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“Much can be gleaned from knowing what drugs a patient is taking, so why does the first stage not require ‘explicit’ consent? Nationally 67 per cent. of GPs oppose implied consent.”
The Minister’s notion that a tiny number of people have objected is no reason to be complacent or to believe that there are not legitimate concerns about the confidentiality of patient information.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): May I ask the hon. Gentleman a simple question? Considering the benefits of making the system work, would he opt out from it, or would he want his own family to do so?
Norman Lamb: That is an interesting point. My sister is a GP. I talked to her last night, and she said, “I wouldn’t, for one moment, agree to my personal medical information going on to the spine.” That was a very simple assertion, and she has a genuine ethical dilemma. If, as a doctor, she would not agree to that, how can she recommend that her patients go on to the spine?
It is interesting that in a survey conducted by Pulse only a third of GPs— [Interruption.] This is an example of the disconnection between the Minister and what people in the NHS think. According to the latest survey by Pulse, only a third of GPs would advise their patients to have their information go on to the national spine. That is not one person. That is a representative sample of GPs. If one talks to GPs, one finds that that view is representative of the concerns across the country. The Government would do well to take them seriously.
Mr. Barron: The hon. Gentleman can speak about his sister as a GP, or about the views of over 63 per cent. of GPs. Can he tell us why I, as a patient, cannot opt out of my personal record being on my GP’s computer? I must be on his computer, or I cannot be a patient there. That goes for millions of people throughout the country.
Norman Lamb: I am not entirely sure of the point that the right hon. Gentleman is making.
Some 80 per cent. of GPs believe that patient confidentiality is threatened by the national spine. The Government and the Chair of the Select Committee ought to take those concerns seriously. Dr. Fiona Underhill, a London doctor—not my sister, but another independent doctor—was quoted as saying that she could not recommend her patients going on to the system
“because we have no guarantees as to who can have access to it.”
I spoke to two GPs in Norfolk a few weeks ago who pointed out to me that across the practice all staff had their cards, personal identification numbers were shared around, and there was no proper security to control access to information.
Caroline Flint: Is the hon. Gentleman against the concept of electronic transfer, or is he in favour of finding a system that can meet the concerns that he, I and every Member of the House share about confidentiality and tackling abuses of the system? If he supports that, he should work with us to make sure that the system works. His arguments go in the direction of defending the existing system which does not offer the safeguards that some GPs suggest and does not engage the public in the information that is carried on their behalf on systems, whether paper or electronic, in various parts of the NHS.
Norman Lamb: The answer to that is that I have strong objections to the national spine. I do not object to local sharing of information, provided that the principles are in place to ensure security of information.
A doctor told me this week that doctors have no advice on the storing of PINs. No advice has been received from the Department of Health about how to store PINs. The doctor told me that the PCT has a store of all the PINs. No guidance has been issued about the security of those. No principles have been issued about the care of smartcards. There are concerns about viewing online and the potential for exploitation of vulnerable elderly people by relatives who might want sensitive information about their health. In her speech the Minister acknowledged that she was considering the penalties that would apply. I am pleased to hear that, but it is rather late in the day. The principles should have been in place much earlier.
Andrew Miller: Will the hon. Gentleman give way?
Norman Lamb: No. I shall make progress.
Labour Members dismiss concerns about patient confidentiality, but have they read the Information Commissioner’s written evidence to the Health Committee? He writes that he is
“conscious that these plans inevitably pose significant data protection risks”,
including confidentiality and accuracy. He refers to challenges posed by policing, consistency and security of access. He is concerned about potential abuses. In a letter to me referring to MTAS the Information Commissioner writes:
“I have no doubt that the experience serves as a stark illustration”—
the hon. Member for Wolverhampton, South-West will sympathise with this—
“of the issues which arise where security of sensitive data is not treated with the utmost seriousness”.
That is why the Government should take greater note of the concerns expressed in the House and outside.
The Information Commissioner reserves judgment on whether controls over access will work. He says that it is too early to tell. He has listened to the assurances, but that is not to say that they will work. He refers to a particular case where smartcards had been shared among a group of consultants in accident and emergency. He says that that increased the risk of breaches of security and confidentiality. He also expresses concern about the potential for enforced
access to HealthSpace, potentially as a condition for securing employment. These issues have not yet been dealt with.
It is remarkable that we have a system that poses such potential risks to individual confidentiality without these matters having been properly resolved. The Information Commissioner speaks of the whole system being vulnerable to the unlawful obtaining, procurement and disclosure of personal data—blagging, as I am told it is called. He raises a host of concerns. The Minister should be taking the concerns of the Information Commissioner, if not of the Opposition parties, extremely seriously.
