House of Commons
Wednesday 6 June 2007
The House met at half-past Eleven o’clock
[Mr. Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Severn Estuary (Electricity)
Will my right hon. Friend seek commitments from UK Cabinet and Assembly colleagues to ensure that Welsh universities have the support to enable them to develop sustainable technologies—such as those harnessing wave, tidal or river current energy—in order to generate electricity and to help bring research and development jobs and manufacturing jobs to Wales?
We certainly want every opportunity to be explored. I welcome my hon. Friend’s interest and support. The Severn barrage could create up to 35,000 jobs over the nine-year construction period, half of them in areas surrounding the Severn estuary. It is anticipated that in the longer term about 40,000 permanent jobs would result from the barrage, which would lead to economic regeneration in terms of recreation, transport, housing, industrial and commercial property, tourism and infrastructure development. My hon. Friend is right that renewable energy has enormous potential not only to fight climate change but to strengthen the economy and to create more jobs.
Further to the question of the hon. Member for Llanelli (Nia Griffith), will the right hon. Gentleman also make sure that in-depth research is undertaken into the possible use of tidal lagoons in Wales, bearing in mind the New Zealand experience where that is a huge component in the energy mix?
I welcome the hon. Gentleman’s interest in that issue, and the Sustainable Development Commission is looking into it. However, previous assessments suggest that a lagoon alternative in the Severn would produce less than a third of the generating capacity of the barrage, and in addition the barrage would save about two and a half times more carbon dioxide emissions than a lagoon. Prior to any further investigations at least, the barrage therefore appears to me to be a much better bet, and it would also offer the opportunity of a transport link between Taunton and south Wales, which could be of enormous benefit on both sides of the Severn.
The Severn estuary is an internationally important site for wild birds. Does the Secretary of State agree that it is important that we protect the habitats that would be affected by the proposal, and that that must be taken into consideration before any development goes ahead?
Yes; my hon. Friend raises an important point. The European Union birds and habitats directives must be considered in relation to the project. However, I should draw it to the House’s attention that the experience at La Rance river in France is that biodiversity can increase as a result of the construction of a barrage. Also, if we are not prepared to take bold steps to fight climate change, biodiversity will be, in a sense, a secondary matter. That will be the case if we get the terrible consequences to life on this planet that would come from climate change, which can be avoided by the adoption of projects such as the Severn barrage, which could create up to 5 per cent. of the UK’s electricity-generating needs.
While I welcome tidal energy in the Severn estuary, is the right hon. Gentleman aware that there is enough tidal power off the north Wales coast to offset the need for a replacement nuclear power station in Anglesey? However, given that all bar one of the Labour deputy leadership candidates said on “Newsnight” that they support more nuclear power stations, including the right hon. Gentleman, how can anyone seriously believe that the second nuclear consultation is not destined to be as big a sham as the first?
It is not a sham. I have always made it clear that if a nuclear new-build is necessary in order to keep the lights on, it would be irresponsible to rule that out. As the hon. Gentleman knows, no one is more enthusiastic about clean, green renewable energy than me. Indeed, I often have scraps with Liberal Democrats about wind farms and other sources of clean, green energy, because they are in favour of green energy in principle, but in practice differences can arise. However, I think that we can work together to make sure that Wales benefits from all forms of energy. Sometimes there is a demand for a replacement nuclear power station. That is the case in Anglesey. The local council and my hon. Friend the Member for Ynys Môn (Albert Owen) support a replacement of the existing nuclear power station, and they deserve to be supported.
I very much thank the Secretary of State for those remarks. I support a rich and diverse energy mix, including tidal power. However, will the Secretary of State assure me that funds and support will not be diverted from established and emerging options into one big project, such as the Severn barrage? If we are serious about security of energy supply and lowering carbon emissions, we need a rich energy mix.
