Supplementary memorandum submitted by
Department of Health
PURPOSE OF
THIS NOTE
As part of its investigation of the NHS National
Programme for IT, the Committee interviewed Mr. Andrew Rollerson
on 7 March 2007. Mr Rollerson is an employee of Fujitsu Services
Limited, one of the suppliers engaged by the Department to deliver
the National Programme.
Fujitsu Services has advised the Committee,
and Mr Rollerson confirmed, that he was not speaking on behalf
of Fujitsu. Mr Rollerson also explained to the Committee that
the reports in Computer Weekly were selective and taken out of
context.
The Department emphasises that Mr Rollerson
has not been employed on Programme-related functions for some
time and that he was not, and never has been, in a position to
make authoritative statements relating to the Programme. We also
understand from Fujitsu that Mr Rollerson was not qualified to
comment on Programme Management methods.
However, some wider issues concerning the deliverability
of the National Programme were raised by Committee members during
the questioning of Mr Rollerson. These related to periods subsequent
to the NAO's study, which included data to 31 March 2006. This
note therefore provides some updated information to help the Committee
to set Mr Rollerson's comments in context.
OVERALL AIMS
OF THE
NHS NATIONAL PROGRAMME
FOR IT
Mr Rollerson referred to problems that arise
when transformation programmes are focussed on IT products. The
National Programme is not focussed in this way. It is focussed
on safer and better patient care. It is a large IT-enabled change
providing a huge opportunity for a generational leap in the delivery
of healthcare, with the potential to provide a measurable improvement
to the health of the nation.
Patient safety is being improved significantly
by more accurate information being available quickly for diagnosis
and prescribing. Drug transcribing errors will be reduced. A 2004
study showed that the root cause of 27% of medication errors was
poor information availability. An Audit Commission report shows
that 1,200 people die each year in England as a result of medication
errors, costing the NHS £500 million a year. That report
also showed that 10% of patients on medical wards experience an
adverse event; 46% of which were judged to be preventable; one-third
led to greater morbidity or death; whilst each event leads to
an average of 8.5 additional days in hospital.
Diagnostic waiting times are already being reduced
dramatically by the availability of new IT systems; especially
Picture Archiving & Communications Systems that replace file-based
x-rays with digital imaging that is immediately and remotely available
at any time of day or night. Several hospitals have delivered
reductions from six days to a few hours for the diagnosis of illness.
Efficiency savings will be made from the release of storage space,
film and chemicals. For example, at Sherwood Forest Hospitals
NHS Trust which went live with PACS on 7 September 2006, the first
year's benefits are expected to be £267,000 from eliminating
the need to use x-ray films, £21,000 from reductions in chemical
expenditure and £8,000 in stationery savings. The NHS Litigation
Authority pays out some £500 million per annum on an uncontested
basis because records cannot be produced: electronic records will
significantly reduce this liability.
The patient experience will be transformed and
they will have the ability to view their own clinical record through
Healthspace, a web based portal that will help to provide increased
patient satisfaction, greater confidence in the NHS, a reduction
in anxiety, greater understanding of personal needs, better relationships
with professionals and positive health effects. There will be
fewer lost records and test results. Decision support software
will be available to help clinicians in their diagnosis and treatment
and improved screening will enable the early detection of disease
clusters and outbreaks.
The programme is a key building block of NHS
reform. Only a ubiquitous, effective, national IT system can deliver
new policy reform such as patient choice, the 18 week reform and
a commissioning model—whilst at the same time retaining
flexibility to adopt future policy.
A proven strength of the National Programme
is its ability to adapt to the changing business environment in
the NHS, which was bound to happen during a ten year programme.
The Programme has already incorporated Quality Management &
Analysis System to implement Quality Outcomes for GPs to deliver
patient benefit, which was delivered on time in 2005. Payment
by Results, a system in national use every working day to move
money to Trusts based on results, was delivered on time in June
2005. Changes to include 18 weeks, practice-based commissioning
and NHS re-structuring are on track to be introduced during 2007.
The architecture is designed to be capable of including new policy
and new technology.
THE NHS AND
NATIONAL PROGRAMME
FOR IT
In a typical week, over six million people visit
their GPs, 800,000 people are treated in hospital clinics, and
thousands of operations are performed. This corresponds to around
three million critical processes per day that need accurate patient
and clinical information to be available immediately.
Since the publication of the NAO report last
year, progress has continued and more and more systems are now
deployed and in use. For example, on a typical day in February
2007, as a result of the Programme's work, there were:
— 100,000 prescriptions transmitted
electronically, reducing errors and inefficiencies,
— 16,000 Choose and Book electronic
bookings made, putting patients in charge of their care,
— 1,400,000 queries recorded on the
patient demographic system enabling letters to be posted to the
correct address and patient information handled more efficiently,
— 460 new users registered for access
to the NHS Care Record Service,
— 50,000 unique, authenticated users
accessing NHS Care Record Service,
— 325 new NHS secure email users registered,
— 107,000 NHSMail users, each of whom
has an email address for life, sending 1 million secure e-mails,
one-third of which contain confidential patient information,
— 20 NHS National Network secure broadband
connections installed,
— 8,800 GP practices (28,000 GPs) using
the Quality Management & Analysis System, to deliver better
care to patients under the new GP contract,
— 1 million records added to the Secondary
Uses Service.
