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and a smiley is tagged on at the end. It is no wonder the Tories do not like this: these are the kind of people they are taking advice from and who have fundamentalist views about the opt-out. [Interruption.] I do not criticise my right hon. Friend the Member for Rother Valley (Mr. Barron) for, as Chairman of the Select Committee, taking a balanced view and having special advisers from both sides, but it is important that we understand that there is a link between the Big Opt Out
organisation, the No2ID people, the NHS IT 23 team and the other people to whom I have referred.
Conservative Members seem to think that that issue is not relevant. On 24 April, those same hon. Members who think it is a big joke and who appear never to have heard of the people I mentioned, would have read Professor Sampson's letter in The Daily Telegraph, in which he fundamentally criticises the NHS IT programme. Those hon. Members say that they have never heard of himperhaps they do not read The Daily Telegraph. Professor Sampson is at the university of Sussex. He has been fundamentally critical of the work of the project, and here we have a complex interaction between people who may not be members of the Conservative partyI am not sure where they fit inbut who are heavily engaged in some outside bodies that are seeking to influence Conservative party thinking.
Against that background, we look at the reality of what is happening in the NHS IT programme. That is where it becomes mission-critical. We should dismiss the motion out of hand as it is ridiculous. There are, of course, ongoing reviews within the management of the process. As my hon. Friend the Member for South Derbyshire said, reviews took place in both the industry and the Department, and there is an argument for such reviews being more transparent. However, the facts cannot be refuted: there are now some 354,559 users of the NHS IT system within the NHS and among prescribing pharmacists and others.
I agree that there are issues to do with security of data. The hon. Member for North Norfolk (Norman Lamb) expressed concerns about that, and it is inevitable that there will be security issues. However, it is not unreasonable to state that the vast majority of those who manage our NHS on a day-to-day basisthe doctors, clinicians, pharmacists and administratorsare fantastic and fundamentally honest people who work their socks off for the benefit of the NHS. Having said that, there will of course be the odd rogue among them who will sell data, as there is among police forces and in any other organisation that holds data, and we should rigorously apply data protection rules. I would make further recommendations if I had more time.
The system is growing. This week alone, almost 7 million picture-archiving and communication records were added to it. This year, a further 307,000 new studies were added, taking the overall figure to more than 11 million. As the system is growing effectively and consistently at a great pace, it does not require an immediate review. The Tory party wishes to force that on it because it wants to make cheap, opportunist attacks on the Government. What the system needs is firm management to take it through some of the difficulties that it has faced, so that we can make sure that we have a world-class and world-beating IT system that leads to the improvement of the health of all citizens.
Adam Afriyie (Windsor) (Con):
Considering the time, I shall keep my comments brief. Over the past 20 or 30 years, the world of technology has changed rapidly. There has been the move from mainframe computers to desktop personal computers, and there have been distributed systems, centralised systems and
the internet. In any major IT projectthe one we are discussing is the largest in the worldaccount must be taken of the technologies that are developed and those that are under-developed.
I spent about 20 years in the IT industry; other Members, including the hon. Member for South Derbyshire (Mr. Todd), have also spent a long time in industry and have had dealings with the IT sector. Anyone who has worked in and around the IT industry comes to learn bitter and painful lessons about the implementation of IT systems. One thing that we learn fairly early on is that if we choose a brand new, bespoke systemone that has never been used before and is created specifically for one purposewe are bound to come a cropper. We in the IT industry use the term bleeding edgerather than leading edgetechnology. That is where the purchaser and the person responsible for a project endure a lot of pain in the attempt to deliver something that ends up not being delivered.
There is also a point to be made about automating inefficiency. If the system currently in service in the NHS does not work efficiently, by automating it we simply make the inefficiency even more part of the system, which is not good. In letting large IT service contracts from the public sector, we must also consider motivation. If a civil servant or a Secretary of State is not accountable for the failure of an IT project, their motivation is to play safeto get in consultants to make the points that they wish to hear from them, so that ultimately they can say it was the suppliers fault or the consultants fault. I fear that in this case, that is what has been going on.
We must bear in mind the fact that if one is paying a consultant by the hour, their motivation is no doubt to prolong matters for as long as possibleunlike my speech, which I shall end now by saying that it would be far better if patients were able to choose whether to be part of the national patient record system. It would also be far better if GPs could choose from various systems, and if the Government now chose to accept a review, which would highlight some of the deficiencies in their approach.
