Select Committee on Public Accounts Minutes of Evidence

Further supplementary memorandum submitted by the Department of Health

  After the hearing, Mr Richard Bacon submitted a series of supplementary questions to the Department of Health, what follows is their response.

1.   What is the total potential financial liability to suppliers if the NHS fails to meet its contractual commitments under the National Programme for IT in the NHS

  The total aggregate liability if the NHS fails to meet its contractual commitments under each of the LSP contracts is capped at £50 million in any contract year or 50% of the charges payable in the preceding year, whichever is the greater.

  This compares with the total aggregate liability of each LSP who, if they fail to meet their contractual obligations, are capped at £250 million or 100% of the charges in the preceding year, whichever is the greater.

2.   Please supply a breakdown of the £654 million of expenditure referred to in paragraph 1.22 of the NAO Report on the National Programme for IT

Programme	Cluster	Expenditure to 31 March 2006 (£ million)
LSP	London	1.3
LSP	North East	51.6
LSP	South	26.5
LSP	North West and West Midlands	119.3
LSP	East	57.9
N3	All	130.5
NHS Care Record	All	239.8
Service Choose and Book	All	27.1
Total	654.0

3.  Please supply a breakdown of any money spent by CfH outside of the LSP and National Application Service Provider (NASP) Contracts

Item	£ million to 31 March 2006
New projects added to the original scope of the Programme	70
Additional services beyond the scope of the original core contracts	48
Non-core projects and contracts added to National Programme for IT	75
National Programme for IT support for local NHS implementation	43
Central administrative expenditure	193
Total	429

Note:  All costs at 2004-05 price base.

4.   Please supply a breakdown of the "approximately £1.5 billion" referred to in Question 147 of the transcript of the PAC evidence session on 26 June 2006 including:

(i)  a breakdown of central administration costs by category; and

(ii)  a breakdown of all forward payments to contractors specifying in the case of every payment:

(a)   the contractor;

(b)   the date; and

(c)   the amount.

Total expenditure to 31 March 2006

Item	£ million to 31 March 2006
Core Contracts	654
New projects added to the original scope of the Programme	70
Additional services beyond the scope of the original core contracts	48
Non-core projects and contracts added to National Programme for IT	75
National Programme support for local NHS implementation	43
Central administrative expenditure (see next table)	193
Expenditure by local NHS organisations (including NHS Connecting for Health's contribution to local costs)	459
Total	1,542

Components of the Central Administration Expenditure
Item	£ million to 31 March 2006
Technology Office: Provision of technical architecture leadership and guidance to suppliers, programmes and the NHS as a whole, and assurance of the solutions produced by suppliers. Technology Office also produces and maintains the NHS classifications and terminologies which are used when entering data into systems such as the Quality Management and Analysis System. These services underpin the Programme's key objective of delivering better patient care by giving patients more choice and health professionals more efficient access to information.	28
Programmes: Co-ordination of work to define Programme requirements including management of clinical input. Ensure stakeholder engagement is maximised. Manage the scope of software releases and monitor the design, build and test stages of development. Manage the relationship with suppliers including the commercial management. Ensure programmes have sound governance structures including quality assurance processes.	50
Systems Implementation: Ensure that the requirements and priorities of the NHS are reflected accurately within the Programme's plans and provides the required level of support to enable the NHS to implement solutions successfully and achieve the expected benefits. Monitor and assure the delivery and implementation of LSP solutions and associated functionality in line with agreed plans and contractual commitments underpinned by the Detailed Implementation Plans.	38
Service Management: Ensure overall quality of services provided to the NHS by the Programme's suppliers. Products and services are constantly monitored to ensure they meet service level standards and to enable faults to be resolved swiftly. This minimises disruption to the NHS and the potential impact on patient services.	12
Support for the delivery of the National Programme comprising legal services; contract and commercial services; financial services; corporate services; programme communications; and Information, Communications and Technology (ICT) services.	65
Total	193

Forward Payments on Core Contracts

Date	£ million	Supplier	Cluster
27 April 2005	18.0	Accenture UK	East of England/East Midlands
27 April 2005	15.0	Accenture UK	North East
13 August 2004	53.0	BT Syntegra	London
8 April 2004	26.7	CSC	North West/West Midlands
28 June 2004	26.7	CSC	North West/West Midlands
1 October 2004	26.6	CSC	North West/West Midlands
1 April 2005	25.0	CSC	North West/West Midlands
1 July 2005	25.0	CSC	North West/West Midlands
23 December 2005	25.0	CSC	North West/West Midlands
23 December 2005	5.0	Fujitsu	Southern
27 July 2005	10.5	Fujitsu	Southern
30 September 2005	58.0	Fujitsu	Southern
Total	314.5

Forward Payments on PACS

Cluster	Payment Date	Payments to 31 March 2006 £ million	Cluster Totals to 31 March 2006 £ million	Supplier
East/East Midlands	October 2005	9.84	9.84	Accenture
North East	October 2005	4.98	4.98	Accenture
London	December 2004	11.88	29.68	BT
	April 2005	17.80
North West/West Midlands	October 2004	12.66	50.26	CSC
	April 2005	14.60
	March 2006	23.00
Southern	December 2004	10.00	34.28	Fujitsu
	May 2005	12.48
	July 2005	0.37
	October 2005	1.81
	January 2006	9.62
Totals	-	129.04	129.04	-

  With the exception of Accenture, the forward payments are protected by Letters of Credit issued by the suppliers' banks, which have to be AAA rated financial institutions. In the event of difficulties, the forward payments are repayable by the financial institutions on demand. The value of the Bonds is adjusted as products are delivered by the suppliers.

  Because of Accenture's unique accounting arrangements, the Letter of Credit was replaced by a charge on their assets of at least an equal value. This provided a similar guarantee. Following the recent announcement of a transfer of responsibilities, the unearned elements of the forward payments made to Accenture have been repaid.

  These arrangements for making forward payments are in line with principles established by Partnerships UK, a public/private sector partnership established by the Treasury. They enable the suppliers to reduce the costs of their working capital which in turn benefits the taxpayer through lower prices. The principle of payment on delivery is maintained.

5.   How much money has been spent on legal fees by or on behalf of the National Programme for IT/Connecting for Health in each year since 2002-03

  Given the size, innovation and complexity of the Programme the costs of the legal fees were estimated initially to be of the order of £40 million. This would equate to around half of one percent of the value of the contracts of nearly £7 billion.

  Actual expenditure on legal fees in respect of the National Programme for IT is set out in the following table:

Year	Legal fees £ million
2002-03 and 2003-04	14.9
2004-05	6.8
2005-06	6.5
Total	28.2

  If the Programme had not been undertaken as a single, central and focused activity, any procurement activity would have been subject to the various processes of multiple NHS organisations. This would have increased the costs, including the costs of external advisors and lawyers, and taken much longer to complete. We estimate that there could have been in excess of 600 procurements, with legal fees of around £200k in each case, which would have totalled £120 million.

  All the law firms providing services to the Programme have leading commercial practices and, as such, they provide a broader service than simply legal advice.

6.   Please list all payments made to iSOFT showing the payer, the date of the payment, and the amount

7.   Please list all advanced payments made by CfH directly to iSOFT

8.   Please list any repayments made by iSOFT against these advanced payments

  Under contracts let by the National Programme for IT, iSOFT is a sub-contractor to two Local Service Providers, CSC (in the North West and West Midlands Cluster) and Accenture (in the North East and East of England Cluster and the East Midlands Cluster).

  NHS Connecting for Health does not make payments directly to iSOFT in respect of contracts relating to the National Programme for IT. Accenture has advised NHS Connecting for Health that they have paid iSOFT £19.6 million. CSC has advised NHS Connecting for Health that they have paid iSOFT £41.8 million. These payments have been made according to the contracts that exist between these prime contractors and iSOFT.

  The Department of Health has an Enterprise Wide Arrangement with iSOFT, negotiated by NHS Connecting for Health, in respect of the contracts with individual NHS Trusts. This arrangement is not part of the National Programme for IT but relates to the existing contracts with iSOFT held by individual NHS Trusts. Under this arrangement, the Department agreed to make advance payments in April 2005 and April 2006 against the charges payable by NHS Trusts to iSOFT.

  In consideration of these advance payments, iSOFT agreed price reductions (approximately £20 million over three years) and, in addition, removed some obligations on certain Trusts; waived certain termination provisions on existing NHS Trust contracts; and provided greater flexibility for contract extensions. This benefited a number of NHS Trusts which would otherwise have incurred costs for contractual obligations; for termination of existing contracts; or for extensions. The advance payments are protected by Letters of Credit that entitle the Department to recover the amounts at any time.

