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4 Feb 2009 : Column 267WH—continued
I want the Minister to answer a few straight questions. What will he do to tackle the 330,000 or so missed calls each year to the Appointments Line? What will he do about the 18-week waiting period “black hole”? What will he do about the fact that only 60 per cent. of appointments in Stockport are made through choose and book? Whether he goes forwards or backwards, can
he at least ensure that all the appointments are on the computer screen? What will he do about the duplication and expense involved? There is the expense of appointments line itself; the duplication of a manual system and of a choose and book system; the wastage of multiple automated letters, complete with postage, even when the fault is on the side of the Appointments Line itself; and of course the retention of parallel paperwork systems, when all the information is supposed to be on the computer.
There is a lot of frustration and annoyance among patients. They face a system that is designed for robots, not people. It denies local choice and blocks opportunities. I do not want my constituents’ concerns to be brushed over with a load of sloppy departmental whitewash. I want some clear, hard answers.
We have now got well past the “teething problems” excuse. We have got past the “waiting for it to get better” stage. We are right up to the “putting it right” stage, and I want to hear from the Minister today exactly how he proposes to put the choose and book system right.
2.59 pm
Mark Hunter (Cheadle) (LD): It is a pleasure to contribute to the debate under your chairmanship, Mrs. Dean. I thank my constituency neighbour, my hon. Friend the Member for Hazel Grove (Andrew Stunell), for securing a debate on what all hon. Members will agree is a very important subject, certainly if our postbags are anything to judge by.
This is not the first time that I have spoken in such a debate or the first time that I have raised this issue. It is a matter of record that in Health questions last November I asked the Minister if he might agree that there is a need to review the choose and book system in the light of the many complaints that we have been receiving and the significant difficulties that it has caused, the likes of which have been so well chronicled today by my hon. Friend. The Minister replied that choose and book is
“one of the great success stories of the national programme for IT.”—[Official Report, 4 November 2008; Vol. 482, c. 102.]
I hope that my colleagues, whatever party they are in, will agree that the Minister’s response to that question showed a failure to understand the real frustration that so many of our constituents feel.
My constituents have contacted me to complain about the system and about what they perceive to be complacency in dealing with the problems that it is helping to create rather than to resolve. If the Minister would term the system a great success—that term is lifted directly from his answer to my question—I sincerely hope, for all our sakes, that we never find out what he would consider to be a failure. It is evident that the choose and book system is an unnecessary, expensive and inefficient IT and administrative system that serves only to divert money away from much-needed improvements to local health services. When one asks local people what they would prefer that money to be spent on—I am sure that many hon. Members on both sides of the House have done that—they say that they want their local surgery or hospital to be improved. They do not want money to be spent on another ridiculous and badly performing Government IT system.
My constituents want to be offered appointments at their local hospital. My hon. Friend and I share a local hospital at Stepping Hill in Stockport. People want to
be offered appointments in a local hospital that is within easy travelling distance from their homes, with the best consultant to deal with their problem. They want to get their appointments quickly and to be treated well when they attend. The choose and book system is making that harder, because people are unable to get through to make appointments, as we have heard in so much detail from my hon. Friend. In some cases, when people do get through, they are told that no appointments are available at their local hospital, sometimes because those places are being booked up by people from outside the area. That is a form of madness.
With the best will in the world, and given the regard that I hold the Minister in, I think that he is being put in the position of having to defend the indefensible. I hope that he is able to respond positively to this debate. All we are asking for at this stage is a review of the system’s operational efficiency. Surely, anyone would accept, on the weight of the evidence, that there are good reasons for asking for such a review, and surely the Minister does not want to defend good money going after bad into a system that is patently failing patients.
It is not only politicians who criticise the system. The British Medical Association and local doctors do not think that it works. Indeed, many have gone on record as saying that it is getting in the way of choice. GPs want to refer patients to the specialists whom they feel are best suited to deal with their patients’ specific problems, but in many areas they cannot do that because the system allows them to make appointments only with departments, not with particular specialists.
This is not a party political issue. All of us in this place, regardless of party affiliation, want to have the best possible health service for our constituents, whom we have the privilege of representing in Parliament. Will the Minister rethink the system, which is failing the very people whom it was set up to serve? It is undoubtedly an expensive system, and the bureaucracy attached to it, with pamphlets and reminder letters being sent out, is relentless and expensive. The system confuses many people and has already proved inefficient and ineffective. Perhaps it is time for a review, so that we can consider using the money that we spend on choose and book, which has patently failed to operate properly, on improving local services instead. I am sure that we would all agree to that. I hope that the Minister will take that message firmly on board today.
3.5 pm
Norman Lamb (North Norfolk) (LD): Let me start by congratulating my hon. Friend the Member for Hazel Grove (Andrew Stunell) on securing this important debate. I congratulate also my hon. Friend the Member for Cheadle (Mark Hunter) on his contribution, which was also important to the debate.