Dr. Andrew Murrison (Westbury) (Con): It is a pleasure to follow my hon. Friend the Member for Windsor (Adam Afriyie) and his expert remarks. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) scoffs, but if some of his hon. Friends had been a little briefer, we might have heard more from my hon. Friend.
I begin with the comments of the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint)or rather, the lack of them. She accused the previous Conservative Government of spending less than 2 per cent. on IT, but she did not know how much she has spent. She touted our figure of 2 per cent., but she should have known that in 2005-06, she spent 1.92 per cent.revenue and capitalwhich is rather less than the 4 per cent. that Wanless recommended. So let us kill that one at the outset.
The right hon. Member for Rother Valley (Mr. Barron), whose remarks I usually value, did not want to draw parallels between MTAS and the national programme for IT. I say to him in all respectdream on. The MTAS debacle has lost the confidence of a generation of junior doctors. The very people whom the Government need to operate NPfIT have seen how the Department of Health mishandles its own confidential material.
have an entirely justifiable sense of grievance,
would have secured the resignation of a Minister. Apparently, however, these Ministers do not think this matter serious enough. It is hardly surprising that the Medix polling organisation found that 79 per cent. of GPs feel that the national electronic care record service will damage confidentiality, and that 51 per cent. would not upload records on to it without explicit consent. The remarks of the hon. Member for North Norfolk (Norman Lamb) about GPs reluctance in the Bolton pilot in that respect were very relevant.
A cohort of doctors will grow up bruised by the experience of having their addresses, phone numbers, sexuality, faith and criminal records displayed for all to see, with nobody apparently responsible. We know that nobody was prepared to take charge, because when Channel 4 News asked a Minister to respond to the MTAS security breach in April, nobody was available. However, the Health Secretary did eventually pop up to reassure the House that only a couple of dozen or so unauthorised users had found the relevant MTAS URL. Unfortunately, one of them just happened to be Channel 4 News.
The Health Secretary hinted darkly at that time that criminals might be involved. Was this a smokescreen to prevent further discussion? If not, six weeks on, how many charges have been brought, what involvement has the Criminal Records Bureau had, and what disciplinary action has she taken? Given the monumental scale of this disaster and the inevitable contempt in which doctors will now hold Department of Health IT systems, it is vital that appropriate action be taken if there is to be any NPfIT buy-in by the health care professionals whom the Health Secretary expects to operate this system.
We raised concerns about online security for medical students applications last year after the system was hacked into. We were given explicit assurances it wouldnt happen again.
The British Orthopaedic Trainees Association, representatives of which we have met on a number of occasions, raised similar concerns with the Department months before the data ended up in the public domain. The Public Accounts Committee report that has been cited today, to which my hon. Friend the Member for South Norfolk (Mr. Bacon) and the hon. Member for Southport (Dr. Pugh) contributed, concluded:
The Department has much still to do to win hearts and minds in the NHS, especially among clinicians.
The Department has failed to carry an important body of clinical opinion with it.
How typical of this Government that their interpretation of the IT needs of the NHS should be centralist. They have produced a lumbering expensive creature that will allow a bewildering and expanding array of public and private sector inquisitors to tap into our most intimate affairs. Our Government are going it alone. Why do Ministers suppose that other health care economies have rejected grand designs of the sort on which they are intent? The hon. Member for North Norfolk referred to the appalled fascination with which other countries regard NPfIT, and rightly so.
Ministers say that it will be handy in an emergency to have medical records freely available in the way that they wish. I have to say that that is pure supposition without a shred of evidence to support it. If Ministers were genuinely exercised about the need for transportable medical records, why have they not been promoting more vigorously the simple devices that already exist for people at risk? If Ministers imagine that doctors will spend time bashing away on computers trying to download the details ofthey hopethe patient in front of them, Ministers need to get out more. I am struggling to recall times when I was a casualty officer and the absence of the sort of data that Ministers assure us is so critical genuinely affected the outcome for my patients.
As a patient, I may well opt out of the unquantified benefits of being on the national spine, because based on the Departments form I have no confidence that my records will not end up on Channel 4 news. What elements of NPfIT will patients be able to refuse? Can the Minister assure me and my hon. Friend the Member for Peterborough (Mr. Jackson) that the option to opt out will be fully explained to patients? Can he say [ Interruption. ] I hope that the Minister is paying attention, because my last question is very important and I would like a specific answer to it. What back-pedalling will be necessary, given the divergence that emerged last month between Europes data protection commissioners and the Government in respect of the electronic patient record?
