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21 Feb 2008 : Column 159WH—continued
“The Government accepts the principle of the second of these recommendations. However, NHS Connecting for Health has reviewed alternative technologies to validate staff identity, such as facial, retinal and fingerprint recognition, and concluded that these are not yet sufficiently mature to operate securely in clinical settings. These technologies will be kept under review.”
I recommend that the Minister talks to his colleagues at the Home Office, which seems to be content to use those technologies: the Department of Health rightly points out the significant problems in their use.
It is interesting to note that Connecting for Health has rejected some of the technology proposed for ID cards. However, when it comes to care records, the debate on the sharing of information between NHS departments and about who should have access to what still has not been resolved. In an intervention earlier in the debate, I mentioned the French system, in which the patient has the key. Patients have to plug in their card before the data can be accessed.
Although there are wider concerns about patient-held records, such as what happens if the key is lost, that system gets around the inter-professional arguments and the protectionism about who should have access to what data. If the patient is happy to give a physiotherapist, a chiropractor, a pharmacist or a nurse permission to look at the information, that should be enough; it should override any professional rivalries.
We need to consider also the sensitive information contained in the sealed envelopes. The Committee learned from its inquiry that the suppliers have not yet been issued a spec for local sealed envelopes. The Government response states that the spec was issued on 3 April 2007, and that
“A timetable will be set as soon as practicable.”
I am not sure why that is so. The spec was released in April 2007. The Government responded in November 2007. I am not sure why, some seven months later, a timetable was not available. I hope that the Minister will update us on progress in that respect.
The Committee was given a demonstration of the summary care record, which revealed some fairly obvious sealed-envelope concerns. For example, if a gentleman is impotent, he might not want it on the face of his medical records. However, health professionals have decided that it is very important to have a full drug history on the first page of the record, because that information can be crucial in making life-saving decisions. It would be clear to anybody who understands generic names of drugs that a gentleman who is on certain medication is impotent. The concept of sealed envelopes was destroyed at a stroke. A discussion is needed, therefore, about the information that goes into the sealed envelope, who can open it and under what circumstances.
Are there other circumstances in which we might unwittingly provide information that a patient might not want to be made quite so readily available? The summary care record is a good example of a system that seems to be added to every time that somebody else gets involved in the process, and it summarises the development of the NHS IT system as a whole. Owing to the lack of initial grass-roots engagement with clinicians, there seems to be no clear idea of what is required and what needs to be delivered through the project as a whole and, in particular, through the summary care record. That variability—the changing that occurs every time the matter is looked at—is a constant feature.
The final area of concern is about the wider use of data. Although the right hon. Member for Rother Valley was very supportive of the need to ensure that we optimise use for research, the Committee became aware of significant and wide-ranging concerns raised by several witnesses about whether the data were sufficiently anonymous, whether it could be tracked to a certain level and whether postcodes would be used as identifiers and so on. Happily, the Government have accepted the Committee’s recommendations to review local and national procedures and has set up the National Information Governance Board. It would be helpful if the Minister, when he sums up, could update us on the work of the research capability programme.
It is very important that we get this right. I was sent a press release today, from the NO2ID campaign. Although I accept that it has an agenda, I support much of what it says. It has taken a very close interest in the electronic patient records. The press release, which it put out to coincide with this debate, states:
“The NHS database is not just used for patient care. The so-called Secondary Uses Service (SUS) does not provide a service to patients. It is a vast hidden system that distributes the most personal (and people think private) information to a horde of bureaucrats and other third parties.
“Pseudonymised” patient information - and in some instances, identifiable patient information - is trafficked for purposes including “clinical audit, performance improvement, research, clinical governance, planning, commissioning, public health and benchmarking”.
Via SUS, a wide range of non-clinical agencies, organisations and even private companies will have massively greater access to personal information on everyone than clinicians. Protection of confidentiality is utterly inadequate and it is unclear how, or even if, individuals can refuse consent for their most private details to be shared among thousands of bureaucrats.”
We know that people can opt out, but that press release will probably be quoted time and again as factual when, in fact, its claims are rather exaggerated. However, often little is done to reassure the public when such things enter the public domain. The Government have work to do to reassure people, if that kind of thing regularly gets into the media.
Mr. Bradshaw: Does the hon. Lady accept that this excellent report, which her party supported, also plays a role in providing that reassurance?
Sandra Gidley: I absolutely accept that. Although I would not quote everything that Richard Granger said as the truth, the absolute truth and nothing but the truth, he made a very interesting point about the fact that many fairly wild accusations have been made about the scheme and get wheeled out and recycled time and again. He said that people are welcome to go and see what his department is doing, but that no one is interested in that—only in scaremongering.
