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The central vision of the Programme is...to introduce an integrated system called NHS Care Records Service
or the national spine. That is where we have a problem. We do not believe that the case has been made to demonstrate that the benefits of a national spine outweigh either the costs to the NHS, given all the other priorities in the service, or the civil liberties and privacy concerns that have been expressed by many people, including the Information Commissioner. I will come back to the concerns that he raised within the past few months in his written evidence to the Select Committee on Health.
The Government reject the call for a review out of hand, but I fail to understand why. They are keen to quote independent reviews when they are positive about the Government. Reviews that say that 90 per cent. of patients are satisfied are great, but when a review is suggested that they find uncomfortable, they resist the proposition. However, given the scale of the concerns that have been expressed by a wide range of people, it would be in their long-term interests to agree to an independent review in order to work out properly where the whole project is going and how best to adjust it given the problems that have occurred.
Mr. Todd: Perhaps I should have challenged the Conservative spokesman, who is the hon. Gentlemans friend in this matter. What exactly is this independent review? Who is supposed to do it and with what brief, what is its scope, and how is it empowered?
Let me first explain why I reached the conclusion that a review was necessary. One of the leading people centrally involved on the private sector side of the project made two assertions to me, which were equally horrifying given that this is the biggest ever IT health care project anywhere in the world. First, he asserted that when the project was launched, there were insufficient numbers of adequately skilled people to implement it, and that that is still the case. Secondly, he asserted
His second assertion was equally shockingthat there has never been a thorough systems review. The
Minister said that end users are now being consulted all over the place, but that is supposed to happen at the start, not much later on.
The person told me that it is necessary to bring together at the start the builders of the system, the purchasers of the systemthe people who will be spending the moneyand the users of the system to ensure that there is a common understanding of what it is supposed to achieve. It was remarkable to hear that there had never been an adequate process of that sort. It is absolutely scandalous to embark on the biggest IT health care project in the world without it. I suspect that the hon. Member for Wolverhampton, South-West (Rob Marris), who is remaining remarkably still and not demonstrating any body language at all, is quietly agreeing with me.
In April 2006, some 23 computer academicsexperts in ITsent an open letter to the Health Committee. The Minister referred to that submission, and she accepted that some of those peopleshe said some, not allwere highly respected. They called for an independent technical assessment of the project, and they said:
the programme appears to be building systems that may not work adequately andeven if they workedmay not meet the needs of many health trusts.
We are struggling with an unacceptable degree of secrecy, too. We have heard that reviews have been undertaken, both internally by the Department, and by the Office of Government Commerce. Why can we not see them? Why not publish them?
Mr. Todd: I have raised the issue of the availability of OGC gateway reviews in the House on many occasions. The standard answer, which I do not entirely accept, is that if they were published, it would ruin the confidentiality of the process and make it difficult for suppliers and other participants in a project to communicate frankly about it. I do not entirely accept that argument, but it does at least deserve recognition.
Norman Lamb: Indeed, it was noble. I note that the hon. Member for South Derbyshire (Mr. Todd) does not entirely accept the argument for secrecy. Earlier, he asked what the proposed review should cover. In March, we put it that first there should be an assessment of whether it is still possible to achieve the original stated objectives, and if so, within what time scale. I shall return to this point later, but given that many IT experts state clearly that it is not possible to achieve those objectives, there is a powerful case for including that consideration in the review. Secondly, the review should consider the impact on health trusts and on general practitioners surgeries of the delays in completing delivery of the project. The hon. Member for Eddisbury (Mr. O'Brien) made the point that hospital trusts are having to acquire interim solutions because they cannot wait any longer. That is pretty crazy, and it is an extraordinary waste of resources.
Norman Lamb: Let me complete the points about what should be included in the review. Thirdly, there should, for the first time, be a proper cost-benefit analysis to determine whether the scale of the project can be justified. To my knowledge, that has not properly been undertaken; if it has, it certainly has not been made public. Fourthly, there should be a full assessment of the civil liberties implications of the national spine. I hope that Labour Members share our concern about ensuring that peoples rights are not undermined or compromised because of the risk, even with summary records, of very sensitive information getting into the wrong hands.