  Payments of £58 million and £23.8 million excluding VAT were made by the Department of Health to iSOFT in April 2005 and April 2006 respectively. Each month iSOFT collects the revenues due from existing contracts held by Trusts/GPs and passes these in full to the Department of Health. Following the end of each quarter the Department of Health adjusts the value of the Bond in line with the monthly payments received from iSOFT. Up to the end of July 2006, iSOFT had collected and passed back to the Department of Health £37.9 million.

  There has been no indication from iSOFT that the advance payments made by the Department of Health are the subject of the suspected accounting irregularities that the iSOFT Board is investigating.

9.   What is the highest amount that has been paid per day to any consultant working on the NPfIT

10.   How many consultants are employed on the NPfIT

11.   What is the range of earnings per day for consultants employed on the NPfIT

  NHS Connecting for Health contracts with a number of suppliers for the provision of consultancy services. The contracts are with the supplying companies and we do not hold information on the salaries received by the individuals.

  Procurement of consultancy services is undertaken within a Framework negotiated by the Office of Government Commerce to ensure provision at the best possible price. The charges levied by the companies supplying consultants to NHS Connecting for Health are within the OGC negotiated parameters and range currently from £158 to £2,493.

  At the end of July 2006 there were 471 consultants/contractors engaged with NHS Connecting for Health. There are a number of reasons for employing consultants, including the provision of expertise, the short term nature of the task or to mobilise an activity quickly while permanent recruitment is undertaken. The mobilisation of the National Programme, given its size and complexity, inevitably required the rapid provision of a highly skilled and experienced workforce. Our policy is to replace consultants with permanent staff as soon as it is practicable to do so, though the nature of our task is such that we will always require a mixed-economy of staff, including consultants.

12.   How many Trusts have asked CfH for a contribution to costs incurred due to late deployment of CfH systems. Please state how much has been claimed by each Trust

13.   How many Trusts have been paid a contribution to costs incurred due to late deployment of CfH systems

  Fourteen Trusts have asked for a contribution. Information on how much has been claimed by each Trust is not available as the requests include a mixture of one-off costs, ongoing costs, alternative interim solutions and unspecified amounts. No payments have been made.

  It should also be noted that no claims have been made in respect of delays generated by NHS Trusts.

14.   Please list any payments made to Trusts by or on behalf of CfH in order to encourage them to deploy CfH solutions

15.   Please list any payments offered to Trusts by or on behalf of CfH in order to encourage them to deploy CfH solutions

  No payments have been either offered or made to Trusts to encourage them to deploy NHS Connecting for Health solutions though, during 2003-04 and 2005-06, NHS Trusts were provided, through normal funding channels, with resources to support the implementation effort.

16.   Please list any financial benefits realised by Trusts as a result of deploying NCRS systems between January 2004 and June 2006

  The notes provided in response to Questions 130 and 255 at the PAC hearing demonstrate the substantial financial benefits being realised by local NHS organisations. They also explain that we accept the NAO's recommendation to provide an annual statement quantifying the benefits delivered by the Programme. The aim is to produce the first statement next year.

17.   Paragraph 4.5 of NAO Report suggests that only 15% of the supplier's charges are based on usage. Does this mean that supplier can be paid 85% even if the systems are not used

  In order to receive payment a supplier must receive a Milestone Achievement Certificate (MAC), which confirms that the system is fit for purpose and in use by an agreed number of NHS staff. This event triggers a payment of 60% of a deployment charge (Location Deployment Charge). A further 20% is payable on achievement of volumetric targets (Volume Charge). The final 20% is payable when full functionality is available to all users (Cluster Deployment Charge).

  In addition there is also a monthly service charge, 80% of which is payable on receipt of the MAC provided that required service levels are achieved. The remaining 20% is paid proportionately to the number of specified staff using the system in any month, provided that service levels are also achieved (Usage Service Charge).

  The following chart provides an example of the composition of the charges over the life of a contract:

18.   The National Audit Office Report outlines savings from a deal with Microsoft (Figure 7, page 36) based on committed volume. What is:

(i)  the committed volume to which the NHS has agreed?

(ii)  the total cost of this commitment?

(iii)  the maximum potential financial penalty for non-compliance?

  The contract with Microsoft includes a confidentiality agreement prohibiting NHS Connecting for Health from revealing the price of an individual licence or information that enables its identification. We can state that the prices of individual licences are significantly cheaper than those in the OGC arrangement with Microsoft.

  As the contract with Microsoft is outside the scope of the National Programme for IT and therefore the scope of the NAO Review and the PAC Hearing, we are reluctant to renegotiate the confidentiality provision with Microsoft. The Committee may wish to consider whether to approach Microsoft themselves.

19.   Please supply a schedule of all delivery dates given in each LSP cluster for Phase 1 Release 2 since January 2004

20.   What are the current delivery dates for Phase 1 Release 2

Cluster	Original scheduled date	Current delivery dates
Southern	Between March 2005 and December 2005.	Deployment began on 20 December 2005. The last scheduled date for this release is currently 27 November 2007.
London	During 2005 and 2006.	Delivery began on 28 November 2005. The LSP is in the process of changing its sub-contractor from GE to Cerner so planned deployment dates for this release are currently being considered.
East of England and East Midlands	Between 31 January 2005 and 5 December 2005	Deployment began on 15 March 2006 but remaining deployments for this release are currently on hold.
North West	By 30 June 2005.	Currently scheduled to complete delivery in the last quarter of 2008.
North East	In 2005.	The dates will be confirmed on the conclusion of the commercial re-planning discussions with the LSP.

Note:  The dates provided are those from the first deployment of Phase 1 Release 2 to the last completed deployment for that cluster.

21.   When did CfH take the decision to deploy the "Plymouth" solution

22.   What estimate did CfH make for the demand for the "Plymouth" solution for 2006

  The proposal was developed with the NHS and the National Programme's suppliers during Autumn 2005. The Clusters consulted with staff, including clinicians, across the NHS. The CEO of Plymouth Hospitals NHS Trust facilitated visits from all SHAs and a number of PCTs from the three Clusters (North East; East of England and East Midlands; and North West and West Midlands). The deployment proposal was approved by the three Cluster Programme Boards, the membership of which comprises Chief Executives and Executive Directors from the NHS Trusts and SHAs. Demand for this solution is expected to exceed 30 deployments during the 2006-07 and 2007-08 financial years.

23.   On what date did CfH realise that there were problems with BT's Child Health Interim Application in London

24.  On what date was the decision made to replace the Child Health Interim Application in London

25.   Why was the decision made to replace the Child Health Interim Application in London

26.   The BT child health deployment is counted as 10 systems in CfH's published deployment statistics. How many of the deployments in the statistics are either "technical deployments" (ie not widely used by NHS staff for the care of patients); or like the BT child health system, deployed but not fit for purpose

  Issues relating to the delay in deployment of CHIA were known during 2005.

  The then service provider, McKesson, gave notice of termination of their contract for the provision of a Child Health System. NHS Connecting for Health was asked by the ten NHS Trusts to deliver a solution through the LSP contract. Given the short timescales, this was agreed to be on a "best endeavours" basis. It was then agreed with the Trusts that the best approach was to deploy the Child Health Interim Application (CHIA) as an interim solution until the reference solution was available from IDX.

  There were no standard business processes in place across the 10 PCTs for the collection, collation and reporting of Child Health activity. Indeed, the conflicting and incompatible business processes that had been developed by each Trust over a number of years made it difficult for a standard solution to be developed and deployed.

  Against these difficulties, NHS Connecting for Health and BT built and deployed the CHIA. Everybody, including BT, did their best and, however regrettable, it was not surprising that some things went wrong. We have supported this deployment; including augmenting the staffing provision in the NHS Trusts to ensure that appropriate information can be collected and reported.

  As the name implies, CHIA was always intended to be an interim solution. The aim was to support the NHS after the existing supplier of the Child Health solutions to these PCTs in London withdrew from the marketplace. Lessons learned from the CHIA experience are being taken seriously in the options' appraisal being completed—the response to Question 27 refers.

  The number of deployments was counted as 10, reflecting the number of Trusts in which CHIA was deployed. Although deployments may have different phases, such as technical deployment of the software followed by business go-live, this would be recorded as one deployment in our statistics. The problems associated with CHIA were exceptional. As a result of rectification work, the CHIA application has been steadily improved.