Ministers believe that NPfIT will help patients get treatment right across the country, but the great majority of us will only really be interested in accessing care within our local health community. Why then, in a system with finite resources, are ministers obsessed with the need to exchange data with geographically remote providers with all that that implies in terms of capacity for mishandling records?
There are signs that Ministers have at least begun to look around them and seen that their grand scheme is unique in the western world. Belatedly, they have developed
an enthusiasm for what they are pleased to call local ownership and in March they issued a tender for bids to become additional systems suppliers from which individual trusts will be able to buy. Given NPfITs sheer scale and its extraordinary cost, why has the Minister not come here of his own volition to explain an apparently significant change of tack? Is it because he would have to admit that his troglodyte stateist solution has caused good local systems that were working effectively to be dumped? Is it because he would have to admit to having alienated the very people that he now invites to make the national programme workour long-suffering health care professionals? Or is the Ministers apparent enthusiasm for localism a ruse to decentralise blame from the Department of Health to health authorities and trusts?
We know that the Department has been reviewing NPfIT, as well it might. But the Government are appealing an order to publish information on gateway reviews. In the meantime, it transpires that Treasury officials have ordered the destructionthe shreddingof relevant documents. That is a serious matter. Will the Minister explain how the public interestnot his political interestis served by withholding the gateway reviews that the hon. Member for South Derbyshire (Mr. Todd) suggested should be published? If that was his suggestion, I would certainly agree with him. Better still, given the Departments appalling track record, let us have a full and independent review of the whole of its IT circus.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Opposition are against electronic patient recordsagainst sharing data that can save lives: they are stuck in the past and not fit to govern. The Labour Government made a bold decision in 2002: to undertake a 10-year programme to computerise the national health service. That was right then and it is right now.
Although thousands of localised systems were implemented in the 1990s, few of them were joined up, as people acknowledged. To have delivered so many systems in so many locations over the past three years is a testament to the success and direction of the Governments strategy. Of course we continue to review and examine what we are doing, but there is absolutely nothing to suggest that we have made a fundamental or structural error in adopting a strategy of ring-fencing central funding for a number of standardised systems delivered by major contractors.
much needed...well managed...based on excellent contracts...delivering major savings...on budget...has made substantial progress.
It is essential that we hold our nerve in the implementation of the systems. Although we do not deny that there are difficulties, the majority of the programme has gone well. Considering the programme on a 10-year basis, there are no significant time-scale issues; the difficulties experienced by suppliers were predicted and the costs were not borne by the taxpayer.
As a Government we will continue to support the delivery of the national programme for IT in the NHS.
The hon. Member for Westbury (Dr. Murrison) referred to the relative proportion of spending on IT by his Government and by our Government. In 2005-06, the Government invested more than 3 per cent., rising to 4 per cent. in 2008the level predicted by Wanless and twice the amount spent by the previous Government. The hon. Gentleman accuses us of an over-centralised system, but in fact the systems are implemented locally and efficiently procured centrally; in short, wherever patients are treated, they will receive much safer care. He implied that such systems were frowned on internationally, yet other countries such as Canada and Australia are adopting our practice. We are leading the definition of international standards in the field.
The hon. Member for North Norfolk (Norman Lamb) wants more than anything an independent review, but the programme has been reviewed repeatedlyby the National Audit Office, the Public Accounts Committee and other bodies, including the august Select Committee on Health. At this stage, another review would add nothing to the interests of patient care. The hon. Gentleman raised legitimate issues about patient confidentiality, but the question that must be asked of a responsible Government is: have they done absolutely everything in the design of the scheme to protect patient confidentiality and private information? The answer is that the Government have done everything possible to protect confidentiality and the individual rights of patients. The hon. Gentleman referred to PINs. All primary care trusts have been sent advice about best practice for the storage of PINs.
In an extremely practical way, my right hon. Friend the Member for Rother Valley (Mr. Barron) talked about the reality for a patient in his local hospital. He described the outdated, luddite handling of a discharge, which would have led to the patient not receiving the care that we would expect a modern health and social care system to provide. Use of the technology is about making a reality of our aspiration to a patient-centred national health service, as well as empowering front-line professionals to do the job as they want to do it.
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