risk to the supplier community. All suppliers bid voluntarily for the delivery of services to the NHS under those contracts, and in a small number of cases there have been significant supplier failures. While that is unfortunate in itself, it is fortunate that the costs of those failures have not been borne by the taxpayer. Simply pouring further funds into inefficient and often paper-based administrative processes might be what is recommended by the experts advising Conservative Members, but the Labour Government believe that a properly supported and financed national programme for systems in the NHS is absolutely essential to how we deliver health services in the 21st century.
There is strong evidence pointing to the fact that the chaotic and ad hoc procurement of local systems delivers poorer care as a consequence of tests being unnecessarily repeated, patients’ treatments being delayed and appointments having to be rebooked when information is not available. Properly networked systems operating across multiple locations with a high degree of standardisation are the common-sense solution.
Far from there being a significant opportunity cost to patient care, efficiencies are delivering significantly better patient care as a consequence of the NHS having a universal wide-area network, an online demographic service that is accessible from more than 7,000 locations and used by more than 50,000 front-line staff each day, and a picture archiving system, the deployment of which throughout the whole country is nearing completion. It would be naive to imagine that the implementation of such long overdue and complex systems would not be without disruption. Many end-users are far from disillusioned; they are delighted to have modern tools available. That is especially the case in community settings, where staff, especially nurses, were frequently dependent on paper and often needed to visit offices to obtain notes and details of further visits.
The NHS IT programme has already been subjected to a number of reviews, including an 18-month full and independent review by the NAO. I note with some sadness that 23 individuals, some of whom are well respected academics, have called for a review of the
programme. As was mentioned earlier, I understand that representatives of the group met David Nicholson, the chief executive of the NHS. Unfortunately, Professors Ross Anderson and Martyn Thomas were unable to articulate any firm grounds to substantiate an independent review, other than the existence of a large volume of negative media coverage—I have seen it—some of which they generated. Is that really a basis for a review when so many of our patients are already benefiting from a better NHS? We, the Government, think not.
Thousands of NHS staff and many thousands more patients are already benefiting from the national programme for IT. In the trusts covering the constituency of the hon. Member for Eddisbury, Connecting for Health systems are already used by 645 GPs and 335 pharmacists. To date, more than 20,000 direct bookings have been made through choose and book in his area, which is already benefiting from the picture archiving and communications system. Our ambition is that all NHS staff and the public throughout England will gain from the enormous benefits that the national programme for IT is enabling. With pride and confidence, I commend the Government amendment to the House.
1.47 pm
Norman Lamb (North Norfolk) (LD): It is extraordinary to listen to Ministers talking about this subject because there seems to be a complete disconnection between the world that they inhabit and that inhabited by most people working in the NHS whom I meet. If one talks to a room full of doctors, whether they are GPs or consultants, one hears a universal groan when one mentions Connecting for Health and the national programme.
Norman Lamb: The hon. Gentleman’s experience must be completely different from mine because I have noted a remarkable loss of confidence in the system among NHS professionals. The same mindset that we have seen regarding MTAS seems to exist for this system. The hon. Gentleman at least acknowledged that there had been problems with the programme. Indeed, he went a little further than the Minister’s tentative acknowledgement of some sort of discontent. He has been forthright in his concerns about MTAS. I suggest that he listens more to the many health professionals with genuine concerns about aspects of the programme that we are considering. I fully understand and acknowledge that many of the constituent parts of the programme have real merit. However, several of its aspects cause genuine concern.
Andrew Miller: Does the hon. Gentleman agree that the underlying problem is that any large-scale change management programme brings out the conservative—with a small “c”—nature in people, and that it is very difficult to carry 100 per cent. of the staff with it?
Norman Lamb:
Of course, I accept that change brings about resistance, and that that is sometimes because of a conservative refusal to move on—[Hon. Members: “With a small “c”.] I readily acknowledge that I meant a small “c”. However, everything that I
have read and that I have heard from the clinicians to whom I have spoken shows that people’s concerns go beyond that. My plea to Ministers and to Labour Back Benchers is that they should acknowledge that there are genuine anxieties and problems. What winds up health professionals most is Ministers simply refusing to acknowledge that there is a problem. The Minister did tentatively acknowledge that there were concerns among some health professionals, but with very carefully chosen words. That is exactly what happened with MTAS. There should be a greater willingness to recognise people’s concerns.
Mr. Stewart Jackson: Is not the more fundamental problem the lack of information that is available to Ministers in the Department of Health in making decisions? I refer the hon. Gentleman to the hon. Member for St. Ives (Andrew George), who, when he challenged the Minister on 24 April, elicited from her the answer that the Department did not collect data on the local efficacy or otherwise of choose and book. If that sort of information is not collected, how can we possibly know whether it is working?
Norman Lamb: That is a fair point. This is far too centrally imposed and grandiose a scheme. If one goes for a centrally imposed, grandiose scheme, of course one has to collect data from everywhere, which makes the whole thing rather unworkable. A better approach would have been to go for something much simpler and more locally based, as has happened in other European countries and the United States.
Margaret Moran: Does the hon. Gentleman accept that Ministers and Labour Back Benchers have acknowledged that things have not necessarily gone according to plan in a major IT operation of this scale? Does he also accept, however, that there are examples of progress to be applauded in areas such as mine? Luton and Dunstable hospital was having to hire taxis to take X-rays and scans down to Harefield hospital, but those imaging facilities are now available within Luton and Dunstable hospital, infinitely improving in-patients’ quality of service and life.
Norman Lamb: I am pleased that we have yet another acknowledgement from a Government Member that there have been problems—we are making progress. I accept that there is a powerful case for investment in appropriate IT. I also accept the Minister’s assertion that there had been a failure adequately to invest prior to this. However, that does not make the whole package right.
Let me deal quickly with the motion itself. Liberal Democrat Members agree with most of its content, particularly its call for an independent review. In fact, we called for an independent review in March. I will return to the case that we made then and the aspects that we think should be included in it. However, I have concerns, which I think may be shared by the hon. Member for South Norfolk (Mr. Bacon), about the opening assertion of the motion. It says that the aims of the programme are supported in principle. That prompts the question of what the aims are, because they have not been clearly articulated and have changed as time has gone on. The National Audit Office itself
was pretty vague about defining them in the section of its report that dealt with the objectives. It made one wonderful assertion:
“The Programme is intended to enable the NHS to become more effective in treating patients.”
I suspect that we can all agree with that. If that is the aim of the project that the Conservatives support in principle, I am fully with them on that. However, one begins to have a problem when one gets into greater detail. The Public Accounts Committee said:
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