27.   Please submit a copy of the lessons learned documentation after the BT child health deployment and explain how this was used to avoid similar problems with other projects

  Reports required by the Health Protection Agency (HPA) to monitor childhood immunisation levels can now be produced for all Primary Care Trusts (PCTs) using the data from the Child Health Interim Application (CHIA). However, the decision to submit reports lies with the PCTs since their accuracy is reliant on the correct information being entered into the system.

  It has been acknowledged that the system had problems. However, we do not believe the new system was a danger to child health: As Dr Martin Baggaley, Clinical Director for NHS CFH, London, explained in a statement:

"We really have to stress that the first place a child's vaccinations are recorded is in the `Red Book' that parents hold. Secondly, a record exists at their GP surgery and then only third, this data is held in CHIA. Soon, CHIA will be able to provide the wider public health reports but it is misleading to say individual babies or children are at any greater risk by using this new computer system."

  A discrete document on the lessons learned was not prepared but there has been immense activity underway. The problems were resolved through diligent work within the PCTs and by BT and NHS Connecting for Health, including:

—    A three month extension of the support contract for the former system was agreed. PCTs were requested to operate temporarily on a "paper" basis whilst a new phased deployment was agreed.

—    In May 2005 the specification was reviewed and improved and a new project plan was agreed.

—    During July 2005 the first release of the re-baselined system went live.

—    During the period from August 2005 to October 2005 remedial action was undertaken to address the performance issues.

—    From October 2005 to April 2006 there was more upgrade work on the system.

—    From April to August 2006 performance and reliability improved. The focus switched from the IT system to analysis and correction of existing historic data.

—    By August 2006, all PCTs were able to produce their quarterly statistics. Those who chose not to produce reports did so because they needed to do more review work on their data.

  As explained earlier, CHIA is an interim solution and the development of the strategic solution is underway. All of the lessons learned from the deployment of CHIA are being applied in full to the development of the strategic solution. Our Technology Office also ensures they are applied to other Programme solutions. In addition, a new group has been set up bringing together senior child health/immunisation expertise, NHS Connecting for Health senior management and senior representatives from users in the NHS. This group is currently completing an options' appraisal for implementation of the best solution to the CHIA failures.

  Today there are more than 850 users of the CHIA system in 135 sites across North London. The database contains approximately 2.5 million records and there are nearly 450,000 children in the area covered by the ten PCTs.

28.   What evaluation was made of the Cerner system installed at the Homerton before the decision was made to switch from IDX to Cerner in the South. Please submit a copy of this evaluation

  The review was built upon the original technical and functional reviews that had been undertaken at the time of the original procurement, during which a large number of clinicians reviewed and scored the Cerner millennium solution highly.

  In addition, at the time of the change, the following additional work was undertaken:

—    NHS Clinicians and senior management reviewed the product both in a "production" and a "live" NHS environment. The clinicians from the Southern Cluster included the following:

Steve Jones	Cardiovascular Consultant Surgeon	Dorset and Somerset SHA
Chris Barham	Consultant Anaesthetist	Kent and Medway SHA
David Bone	Registered General Nurse/Informatics Manager	South West Peninsula SHA
Rina Merwaha	Consultant Paediatrician	Kent and Medway SHA
Beverley Castleton	Consultant in Care of the Elderly	Surrey and Sussex SHA
Nick Vaughan	Consultant Physician	Surrey and Sussex SHA
Paul Altmann	Consultant Physician-Nephrologist	Thames Valley SHA
Irene Sanson	Registered Nurse (NHS Care Record Project)	Thames Valley SHA
Chris Canning	Consultant Surgeon- Opthalmologist	Hampshire and Isle of Wight SHA
Mike Richards	Consultant Anaesthetist	Avon, Gloucester Wiltshire SHA
Richard Dunnill	Consultant Anaesthetist	Dorset and Somerset SHA
Glyn Brace	Midwife (NHS Care Record Service-Clinical Lead)	South West Peninsula SHA
Roger Tackley	Consultant Anaesthetist	South West Peninsula SHA
Sue Leake	Head of Therapy Services	Thames Valley SHA

—    NHS Connecting for Health reviewed the Production Environment and Build Centre in the USA.

—    NHS staff undertook a detailed review and mapping of functionality and build against the Programme's Output Based Specification (OBS).

—    A maintenance release and some process improvements were introduced to avoid earlier problems.

—    The LSP (Fujitsu) provided a mapping of the proposed solution that met the Programme's requirements.

  The lessons learned from each deployment are studied carefully and steps are taken to ensure that problems are not repeated. The Chief Executive of Weston Area Health NHS Trust wrote to us expressing his thanks for our support during the recent deployment there. In particular he thanked us for the support "that was provided in a number of ways, including production testing, contract assurance and infrastructure assurance."

29.   Were any of the problems encountered by the Nuffield Orthopaedic Hospital previously encountered at Homerton

  No. The problems encountered by the Nuffield Orthopaedic Hospital arose from poor quality data and the NOC's different working practices, combined with difficulties created by the short implementation timescale. The problems that had arisen during the earlier implementations at the Newham Hospital NHS Trust and Homerton Hospitals Foundation Trust had already been resolved through a system enhancement.

30.   Are any of the problems encountered at the Nuffield Orthopaedic Hospital expected to occur at future Cerner deployments

  No. We will support the local NHS and ensure the problems are not repeated. Indeed, the Chief Executive of Weston Area Health NHS Trust wrote to us expressing his thanks for our support during the recent deployment there. In particular he thanked us for the support "that was provided in a number of ways, including production testing, contract assurance and infrastructure assurance".

31.   Will Cerner deployments be allowed in other clusters such as London before the system has been proven in the South

  A significant number of deployments will have been completed in the South before installation commences in London, which will therefore take account of any lessons learned.

32.  What plans does CfH have to fund locally-selected spine-compliant solutions

  NHS Connecting for Health has a National Integration Centre (NIC) whose role is to technically assure spine-compliant systems before deployment into the live environment. Suppliers are required to follow a rigorous accreditation process with pre-defined entry and exit criteria. Our Technical Assurance Team witnesses the supplier testing, which is followed by formal technical integration testing using live-like test environments in the NIC. Following successful completion of the integration test phase, a formal certificate, Technical Authority to Deploy (TATD) is issued for the current version of the system.

  Alongside the TATD process and in support of any decision to allow a system to go-live, the NHS Connecting for Health Clinical Safety Officer, working with the Trust, uses the NHS Connecting for Health Clinical Safety Management System to ensure that the system is clinically safe to deploy.

  To date, 73 Technical Authority to Deploy certificates have been awarded to 65 suppliers.

  Additionally, 76 Clinical Authority to Release certificates have been granted. The CATRs are reviewed for system upgrades and changes. Where the care setting for deployment is different or there are business-affecting changes then it necessary to revise the scope of the CATR in line with the changed risk profile.

  NHS Connecting for Health funds only the core solutions provided by the LSPs. Other compliant solutions continue to be funded by the NHS.

33.   Please submit a copy of the lessons learned documentation from the Homerton deployment

  This document is available from the Trust directly: Homerton University Hospital NHS Trust Homerton Row London E9 6SR.

34.   How many customer satisfaction studies have been carried out to measure the organisational satisfaction by NHS trusts with CfH solutions. Please supply a copy of each survey with the results

35.   What customer satisfaction studies have been carried out to measure satisfaction by individual end users with CfH solutions. Please supply a copy of each survey with the results

  The following surveys have been carried out on behalf of NHS Connecting for Health.

  Two customer awareness surveys have been conducted by MORI. The results of both surveys have been published and are available on the NHS Connecting for Health website. The results of the first survey were used by the NAO to inform their Report.

  An independent survey of users' opinions was conducted by YouGov in May 2006. This surveyed users of services already deployed. The results are available.

  A rolling cycle of satisfaction surveys of customers of the N3 network is carried out by an independent third party (GFK-NOP), in accordance with BT's contractual responsibilities. The latest summary report is enclosed as Enclosure 3.

  The note provided in response to Question 93 at the PAC Hearing includes examples of the many favourable comments received from users of our systems.

36.   Please list the deployments that were due to be delivered in 2004, 2005 and 2006 according to the deployment schedules first provided by each LSP for:

(i)  acute trusts;

(ii)  mental health trusts; and

(iii)  community trusts.

  The following tables provide by Cluster:

(1)  the number of deployments that were due to be delivered during 2004, 2005 and 2006 according to the original LSP deployment schedules;

(2)  the number of actual deployments to 25 September 2006.