Andrew Miller: I agree with the hon. Gentlemans observationit is important that records are properly protected, but conversely, does he accept that in years to come, when the system is fully flowing, if the No. 73 bus hit him, it would be rather a good idea for the first responder instantly to blood-match him, identify his allergies and so on? There are costs and benefits to be traded off, and we need to work carefully on that.
Norman Lamb: The hon. Gentleman proves my point: a cost-benefit analysis has to be done, so that we can balance the potential benefits. On the example that he gives, when I talk to clinicians, they are somewhat resistant to the idea that it would be valuable for them, if I got knocked over by a bus in Cornwall, readily to access my records on-screen in Cornwall. They say that there are protocols that they would follow in those circumstances, and that if there was any error in the national records, mistakes could be made. I repeat that the hon. Gentleman makes the case for me that a cost-benefit analysis needs to be conducted.
Finally on the review, there should be a proper and thorough consideration of where we go from here. If there are genuine concerns about whether the programme can achieve its original objectives, surely we should determine together how best to move the project forward so that we can achieve the objectives that are achievable.
An enlightened Government would announce a review in response to this debate. Alongside that review, the Secretary of State, or the Minister, should acknowledge the scale of the problems, rather than seek to deny them.
Margaret Moran: On the hon. Gentlemans complaint about delays with the project, is not one of the problems with his proposal the fact that it will cause injury to patients, as his review would further lengthen the time needed for the implementation of valuable projects? Reviews have taken place, not only at the gateway stage but throughout the project, and that has indeed caused delay. On the gateway reviews, is it not important that there be a degree of confidentiality, so that consumers, end-users and suppliers can be honest in any dialogue about what works and what does not? Surely that is more important than the hon. Gentleman being able to read gateway reviews, if he so chooses.
Norman Lamb: I pray in aid the Ministers comments: she said in her speech that it was better to get it right than to rush ahead. That is precisely what she said in justifying the delays that had occurred. The experts whose opinion I have read who have argued the case for review say that it would be possible to conduct a review quite quickly; it would be a matter of weeks, and not months. Surely it is in the Governments long-term interests to conduct such a review, and to make sure that wherever we go from here, we have the backing of clinicians and, hopefully, everyone in the House. That would be better than the Government simply pressing on, with their head in the sand, without acknowledging the scale of the problems.
In arguing the case for a review, I want to deal with three key areas: technical concerns, costs and delays, and the civil liberties implications. On the technical side, I refer again to the 23 IT academics who raised concerns. I refer, too, to the written evidence of Tom Brooks, who submitted a paper to the Health Committee. He has substantial experience in the NHS and with the national programme, so we should take his evidence seriously, as I am sure that Labour Members will agree. He focuses on the central infrastructure for the national patient data, and he highlights the fact that Connecting for Health has not published any details of the calculations that it made to demonstrate that implementation on the scale envisaged is technically achievable. He says that Connecting for Health has not presented that evidence to us. He asks what records clinicians should rely on if there is a difference between the records on the national register and those held locally. It is quite possible that there may be a difference between the two because of inputting errors. Who is accountable for clinical or care errors resulting from reliance on the national summary record? He has direct experience of the national programme, and his conclusion is that the Government should acknowledge that the original goal is unattainable. He says that work on the national records
system should be suspended, because that is his particular area of concern. I am not an expert, but I take the concerns of someone with that experience extremely seriously, and I hope that the Government do so, too.
Turning to the history of the problems that have occurred, Queen Marys hospital in Sidcup was one of the first to introduce a patient records system, but it found that it was frequently unavailable. In November last year, E-Health Insider reported hospital plans to replace the patient administration system just 18 months after it had been introduced. The Nuffield orthopaedic centre reported problems with the installation of Cerner software, with patient records disappearing. We cannot be happy about such experiences. An insider described the system as a white knuckle ride. Is that something that should give us confidence? In September last year, Computer Weekly, which has already received a fair airing in our debate, referred to the fact that there had been 110 major incidentsincidentally, Tony Collins has spoken to me, too, so it is not just the Conservatives to whom he is talkingthat impacted on patient care. In July last year, the Computer Sciences Corporation data centre broke down, leaving 80 trusts without admin systems for several days.
