Examination of Witnesses (Questions 80-99)
DEPARTMENT OF
HEALTH, PROFESSOR
PETER HUTTON
AND DR
ANTHONY NOWLAN
26 JUNE 2006
Q80 Mr Khan: Why is it not specifically
mentioned in the PSA targets?
Sir Ian Carruthers: I do not know.
We can let you have a note on that.[5]
Q81 Mr Khan: Please.
Sir Ian Carruthers: We shall do
that.
Q82 Mr Khan: Okay. Despite this slippage,
you are still extremely confident and you have persuaded the NAO
that the entire implementation will be completed by 2010 in accordance
with the originally-contracted timescales. How can you be so confident?
Sir Ian Carruthers: What we have
is an end-point. What I have also said, and I have said it earlier
this afternoon, is that it is a large project, it has its risk
and it has its delay. Whilst we are working to those timeframes,
it is more important that we have safe systems which are right
and appropriate and with value for money. That will be the emphasis
because at the end of the day we want those ingredients rather
than a system that is put in quickly and less good than it should
be. We are working to that.
Mr Granger: Two further reasons.
One, when one looks at BT's core contract to deliver the Spine,
they had five software deliveries to make last year, they made
each of them on schedule. Secondly, the work in progress that
has been carried on the balance sheets of the suppliers is a strong
incentive for them to catch up. They will only get to a position
of financial balance by doing it; the dogs will then get fed.
Q83 Mr Khan: In percentage terms,
how confident are you of us reaching completion by 2010?
Mr Granger: I am confident that
by 2010 we shall have done far more work than was set out in 2002
and the core elements of the programme will be in place.
Q84 Mr Khan: Are you 100% confident?
Mr Granger: 100% is a dangerous
statistic.
Q85 Mr Khan: The question was: what
percentage? How confident are you?
Mr Granger: We shall have done
more work by 2010. There will be more benefits out there and more
systems out there.
Q86 Mr Khan: You do not want to answer
the question. That is fine. May I put to you Sir Ian an article
in one of yesterday's newspapers, I am sure you have read it,
in The Observer? There is a heading saying, "NHS computer
chaos puts patients at risk". Have you not read this article?
Sir Ian Carruthers: We have read
that but not the one you were brandishing.
Q87 Mr Khan: It starts by saying
that people could be put at clinical risk. What do you say to
that?
Sir Ian Carruthers: We should
like Professor Sir Muir Gray to answer that.
Sir Muir Gray: Like all technology,
information technology has a clinical risk. Everything we do is
a clinical risk.
Q88 Mr Khan: So what do you say in
relation to the specific example they gave about the e-mail in
February from one of the managers in West Midlands who acknowledges
the potentially "significant" clinical risk?
Sir Muir Gray: We have a system
now to identify potential clinical risk. We deal with that at
the design stage, the build stage and the test stage when it is
first put into practice and then we shall be monitoring when things
are in practice.
Q89 Mr Khan: You are not reassuring
my constituents. Are you saying my constituents are at risk because
of problems with the implementation?
Sir Muir Gray: Everything is a
risk; a balance of risk. There is a risk with all technology,
but when this is in, at minimal risk, which we shall do through
our risk and safety process, this will dramatically reduce the
risk of prescribing and of lab tests.
Q90 Mr Khan: My time is running out.
Could you please do me a note on the very serious points made
in this article and your reassurance for me, my constituents and
colleagues about the points they raise.[6]
My final area of questions is on the area around an issue raised
by the Chairman and I raised it earlier on. How are you going
to make sure that staff follow the rules so the security and confidentiality
of patients' records is protected?
Mr Granger: Gillian
will say a few words on this as somebody who carries one of these
smartcards which are more secure than the instruments we are all
using to access money in this country. This is more secure than
single factor authentication chip and PIN technology. We are supporting
the Information Commissioner in his demands for higher penalties
for information abuse and you will be aware that the penalty for
information abuse in this country is currently capped at £5,000.