Table 1

Original Planned Deployments by Cluster

Cluster	Deployment Type	Care Setting	Trust Size	Year	Number of Deployments
North East	PAS	Acute	Small	2004	4
Cluster	PAS	Acute	Medium	2004	6
	PAS	Acute	Large	2004	13
	Mental Health PAS	Mental Heath	Medium	2004	6
	Mental Health PAS	Mental Heath	Large	2004	6
	Primary Care	GP	n/a	2004	1,265 GP Practices
	Ambulance		n/a	2004	2
	PAS	Acute	Small	2005	4
	PAS	Acute	Medium	2005	6
	PAS	Acute	Large	2005	13
	Mental Health PAS	Mental Heath	Medium	2005	6
	Mental Health PAS	Mental Heath	Large	2005	6
	Primary Care	GP	n/a	2005	1,265 GP Practices
	Ambulance		n/a	2005	4
	PAS	Acute	Small	2006	4
	PAS	Acute	Medium	2006	6
	PAS	Acute	Large	2006	13
	Mental Health PAS	Mental Heath	Medium	2006	6
	Mental Health PAS	Mental Heath	Large	2006	6
	Primary Care	GP	n/a	2006	1,265 GP Practices
	Ambulance		n/a	2006	4
North West	PAS	Acute	n/a	2005	16
& West	Mental Health PAS	Mental Health	n/a	2005	3
Midlands	Community PAS	PCT	n/a	2005	29
Cluster	Theatres	Acute	n/a	2005	21
	Maternity	Acute	n/a	2005	7
	Ambulance		n/a	2005	2
	PAS	Acute	n/a	2006	73
	Mental Health PAS	Mental Health	n/a	2006	9
	Community PAS	PCT	n/a	2006	25
	Theatres	Acute	n/a	2006	13
	Maternity	Acute	n/a	2006	13
	Ambulance		n/a	2006	2
East of	PAS (P1R1)	Mental Health	Small	2004	2 Trusts
England and		Community	Small	2004	19 PCTs
East Midlands	PAS (P1R1)	Acute	Medium	2004	3 Trusts
Cluster		Mental Health	Medium	2004	1 Trust
		Community	Medium	2004	16 PCTs
	PAS (P1R1)	Acute	Large	2004	3 Trusts
		Mental Health	Large	2004	2 Trusts
	GP (P1R1)	Primary Care	Medium	2004	131 + 30% of GPs across 4 PCTs
	SAP (P1R1)	Primary Care	Small	2004	1 LHC (=4 PCTs)
	PAS (P1R1)	Acute	Medium	2005	1 Trust
		Acute	Large	2005	1 Trust
		Mental Health	Large	2005	1 Trust
	PAS (P1R2)	Acute	Small	2005	3 Trusts
		Community (inc Child Health)	Small	2005	4 PCTs
	PAS (P1R2)	Acute	Medium	2005	8 Trusts
		Mental Health	Medium	2005	5 Trusts
		Community (inc Child Health)	Medium	2005	2 LHC (=3 PCTs)
		Community	Medium	2005	23 PCTs
	PAS (P1R2)	Acute	Large	2005	5 Trusts
		Mental Health	Large	2005	1 Trust
		Community (inc Child Health)	Large	2005	5 PCTs
	GP (P1R2)	Primary Care	Medium	2005	275 + 35% of GPs across 4 PCTs + 72 % of GPs across 3 PCTs + 35 % of GPs across 3 PCTs
	SAP (P1R2)	Primary Care	Medium	2005	2 LHC (=3 PCTs)
	Ambulance (P1R2)	Ambulance	Medium	2005	2
	GP Community Nurses (P1R2)	Primary Care	Medium	2005	Across 6 PCTs
	PAS (P2R1)	Mental Health	Small	2005	1 Trust
		Community	Small	2005	1 PCT
	PAS (P2R1)	Mental Health	Large	2005	1 Trust
	Ambulance (P2R1)	Ambulance	Medium	2005	3 Trusts
	GP (P2R1)	Primary Care	Medium	2005	20 GPs
	PAS (P2R1)	Acute	Large	2006	1 Trust
	GP (P2R1)	Primary Care	Medium	2006	18 GPs
	PAS (P2R1)	Acute	Small	2007	1 Trust
London	PAS	Acute	Small	2004	1
Cluster			Medium		2
			Large		3
			Small	2005	1
			Medium		3
			Large		2
			Small	2006	1
			Medium		3
			Large		3
	Integrated Care	Acute	Small	2004	5
	Record System		Medium		10
	(ICRS)		Large		15
			Small	2005	1
			Medium		1
	Clinicals	Acute	Large	2004	1
			Small	2005	2
			Medium		4
			Large		4
			Small	2006	2
			Medium		4
			Large		3
	Maternity	Acute	Large	2005	1
			Small	2006	2
			Medium		5
			Large		7
	Theatres	Acute	Large	2005	1
			Small	2006	2
			Medium		5
			Large		7
	Ambulance	Acute	Large	2006	1
	Enterprise	Acute	Small	2005	1
	Architecture 1		Medium		2
	(Integration with		Large		4
	local systems		Small	2006	2
	including firewall,		Medium		4
	existing systems, data centre setup)		Large		4
	Enterprise	Acute	Small	2004	1
	Architecture 2		Medium		2
	(integration with		Large		3
	local systems		Small	2005	2
	including firewall,		Medium		3
	existing systems		Large		2
	data centre setup)		Small	2006	1
			Medium		3
			Large		3
	Enterprise	Acute	Large	2006	1
	Architecture 3 (Integration with local systems including firewall, existing systems, data centre setup)
	Prescribing	Acute	Large	2006	1
	Advanced Scheduling	Acute	Large	2006	1
	Complex Clinicals	Acute	Large	2006	1
	Prevention Surveillance & Screening (PSS)	Acute	Large	2006	1
	Orders	Acute	Large	2006	1
			Small	2006	2
			Medium		5
			Large		7
	Portals	Mental Health	Small	2004	1
			Large		5
			Large	2005	4
	Basic NSF	Mental Health	Small	2004	1
	(National Services		Large		5
	Framework-Mental		Large	2005	4
	Health, Diabetes, Cancer, Old Persons, Child Health, Renal Services) Care Programme Approach (CPA) & Single Assessment Process (SAP)
	PAS	Mental Health	Large	2004	3
			Large	2005	3
			Small	2006	1
			Large		3
	Clinicals	Mental Health	Large	2004	3
			Large	2005	3
			Small	2006	1
			Large		3
	Orders	Mental Health	Large	2006	5
	Adv Clinical	Mental Health	Large	2006	5
	Portal	PCT	n/a	2004	26
	Portal	PCT	n/a	2005	5
	Basic National Services Framework (NSF), Care Programme Approach (CPA) & Single Assessment Process (SAP)	PCT	n/a	2004	26
	Basic National Services Framework (NSF), Care Programme Approach (CPA) & Single Assessment Process (SAP)	PCT	n/a	2005	5
	PAS	PCT	n/a	2004	5
	PAS	PCT	n/a	2005	13
	PAS	PCT	n/a	2006	12
	Clinicals	PCT	n/a	2004	5
	Clinicals	PCT	n/a	2005	13
	Clinicals	PCT	n/a	2006	12
	Orders	PCT	n/a	2006	18
	Advanced Clinicals	PCT	n/a	2006	18
Southern	PAS	Acute	Small	2005	1
Cluster	PAS	Acute	Large	2006	2
	PAS	Acute	Medium	2006	10
	PAS	Acute	Small	2006	4
	PAS	Mental Heath	Large	2006	1
	PAS	Mental Heath	Medium	2006	2
	PAS	PCT	n/a	2006	32

Notes:

Deployments are at trust level unless otherwise indicated.

The NE cluster shows the same deployment numbers across 2004, 2005, 2006. This reflects the original deployment plan, which was to deploy Programme solutions across all Trusts in 2004 followed by subsequent upgrades to all Trusts in 2005 and 2006.

Upgrades were not included in the original plans for clusters other than North East.

