Examination of Witnesses (Questions 180-199)
DEPARTMENT OF
HEALTH, PROFESSOR
PETER HUTTON
AND DR
ANTHONY NOWLAN
26 JUNE 2006
Q180 Mr Bacon: What are the consequences
for the NHS, for example for Patient Pathways, if the programme
is not delivered on schedule?
Dr Nowlan: The way all modern
healthcare is going, certainly in the NHS, is moving away from
packing people into buildings to do things, to caring for them
in many settings; care is a lot more complex. The thing that will
hold that together safely and effectively is information. Without
certain key pieces it is going to be extremely difficult to practice
that healthcare and that is why there is such huge support from
the clinical leadership for at least for the principles of the
health record.
Q181 Mr Bacon: So you would not describe
yourself as a Neanderthal in terms of electronic patient records.
Dr Nowlan: I have made it my career
for the best part of the last 20 years.
Q182 Mr Bacon: If you could make
this work, you would be in favour of it.
Dr Nowlan: Absolutely; it is the
single most important thing to do in healthcare.
Q183 Mr Bacon: May I ask you to turn
to page 31? There is a reference here in paragraph 2.12 to these
400 clinicians. You wrote to the Committee about this and said
you were asked to find hundreds of clinicians. What exactly did
you mean by this?
Dr Nowlan: In preparing for various
reviews I was told that they required lots of names of clinicians
who had been consulted or involved. I said I did not think that
was appropriate.
Q184 Mr Bacon: In your letter you
put "hundreds".
Dr Nowlan: Yes, hundreds.
Q185 Mr Bacon: You put "hundreds"
in inverted commas.
Dr Nowlan: Yes; "lots",
"hundreds".
Q186 Mr Bacon: It was just "Go and
find some clinicians".
Dr Nowlan: Yes. I just felt it
was not at all a fair representation of the actual situation in
the few months that work had been done. Besides which, just having
given people a document and got some view is not a satisfactory
test of the feasibility of doing this.
Q187 Mr Bacon: Were people on that
list people who had signed up to the output-based specification?
Dr Nowlan: I did not take part
in producing any list of names for the output-based specification.
I know that subsequently Professor Hutton managed to secure some
names. The evidence was not there. The main work that was done
with the leadership specifically on that common national part
of the record, which then became confusingly referred to as the
Spine; that was the piece that the main work was done about.
Q188 Mr Bacon: If the clinicians
were not really controlling the creation of the specification
for the healthcare record, who was?
Dr Nowlan: A design authority
was established.
Q189 Mr Bacon: Was this within the
NPfIT?
Dr Nowlan: Yes; at the end of
2002.
Q190 Mr Bacon: What experience did
the design authority have of healthcare?
Dr Nowlan: In terms of the people
who took charge of it, none to speak of.
Q191 Mr Bacon: None? No experience
of healthcare at all?
Dr Nowlan: No, not that I can
recall. We worked within that team to produce the specification
but it was done at breakneck speed and largely by putting together
information from a whole raft of previous specifications and then
it had to be reduced. I must say it was not exactly the ideal
process to commit this sort of resource.
Q192 Mr Bacon: Is it not right that
the output-based specification is the thing which drives inside
the contract what people get paid basically?
Dr Nowlan: Yes.
Q193 Mr Bacon: In paragraph 2.13
it says: "...there was no recorded link between the detailed
item in the OBS and the source of the person or group making the
contribution. NHS Connecting for Health replied that these links
were not directly attributable, given that much of the OBS was
developed in workshops involving a cross section of stakeholders
and NHS Connecting for Health had not had the resources to record
the attributions individually". Of course there was £900
million on top of the £654 million, but plainly not enough
resources to do that. I should have thought, would you not, that
if you are going to be spending all this money on the world's
largest IT programme, having a good audit trail for where you
had done your consultation would be paramount, would it not?
Dr Nowlan: It is certainly paramount
if things go wrong. It is even more important for getting it right
and moving it forward, yes.
Q194 Mr Bacon: Mr Granger may I ask
you a question about your contract? Are you incentivised in your
contract by the speed with which the procurement took place?
Mr Granger: Are we talking about
my personal contract?
Q195 Mr Bacon: Yes, your contract
of employment. Are there financial incentives for you relating
to the speed of the contracting process or were there for you
at the time you were doing the contracting? Everyone commented
on the incredible speed with which the contracts were let.
Mr Granger: I am sorry; what a
strange question. Are you imputing my motives for driving the
programme on time to my personal remuneration?
Q196 Mr Bacon: No, I am asking you
a question which admits of a clear answer; there either were or
were not.
Mr Granger: My remuneration has
absolutely no incentives associated with having concluded the
procurement process within a given period of time.
Q197 Mr Bacon: Thank you.
Mr Granger: Dr Nowlan's statement
that there were no clinicians involved in the OBS is a slur on
the character of three whose names I have here, who were his colleagues:
Mike Bainbridge, Steve Bentley and Ian Arrowsmith, who have actually
managed to stay the pace and continue to work in a difficult programme
environment.
Q198 Mr Bacon: In addition to the
PAS timetables which you very kindly sent me, could you send me
also the original schedules, this is inside the LSP contract schedules,
for what CRS modules would be deployed where and by when? Can
you do that? In other words, the original target dates which are
contained in the LSP contracts.
Mr Granger: If the LSPs are content
for that. If they are not, I shall contact you and the power of
this Committee will be used to get them.[14]
Q199 Mr Bacon: Professor Hutton, did
you want to come back in?
Professor Hutton: A couple of
things. On a point of accuracy, PACS was not part of the original
specification.
Mr Bacon: I did not think it was.
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