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I say robustly to Opposition Members that it is surely better that suppliers bear some of the damage of failure to analyse risk appropriately, rather than the taxpayer, as is normally the case in major IT programmes. I congratulate Richard Granger and his team—a view shared by the National Audit Office—on the robust purchasing process now. I accept the point of the hon. Member for South Norfolk that taking too hard a line with one’s suppliers will eventually lead to a position in
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which one might face failure to deliver and failure to maintain. As the project continues, we will face the challenge of how to strike that balance correctly.

Any major project or collection of projects of this kind should be under constant review, but within a robust environment—I mentioned project creep—in which changes introduced at late stages to meet whims of individual partisan forces within the customer base are resisted. I have been involved in cancelling a major IT project, and there are points at which one must simply say, “We are not achieving what we set out to do, and we should be brave enough to own that.” I assume that there is a proper review process within the project; certainly, there is a process through the Office of Government Commerce gateway mechanism to examine how the project works. The NAO has also produced its report.

I am not averse to a properly qualified, objective, external input to that process. I cannot believe, however, that a full-blown external review—as I have understood it from the extraordinarily limited information given by the Opposition as to what in heaven’s name they mean by the process—would be of great assistance. Inevitably, it would distract resources and encourage delay.

Mr. Bacon: The review in which I am interested is outlined in the recommendation in paragraph 4 of the PAC report—a review of the contractual obligations into which local service providers originally entered. My contention is that that would strengthen hugely the arm of the Government and release resources, as it would show that LSPs have in many ways failed to meet those obligations.

Mr. Todd: If the hon. Gentleman is interpreting the motion, and if that is what it means, I would accept that that is a helpful step. That has not been explained, however, in the vague and sometimes naive remarks made on the subject by those on either Opposition Front Bench.

There certainly needs to be further robust engagement on the care record, its design and security. I say that partly because I have a concern myself, but also because we have an opportunity to reassure the profession and re-engage them in the project. The argument for sharing the care record was extraordinarily well made by the appalling incident of the woman who repeatedly contacted an out-of-hours service but there was no inherited memory of her previous contacts with it and what had been said. As a result, she received no proper treatment for her condition. Obviously, having a decent care record even within one organisation would have been a huge benefit in that example, and the case for it to be shared on a wider scale is clear.

We need to keep the project under continuous review, and an external input into that process should be welcomed but qualified. Incidentally, I have corresponded with a group of academics on the subject and found it difficult to define their goals. As I looked through their compendium of information, I saw that it was essentially a collection of press cuttings. I was looking for a much more technical and robust approach to what they were saying than simply a reiteration of various press remarks.

Dr. Pugh: Will the hon. Gentleman give way?

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Mr. Todd: I am conscious of the time and that other people wish to speak, so I shall not.

I would welcome the group of academics being clearer on their agenda. However we should welcome some external input. We need to re-engage with stakeholders, and looking at the care record and some of the choices that are delivered at a local level would help us to do that. With those qualifications, we should hold our nerve.

3.12 pm

Mr. Stewart Jackson (Peterborough) (Con): I pay tribute to the knowledge and experience of the hon. Member for South Derbyshire (Mr. Todd), who is at the very least smooth, and almost plausible, in his defence of the Government’s position.

At times like these it is clear that we have a poverty of ambition as a Parliament in holding the Executive to account. Frankly, that would not be the case were we in the House of Representatives in the United States. The Government have criticised the Opposition for bringing to the attention of the House the fact that an IT programme initially mooted to cost £2.6 billion is now likely to cost £35 billion or perhaps £50 billion. As you will have seen yesterday, Mr. Deputy Speaker, The Daily Telegraph reported the bizarre and appalling situation, especially given the warm words of our new Prime Minister un-elect that he is open and listening, of civil servants, under the auspices of the Office of Government Commerce, being encouraged to shred documents, in particular reports that are critical of the mismanagement of the NHS IT programme. How we can be lectured by the Government that it is inappropriate that we should draw that to the attention of the House and the electorate is perverse.

As my hon. Friend the Member for South Norfolk (Mr. Bacon) said, we are dealing with a huge programme involving 30,000 general practitioners and 300 hospitals, and which has risen exponentially. The last official figure was in June 2006, when the National Audit Office put the cost at £12.4 billion, but in May last year, Lord Warner no less said that it may be £20 billion or more.