Table 2

Actual Deployments to Date by Cluster

Cluster	Deployment Type	Care Setting	Year	Number of Deployments	Number of Deployment Upgrades
North East	C&B Enabled PAS	Acute	2004	2	0
Cluster	SAP	Acute	2004	2	0
	SAP	Mental Health	2004	2	0
	SAP	Primary	2004	4	0
	Accident & Emergency	Acute	2005	1	0
	C&B Enabled PAS	Acute	2005	8	0
	SAP	Acute	2005	4	6
	Theatres	Acute	2005	1	0
	Emergency Care System	Ambulance	2005	1	1
	Mental Health PAS	Mental Health	2005	2	0
	SAP	Mental Health	2005	0	2
	Child Health	Primary	2005	9	0
	Community	Primary	2005	4	0
	Map of Medicine	Primary	2005	11	5
	SAP	Primary	2005	8	10
	Theatres	Primary	2005	1	0
	Alt GP Solution	Primary GP	2005	114	73
	C&B Enabled GP System	Primary GP	2005	210	0
	EPS Enabled Alt GP Solution	Primary GP	2005	114	0
	EPS Enabled GP System	Primary GP	2005	15	0
	GP System	Primary GP	2005	10	0
	GP2GP Enabled GP System	Primary GP	2005	9	0
	Map of Medicine	Primary GP	2005	2	1
	Web Based Referer	Primary GP	2005	484	0
	Pharmacy System	Primary PH	2005	4	0
	Acute PAS	Acute	2006	1	0
	C&B Enabled PAS	Acute	2006	8	0
	Map of Medicine	Acute	2006	3	0
	Order Communications	Acute	2006	1	0
	PACS	Acute	2006	3	0
	SAP	Acute	2006	0	6
	Theatres	Acute	2006	1	0
	Emergency Care System	Ambulance	2006	1	0
	Mental Health PAS	Mental Health	2006	0	1
	SAP	Mental Health	2006	1	3
	Child Health	Primary	2006	3	1
	Community	Primary	2006	20	1
	Map of Medicine	Primary	2006	12	1
	SAP	Primary	2006	7	17
	Alt GP Solution	Primary GP	2006	94	0
	C&B Enabled Alt GP System	Primary GP	2006	1	0
	C&B Enabled GP Solution	Primary GP	2006	403	0
	EPS Enabled Alt GP Solution	Primary GP	2006	89	0
	EPS Enabled GP System	Primary GP	2006	86	0
	GP2GP Enabled GP System	Primary GP	2006	20	0
	Map of Medicine	Primary GP	2006	67	9
	Web Based Referer	Primary GP	2006	98	4
	Pharmacy System	Primary PH	2006	350	0
	N3 Connection	n/a	2004	113	n/a
	N3 Connection	n/a	2005	1,834	n/a
	N3 Connection	n/a	2006	494	n/a
	QMAS	Primary	2004	1,215	n/a
	Smartcard Readers	n/a	2004	1,000	n/a
	Smartcard Readers	n/a	2005	29,780	n/a
	Smartcard Readers	n/a	2006	200	n/a
North West	Acute PAS	Acute	2005	2	0
& West	C&B Enabled PAS	Acute	2005	10	1
Midlands	Theatres	Acute	2005	5	0
	Mental Health PAS	Mental Health	2005	4	1
	Community PAS	Primary	2005	51	1
	C&B Enabled GP System	Primary GP	2005	553	0
	EPS Enabled GP System	Primary GP	2005	100	0
	Web Based Referer	Primary GP	2005	493	0
	Pharmacy System	Primary PH	2005	2	0
	Acute PAS	Acute	2006	7	1
	C&B Enabled PAS	Acute	2006	8	0
	PACS	Acute	2006	3	0
	Theatres	Acute	2006	4	0
	Mental Health PAS	Mental Health	2006	0	1
	Community PAS	Primary	2006	7	18
	Health Data Miner	Primary	2006	2	0
	C&B Enabled GP System	Primary GP	2006	1,062	0
	EPS Enabled GP System	Primary GP	2006	287	0
	Web Based Referrer	Primary GP	2006	127	0
	Pharmacy	Primary PH	2006	483	0
	N3 Connection	n/a	2004	128	n/a
	N3 Connection	n/a	2005	2,401	n/a
	N3 Connection	n/a	2006	800	n/a
	QMAS	Primary	2004	2,578	n/a
	Smartcard Readers	n/a	2004	0	n/a
	Smartcard Readers	n/a	2005	55,700	n/a
	Smartcard Readers	n/a	2006	2,200	n/a
East of	Accident & Emergency	Acute	2004	1	0
England and	C&B Enabled PAS	Acute	2004	1	0
East Midlands	Community	Acute	2005	1	0
Cluster	C&B Enabled PAS	Acute	2005	16	2
	Map of Medicine	Acute	2005	14	8
	PACS	Acute	2005	1	0
	Pathology	Acute	2005	1	0
	SAP	Acute	2005	2	0
	Theatres	Acute	2005	1	0
	Emergency Care System	Ambulance	2005	2	1
	Map of Medicine	Ambulance	2005	1	1
	Map of Medicine	Mental Health	2005	5	4
	Mental Health PAS	Mental Health	2005	2	0
	SAP	Mental Health	2005	2	0
	Child Health	Primary		11	0
	Community	Primary		19	0
	Community PAS	Primary		9	0
	Map of Medicine	Primary		46	33
	SAP	Primary		14	11
	Alt GP Solution	Primary	2005	116	88
	C&B Enabled GP System	Primary GP	2005	260	0
	EPS Enabled Alt GP Solution	Primary GP	2005	114	0
	EPS Enabled GP System	Primary GP	2005	48	0
	GP System	Primary GP	2005	7	2
	Map of Medicine	Primary GP	2005	11	0
	Web Based Referrer	Primary GP	2005	332	0
	Acute Community	Acute	2006	2	0
	C&B Enabled PAS	Acute	2006	2	0
	Map of Medicine	Acute	2006	5	0
	PACS	Acute	2006	5	0
	Pathology	Acute	2006	0	2
	SAP	Acute	2006	0	2
	Theatres	Acute	2006	3	0
	Tray Management	Acute	2006	1	0
	Child Health	Mental Health	2006	1	0
	Community	Mental Health	2006	1	0
	Map of Medicine	Mental Health	2006	2	0
	Mental Health PAS	Mental Health	2006	2	0
	SAP	Mental Health	2006	0	3
	Child Health	Primary	2006	24	8
	Community	Primary	2006	30	0
	Community PAS	Primary	2006	8	0
	Map of Medicine	Primary	2006	70	0
	SAP	Primary	2006	12	14
	Alt GP Solution	Primary GP	2006	128	2
	C&B Enabled Alt GP Solution	Primary GP	2006	199	0
	C&B Enabled GP System	Primary GP	2006	535	0
	EPS Enabled Alt GP System	Primary GP	2006	117	0
	EPS Enabled GP System	Primary GP	2006	120	0
	Map of Medicine	Primary GP	2006	140	0
	Web Based Referer	Primary GP	2006	103	0
	Pharmacy System	Primary PH	2006	366	0
	N3 Connection	n/a	2004	109	n/a
	N3 Connection	n/a	2005	2,203	n/a
	N3 Connection	n/a	2006	1,129	n/a
	QMAS	Primary	2004	1,468	n/a
	Smartcard Readers	n/a	2004	7,365	n/a
	Smartcard Readers	n/a	2005	48,379	n/a
	Smartcard Readers	n/a	2006	4,260	n/a
London	C&B Enabled PAS	Acute	2004	3	0
Cluster	Alt GP Solution	Primary GP	2004	17	0
	C&B Enabled Alt GP Solution	Primary GP	2004	12	0
	Web Based Referer	Primary GP	2004	2	0
	Accident & Emergency	Acute	2005	1	0
	Acute PAS	Acute	2005	1	0
	C&B Enabled PAS	Acute	2005	11	0
	Hospital Pharmacy System	Acute	2005	2	0
	PACS	Acute	2005	3	0
	Pathology	Acute	2005	1	0
	Child Health	Primary	2005	10	0
	Alt GP Solution	Primary GP	2005	24	24
	C&B Enabled Alt GP Solution	Primary GP	2005	18	2
	C&B Enabled GP System	Primary GP	2005	250	0
	EPS Enabled GP System	Primary GP	2005	122	0
	Web Based Referer	Primary GP	2005	778	0
	Pharmacy System	Primary PH	2005	1	0
	C&B Enabled PAS	Acute	2006	4	0
	Hospital Pharmacy System	Acute	2006	1	0
	PACS	Acute	2006	7	0
	Mental Health	Mental Health	2006	2	0
	Child Health	Primary	2006	0	20
	Community PAS	Primary	2006	4	0
	PACS	Primary	2006	1	0
	SAP	Primary	2006	1	0
	Alt GP Solution	Primary GP	2006	15	7
	C&B Enabled Alt GP Solution	Primary GP	2006	9	0
	C&B Enabled GP System	Primary GP	2006	167	0
	EPS Enabled Alt GP System	Primary GP	2006	9	0
	EPS Enabled GP System	Primary GP	2006	168	0
	Web Based Referer	Primary GP	2006	257	0
	Pharmacy System	Primary PH	2006	90	0
	N3 Connection	n/a	2004	130	n/a
	N3 Connection	n/a	2005	2,043	n/a
	N3 Connection	n/a	2006	431	n/a
	QMAS	Primary	2004	1,572	n/a
	Smartcard Readers	n/a	2004	0	n/a
	Smartcard Readers	n/a	2005	21,264	n/a
	Smartcard Readers	n/a	2006	7,376	n/a
Southern	Acute PAS	Acute	2005	1	0
Cluster	C&B Enabled PAS	Acute	2005	14	0
	PACS	Acute	2005	5	0
	PACS	Primary	2005	1	0
	C&B Enabled GP System	Primary GP	2005	441	0
	EPS Enabled GP System	Primary GP	2005	110	0
	Web Based Referer	Primary GP	2005	504	0
	Pharmacy System	Primary PH	2005	4	0
	Acute PAS	Acute	2006	2	0
	C&B Enabled PAS	Acute	2006	8	0
	PACS	Acute	2006	20	0
	Community PAS	Primary	2006	28	0
	Primary Care PAS	Primary	2006	0	0
	C&B Enabled GP System	Primary GP	2006	882	0
	EPS Enabled GP System	Primary GP	2006	270	0
	GP2GP Enabled GP System	Primary GP	2006	8	0
	Web Based Referer	Primary GP	2006	28	0
	Pharmacy System	Primary PH	2006	616	0
	N3 Connection	n/a	2004	80	n/a
	N3 Connection	n/a	2005	2,424	n/a
	N3 Connection	n/a	2006	827	n/a
	QMAS	Primary	2004	1,889	n/a
	Smartcard Readers	n/a	2004	0	n/a
	Smartcard Readers	n/a	2005	44,000	n/a
	Smartcard Readers	n/a	2006	5,000	n/a