We do, and we need our energy to be developed and sustained as much as possible in home-grown forms, so that we are not dependent on fossil fuels imported from abroad, including from many unstable areas of the world. So this is not just a climate change but a security of supply issue. However, I see no conflict here between strong renewable energy and considering the nuclear option in Anglesey, for example, if that is appropriate. The Severn barrage is a privately funded project; the construction companies—McAlpine, Balfour Beatty and others—that formed a consortium intend to fund it privately. Indeed, that is the point: there would not be a big draw on public funds.
Will the Secretary of State assure me that despite the obvious, early and absolute backing for the Severn barrage scheme given in answer to the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd), the Secretary of State is not going to rule out investigating tidal lagoons? Has he had the opportunity to read the research produced by Friends of the Earth showing that the generation cost from tidal lagoons is more economically beneficial than that from the barrage; and will he give this House and the people of Wales an absolute assurance that he will carry out full investigations into the environmental impact of the barrage and of the lagoons, and not rule out the lagoon option at this stage?
I can assure the hon. Lady that I am not ruling it out; indeed, the Sustainable Development Commission is looking at this option. However, the facts are reasonably clear—unless they are contradicted by any further study—that the barrage would generate masses more power and is lower in emissions, and there are other benefits. The risk in the Severn area of flooding, especially as sea levels rise, is enormous, and the barrage would clearly help by providing a much securer environment for local houses and businesses. It also offers the exciting prospect of a transport link, with Cardiff airport being just round the corner. So there are benefits, which is why there is a lot of support in the south-west of England for this proposal, especially along the coast. The local regional development agency, for example, supports the idea of a barrage. So that is where my preference lies, but obviously we will look at the evidence.
However bold the Severn barrage project is, we must not ignore the opportunities along other parts of our coastline. In Swansea, particularly Swansea bay, the lagoon has captured people’s imagination and there is a great deal of support for it. There should be more localisation of power generation. Does the Secretary of State agree?
I completely agree with my hon. Friend. Indeed, Wales is supremely well placed to harness the benefits of tidal and wave power because we have such an extensive coastline, including in the Swansea bay area, which provides a great tidal power opportunity. We should look at all options there, including the one that she mentions.
My right hon. Friend has regular discussions with the Secretary of State for Health on a range of health issues. I understand that Wales has opted out of using MTAS for recruitment, and that the Department of Health had no difficulty with its doing that.
When I tackled the Secretary of State for Health on this matter some two weeks ago, I asked her where in the application form there was a reference to the qualification of being able to speak Welsh. Her answer was, I am afraid, woefully inadequate. Will the Minister take this matter up with the Department of Health, given that there are shortages of Welsh-speaking doctors not only in general practice but in paediatrics, psychiatry and geriatrics? There is a pool of Welsh-speaking doctors—not only in Wales—who could be recruited.
I saw the exchange between the hon. Gentleman and the Secretary of State for Health, and I can tell him that the current recruitment system in Wales does allow for applicants to complete their form and then be interviewed in the Welsh language, provided that they inform the recruitment panel in advance. As we are interviewing every applicant, there is that clear opportunity for them to make the case that they have this additional benefit—it clearly is a benefit in many parts of Wales—of being able to communicate with their patients in Welsh. When I have discussions with Edwina Hart, the new Welsh Assembly Health Minister, I will raise this matter.
I welcome the fact that we are not going to be using in Wales a scheme that has been described by the British Medical Association as a disaster. Can the Minister assure us that any alternative that we do use will rely on doctors’ experience and their proven ability to make people better, and not on their ability to write 150-word vignettes full of jargon, or even—dare I say it?—the ability to speak Welsh?
Well, the hon. Gentleman gives us his usual rant, but the system that is now being used in Wales—in which every applicant will receive an interview—has been warmly welcomed by the Welsh deanery and the BMA Welsh junior doctors committee. The process is working well in Wales and we now have more than 2,200 doctors in training in Wales. The number of training places in Wales will rise from 261 last year to 320 next year. The investment in doctors’ training and medical students is proving to be a great success, and that is why we are seeing substantial improvements in the quality of care being provided in Wales and in England.
Hospital Waiting Times
The Assembly Government are investing record amounts in the NHS in Wales and are delivering real improvements in the standard of service to patients. Waiting times for Welsh patients in English hospitals are falling.
