The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee Contents

Examination of Witnesses (Question Numbers 80-99)


16 June 2008

  Q80  Keith Hill: When will the trusts in the south get meaningful clinical functionality?

  Professor Thick: The start will be the next implementation which I think is in Worcester, it is certainly the West Country, and it will have order communications in it.

  Q81  Keith Hill: Finally, why is there no realistic training environment for Trust staff to use prior to deployment of the new care record system?

  Mr Hextall: In the early deployments there was certainly a mismatch between the training environment that the Trusts were using to train and the system they eventually got, and given that there are differences during the test cycles with the release of software going in in little mini stages, it was inevitable that the training system that was being delivered to them for training, I do not know, three months in advance of the implementation was slightly different to the system they eventually got. With all of our suppliers we recognise that, and there is much less of a mismatch now between the training environment and the system that is being taken, and, where there is, then it needs to be supported by notes explaining where those differences arise.

  Q82  Dr Pugh: All my questions really are about long-term running costs, value for money and lock-in, but I want to talk about specific aspects of the Programme with that focus on it. First, the national network itself. I note in the NAO Report the service contract comes up for renewal every three years, and is not a completely straightforward renewal because presumably in the core services you need to buy your hospital or whatever, and there are others you can choose to add on. I am correct in that, am I?

  Mr Nicholson: Yes.

  Q83  Dr Pugh: Who is the contract with?

  Mr Hextall: The N3 broadband network is with BT.

  Q84  Dr Pugh: If I earmark a hospital, I do not really have an option other than to go to BT for the core services, do I?

  Mr Hextall: Well, it is important to recognise that the contract BT have to supply the N3 broadband network is not for them to supply a BT network; it is for them to act as an agent on behalf of the NHS and get the best price they can. So they do not deploy BT networks everywhere; they buy networks off the whole range of network providers.

  Q85  Dr Pugh: What I am trying to figure out is what scope there is for re-negotiation or negotiation on the part of institutions when you are buying into the national network—and you cannot not buy into the national network?

  Mr Hextall: That is correct.

  Q86  Dr Pugh: There is limited scope?

  Mr Hextall: There is no scope.

  Q87  Dr Pugh: On the national data Spine, again you are using the Oracle database server platform for that, and presumably at some point in time that might become very expensive to use. Is it a realistic option to find another supplier?

  Mr Hextall: Bearing in mind that we have an enterprise-wide agreement with Oracle to supply unlimited—within the parlance it is all you can eat—so as much of the Oracle products as you can buy at a fixed price.

  Q88  Dr Pugh: That may be a very good deal, but if you do not like the deal you are offering is it realistic or sensible or highly disruptive to go elsewhere?

  Mr Hextall: It would be disruptive. That particular decision as to which database platform they use is the supplier's, since they are getting it for nothing effectively.

  Q89  Dr Pugh: So in one case you are stuck with BT, in the other you are stuck with Oracle. I am satisfied with those answers. In terms of the documents generated on the data Spine and so on, they are all presumably in some open European document format so if we did have to use Oracle or whatever, we could. Is that the case?

  Mr Hextall: Yes. They would typically be XML documentation. You mention the servers and being open. 95% of the servers on the BT Spine are—some are Micro systems, Open Solaris.

  Q90  Dr Pugh: So you are not locked into any particular format or suppliers. What is the running cost of the national data supply as opposed to the cost of implementing it?

  Mr Hextall: I will have to give you a note on that. [4]

  Q91 Dr Pugh: Moving on to Choose and Book, are there any central running costs to the NHS as opposed to the costs to the PCTs of actually running Choose and Book?

  Mr Hextall: The contract with Atos is centrally funded so there are not any costs on the PCTs other than providing the GP systems.

  Q92  Dr Pugh: So what is the annual year to year running cost of having Choose and Book?

  Mr Hextall: The whole contract for seven years was £64.5 million.[5]

  Q93 Dr Pugh: Can I just turn to Fujitsu for a second? One thing that is proven about Choose and Book is that GPs are allowed to choose their own systems, and that has been much appreciated by GPs. It did say, page 39, in paragraph 3.42 of our previous NAO Report that this had not been anticipated in the Fujitsu contract. I am right in thinking that, am I not? There is this kind of flexibility?

  Mr Hutchinson: There was no demand for GP in the Fujitsu contract so it was always expected we would add that on later, and that was part of the re-set discussion.

  Q94  Dr Pugh: The extra cost was estimated at £105.9 million?

  Mr Hutchinson: Yes.

  Q95 Dr Pugh: But that was not the deal breaker?

  Mr Hutchinson: No.

  Q96  Dr Pugh: So there was agreement reached on doing that?

  Mr Hutchinson: That would not have been an issue, no.

  Q97  Dr Pugh: After all this IT development—and there is a great deal of it—does the NHS own any software?

  Mr Hextall: We certainly own the intellectual property rights, so the intellectual property rights remain with the NHS.

  Q98  Dr Pugh: Do you have any access to the code of any software you license?

  Mr Hextall: Yes, because we have given a free licence to the Rest of the World for the Microsoft common user interface, for example, because it is to the benefit of patients everywhere if the same interface with clinical systems is used.

  Q99  Dr Pugh: You see, I am just thinking what happens if you do not have a happy relationship with the companies you currently have and you wish to find other companies. Can we turn to patient administration systems? There are a number of them, and obviously Millennium and Lorenzo are two of the better known ones. If I am in a hospital in the north and I have this very rich record listing all my ailments, prescriptions and so on, but I move south and I want a similar record but it would be sitting in a different patient administration system, is it a relatively straightforward process to import all this data, all these ones and noughts, from one system to another, and have you ensured that is the case?

  Mr Hextall: It is not at the moment while both Cerner and Lorenzo are in development. Once both are fully deployed we would hope to be able to achieve transfer of patient records, in the same way we already do with GP records.

4   Ev 24 Back

5   The contract is for five years with an option to extend by two years. The £64.5 million is the cost of the core contract over 5 years. There was also a provision of £80 million over the same period, made at the time of the contract, to purchase services beyond the scope of the original contract, specifically to deliver additional services to support the Department's new policy requirements such as Extended Choice. Together these equate to the £144 million shown in the C&AG's Report. Back

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