37.   Please list the administrative and clinical functionality that was due to be delivered in 2004, 2005 and 2006 for each LSP. For example, when were prescribing, results and order requesting due to be delivered by each LSP

  The information is shown below in respect of planned Releases. All clusters started out with the same intent on the functionality to be delivered in each release. Clusters now have divergent plans from the original contracts and hence would now show different delivery dates for each type of functionality.

PHASE 1 RELEASE 1

  Basic Patient Administration System (PAS):

—    Core PAS functionality to replace existing functionality and core User Tools.

—    Enable set up and tailoring of basic ICRS functionality and statutory reporting.

PHASE 1 RELEASE 2

  P1R1 plus elements of clinical functionality including order communications and results reporting:

—    Care Management—simple within organisations.

—    Patient Index—all requirements.

—    Care Management—across organisations and communities.

—    Document Management—document/casenote tracking.

—    Primary and Community Care—Caseload management.

—    Mental Health Administration.

—    Assessment—simple within organisation.

—  Clinical documentation—current environment.

—    Pathology and Radiology Results Reporting—basic services available to all care settings.

—    Decision Support—Library Services available to all care settings.

—    Scheduling—simple within organisation.

—    View, construct and modify care plans and pathways in current environment.

—    Maternity across all care settings.

—    Information for secondary purposes—core reporting within each organisation.

—    Basic A&E within Acute and Community Hospitals.

—    Theatres (including basic scheduling).

—    Alternative solution for GP's.

—    Identification of patients eligible for screening, Disease registers, School health, call and recall, collection of data relating to prevention and screening activities, recording of outcomes.

PHASE 2 RELEASE 1

—    Clinical Documentation—Discharge summaries derived from data collected as part of patient record.

—    Order processing available to all care settings.

—    Specimens and samples, available to all care settings.

—    Order enquiries/management available to all care settings.

—    Further requirements available to all care settings.

—    Outpatient electronic prescribing.

—    Scheduling—across organisations and communities.

—    Information for secondary purposes—advanced reporting including cross cluster reporting.

—    Out of hours services in Primary Care.

—    Critical care—basic within acute care.

PHASE 2 RELEASE 2

—    User Tools—data retrieval.

—    User Tools—remote access to information.

—    Assessment (advanced)—Multi-disciplinary assessment records created.

—    Clinical documentation—integration with cluster wide patient record.

—    Results reporting—further requirements available to all care settings.

—    Embedded guidance available in all care settings.

—    Basic alerts supporting order entry, results reporting, ICP's and other appropriate functions in all care settings.

—    Complex multi-resource scheduling across organisations.

—    Integration with cluster wide patient record.

—    Critical care—advanced within acute care.

—    Prevention, screening and surveillance.

—    Ambulance.

38.   For each acute, community and mental health deployment please state for the month of June 2006:

(i)   The numbers of registered users;

(ii)   The number of unique users that logged on to the system at some time during the month; and

(iii)   The maximum number of concurrent users.

  The information is provided in the tables below. The figures for users of stand-alone systems that are not or not yet Spine connected are not included.

Registered Users (September 2006)

Entity	No of Registered Users
Acute	64,934
Community Health	102,410
Mental Health	15,732
NHSMail	186,036
Pharmacies	15,157
Secondary Uses Service	6,752
Service Definers (SHAs)	4,234
GPs	40,221
Registration Authority Personnel	25,653

Unique Logons Totals (September 2006)

Entity	No of Unique Logons
Acute	44,753
Community Health	70,580
Mental Health	10,842
NHSMail	128,215
Pharmacies	10,446
Secondary Uses Service	4,653
Service Definers (SHAs)	2,918
GPs	27,720
Registration Authority Personnel	17,680

Maximum Concurrent Users*

Entity	No of Concurrent Users
Acute	5,276
Community Health	32,257
Mental Health	1,380
NHSMail	35,019
Pharmacies	2,853
Secondary Uses Service	1,271
Service Definers (SHAs)	797
GPs	7,571
Registration Authority Personnel	4,829

*Note:    Acute, Community Health and Mental Health are actual figures. All other figures for the number of concurrent users are estimated.

39.   Please state the total cost of each acute, mental health and community deployment

  The estimated gross costs of the Programme, including local implementation costs, were set out in the NAO Report. The notes provided in response to Questions 130 and 255 at the PAC Hearing provide some examples of the local costs and benefits of Programme deployments and, as the Programme develops, the original forecasts will be reviewed. The notes referred to also explain our intention to develop an annual statement of the benefits delivered by the Programme, in line with the recommendation in the NAO Report. The first statement will be published next year.

40.   Please supply the total number of GP systems that each LSP will be supplying under the terms of its LSP contract

North East Cluster	1,265—all GP practices
London Cluster	1,661—all GP practices
Southern Cluster	There is an option to require the LSP to provide GP systems to all GP practices but no volumes are currently committed.
East and East Midlands	1,632—all GP practices
North West and West Midlands	CSC is required to make a GP system available but no volumes are currently committed.

41.   Please supply a list of severity one and severity two errors from January to June 2006 stating the Trusts, LSP, date, severity level and nature of the problem for each error

  The summary position is as follows:

Month	Severity 1	Severity 2
January	13	30
February	15	56
March	6	45
April	12	54
May	16	33
June	9	48

  All severity one and two incidents are recorded above, even if the problem proved to be a local one unrelated to the National Programme.

  The breakdown of the information in the form requested would have to be provided by our suppliers and considerable work would be involved to review these past events to provide the full descriptions.

  A chart showing the percentage availability of the services provided under the Programme, both in respect of the National and Local Service Providers, for each month January to June 2006 is provided below. This shows clearly that service availability has been continuously either at 100% or very close to 100% across the whole range of services, demonstrating the rarity of system unavailability.

Enclosure 4: Question 41 - AVAILABILITY PERCENTAGES BY SERVICE AND MONTH

National Service Providers

Local Service Providers

Note: '-' is employed where no availability statistics collated or reported on

  The system failures that do occur do not necessarily affect all users, indeed the effects can be quite localised. The following table demonstrates the rarity of system unavailability for individual users. It shows the product of the number of minutes for which the system was planned to be available multiplied by the number of potential users (ie the planned user minutes). It then shows the percentage of this user time that the systems have actually been available. The data covers the period from August 2005 to September 2006.

System	Total Planned User Minutes (millions)	Availability Service Level %
N3	524,843	99.91
QMAS	4,053	100.00
NHSmail	38,903	99.99
Choose and Book	1,022	99.77
Electronic Prescription Service	4,135	99.99
PACS	1,033	99.78

  Given the rarity of system unavailability, we have not asked our suppliers for the detailed information requested. The Committee may wish to consider whether it is necessary.