That is not a sufficient penalty, given the risks that are carried
there, but you have to look at the risks that paper itself carries
in the absence of audit trails.
Dr Gillian Braunold: I shall not
keep you long because I know that time is very short. We try to
make sure that through all of the—
Q91 Mr Khan: I am sorry but may I
be very rude and cut you short? Could you do us a note about that
as well, because my time is up?[7]
Dr Gillian Braunold: Yes, we could
Q92 Mr Khan: My final question, with
the Chairman's indulgence, is that the main aim of the programme
is clearly to improve services rather than reduce costs. Why have
you been so poor at selling the benefits of the programme?
Sir Ian Carruthers: The benefits
of the programme are clear.
Q93 Mr Khan: Why have you been so
poor at selling them?
Sir Ian Carruthers: There is a
matter as to whether we are so poor. Many clinicians, as the Report
says, think that this will very much improve their working life.
Secondly, seven out of 10 know a great deal about the programme
and to one of the questions before where you were saying that
the clinician impasse was reducing, it was because they are keen
to get hold of it. It depends what you mean.[8]
Q94 Mr Khan: Sorry, my time is up. What
I mean is the research carried out by MORI on pages 45, 46, 47,
48 and 49. My time is up and the Chairman has indulged me. Can
you also do a note on those comments on pages 45 to 49 please? Sir
Ian Carruthers: Yes, we can do that.
Q95 Mr Curry: I do think that if
we do have doubts about the inherent quality of the NAO Report,
then we ought to discuss those in private before we have witnesses,
rather than make it part of our public debate. Sir Ian, what bothers
me is the local end of this. If I look at my local NHS, at the
moment it is in turmoil. We have a reorganisation of the PCTs,
we have a reorganisation of the strategic health authorities and
we have the GPs pretty disaffected by what is happening. How confident
are you? It only has to go wrong in one place, has it not, for
the system to go wrong? How confident are you that in these very
difficult circumstances for the local NHS, this is going to be
okay on the night?
Sir Ian Carruthers: Firstly, we
are going through a period of structural change as you rightly
mention. During the course of this year, we shall have new leaders
in place, new organisations and it will be their responsibility
to take forward the programme. In actual fact, it is only at that
level where this can be implemented in the most appropriate way.
Q96 Mr Curry: How is that going to
happen in practice? We have PCT reorganisation, we discussed this
before, we are moving to much larger PCTs. Some of them are serving
a population of 650,000 to 750,000 and some are inheriting huge
deficits they have to work through the system and at the moment
they are trying to work back through the system, which is why
a lot of people are disaffected and fed up and then the strategic
health authorities. Is there one person who has specifically been
told that he is in charge of getting this thing delivered?
Sir Ian Carruthers: Yes.
Q97 Mr Curry: Who is it and how did you
choose him or her?
Sir Ian Carruthers: The senior
responsible officer for the programme in each area is the chief
executive of the new strategic health authority and there are
10 of those. The responsibility for delivering in each organisation
is the chief executive of that organisation. As the end of the
Report says, we are putting in monitoring systems to check that.
Q98 Mr Curry: Is it your advice to
them that they should have a Mr Granger alongside them, as it
were, to deliver this? They are going to have lots of other things
to deliver, are they not? They have to live within their means,
to quote the Government's favourite expression at the moment and
lots of other things.
Sir Ian Carruthers: As the new
strategic health authorities are established, we are making sure
that each one has a senior chief information officer who will
be accountable to the chief executive for taking it forward. We
would expect that to be mirrored in more local organisations.
So we do have that. Whether it is another Mr Granger remains to
be seen, but we want someone to be accountable for that particular
area.
Q99 Mr Curry: So we shall be able
to see this handful of people. Are they going to be Mr Granger's
disciples in the new strategic health authorities?
Sir Ian Carruthers: No, they are
going to be accountable—
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