There was some debate in the Committee about whether we should even consider electronic patient records, because the Public Administration Committee did such a good job on that itself. However, the public perception was such that the Committee felt that it needed looking at again, so that we could discover things for ourselves and debunk some of the myths. I am not saying that there are not problems with the project. Everybody acknowledged that. However, the problems are not always on the scale that others claim.
It is important to address some matters, however, if the system is to enjoy full public confidence. In December, The Times carried out a poll of doctors, which showed that only a fifth of them believed that the system would be secure. They might have an agenda. Some of them are against all information sharing and would like to restrict the use of the data to themselves. To an extent, I can understand that. However, the poll also revealed the following:
“More than three quarters are either ‘not confident’ or ‘very worried’ that data will leak once the Pounds 20 billion National Programme for IT (NPfIT) is up and running. Asked how well they thought that local NHS organisations would be able to maintain the privacy of data, only 4 per cent said very well. The majority, 57 per cent, said quite or very poorly.”
That was an online poll over Christmas, so presumably it engaged with those who were happiest with IT. Again, however, such reports in the press do little to inspire public confidence, so work needs to be done.
The right hon. Member for Rother Valley mentioned choose and book. I do not think that it has been quite as successful as he suggested. It might be working brilliantly in Rother Valley, but a recent NHS survey in my constituency found that a frequent complaint was about the booking system, which has many flaws. One of those is that general practitioners can no longer book with individual specialists and have to book with a hospital, which upsets some people who feel that they know which specialist is best for their patients. There is another problem because different hospitals will describe the same clinical service differently. There is not a one-size-fits-all scheme for running hospitals. Furthermore, it is a myth that there is a choice, because it is limited by local commissioning decisions. A patient might have an option of four places to go to, but the local hospital down the road might not be among those four because it is fully booked or the local commissioners are trying to divert business to the local independent sector treatment centre. It is a very complicated system that is not working well in all areas.
I have a few comments to make about the project overall. To sum them up, there was a lack of clarity and direction in the beginning. It is a bit of a red herring to say, “Oh, but we had to put in all these extra systems.” The picture archiving and communications system is often mentioned. Everyone thinks that it is a good thing, but as has been pointed out by other hon. Members, the technology was available for some time before the national programme for IT was even envisaged and would probably have been implemented anyway. Obviously it made sense to incorporate it into the national programme.
The biggest problem is probably the lack of initial engagement with grass-roots users. The number of submissions that mentioned that point is quite overwhelming. I shall quote from the submission by the Royal College of Nursing:
“Although the aims were laudable, the top-down, contract driven approach to implementation has presented tremendous challenges to those who are trying to introduce and implement new systems and ways of working within the clinical environment.”
That sentiment was repeated time and again, and those are the people who want to make the system work. They are not against the system per se; they want a system that they can use and that is in the best interests of the patient.
That problem is at the root of so many delays and extra costs. It probably cannot be blamed for the supplier
problems, which relate to procurement, but I cannot end my comments without mentioning Richard Granger, who was bullish throughout his evidence to the Committee. We learned, among numerous things, that if he had been in charge of the modernising medical careers computer system, there would have been no problems. I do not know whether it was significant that he appeared to announce his resignation the day after he came before the Committee for the second time, but I should like to think so. I have heard rumours—perhaps the Minister will clarify the situation—that he has not left the NHS yet and is still on its payroll.
Mr. Bacon: I was told today, and I believe it to be accurate, that Mr. Granger left the employ of the NHS on 31 January. The Minister will confirm whether that is accurate. The rumour that I have heard is that Mr. Granger has gone to implement the congestion charge in Beijing, where his methods will be better appreciated.
Sandra Gidley: I was given my information before the end of January, so the hon. Gentleman is probably right. It is interesting that Mr. Granger is going to Beijing to implement the congestion charge, because when I first met him, I knew that he had been responsible for implementing the London congestion charge, so I said to him, “Okay, in London, you stopped roadworks for a month, introduced the first week of the congestion charging system during half term, so what will be your equivalent for the NHS?” He just glared at me and said, “That’s a very facetious question,” but it was actually a very serious question.
Will the Minister confirm that Richard Granger finally left the NHS on 31 January? We would also all be interested to know whether he received a pay-off, and if so, how much it was.
4.32 pm
Jeremy Wright (Rugby and Kenilworth) (Con): I begin on a note of complete consensus; I shall not pick up on that last point, which is definitely one that I shall leave to the Minister. We totally support the use of information technology to improve patient care. Although I accept entirely, as my hon. Friend the Member for South Norfolk (Mr. Bacon) said, that the process began long before 2002, there is complete agreement among contributors to the debate that it is a good thing in principle. I shall make two general observations about the report, and then I shall deal with matters in more detail.
