Examination of Witnesses (Questions 220-239)
DEPARTMENT OF
HEALTH, PROFESSOR
PETER HUTTON
AND DR
ANTHONY NOWLAN
26 JUNE 2006
Q220 Mr Williams: I have had rather
long answers, but it is only fair to allow them to answer fully.
Comptroller and Auditor General you, even more than we, are aware
of the importance of the involvement of the user early on. I believe
the information Dr Nowlan has given us was also made available
to the National Audit Office and Professor Hutton. From the examinations
you carried out did you feel, given the scale of this and the
nature of the contracts, the complexity of the contracts, that
there had been adequate time and scope, width of consultation
before they entered into the contract-seeking stage?
Sir John Bourn: What I feel about
the programme as a whole is that the approach from the top down
had not admitted the full degree of consultation with all the
members of the National Health Service who will have to operate
it, as the general practitioner herself said and as Sir Ian and
colleagues have said. There was more that could usefully have
been done and the Report has drawn attention to that.
Q221 Mr Williams: We are talking
about systems, part of which are two and a half years late, which
are dependent upon detail and yet you are saying that there had
not been adequate consultation before the contracts relating to
this work were placed.
Sir John Bourn: I put it in relation
to the development of the system as a whole, for which the contract
is an important and necessary aspect. Overall you have a system
which is, as we know, the biggest system in the world.
Q222 Mr Williams: It is not working,
mind. It is going to be the biggest system in the world if it
works and when it works.
Sir John Bourn: It is going to
be the biggest system in the world and the design of that system
is complicated. It is a system which has to have regard to the
thousands of people who will be engaged in working it. Perhaps
inevitably there was not a full engagement of both sides.
Q223 Mr Williams: Does the complexity
not mean that it was absolutely imperative that there was the
fullest possible involvement of users before the contracts were
placed in view of the scale of those contracts?
Sir John Bourn: The fullest possible
given all the exigencies of the situation in which the programme
was sought to be introduced.
Q224 Mr Williams: I appreciate that.
What you have had to say is very important; it is also somewhat
damning.
Mr Granger: Out in the real world,
in the hospital where Professor Hutton works six sessions a week
there is a new system with significant clinical functionality
as well. One could differentiate between some aspects of the programme
where consultation has been ongoing, the summary clinical record,
and a significant number of systems which have been implemented.
Q225 Mr Williams: But as Kitty demonstrated
and we know from other evidence, it is not working where it is
needed. It is not delivering what it is supposed to be delivering
even at this stage and it is several years behind meeting targets
you set it.
Sir Ian Carruthers: We should
be clear about what is not working. I said at the very beginning—
Q226 Mr Williams: Be sure to tell
us what is.
Sir Ian Carruthers: Some PACS
systems have been introduced.
Q227 Mr Williams: Some?
Sir Ian Carruthers: Yes, because
it is part of a rolling programme. There are something like 10,000
applications—9,600 is the actual figure in this Report.
We have a Spine which is handling personal demographics and so
on which GPs are using every day. The NHS sees delivery. The thing
which is behind is the care record and that is behind for two
reasons: one is because suppliers felt it would be appropriate,
because of the delivery of products and the difficulties with
that; secondly, because clinicians said they wanted to pilot it
first, which is another way of handling the clinical involvement
in a much more dramatic way. So I should say that the pilots which
are about to start will do more than any consultation because
people have the chance from experience to say how it works and
what it can do. The notion that nothing is happening is quite
erroneous.
Mr Williams: But contracts have already
been placed.
Q228 Chairman: In all fairness I
must let Professor Hutton comment on this. Do you remember that
right at the beginning of the session I asked about the 170-odd
acute hospitals and that the clinical system actually has not
been deployed into any of them? Is this right? I did not give
you a chance to comment at that stage; Mr Granger commented. This
follows on directly from Mr Williams' question and is absolutely
key, is it not? What is going on?
Professor Hutton: I have not been
in the programme for two years. My understanding is that your
assertion is correct. That is my understanding.
Sir Ian Carruthers: That is just
not the case. Your question is on clinical systems and we can
deal with that.
Mr Jeavons: The heart of this
is that there are many systems which have already been deployed
which bring real benefit to patients and clinicians in the execution
and delivery of care. You only have to go and talk to real clinicians
using some of these things to hear that for yourself. The heart
of this however is the National Care Records Service.
Q229 Chairman: Are my care records
arriving through these systems at the hospital yet? Is the answer
yes or no?
Mr Jeavons: There is already national
care record functionality available, a personal demographic service—
Q230 Chairman: Is my GP able to send
my records to a hospital from London up to an accident I have
in Middlesbrough or somewhere? Is that now happening?
Mr Granger: Yes, he can do that
because for the first time the NHS has a reliable network of over
14,000 end points on it which are available almost all the time.
The point about hospitals and the systems they have is that 13
acute patient administration systems were deployed as of 26 June
across 40 sites, 17 community hospital PAS solutions delivered,
129 community care solutions delivered, 13 mental health patient
administration systems delivered, 59 child health solutions delivered,
118 different communities with a single assessment process solution
delivered, 255 map of medicines solutions delivered, five ambulance
solutions delivered, 122 LSP solutions delivered to GP practices,
24 departmental solutions.
Q231 Chairman: We could have a ding-dong
here. It is quite useful to know what has been delivered. Professor
Hutton, do you want to comment on this? We are only laymen and
it is very difficult to find a way through this.
Professor Hutton: Just to sum
up, I do not doubt that all those things have been delivered,
but they are nothing to do with the NHS care record which is a
central repository of key information of each person that is available
anywhere within the NHS with their consent.
Q232 Chairman: Yes, that is how I
understand it.
Professor Hutton: As far as I
know, that has not yet happened.
Q233 Chairman: Mr Shapcott, what
is the truth of this. You have been writing this Report for the
best part of two years. What is the truth of this?
Mr Shapcott: My understanding
of the situation is that there are many systems in hospitals which
are delivering some clinical functionality such as X-rays and
so on. The core nationally available information on your clinical
condition, as I understand it, still has some time to go.
Q234 Chairman: Still has some time
to go?
Mr Shapcott: Yes.
Q235 Chairman: So your conclusion
is that it has not been delivered.
Mr Shapcott: That is my understanding.
Mr Granger: The demographic component
of it is live with 72 million records on it, five million of which
have been converted and cleansed in the last year, the name, address
and so on.
Dr Nowlan: That has existed in
the NHS for many, many years.
Mr Granger: I am sorry, but if
you want to come to see what we have done since you left, you
might be pleasantly surprised.
Chairman: I should like you to put in
a note.[15]
Q236 Greg Clark: Is it true that Fujitsu,
who were responsible for the southern region, have fined the local
NHS £19 million because the local NHS failed a contract obligation
to second 50 employees.
Mr Jeavons: No, that is not true.
Q237 Mr Bacon: What word would you
use? Has a £19 million payment been made or is it due?
Mr Jeavons: The original contract
included, quite sensibly, recognition of the contribution that
local NHS staff needed to make to deliver the types of systems
which were required. A contract change notice was done in September
2005. Part of that renegotiation took that part of the obligation
out. That is what that number refers to.
Q238 Mr Bacon: This is basically
the supplier attachment scheme, is it?
Mr Jeavons: It is called managed
employee scheme.
Q239 Greg Clark: Basically no NHS region
has been fined or charged a penalty—I do not want to play
with words here—had a financial consequence for failing
to give enough staff. Can you give me a categorical assurance
about that?
Mr Jeavons: Part of the contract
change notice included—
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