The Public Accounts Committee has on several occasions drawn attention to the shortcomings of the IT projects undertaken by the Government. It said in July 2005 that Government IT projects are characterised by

I notice that the Minister did not quote that in her remarks. The Government have generally sought to disregard the PAC’s report, published in April 2007, but its remarks need repeating. Being critical of the Government and the way in which the programme has been handled is not to say that we inherently disagree with the programme. Of course we believe that it is right to proceed in that way, but individual Members of Parliament with an interest—I have the honour and privilege to serve on the Select Committee on Health under the chairmanship of the right hon. Member for Rother Valley (Mr. Barron)—have a right, duty and responsibility to draw failings to the attention of the House, and there have been many failings.

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The report says specifically that the pilot schemes are two years late, especially in relation to the care record service, and that no fall-back date is in place, although Ministers disagree with that. Cost estimates are opaque and have not been fully quantified. There has hitherto been no proper cost-benefit analysis on what will have been delivered to the NHS when the contract ends in 2014. We have heard that Accenture has pulled out of the project at a loss of anything between £240 million to £385 million, along with other IT providers, IDX and ComMedica. Other companies with the skills and experience have not come on board for the programme. We learned earlier that iSOFT faces an uncertain financial future, and we will see whether it manages to stay afloat after its refinancing later this year.

The key point is that despite protestations from the Government, health care professionals up and down the country have not voted to support the programme with their opinions and have voted with their feet. I said that it is all very well for Ministers to say that choose and book is working, but if they do not collate the figures properly, there is no way they can fully understand the efficacy of that particular record system.

As we heard from my hon. Friend the Member for Eddisbury (Mr. O'Brien), the number of GPs that support the programme has plummeted from about 55 per cent. a year or so ago to the most recent figure of only 26 per cent. We have a North Korean-style thumbs down from readers of the Health Service Journal. In a poll of its readers, 97 per cent. said that they did not believe that the choose and book target could be met by March 2008. Incidentally, that is the third target; the other two were missed. We now have approximately 38 per cent. take-up of choose and book, although we do not have the raw data to confirm that.

The Government often quote the NHS Confederation and pray in aid its opinions to support their viewpoint. It has said:

It is reasonable for people who make their living as professionals and experts in information technology in the academic world to express a value judgment on the success or otherwise of the programme. It is right to draw attention to the fact that core software has not yet been delivered, as my hon. Friend the Member for South Norfolk said. There are issues about technical architecture, project planning and detailed design, and about the estimate of the amount of data and the traffic in the programme when it is fully operational. That is a fair point to make.

There is a degree of complacency. I draw the House’s attention to the Minister’s comments last year, when she said:

That patently is not the case. The Chairman of the PAC said:

That is hardly a ringing endorsement of progress. As at February 2007, only 18 hospitals had the patient
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administration system. Incidentally, the Department of Health promised a year before that 35 acute trusts would have it in place.

I have some key questions for Ministers. Before I ask them, however, I want to deal with the questions asked by the hon. Member for North Norfolk (Norman Lamb) about privacy.

I was present when the Health Committee heard evidence from the Patients Association and others recently, and I must respectfully tell the hon. Gentleman that I think he over-egged the pudding slightly in describing the dangers involved in privacy issues. It is incumbent on him, and on others, to prove that the changeover would have a significant negative impact on most or all patients. However, he made an important point about accountability. At present patients benefit from a degree of accountability through their local primary care practices and local trust, but that accountability will be removed if all data are transferred to a national system. We are talking not about articulate, intelligent, well-read middle-class people but about the most vulnerable, those who are least able to say: “I do not want my medical records to be online.”

These are my questions to Ministers. When will they engage properly with health care professionals to win their support for the implementation of a system that has demonstrably failed so far? Will they ring-fence primary care trust funds for expenditure on opt-out information? Will they concede that there has been a systemic failure as a result of the dichotomy between national contracts for procurement and the local delivery of those contracts?

We need action now. I strongly agree with my hon. Friend the Member for Eddisbury that we need a full, zero-based review as well as an audit. We need an annual statement of where we are now and where we will be in 2014. As one or two Members have said, we need to disaggregate local delivery to local trusts where appropriate, with a wider range of suppliers in the IT market. We need to review current performance, and we need to communicate the importance of the programme to all health care professionals more effectively. I agree with the hon. Member for South Derbyshire in that respect.

