Comments from Dr Anthony Nowlan on the
evidence session
Question 1
As regards the two reasons for the delays:
(i) Supplier difficulty—if there are
now difficulties, what was tested in the technical proofs conducted
in 2003?
(ii) Clinicians want to pilot—this
was obvious in early 2003 but would have been an obstacle to contracting.
Question 5
In early 2003 senior representatives from the
Royal College of Radiologists (contact Peter Dawson) were clear
that if the money was available PACS could be deployed and this
would improve radiology services. PACS is a well-understood product.
They were also clear however that the care record was vital for
all, because they want to share care, not just images.
Question 6
The NHS has had demographic databases for many
years prior to CfH. The NHAIS/Exeter system and the National Strategic
Tracing Service. The NHAIS system remains the bedrock of most
of the business processes that maintain the database.
The NHS has had a secure network for many years
prior to CfH. The new network may well be an improvement, but
it is not a transformation.
Question 7
"What we want is a system that works rather
than a system which is put in quickly for its own sake".
Then why was the procurement rushed through without adequate consideration
of what is required or how it would be implemented?
Question 8
(i) How can something be value for money
if it does not yet exist let alone work? The answer confuses value
and reducing prices.
(ii) The answer equates central procurement
with the delivery of a common approach to the management of healthcare
information across the NHS.
Question 11
This was happening prior to CfH. There have
been technology upgrades but no major developments in healthcare/business
services such as a core health record.
Question 14
These are only financial obligations, and say
nothing about the likelihood of delivering any healthcare benefit.
Question 15
Because PACS has a well-established commercial
model based on the impact on radiology departments alone. This
is not the case for the bulk of what is proposed under the care
record work.
Question 22
I met informally with the NAO at its request
and the question of reviewing the report was discussed. I have
provided further information at [inset ref to note 4].
Question 26
What was the "structured requirements-evaluation
process" and what is the evidence that it was fit for purpose
and would produce a meaningful result against which it was safe
to proceed?
On the point of patient involvement. I appointed
a head of Patient and Citizen Relations at the NHSIA in 2000 (Marlene
Winfield). In the context of NPfIT, a Patient Advisory Group was
established by myself and Marlene Winfield in early 2003. I think
two meetings were held before I left. They considered the same
proposals as the Clinical Care Advisory Group.
As regards people having significant amounts
of time: I ran a recruitment in early 2003 to build a clinical
team intended to support the clinical development.
Question 30
This completely supports my contention that
the procurement was run without credible consideration to what
was being proposed. These are exactly the sorts of complex issues
that it was known would arise. It is extraordinary that it has
take so long to admit this.
Question 31
GPs were being paid before NPfIT. The bedrock
of this was the Exeter system. QMAS was implemented by the Exeter
team that was at the time part of the NHS Information Authority.
All of this would have happened with or without NPfIT.
Question 61
Neither of whom were there at the time.
Question 64
They should be asked to produce the evidence
that what was done (consultation or whatever) was an appropriate
basis on which to commit the future of the NHS.
It was obvious to anyone with any knowledge
at all of primary care that the idea of LSPs replacing all the
GP systems with brand new systems was madness. It was neither
needed nor possible. Yet, at the time, there were boasts of putting
EMIS out of business.
Question 65
Unfortunately the contracts have been let and
the NHS committed to a course of action.
Question 114
The project in the NHS is an end-to-end project.
It is not acceptable to make these artificial distinctions between
CfH and the local NHS. That helps no one.
Question 115
This is a major fallacy. The only risk pushed
on to the suppliers is financial. All the healthcare risks of
the NHS not working remain with the NHS and the public.
Question 117
The main risks are over can "it" work
at all regardless of time and money. The programme has to all
practical purposes had unlimited money (it has given money back)
and has had all the time (it is 2.5 years late) but it has not
produced a care record.
Question 118
Users of what? The care record does not exist.
Question 126
The commercial suppliers and the NHS in many
areas are competing for the same skills.
Question 195
I did not state that "no clinicians were
involved in the OBS". I state that the process that created
the OBS, including involvement of clinicians, what not appropriate
for the scale and nature of the resultant commitment. I have addressed
the specific accusations in Mr Granger's answer in Ev .
Question 217 (Mr Granger) (also see Ev )
This is a most serious representation of the
state of the programme. Firstly I was removed from the programme
and not `lost' as explained in Ev . Secondly, I don't know who
can recall events because none of the clinical witnesses, or any
of the others apart from Mr Granger was there at the time. The
reference to Sir Muir Gray's work is a complete distraction: it
has nothing to do with the events we are addressing.
Question 217 (Dr Braunold)
This is the real tragedy. There was a consensus
document in March 2003. Subsequent events wrecked that consensus
and associated trust, before Dr Braunold joined the programme.
Dr Braunold and others are now trying to rebuild that consensus
and trusts. Unfortunately, the document to which she refers states
in it's opening paragraph:
"Now that the architecture for England
has been commissioned, designed and being built, there is a need
for clarity concerning how it will be used by people using the
NHS and those working in the NHS".[21]
ie It is all back to front because the contracts
have been let.
21 Connecting for Health, The clinical development
of the NHS care records service (2005). Back
| 