I am grateful to the Minister for that optimistic response. The Royal Shrewsbury hospital supplies tremendous service to Welsh patients, especially those from mid-Wales, but why do Welsh patients have to wait 29 per cent. longer than English patients for routine elective operations and 39 per cent. longer for a first out-patient appointment?
The facts are that there are no Welsh patients waiting more than eight months for treatment in hospitals, including the Royal Shrewsbury, compared with 900 a year ago, and in the past three years the number of Welsh patients waiting for more than six months for a first appointment at an English hospital has fallen by 61 per cent. Those are significant improvements. Yes, further improvements can be made, but the Welsh Assembly Government will spend £5.5 billion on the health service in Wales next year, amounting to £1,800 per person, something that could not be achieved by the hon. Gentleman’s policy of sharing tax cuts with public service investment. That would mean a £21 billion cut.
Much progress has been made in reducing waiting times for patients from Wales attending hospitals in England. In Wrexham, visits to the Countess of Chester and Gobowen hospitals have much shorter waiting times. I suggest, however, that there be close discussions with the new Welsh Health Minister on that issue and on cross-border funding issues. I suggest that my hon. Friend also discuss the matter with the new Assembly Member for Wrexham, Lesley Griffiths. I may have omitted to mention the fact that Wrexham was a Labour gain—
Indeed. I congratulate Lesley Griffiths on her recent success. My hon. Friend is right that the investment in the health service in Wales is delivering real improvements and waiting times are falling. Local health boards in Wales need to talk to hospitals in England about local packages of care, but given the money that is now going into the health service in Wales, finance should not be a problem.
The Minister mentions that the target waiting time for elective surgery is eight months. In fact, as I am sure he will agree, that is the target waiting time for in-patient treatment. The combined target waiting time for Welsh patients is a total of 68 weeks, whereas for English patients it is 31 weeks. Can the Minister explain why Welsh patients—who after all pay their taxes at the same rates as English patients—should be expected to wait in pain for an additional 37 weeks? Is that a policy decision by the Welsh Assembly Government, or is it incompetence?
As I said earlier, no Welsh patient is waiting for care in an English hospital for more than 12 months, compared with 900 last year. I suggest that the hon. Gentleman look back at the figures for 1996-97, which were substantially higher than those for last year. No patient in Wales waits longer than eight months for in-patient care, which means that many of them actually receive care long before the eight-month target time.
The First Minister will announce later today the Welsh Assembly Government’s strategic and legislative programme for the coming months. He has already announced in plenary on 25 May that he will bring forward proposals in relation to child poverty, affordable housing, climate change and better access to health care.
I thank the Secretary of State for his reply. How closely do the Labour Government in Westminster intend to involve Westminster MPs in scrutinising Welsh legislative issues? Is not the Secretary of State concerned—as Opposition Members are—that such scrutiny opportunities for Westminster MPs are limited to statutory instruments, secondary legislative bodies and Welsh Committees? What can he do to give more scrutiny by the House?
I very much support the principle of scrutiny, particularly pre-legislative scrutiny, which I took forward in my previous post as Leader of the House. The Welsh Affairs Committee has the opportunity to pre-scrutinise matters and only yesterday produced a valuable report, which noted that the whole House could be involved. Although it is a Welsh Members’ Select Committee, other Members have the opportunity to give evidence to it and to contribute to the scrutiny process. There are other ways of achieving that, too.
I welcome the Secretary of State’s positive comments about our report. Would he be prepared to appear before the Select Committee to discuss the matter more fully? Like him and the whole House, we are keen to ensure that there is thorough scrutiny of all framework powers going through the Welsh Assembly Government.