Choose and book is part of the national programme for IT. It seems to me, and to most people who have looked into this issue, that the Government are in complete denial regarding the scale of the problems with that programme. The Minister is a reasonable man, and I suggest that he should take this opportunity to accept the problems that the programme has experienced. He is not responsible for instituting the system, as he has inherited this nightmare, and everyone would welcome his acceptance of the massive challenges that the national programme faces.
My hon. Friend the Member for Hazel Grove has described the experiences of his individual constituents. I am sure that the Minister will agree that the situation in the first case that my hon. Friend described, that of Mr. I, is intolerable. We cannot accept a situation in which someone who experiences anxiety about hospital referrals has to go through such an experience. It should be incumbent on us all to realise that that is not acceptable and to find ways of changing things for the better.
The national programme was centrally flawed from the start. I went to a fascinating seminar at which someone who has been heavily involved in the national programme spoke candidly about its whole design. He said that there had been no systems review at the start, which means that there had been no process by which the different people who were building and buying the system reached agreement with those who would be using it about what they were trying to achieve. He explained that although such a review is of fundamental importance to any IT project, it had been missed from that project because of the political imperative to drive it forward. He also said that we do not have sufficient skills in the UK to deliver the programme as it was originally designed.
Many other people have made the absolutely valid point that it is stupid and wrong centrally to impose a system on a highly diverse health system without getting buy-in from the clinicians who are to use it. A small number of providers are involved: at first there were four, and now there are only two because the other two have deserted the project. Smaller IT providers, which have historically provided all the innovation, have been excluded from the project, and we now have the highly vulnerable situation in which the whole system depends on just two providers because the other two have left. We are told in a report in The Times this week that one of those that has left—Fujitsu—is pursuing a claim for some £600 million against the Government. I would be grateful if the Minister responded to that report and confirmed whether it is true.
The national programme for IT is years behind schedule. We were told by the National Audit Office that completion was expected around 2014, but that now appears to be in doubt; it looks as if the time scale will be even longer. We also know that the whole programme is billions of pounds over budget. In a response to a parliamentary question that I recently tabled, it has been revealed that the number of severe faults in NHS computer systems has almost doubled in the past three years. That potentially puts patients and their care at risk. We have to take that matter very seriously.
There are two particular problem areas in the national programme for IT. The first is the national care records system, which is the national database of all of our patient records. In this day and age, I do not know who on earth would trust the Government to look after sensitive patient records—I certainly do not. In its report this week, the Public Accounts Committee has highlighted its serious concerns about the scale of the crisis that the national care records system now faces.
This debate is on the other matter that has caused real concern: choose and book. I want to start the analysis of where we are going wrong with choose and book by establishing some principles. First, I fully accept that the concept of electronic booking and someone being able to sit with their GP or someone else in the
practice and make a booking—for example, for the Stepping Hill hospital in Stockport—is an attractive proposition. For the patient to know that an appointment has been booked when they leave the GP practice is a good concept and we should not lose sight of that.
The second principle, which I absolutely support, is the concept of enabling patients to choose the clinician whom they want to see. Critically, that should be done on the advice of a person’s GP, because they will often be guiding us in the decisions that we make. As my hon. Friend pointed out, in the vast majority of cases the individual patient will want to choose their local hospital. However, there might sometimes be a good reason why someone does not want to choose their local hospital—for example, it could be that an elderly person wants to stay with a son or daughter somewhere else in the country, or that someone’s local hospital has a poor record on hospital-acquired infections. There could be all sorts of reasons why an individual might choose to go elsewhere, and people should have the right to do so.
Andrew Stunell: Does my hon. Friend agree that the choice that people want to exercise is to balance convenience against the timing of the appointment? If it is a question of going to Stepping Hill in two months’ time or somewhere further away in one month’s time, they should have that choice. There should not be a black hole preventing them from exercising that choice.
Norman Lamb: I agree with that point, which I was going to come on to. Critically, when we talk about choice, we must be clear about what we mean and have a clear idea about what is a good thing for patients to have a say on. It is not just a matter of patients being able to choose hospital buildings; it is about patients having a central involvement with the clinician to whom they are referred. As my hon. Friend pointed out, the system is not good at enabling someone to choose a particular specialist or consultant. I understand that the system is theoretically capable of doing that, but in most cases the way in which it is used does not provide that choice—people are simply presented with a list of hospital buildings. People should also, of course, have a central say in the treatment options that might be available.
As my hon. Friend pointed out, there are a whole load of unacceptable practical problems with the system that individual patients, their GPs and, indeed, the people at the other end of the link—the clinicians in the hospital—are experiencing. It is worth pointing out that this problem is not peculiar to Stockport and Cheadle; I have had to take up concerns about it in Norfolk. When I raised the issue with the local hospital and primary care trust, their response was, “Yes, we agree. We’re having problems with the choose and book regional office down in Milton Keynes.” They accepted that there were problems with the operation of the system in the east of England.