The written evidence to the Select Committee makes fascinating reading. The NHS Confederation has a number of serious reservations, as do Patient Concern, the Renal Association, and Londonwide LMCs representing 5,000 GPs in London. Many individuals who made submissions to the Health Committee raise serious concerns about the way in which the project is developing.
My message to the Government is that they should learn the lesson from MTAS. They should learn what happened when they did not listen to all the concerns that were being expressed, and stop digging when they know they are already in a hole. They should acknowledge the problems and agree to an independent review.
Madam Deputy Speaker (Sylvia Heal): Order. Several Members are hoping to catch my eye. The time left for Back-Bench contributions is somewhat limited, so I hope contributions will be brief.
2.27 pm
Mr. Kevin Barron (Rother Valley) (Lab): I apologise for my late arrival for the debate. With other members of the Health Committee, I went to see the IT system at Homerton hospital in Hackney this morning, as part of our evidence gathering for our inquiry into electronic patient records. I apologise for being late and missing some of the speech of the hon. Member for Eddisbury (Mr. O'Brien).
The hon. Member for North Norfolk (Norman Lamb) read out a litany of concerns. I wonder how many of the doctors whom he quoted are involved in the national programme.
Mr. Barron: Part of the criticism is that the programme has been a long time coming. There are difficulties with the programme, some of which are dealt with in the report, such as the engagement of staff, clinicians and others involved in various aspects of the national health service. That is one of the reasons for the delay, so let us not say that the delay shows that there is a weakness in the programme. The delay has been caused in part by what the motion calls for—engagement with clinical staff in the development of IT programmes.
The Opposition Front-Bench team say that they support the national IT programme. The press releases and the debates that we have had in the House over the past six months seem to contradict that—unless, as has been said, we are to interpret the word “support” in the
same sense as the rope supports the hanged man. For months we have heard criticism from the Opposition Front Bench about aspects of the programme. As Chair of the Health Committee, I can say that we will report our findings in relation to electronic patient records in due course. The Opposition have gone far wider, and have been extremely negative in their interpretation of what has taken place.
The Opposition motion mentions
“the hasty conception of the National Programme”.
I shall provide an example from out in the field relevant to that, which happened quite a long time ago. When Labour was in opposition I was shadow health spokesman for a while, and I went to my local hospital to look at the patient administration scheme. That hospital, Rotherham district general hospital, is now famous for its work with Gerry Robinson, which was on BBC television earlier this year.
When I visited the hospital, it had just introduced a pass scheme. I watched the nurse fill in a discharge sheet for a patient. The discharge sheet was typed up wonderfully well. I said, “What happens to that?” The nurse said, “On the night shift, it’s printed out and sent in the post to the GP.” I said, “What happens if the patient needs some attention, such as an injection from a district nurse or some aftercare, having just got out of the acute sector?” The nurse replied, “We would phone the district nurse or the GP surgery to make sure about that aftercare.”
What upsets me more than anything else is that, like everybody else in this Chamber, I am a taxpayer. We have been paying for electronic patient systems in the primary and acute sectors for decades. Those sectors have had the choice to buy what they believed to be right for their little part of the national health service. We have allowed patients, some of whom have ongoing medical needs, to be discharged from the acute sector without anybody asking the question, “Why can’t we contact the primary care sector electronically, so that the ongoing care that this patient needs is provided?” I am not saying that that is happening today, but that is one of the major issues behind the national programme. As someone who is concerned about health care and the use of taxpayers’ money, I say that something should have been done decades ago. There should have been some choice about what was put into surgeries or hospitals, but such bodies should at least have had the ability to talk to their immediate health family neighbours about the needs of the patient. That did not happen, and that is what the national programme is about.
The national programme has been criticised by some health professionals, because they believe that their choice will be eroded if they are told that they must introduce one of seven systems in their GP surgery. As Members of this House, we should talk about not only clinicians’ choice in how they spend our money, but patients. Where does the patient come in all this? In Homerton hospital today I saw a great system, and other members of the Health Committee saw it, too. It allows appointments to be booked electronically in clinics before discharge. It does not allow the hospital to talk to the local GP practice, but the system is a bit better than that used at Rotherham district general
hospital a few years ago; for example, the discharge report is printed out and handed to the patient on discharge.
The hon. Member for Eddisbury said that there was no evidence about how good the system is now. I say that hon. Members should visit their local GP surgeries. My local GP surgery has had choose and book since the middle of last year, and the system works. Hon. Members should go to the Homerton hospital and see the system, which is being improved by clinicians. The introduction of that system has taken a long time and there have been delays, but it is likely to be in all London hospitals in a few years’ time.