42.   Please list each occurrence of a Trust losing or being unable to see patient records and for each occurrence please list the number of records believed to have been affected.

  There have been no instances of data being lost or of patient records becoming permanently unavailable. This contrasts with paper records, in reference to which the BMA discussion paper 2005 Confidentiality as part of a bigger picture said "Lost medical notes, missing information about appointments and concerns about lack of information at times of medical emergency are frequently cited."

43.   Please list any occurrences of patients breaching waiting list guidelines as a result of lost or missing computer records

  We do not hold records of patients breaching waiting list guidelines as a result of lost or missing computer records. The products of the National Programme will improve the administrative processes and are key enablers in the planned reduction of patient waiting times.

44.   Please provide the best estimate of (i) the total number and (ii) the proportion of hospital appointments that are missed because the appointment letter is either sent to the wrong address or is undelivered

  Services such as Choose and Book and the Electronic Prescription Service have provided patients with an opportunity to inform the NHS of changes to their address details. For example when booking appointments, either through the national telephone booking service or directly within a GP practice, healthcare professionals are prompted to check patient demographic details and, as a result, the Personal Demographics Service is updated. This helps maintain the quality of data held on the Personal Demographics Service and ensures it is an efficient reliable source of demographic information for use across the NHS.

  The Personal Demographic Service is currently used daily at over 7,000 locations and the number of updates to patient demographic details received daily is reducing the risk of NHS correspondence being sent to the wrong address or undelivered.

  Initial analysis shows that the use of Choose and Book reduces patient Did Not Attend (DNA) rates. Research from three Primary Care Trusts has shown a 50% reduction in DNA rates based on a very significant sample. A formal DNA research programme is currently ongoing over a larger sample of communities.

  It will be seen from the answer to Question 46 that incidences of undelivered mail are quite small.

45.   Please provide (i) the latest figures available for the total number of patients now registered on Connecting for Health's Patient Demographic Service, and (ii) what the best estimate is of the proportion this represents of the total patient population

  The Personal Demographic Service contains a record for every person who has registered for primary care services (registered with a GP) since 1991 in England, Wales and the Isle of Man. The PDS also includes a record for every baby born since 2002. This represents the majority of the total patient population. However, the Personal Demographic Service is not a population database and it is recognised that there will not be an exact correlation.

  PDS now contains over 73 million patient records which the Choose and Book and Electronic Prescription Services are using successfully as the single authoritative source of patient demographic information.

  The 73 million patient records comprise:

—    50 million people living within England.

—    Patients living within Wales.

—    Patients from other countries, including Scotland, receiving treatment from an English GP.

—    Duplicate records.

—    Deceased patient records.

—    Patients who have emigrated since 1991.

46.   Has a quality audit on the data held on the Patient Demographic Service been commissioned or conducted, and if there has been such an audit what figures were provided by that audit of:

(i)   the number of missing or incorrect GPs on the PDS database;

(ii)   the number of missing or incorrect addresses on the PDS database; and

(iii)    the number of duplicate entries on the PDS database.

  Various audits and data quality initiatives have been undertaken to measure the quality of the PDS data. A recent audit of a sample number of addresses held on PDS showed the quality and format of the data to be good, with 95.5% of recorded addresses matching the Post Office Address File and the remainder being of good quality.

  The Audit Commission undertook a National Duplicate Registration Initiative (NDRI) and published its report in August 2006. Although the initiative did not cover the data held on the Personal Demographic Service, the report recognised that the timing of the initiative had ensured that the full benefits offered by the NDRI data cleanse would be realised as part of the plans for the implementation of the NHS Care Records Service.

MISSING OR INCORRECT GPS ON THE PDS DATABASE

  Approximately 4.5 million records for living persons on the PDS do not include details of a registered GP. This represents approximately 7% of the records held. The majority of these are valid as the PDS contains records where the patient has joined the armed forces or is resident in a prison for longer than two years. Such patients no longer remain with their GP. There are also some cases where a patient is not registered with a GP.

  A recent (May 2006) reconciliation of GP data held by PDS source systems showed a 99.7% reconciliation rate. This indicates that the number of GPs recorded incorrectly on the PDS is very small.

MISSING OR INCORRECT ADDRESSES ON THE PDS DATABASE

  Currently, throughout the NHS regions, there are many locally-held databases containing demographic information about patients. These are available only to healthcare professionals from within the same demographic area or organisation. The information is therefore not always accessible to doctors treating patients who, for example, may have fallen ill in a different part of the country. This can result in delays in identifying a patient, accessing their correct clinical information or in providing treatment. It is for this reason that the NHS in England needs a single, national demographics service to provide an efficient reliable source of demographic information.

  A recent study with a primary care trust indicated that, of approximately half a million patient correspondence items issued per year, approximately 1% are undelivered as the patient is not known at the address.

  Each record on PDS is checked and verified at each patient encounter. The 1% of undelivered patient correspondence implies that the address data is recorded correctly for 99% of the records held.

DUPLICATE ENTRIES ON THE PDS DATABASE

  An audit to establish the number of duplicate entries on the PDS has not been undertaken to date as the NHS Central Register (CHRIS) continues to be the master source for NHS numbers (the unique identifier for each person using the NHS). The CHRIS system ultimately feeds the PDS and will be replaced by the PDS as part of the deployment of the Spine.

  A number of data quality processes are in place to identify, investigate and resolve potential duplicate records on CHRIS.

  In addition to the staff at the NHS Central Register, local "back offices" exist to support the registration of patients with the NHS. There are 82 local, primary care back offices providing support to the registration of patients with the NHS and they are also involved in the identification, investigation and resolution of duplicate entries.

  The average number of potentially duplicate cases resolved each month is currently 330. This includes potentially duplicate cases in both the legacy demographic systems and the PDS.

47.   Please provide details of the spine functionality that has been provided under the BT National Application Service Provider (NASP) contract and details of functionality yet to be provided