When supported fully by a single electronic
records system, this will result in approximately 30 million transactions
per day over a cohesive, robust and resilient infrastructure.
The NHS has already become a digital organisation that is dependent
on IT for the diagnosis and treatment of patients.
Today the NHS could not function without the
systems that have been delivered by the National Programme for
Information Technology.
DELAYS TO
THE PROGRAMME
It was acknowledged in the NAO Report that some
delays had occurred. However, the record shows that much of the
Programme is complete such as the Quality Management & Analysis
System, the N3 broadband roll-out and the technical development
of Picture Archiving & Communications Systems, Choose and
Book and the Electronic Prescription Service; all to time and
to budget.
Picture Archiving & Communications Systems
is on track for deployment by the end of 2007-08, Choose and Book
and the Electronic Prescription Service are both making steady
progress in their deployment into the NHS.
Although much of the NHS Care Record Service
(or "central database") was delivered on time and to
budget, including the Personal Demographics System (PDS), Security
and Authentication Systems and Messaging Systems, the national
summary care record containing the clinical record has been delayed
by around two years against the original plan. This is due partly
to its complexity and partly because of the need to secure consensus
from the medical profession on its contents.
Significant progress has been made at a local
NHS level by the installation of community and child health systems
into Trusts that have not had any previous IT support. Managers
and clinicians have praised the transformation.
PROGRESS TO
DATE
The programme has already made substantial progress.
The position across the major elements of the programme is as
follows:
NHS Care Record Service
— 322,078 registered users
— contains national patient demographic
information for over 48 million patients in England
— patient confidentiality protected
by a Care Record Guarantee and system controls
— over 1.4 million patient records
retrieved successfully from the Personal Demographics Service
every day, helping to identify patients correctly
The NHS Care Record Service is creating an electronic
record for each of England's 50 million patients, replacing four
existing national systems. There are already 322,078 registered
users and over 400 million activity records have been submitted
to Secondary Uses Services. The NHS Care Record Service will bring
process efficiencies and improvements to patient safety, care
and experience, helping to reduce deaths through adverse drug
reactions, of which there were 570 in 2001-02, as well as reducing
the cost of litigation by reducing the number of avoidable adverse
incidents. The summary clinical record is now ready for launch
in April 2007.
Choose and Book
— over 2.5 million Choose and Book
bookings made to date
— over 16,000 bookings made in a typical
day
— now available to 97% of GP practices
— software delivered to time and budget
http://www.chooseandbook.nhs.uk/
GPs and other care staff are booking initial
hospital appointments at a convenient date, time and place for
patients. Currently, there are over 16,000 bookings made per day
and in total over 2.5 million bookings have been made to date.
97% of GP practices are able to make electronic bookings.
Choose and Book has been shown to halve the
number of "did not attends" by giving the patient choice
and placing them in control of their booking. Choose and Book
will save the NHS approximately £50 million a year or 75,000
days a year of nursing and clinical time. "Did not Attend"
rates are 5% for Choose and Book compared to 9% for non-Choose
and Book bookings. Most bookings are made in 44 seconds.
Electronic Prescription Service
— software delivered to time and budget
— over 12 million prescription messages
issued
The Electronic Prescription Service will allow
prescriptions generated by GPs to be transferred electronically
from their surgeries to their local pharmacies. Over 12 million
prescriptions have been transmitted to date and over 550,000 prescriptions
are issued each week. 1,628 GP practices have transmitted prescriptions.
The Electronic Prescription Service more than halves keying time,
by both the pharmacy and the Business Services Authority, equating
to £13 million savings or 700 staff equivalents. The Electronic
Prescription Service will save an estimated eleven lives per week
and will free up 3,920 hospital beds per week by reducing prescribing
errors. The Electronic Prescription Service brings more choice
in access to medication including home delivery and involves less
time for GPs administering repeat prescriptions, reducing this
by 70%. Electronic Prescription Service data will be included
in the patient summary care record.
National Network for the NHS (N3)
— target achieved two months ahead
of schedule with over 18,000 connections delivered
N3 is providing reliable supporting IT infrastructure,
world class networking services, sufficient, secure connectivity
and broadband capacity potential to meet current and future NHS
IT needs. There are 18,362 secure connections of which 10,682
are GP connections. Approximately 1,000,000 NHS employees use
N3 services. All GP sites and branch practices get at least 512Kbps
N3 service. For every £1 spent on N3 the NHS would have spent
£2.25 on the legacy NHS Net. By using N3 to monitor four
ambulance trusts, Yorkshire Air Ambulance has reduced scramble
time from seven to two minutes. N3 transfers 96.5 terabytes of
data per month which is equal to the Encyclopaedia Britannica
every four seconds. There are connections to all sites where healthcare
is offered.