The hon. Member for North Norfolk has mentioned the medical training application service—MTAS—which, as I have said before, is a separate issue. What happened to medical training had nothing to do with the national programme. Opposition Front Benchers are agitated, but I think it wholly wrong to bring those issues together. There are clearly issues about MTAS, but it should not have been included in the Opposition motion, because it has nothing to do with this system. I have said that that is scaremongering by backwoodsmen and luddites, and I do not resile from that description of Opposition Front Benchers in that area.
Mr. Barron: We have been asked to be brief, and I am going to be. The hon. Gentleman has had a bit more time than Back Benchers have, so I will not give way. I normally give way, which gets me into trouble with timing.
On care records and patient confidentiality, hon. Members will have seen the Public Accounts Committee report on the national IT programme. I shall refer to evidence taken in response to a question asked by the hon. Member for South Norfolk (Mr. Bacon) on confidentiality. The man from Fujitsu was the only person to give evidence to the PAC, and according to my information, things have moved on dramatically in the national programme since June last year, when the evidence was taken. He said that we should not return to the old myriad of systems. Computer Weekly magazine described him as a critic, and, following its article, he had been suspended by the time he gave evidence to the Public Accounts Committee. On data confidentiality, he said:
“Personally, I see no concern around data confidentiality because a lot of effort is going into making sure that is dealt with adequately.”
The Health Committee report is ongoing, and we have been looking at other systems. The biggest single database of health records in the world is American veterinary records. We have spoken to the people who run that database and visited Canada to look at databases. The issues will be covered in our report. I do not want to second-guess the report, but people in America and Canada looked quizzical when we discussed confidentiality and security of systems.
Although I was an engineer, I am not technically capable of giving a view on the security system, but if the Health Committee’s information is correct, the security used for national patient records is similar to that used by banks. Although there are often security breaches involving people’s credit cards, those breaches
are not due to the system itself, but occur because credit cards have been copied.
We took evidence on the independent review. I questioned one of the 23 academics in some detail about the independent review. The academics initially said that they wanted a technical review. In my view, any type of review that slows down the implementation of the national programme would not be in the interests of the NHS. Hon. Members should go to Homerton hospital, where health professionals do not have to wait for X-rays. X-rays appear on a screen, which allows different parts of the hospital to discuss them. Clinicians do not even need to be brought together when they conduct a diagnosis.
When I asked Professor Martyn Thomas about the review, he went on and on. Eventually, I told him—I do not think that this was an unkind comment, and hon. Members can read the transcript—that he wanted an inquest rather than a review. There is no doubt that a number of the 23 academics are against the programme, and some of them are against all public sector national IT programmes.
I hope that when the Health Committee considers the electronic patient record, we will make recommendations and contribute serious points to the debate so that we can look after patients’ interests and ensure that we use IT in the 21st century to improve their quality of life and care.
2.39 pm
Mr. Richard Bacon (South Norfolk) (Con): I am grateful for the opportunity to speak in the debate. I have followed the national programme for IT in the health service for several years, principally because of my membership of the Public Accounts Committee and that Committee’s interest in value for money, delivery, effectiveness, efficiency and economy. Of course, IT projects are notorious, across Governments of different political persuasions, for failure to deliver. The national programme for IT in the health service is the largest civilian IT project in the world. For that reason alone, I have been following its progress with great interest.
I am not a specialist in health matters or in IT, but I am greatly interested in value for money. The hon. Member for South Derbyshire (Mr. Todd), who is a former member of the PAC, will confirm that serving on that Committee makes one put on spectacles that are primarily non-party-political, because one is considering value for money. That is what we do. I say in parenthesis that I agreed with the hon. Gentleman’s point about private sector IT contractors. Of course, things go wrong with such contractors and they are better at hiding it. I hold no brief for any national or local IT contractors or any specific supplier.
It is extraordinary and regrettable that the important national programme for IT has become party political. I can think of nothing less party political than a computer system. There are legitimate matters for political debate—perhaps fewer than existed 30 years ago, but many remain, including housing and—dare I mention it?—schooling. However, computer systems are not among them. There are computer systems that work and computer systems that do not work. We should all want the former—and that should be it.
Serious technical problems remain with the system, which needs to be put back on track. However, the Department of Health’s current proposal for the local ownership programme is not the right way to do it. The right answer involves more choice for trusts and more competition between suppliers to get the confidence and business of the trusts. One gets ownership through choice and successful delivery through ownership.
Where needed, the Government should review the operational performance of the local service providers against their original contractual obligations and examine how they have accounted financially for their actions. I believe that forensic accountants would reveal some interesting facts about millions of pounds of losses being hidden. I also want to comment briefly on the Computer Sciences Corporation and iSOFT; we learned this morning that CSC is considering a bid for iSOFT.
It is indisputable that the programme is not working properly technically. I was surprised to note in the presentation made to the Prime Minister on 19 February the sentence:
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