Caroline Flint: Does the hon. Gentleman agree that under previous systems, particularly before 1997, there were numerous examples of systems breaking down, not for days but for weeks? The paper system, as well as a system in which computers could not even communicate from one GP practice to another or from one hospital to another, left much to be desired in terms of patient safety. I acknowledge the fact that there have been some breakdowns, but it is wrong to distort the problem by failing to compare it with the systems that the NHS operated in the past, both electronic and paper.
Norman Lamb: I fully accept there were many problems, but that is no reason for failing to be concerned about the situation or failing to acknowledge the concerns of people working in the system about the problems that are occurring here and now. In April this year, 79 doctors and admin staff in Milton Keynes hospital wrote that the patient administration system was not fit for purpose. It was reported in May this year that the Royal United hospital in Bath had still not had its Cerner software installed. The system was supposed to go live in November 2005, but the hospital was still waiting in May. In the same month Manchester reported hundreds of inaccurate patient records in the online booking system. The Minister ought to be concerned that those problems are still occurring.
All those technical problems have led to extra costs and delays. Reference has been made to the fact that many of the costs arising from the problems have been incurred by the private sectorI acknowledge that that has been a feature of the contractual arrangementsbut it would be naive to believe that that does not have an impact on the delivery of the system. The private sector appears to be in a mess financially: Accenture is in all sorts of financial difficulty, and it has withdrawn from the system. Those problems have an impact on
the delivery of the system, and I am pleased that the Government acknowledge that.
The plan was hatched in February 2003. Despite Government claims, there was no proper analysis of need or of the purpose of the whole scheme. The original budget was £2.3 billion, but it was adjusted to £6 billion, and the National Audit Office referred to £12.4 billion. We have heard estimates from insiders of a total budget of £20 billion to £40 billionthe figure keeps going up. Targets have been missed. The Minister referred to all the targets that had been hit, but what about the fact that 155 of the 176 acute trusts, according to Connecting for Health, should have been operating systems by the end of 2006-07? Only 16 of the 155 got there. We heard about the problems with iSOFT and the fact that it is under investigation by the Financial Services Authority. That is finewe can say that it is iSOFTs problem, but iSOFT was a key player in this whole thing, and it has an impact on the delivery of systems, so we ought to be concerned.
The Foundation for Information Policy Research says that the reason for the delay in the care records service is that it is the wrong system to build in the first place. It says that it is not how the rest of the world works. It says:
Connecting for health is watched with appalled fascination by colleagues overseas.
Rob Marris: I am grateful to the hon. Gentleman for his usual generosity. I should like to take him back to the review, because the tenor of his remarks suggests that he has overlooked the fact that this is not one IT programme, which would complicate any review that were carried out. There is the spine, the picture archiving and communications system, the care records service, choose and book, the electronic prescriptions service, NHS mail, a quality management and analysis system, and GP to GP transfer. There are eight or nine different systems, so given what the hon. Gentleman said about iSOFT and so on, as well as the fact that there are a limited number of experts, who would carry out the review, or reviews? From where he is coming from, we would need a review of eight or nine systems, and perhaps a review of the reviews, even though he is talking about delay.
Norman Lamb: I am sure that the 23 IT academics could come up with some names to carry out the review. To suggest that it may be difficult to find appropriate people to conduct such a review is no argument at all against the need for proper analysis of where the system is and where we should go from here.
May I deal with civil liberties issues, starting with the opt-out point? The plan is that individuals receive a letter from their local PCT telling them that they have a period of time in which to opt out. If they do not do so within that time their consent is implied. I am seriously concerned about thatI do not know whether other hon. Members share my concernbecause we are
dealing with elderly and vulnerable people, as well as people with learning difficulties. Should we assume their consent, as sensitive information could be shared on a national basis? The more widely such information is shared, the greater the risks involved. The House may be interested to know that, this week, Pulse reported that in Bolton, which is the site of the trial, GPs are falling out over the project. A group of GPs has sent a letter expressing concern, particularly about the issue of implied consent. They say:
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