Release title	Functionality and Benefits	Live date
P1R1	(1) The Personal Demographics Service (PDS)	June 2004
	The Personal Demographics Service (PDS) is an essential element of the NHS Care Records Service (NHS CRS) which underpins the creation of an electronic care record for every registered NHS patient in England by 2010.
	The PDS is the national electronic database of NHS patient demographic details. It will enable a patient to be readily identified by healthcare professionals and associated, quickly and accurately, with their correct medical details. The PDS will not hold any clinical or sensitive data items such as ethnicity or religion.
	Patient Safety The PDS and access to it for every NHS organisation enables the safe movement of patient data between NHS organisations. This reduces the number of errors in the matching of patients with their care and improves patient safety.
	Patient Convenience With the PDS, patients need only notify one authorised healthcare organisation of a change of address and this change will be available to all organisations as and when patient records are accessed. Eventually, the patient will be able to check and update their own contact details via HealthSpace and these will be made available to healthcare organisations via the PDS. Additionally, the patient's next of kin and carer's details are held on the PDS, two items which are considered by healthcare workers to be key pieces of information when caring for patients.
	Benefits for Healthcare Professionals There are a number of benefits for healthcare professionals. By using the PDS, they can: —  be confident they have access to accurate and complete patient demographic information; —  access the most up to date contact details to ensure that mailings are more likely to reach the intended recipient; —  find more easily the right record for the right patient meaning less chasing records and more time delivering care; —  where necessary, gain urgent access to patients' previous clinical history via direct GP to GP contact as PDS holds a patient's previous GP address and telephone contact details; and —  access the patient's registered GP on encounters where a third party patient's (paper) notes had been incorrectly filed into notes of a newly registered patient's notes.
	(2)  Transaction and Messaging Spine (TMS) Implementation of the Transaction and Messaging Spine (TMS) functionality supported by the implementation of User Registration and Authentication Services. The TMS supports the PDS and Choose and Book message interactions. This enables messages to be passed through Choose and Book between GP and the hospital or specialist care provider. Choose and Book enables hospital bookings to be made by or on behalf of the patient during consultation with GP or after leaving the surgery. It also enables referral information to be sent electronically and securely from GP to hospital consultant.
P1R2	(1)  Implementation of improved business continuity and disaster recovery solution.	Nov 2004
2005-1	(1)  Electronic Transfer of Prescriptions (ETP)	Feb 2005
	The ETP Service allows prescriptions (including for repeat dispensing) generated by GPs and other prescribers to be transferred electronically between prescribers, dispensers and the reimbursement agency, currently the Shared Business Services (SBS) formerly Prescription Pricing Authority. The release includes the SBS interface, and retains the prescription message in ETP until advised by SBS that it has been fulfilled, when it would be discarded as normal. The ETP Service is supported by enhancements to Spine Directory Services (SDS) for accredited systems check, pharmacy and branch surgery information, and support of digital signatures. The main benefit in the first release is that accuracy at the point of dispensing would be improved as the bulk of the prescription details no longer need to be typed manually by dispensing staff. Instead, a bar code on the prescription is scanned to retrieve the details from the Spine.
	(2)  General Practice to General Practice (GP2GP) health record transfer service. The General Practice to General Practice (GP2GP) patient health record transfer solution supports the electronic component of a general practice patient health record being transferred to a new practice when a patient registers with a new practice for primary health care.
2005-2	(1)  Secondary Uses Service	June 2005
	The release comprises, in the main, replacement function for the existing NHS Wide Clearing Services (NWCS) with some additional flexible reporting functionality.
	(2)  Secondary Uses Service—Payment By Results The release supports the 2005-06 algorithms for Payment by Results, implementing rigorous validation and hence improving data quality.
2005-3	(1)  Support for Choose and Book Version 2	Aug 2005
	This release enables referrals to be made to named clinicians for example, if a patient had been treated previously by a consultant and wished to see the same consultant. This gives patients and GPs the ability to refer to a specialist they know and trust and help reduce patient anxiety at a worrying time. The release also enables better integration between Choose and Book and the Patient Administration System (PAS). One of the ways it benefits consultants is that it tells them which GP made the referral so that he or she could refer back quickly to that GP with any query about the referral.
2005-4	(1)  Service enhancements, including database and operating system patches to enhance Spine resilience.	Aug 2005
	(2)  Automated software deployment capability to reduce the risk of service disruption of future releases.
2005-5	(1)  Upgrade to the PDS	Dec 2005
	Upgrades to the PDS that enable recording of pharmacy nominations for the ETP Service The release also enables NHS numbers to be allocated through PDS. This speeds up the process of allocating a NHS number and potentially reduces the number of duplicated/confused patient records. (2)  Legitimate Relationship Service Introduction of the Legitimate Relationship Service to enable Local Service Provider (LSP) deployment of solutions to meet principles of the Care Record Guarantee.
2006-A-1-1	(1)  Secondary Uses Service—Payment by Results	Mar 2006
	Implementation of Algorithm for financial year 2006-07. Building on the previous release, this now supports 100% implementation of Payment by Results (PbR) for 2006/07 reporting on £22 billion of NHS care.
2006-A-1-2	(1)  Secondary Uses Service	May 2006
	The release provides views and reports of data (Provider, Strategic Health Authority, National etc). Enables full "on-line" access for users to report and extract.
2006-A-2	(1)  TMS Upgrade The introduction of new TMS architecture to provide support for increased messaging capacity and performance.
	(2)  PDS Upgrade Supports the transfer of the new PDS messages. (3)  ETP Upgrade This enables the Spine to handle ETP Release 2 messages. The main changes to the prescribing/dispensing process in ETP Release 2 is the extended functionality to enable prescribers to apply digital signatures to the electronic prescription messages—therefore making them the legal prescription over the paper copy. This release will also enable patients to nominate dispensers. The release also includes the addition of management reports and administrative functions.
	Business benefits include: —  Reduced administrative burden placed on prescribers and their staff as there will be less requirement for paper prescriptions (as the digital signature makes the electronic prescription the legal entity); —  Dispensers may be able to enhance workflow and stock control as it may be possible for them to "pull down" and prepare nominated prescriptions from the spine prior to the patient arriving; —  It will be possible for reimbursement claims to be sent electronically, reducing the administrative burden for dispensing staff and the SBS; and —  The ability for prescribers to cancel electronic prescriptions at any time up until the prescription is dispensed. Patient benefits include: —  Increased convenience as they may no longer need to visit the prescribing staff just to collect a paper prescription. Instead they can go straight to their nominated pharmacy; and —  Waiting times at pharmacies may be reduced through improved dispensing workflow.
2006-B-1	(1)  Secondary Uses Service	Nov 2006
	This release supports the functionality previously provided through the NWCS as well as enabling a range of reporting and analysis features including support for national assurance of PbR usage across the country. The functionality allows demonstration of SUS fitness for purpose as a replacement for NWCS.
To be delivered in the future	(1)  Summary Record The Summary Care Record will act as a source of information to support first contact care and less complex care across organisations. This could include out-of-hours, accident and emergency care, ambulance services, treatment of temporary residents on first presentation at a new practice and on acute admission. When a care professional is seeing someone for a straightforward problem, the Summary Care Record will often be all they need to supplement their own records in order to deliver safe care. In circumstances where organisations will ultimately need to access information from the Detailed Care Record, the summary record will be used before a person consents to that wider access. The Summary Care Record will contain significant aspects of a person's care, such as major diagnoses, procedures, current and regular prescriptions, allergies, adverse reactions, drug interactions, and recent investigation results.
	(2)  PDS Upgrades Enhanced PDS Back Office functionality to better report and manage the quality of demographic data through the Demographic Spine Application (DSA). Whilst this will deliver huge financial benefits to the business, the patient will gain intangible benefits as the data quality improves. The functionality includes: —  The manual processing of Civil Births and Deaths rejected from automated processes (including processing of paper-based death notifications from Scotland, Isle of Man, Overseas deaths); —  Changes of identity (gender re-assignments, adoptions and identity protection); —  Birth notifications; —  Resolution of NCRS potential duplicates (inc merge) and confusion cases; —  Resolution of wrongly posted deaths (formal and informal); —  Back office Data Quality reporting; —  Back office processing of removals from a GP list; —  Allocation of NHS numbers to Service Dependants; —  Permanent deletions of NHS CRS records; —  Resetting of consent; —  Ad-hoc general updates to PDS records; —  Management of Back Office Work Items (workflow); and —  Improved management of NHS Numbers.
	(3)  ETP Upgrades Activation of the following ETP functions: —  Reject and Resubmit Reimbursement Claim; and —  Shared Business Services Interface Completion.
	(4)  Support for GP2GP Upgrades Enhancements to enable GP2GP national roll-out.
	(5)  Support for Healthspace Enabling public access to their care records is an important principle for the following reasons: —  Information quality will be improved because patients will be able to check the accuracy of their data through HealthSpace. They may be able to update some elements themselves or flag it for the attention of a healthcare professional; —  Data Protection—HealthSpace will provide systematic access to data held by numerous organisations and will reduce the administrative burden of those organisations in responding to requests under the DPA; —  Customer care: HealthSpace will enable patients to update personal preferences (in PDS)—communicating their wants and needs to NHS organisations with which they interact. Potentially, a hospital will already know your dietary requirements, whether you need an interpreter, whether you need disabled access etc before you even arrive; —  Public involvement: as well as viewing care record data entered by healthcare professionals, HealthSpace will allow patients to enter data into their own care records. This is especially important for people with long-terms conditions (often expert patients) who routinely monitor key metrics themselves. This will open up a new channel of communication between patients and clinicians; —  Personalisation and choice: HealthSpace will bring together data and information to support patient choice in a single, personalised web interface. It will integrate existing systems (like the Choose and Book online application) with the data on which choice is based (waiting times, quality assessments, travel times), augmenting this with value-added services like personalised appointment reminders; —  Modernisation: public access through HealthSpace offers highly visible proof that the NHS is modernising and offering online services comparable with other industries; and —  Public expectations: in a programme of work costing several billions of pounds, it is not unreasonable to expect a modest proportion of this to be devoted to giving the public access to the data that they own, and that is collected and managed at their expense. There is a growing public awareness that public access to care records is coming, and a high level of expectation that this will be soon.

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48.   Please provide details of the current utilisation of the spine in terms of numbers of requests

49.   Please provide details of the anticipated utilisation of the spine once the NCRS service is fully deployed

  The current Spine utilisation is approximately 22 million messages per month. This includes supporting:

—  over 1.2 million bookings through the Choose and Book service, including approximately 270,000 bookings over the past month;

—  over five million prescriptions through the Electronic Prescription Service, including approximately 1.5 million prescriptions over the past month; and

—  580 Medical Record Transfers through GP to GP messaging, including approximately 420 transfers over the past month.

User activity in September

Total Log-ins	1,586,911
Peak Day number of Log-ins	85,066
Total Unique Log-ins	762,682
Peak Day number of Unique Logins	40,636

—    Unique Connections take account of one log-in in for the individual user regardless of the number of times this occurs during the day.

—    The anticipated/forecast volume of Spine Messaging in 2012 (the end of the current roll-out programme) is just over 11 billion for the full year.

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Prepared 17 April 2007