First, the NHS IT programme covers a good deal more ground than the report. Mr. Weir, you would not wish me to go into detail about the stuff that the report does not include, so I shall restrict myself to that which it does. It does not, for example, include choose and book, which has been mentioned, or the electronic prescription service. That is worth noting.
Secondly, the report was not unanimous, as the right hon. Member for Rother Valley (Mr. Barron) said. It is true that part of the reason why was the perception—I am sure that it was inaccurate—that the right hon. Gentleman had, to some extent, made up his mind at an early stage about some of the issues that the report
covers. He spoke on 6 June 2007 in an Opposition-day debate about the more general subject of NHS information technology, and he made two points of note for today’s debate. First, he appeared to indicate that an independent review of the electronic patient record project would not be in the interests of the NHS, which is entirely consistent with what he said today. Secondly, in his view, confidentiality and security of electronic patient records was not a significant concern, which is not entirely similar to what he has said today. Be that as it may, we should concentrate on those two issues: first, whether a wide-ranging review of the system is appropriate; and secondly, whether issues of confidentiality and security have been adequately dealt with.
On the question of a review, we have already heard that the National Audit Office makes multi-billion pound estimates of the system’s cost to the taxpayer, but it seems that a full zero-based independent review of the project, which can be conducted while the work on the system continues, would allow us to know whether the investment will deliver the improvements that it should. I take entirely the point that the hon. Member for Wyre Forest (Dr. Taylor) made. It must be an option for any such review to say that we should go back to square one. If the review, properly conducted, came to that conclusion, we would be well advised to listen, but the process of reviewing need not stop the process of developing the programme.
There is clearly room for doubt about whether the programme will deliver what it is expected to. Although the Committee was right to reject the option of a full review, in the areas that the report covers, it seems to me that the Committee made a pretty good case for one. Several extracts from the report have already been quoted. I will not read them all, but it is worth noting several fairly trenchant criticisms that were made about the general direction of, and grip on, the project, which is clearly not there. Paragraph 115 states:
“The Committee was dismayed, however, by the lack of clarity about what information will be included in the SCR and what the record will be used for”,
which has already been quoted. Paragraph 131 states:
“There was a stark contrast between the specific and detailed vision set out for the ‘Integrated Care Records Service’ in 2003, and the vague and shifting vision set out for the DCR in 2007.”
Further, at paragraph 192, the Committee states
“that other parts of the project are beset by significant problems. The most serious of these are: the lack of clarity about the ultimate vision for the shared DCR record, particularly the area which will be covered and the level of information which will be shared; the absence of a clear timetable for implementing shared DCR records”.
Finally, paragraph 229, which the right hon. Member for Rother Valley quoted, indicates the
“perplexing lack of clarity about exactly what NPfIT will now deliver.”
Indeed, the report later states:
“There is an explanatory vacuum surrounding DCR systems and this must be addressed”.
If those issues are not properly understood and dealt with, the system cannot be effective, and that is why a full review is necessary.
Charlotte Atkins: The hon. Gentleman has clearly taken the trouble to read the debate of 6 June 2007. During it, the hon. Member for Eddisbury (Mr. O'Brien) said:
“If the Government do not agree to a full and independent review today as a result of our call, we will, as a matter of urgency, set one up ourselves.”—[Official Report, 6 June 2007; Vol. 461, c. 264.]
I wonder how that review is going.
Jeremy Wright: It is under way, and I am sure that the hon. Lady will be fascinated to hear the results. However, it should not be up to Her Majesty’s Opposition to do that work; it should have been done by the Government. There is still an opportunity—if the Minister takes it—to engage in the process, because I maintain that it is possible to do so while the work on the programme continues. The case for it, which was made in the report by the Committee of which the hon. Lady is a member, is very strong indeed.
The Committee rejected the review, at least in part, on the ground that the programme had already been scrutinised by the National Audit Office, the Public Accounts Committee, which is represented by my hon. Friend the Member for South Norfolk in the Chamber today, and of course by the Health Committee itself. However, it is also right to point out that the NAO and the PAC are primarily concerned, quite rightly, with value for taxpayers’ money. However, that is not the only issue; indeed, it is not the only issue—far from it—that has been canvassed in the debate so far.
As I have already observed, the Health Committee’s report covers only part of the NHS IT programme, and even in the part that it covers, which is the topic of our discussion, it is not complete. It does not deal, for example, with security of data, to which I shall turn next.
Mr. Bacon: My hon. Friend points out that one reason why the Health Committee did not agree to a review was that the NAO and the PAC had already considered the matter. However, if he reads the relevant PAC report, he will see from paragraph 3 that one of its recommendations was:
“The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.”
Furthermore, paragraph 4 contained what I thought was one of our Committee’s most important recommendations:
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