The consequence of failure is massive. The expenditure of £50 billion of public money should give us all pause for thought. As my hon. Friend the Member for Eddisbury said, this is not just a “techie” issue; it is about the importance of reforming the NHS through choose and book, about electronic prescriptions, and about the care records service. If mistakes are made, people may die.

As the right hon. Member for Rother Valley observed, patients should be at the very heart of our considerations. The Government must get a grip on the situation. They owe it to patients, they owe it to my constituents, and they owe it to the whole country. It is right and proper for us to call the Government to account today, and for the Government to explain why this has happened and how we can adopt a bipartisan approach to ensure that we deliver the results that patients expect.

3.23 pm

Andrew Miller (Ellesmere Port and Neston) (Lab): The Opposition argued that nothing had been
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published about the purpose of the project and the safety case for it. That is manifestly untrue. The introduction to a document entitled “Supporting the Patient Safety Agenda” clearly explains the purpose of the scheme. It tells us:

That, then, is the core reason for the programme’s existence. I shall say more in a moment about the work undertaken thus far—enormous strides have been made—but I am glad to see that the shadow Secretary of State, the hon. Member for South Cambridgeshire (Mr. Lansley), has arrived, as I am about to refer to him. He wrote the foreword to a document called “Computerising the Chinese Army—Information Systems in the NHS”, which has been mentioned tangentially by a number of Opposition Members. That is not surprising, because it originated from a Conservative think-tank. Contributors include Tony Collins of Computer Weekly, the shadow Secretary of State and Dr. Simon Moores of the Conservative Technology Forum.

Having read the document closely—particularly chapter 10 on the proposed action plan—I can see the genesis of the Opposition motion. It is the result of people thinking very carefully about how to exploit what is, after all, a complex change management programme, described in some detail by my hon. Friend the Member for South Derbyshire (Mr. Todd). In a sense, it is pushing at an open door.

I have experience of dealing with change management programmes, having been both poacher and gamekeeper. As was acknowledged by the hon. Member for North Norfolk (Norman Lamb), people have been put on the spot. They do not like having change imposed on them. The net consequence is a potential for what could be described as insubordination in the ranks. In one company with which I dealt, a senior director fed shop stewards information to undermine what he saw as the damaging impact on his bailiwick of the change management programme.

If I have any criticism of Ministers, it relates not to the superb work being done by Richard Granger and his team, but to the management of people in the process. In preparing for the debate, I noted how successful the roll-out has been—contrary to what one would believe from some assertions, and contrary to what I must tell my colleagues on the Public Accounts Committee was a very out-of-date PAC report. As I said earlier, there have now been more than 250 PACS records: as of this week, 25.981 million digital images have been stored. That is a fantastic success. The roll-out has made enormous progress, complex though it may be.

Mr. Bacon: Will the hon. Gentleman give way?

Andrew Miller: No. The hon. Gentleman spoke for 20 minutes, although I thought that there was an agreement between the parties.

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We are dealing with some interesting relationships. Many people who are getting puffed up about the programme have vested interests. Let us look first at the Big Opt Out organisation, or Professor Ross Anderson from Cambridge university is in that organisation. He is now one of the advisers to the Select Committee on Health, and I will refer in a moment to an exchange involving him. Also in that organisation is Councillor Helen Wilkinson, who is involved with the Conservative party. There are interesting links with NHS IT 23, which is where Ross Anderson appears again.

Also in NHS IT 23 is Professor Geoffrey Sampson. I do not want to do a disservice to the Conservative party—I am not sure whether it threw him out of the party because of his extreme views on racism. I have a feeling it threw him out, but I might be being totally unfair— [Interruption.] I have the cuttings here if hon. Members want to have a look. I am referring to Professor Geoffrey Sampson, who is a Conservative member of NHS IT 23 and was a Conservative councillor.

Anne Main (St. Albans) (Con): Will the hon. Gentleman give way?

Andrew Miller: No. The hon. Lady has only just turned up.

Dr. Andrew Murrison (Westbury) (Con): Will the hon. Gentleman give way?

Andrew Miller: No. The simple fact is that those links are fascinating. The Foundation for Information Policy Research, which was referred to earlier, recently received an e-mail from Ross Anderson saying:

Well, he has. He continues:

along with Professor Sampson who Conservative Members seem never to have heard of. Professor Anderson continued:

In response to a subsequent exchange, he says:

the Health Committee—

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