We have had complaints that the system is slow. GPs get totally frustrated at the fact that it takes a long time to open up attachments and so on, so the temptation is not to use it. The system is unreliable and we are told that it crashes when people try to open attachments. The telephone system is a complete nightmare and a third of a million calls were unanswered in a year, which
is completely unacceptable. When one hears the experience of Mr I, one is left with the sense that, far from personalising care—a concept that we all ought to be able to sign up to—the system is making it far more impersonal. People try their best to book an appointment but keep getting rebuffed. They then receive a letter complaining that they have not booked an appointment, and when they try to respond, they find there is no address to which to respond. This is driving people crazy, and it ought not to be necessary for Members of Parliament to intervene. Whenever people go to their MP to sort out problems, one always has the sense that there are a whole load of other people out there who may not have the wherewithal to go to their MP. Such people are left unable to get their hospital appointment booked up. That is completely unacceptable.
Another problem with choose and book relates to the central issue of choice. The great paradox of this system is that it actually constrains choice. The Government’s great claim is that the system is the central feature of offering choice to patients, but if someone happens to want to see a consultant because their GP has recommended that consultant to them, and the waiting list for that consultant is longer than 18 weeks, that choice is removed—even if it is for a speciality where a wait of 18 weeks is not damaging to someone’s health. For example, someone might want an appointment for orthopaedics and be prepared to wait a little longer, albeit in pain, because they want to go to a particular consultant. However, as my hon. Friend has pointed out, if that wait is longer than 18 weeks the choice disappears. This is centrally constrained choice. The truth is that the system has more to do with managing the 18-week target than with offering real, genuine choice for patients. If the system was about the latter, I should have the right to wait longer than 18 weeks if I wish to see a particular consultant.
I completely support the principle of informed choice guided and supported by someone’s GP, but because so many GPs are frustrated with dealing with a slow system, they refer bookings to the practice administrator. The recent British Medical Association report makes the point that the system is working reasonably well when an administrator is doing the booking. However, that administrator will not always make the right judgment. The clinicians at the hospital end of the divide often find that the wrong booking has been made—for example, for a general clinic rather than a specialist clinic. The patient then has to be referred somewhere else. I have had reports of patients being confronted by two appointments that clash. They are then left to make a judgment themselves about which appointment to take and which to cancel, and they may well make the wrong decision.
Professor Wendy Currie, head of information systems and management at the Warwick business school—it is part of Warwick university—has studied the national programme, including choose and book. She says that the software for choose and book started life as a billing system in the United States. It was then developed into an electronic booking system—a simple system for booking appointments from the GP’s surgery. It was nothing to do with choice or with presenting the GP and the patient with a list of four different hospitals; it was just a system for booking appointments—very sensible, as I said at the start of my remarks. The previous Secretary
of State then morphed the UK system, Professor Currie says, into the central plank of the Government’s “choice” strategy. She also says that we need to get the function and technical specification right at the start. However, the software was designed for one purpose but it is being used for a different one, and all the evidence suggests that it is not sufficiently robust to cope with the demands that it faces; and this is when, nationally, only 50 per cent. of appointments are booked using the system.
Andrew Stunell: Does my hon. Friend acknowledge that when the chief executive of NHS Direct reports software problems, and when the software is on version 4.6 after only three years, there is clear evidence that the IT system is not robust enough for the job that it has been asked to do?
Norman Lamb: Absolutely. There is clear and mounting evidence of the software’s inadequacy to live up to expectations. Returning to the point that I made to the Minister earlier, I hope he will concede that, for those of us who believe both in empowering patients to make decisions about which clinician to be referred to, which hospital to go to, the treatment options and so on, and in booking appointments electronically, the system does not provide patients with real choice. It causes immense frustration for clinicians who are already under enormous time pressure.
Professor Currie argues for de-scoping the contract and returning it to what it was originally intended to be: a straightforward electronic booking system. There is enormous merit in that. We may eventually get there, but it would be an enormous help if the Government conceded the scale of the problems—the monumental mess that we face. We need, first, Government recognition of the problems for clinicians and, critically, for patients, many of whom are vulnerable; secondly, as my hon. Friend the Member for Cheadle said, we need a thorough review, which the Government must act on; thirdly, we need to learn the lesson that grandiose, centrally imposed systems that are ill-thought through and do not get buy-in from clinicians are doomed to failure.
3.22 pm
Mark Simmonds (Boston and Skegness) (Con): It is a pleasure to serve under your guidance, Mrs. Dean—for the first time, I think. I congratulate the hon. Member for Hazel Grove (Andrew Stunell) on securing the debate and on the excellent way in which he highlighted, in considerable detail, the concerns of many of his constituents. I suspect that he highlighted only the worst cases, and that if he had had more time he could have brought many more cases to our attention. I have had similar issues in my constituency in Lincolnshire, so they are clearly not limited to a particular part of the country. Indeed, I know that the hon. Member for North Norfolk (Norman Lamb) has had similar problems in Norfolk, across the Wash from my constituency.
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