Picture Archiving & Communications Systems
— two Picture Archiving & Communications
Systems going live almost every week (only five a year before
the Programme)
— over 157 million digital images now
stored
— 5.3 million images are typically
added each week
— around 800,000 patient studies per
day
Picture Archiving & Communications Systems
capture, store, distribute and display static or moving digital
images, including x-rays and scans. Over 157 million digital images
have already been stored. Currently there are 71 live deployments
and we are digitising around two hospitals each week. The Picture
Archiving & Communications Systems' Business Case shows £1
billion net benefit, both cash and non-cash, to the NHS over 10
years. Trusts with Picture Archiving & Communications Systems
are more efficient—a typical medium hospital can save 100,000
staff hours, equivalent to 50 staff. Picture Archiving & Communications
Systems enable earlier diagnosis and more prompt treatment—providing
digital transfer of images as required. Before Picture Archiving
& Communications Systems, 5,000 patient procedures per annum
were cancelled due to lost x-ray films.
NHSmail
— over 230,000 registered users
— around one million emails a day,
one-third of which are clinical information
NHSmail is a centrally managed, secure, clinical
email and directory service provided free of charge to the NHS
organisation in England. Currently there are 230,654 registered
users. Over 181 million emails have been transmitted to date,
30% for secure transfer of patient identifiable data. University
City Hospital Leicester estimates £1 million saving over
four years equivalent to an extra 10 nurses a year. All users
have one email account, contact details and diary that can be
shared across multiple organisations. NHSmail will save £185
million over the life of the contract. NHSmail is a secure service
with the highest level of encryption available.
Overall position
The technology to support most aspects of the
National Programme for IT has already been delivered and the remaining
challenge is to utilise these systems fully at local level.
PROGRESS IN
THE SOUTHERN
CLUSTER
At the recent hearing, Richard Bacon MP referred
to some hospitals, like Winchester, who he said have had to take
many steps backwards rather than forward. Whilst it is true that
in some cases hospitals will have individual functionality in
advance of the initial Programme releases, it is worth noting
the comments made by Peter Knight, Winchester's managing director
for clinical support services and asset management, as a contribution
to an article in E-Health Insider. A copy is enclosed. The article
shows the enormous benefits of the systems deployed and does not
support an overall summary of "many steps backwards."
(Enclosure 1)
It may also help the Committee to see the fuller
picture of the deployments that have been made in the South, as
this again shows that progress is more significant than may have
been suggested at the hearing. A summary report is also enclosed.
(Enclosure 2)
CLINICAL ENGAGEMENT
There has been substantial clinical engagement
throughout the life of the programme. Thousands of clinicians
were involved in writing and assuring the original Output Based
Specification on which the contracts were let. Similarly, teams
of clinicians were involved directly in evaluating the proof of
solution and bids from suppliers, prior to contracts being let.
Teams of clinicians across the country have been, and continue
to be, involved on a daily basis to inform the continuing requirement,
specification, design, build and test with suppliers. National
Clinical Leads for GPs, hospital doctors, nurses and Allied Health
Professionals have been in place for two years; and the programme
has appointed a full-time Chief Clinical Officer, who is also
a member of NHS Connecting for Health's Agency Management Board.
CONCLUSION
An effective national information technology
system is a central plank of NHS modernisation. The Programme
has real potential to transform and save lives.
The transformation from paper to digital information
is taking place gradually, and will take to 2010 and beyond. The
NHS will move from being an organisation with fragmented, or incomplete
systems, with physical processing and storage of records on paper
which are often unavailable when required to a position where
national systems are fully integrated, record keeping is digital
and patients have unprecedented access to their personal health
records.
Our last comment is that we dispute the suggestions
from Mr Rollerson that the project control processes are not suited
to their purpose. The Programme Governance systems not only meet,
but have informed the development of OGC best practice. Additionally,
the NAO commissioned an independent appraisal of the project control
processes against an internationally recognised systems' engineering
standard. The NAO concluded that NHS Connecting for Health had
established management systems and structures to match the scale
of the challenge. Fujitsu has informed us that Mr Rollerson has
no recent experience of project management and it was notable
that he was unable to offer any suggestions to the Committee.
Finally, we note the ongoing interest from the
Committee with regard to the NHS National Programme for IT and
would welcome the opportunity to host a visit, or a number of
visits, by Members of the Committee to sites where the systems
are running. There have been over 17,000 deployments since the
Programme's inception and the Committee's may find it helpful
to see for themselves the systems working within the NHS.
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