Undoubtedly, the introduction of Orders in Council, as provided for in the Government of Wales Act 2006, to give the Assembly the opportunity to take extra measure-making powers is an important advance, and my hon. Friend’s Committee will have a valuable pre-scrutiny role. He referred to framework powers, as did the report, and my right hon. Friends the Members for Torfaen (Mr. Murphy) and for Islwyn (Mr. Touhig) have also raised the issue on the Floor of the House. It is an important issue, and an explanatory memorandum will of course accompany each proposed framework power in an England and Wales Bill and will be placed in the Libraries of both Houses. We need to make sure that a full explanation is provided by the Welsh Assembly Government so that Members have the chance to look at what they are being invited to endorse in a Bill.
In discussing with the First Minister his proposals for climate change legislation, will the Secretary of State ensure that the First Minister is fully aware of the controversial cross-border issues that will arise over proposals for the Severn barrage? Will the Secretary of State and the First Minister ensure that before they proceed they visit the barrage de La Rance at St. Malo, where they will see how over 40 years, and to generate only 3 per cent. of the electricity of Brittany, the environment has been devastated and biodiversity has been sterilised? The impact of the barrage on that part of France has been devastatingly bad and there will be great opposition to the Severn barrage on those grounds alone.
That is not my understanding, but obviously if the hon. Gentleman wants to put evidence before me I shall be happy to look at it. As I understand it, the evidence shows that La Rance river, which is the only equivalent project that I know about, has seen an increase in biodiversity. Given the support for the proposal in the south-west, from Bristol down to Taunton, including the regional development agency and local authorities, I think the Severn barrage could be of enormous benefit environmentally and in every other way.
I am not sure that the Secretary of State will have time to visit the Rance project; after all, he did not have time, or was unable, to attend the opening of the Welsh Assembly yesterday. However, will he find time to ask the First Minister how he can claim to be leading a listening Government in Wales when he has not discussed his legislative programme with the other parties and did not even attend the televised debate between party leaders on the legislation last night? Is not the truth that Labour continues to take Wales for granted even when it has lost its majority and lost its authority?
This is from a Welsh Conservative party that did extremely badly at the 3 May elections and that has consistently lost ground in Wales over the past 20 years because of its anti-Welsh policies and the way in which unemployment went up and bankruptcies and public spending cuts increased in Wales under the Tories. All that would lie in Wales’s future if Tory Ministers took power away from a Welsh Assembly Labour Government. Tory Ministers back in power and in charge of Wales is not something that the people of Wales want.
I have regular discussions on a range of issues, including housing. I welcome the extra £1 billion for Wales that my right hon. Friend the Chancellor provided in his Budget, which covers, of course, every public service.
I thank my right hon. Friend for that reply. Does he agree that council housing must be part of the social housing mix? Will he assure me that he and the Government will respond positively to the message coming from council house tenants such as those in Swansea who say that they wish to stick with the local authority as their landlord and want proper investment in council housing?
I am strongly sympathetic to the point of view that my hon. Friend argues. Indeed, the Welsh Labour manifesto pledged to invest £450 million in new social and affordable housing, thus bringing about 6,500 additional homes. It is important that we make housing a real priority, including that of councils and housing associations, because there is a real need for more affordable homes to rent in Wales and right throughout Britain.
I have regular meetings with the Assembly Minister for Health and Social Services on a range of issues, including the provision of ambulance services.
I thank the Minister for that answer. Ambulance services are a particular challenge in Gloucestershire, especially in Forest of Dean, given the nature of its geography. In some cases, it would make sense for the Welsh ambulance service to deal with patients in the southern part of my constituency. Will the Minister use whatever good offices he has to encourage Welsh Assembly Ministers to urge the Welsh ambulance service to work seamlessly with its colleagues in Gloucestershire, because we do not want the Welsh border to become a barrier to effective health care? [Interruption.]
The hon. Member for Forest of Dean (Mr. Harper) makes a very good point. I understand that the Great Western ambulance service, which covers his constituency, has joint working arrangements with the Welsh ambulance service to deal with specific sites such as bridges and tunnels. Those working arrangements are regularly reviewed. I understand that there are closer working arrangements and co-operation elsewhere on the border. I will shortly be meeting Edwina Hart, the Assembly Minister with responsibility for health, and I will take up the point that the hon. Gentleman makes.
In fact, response times have improved dramatically in the Welsh Ambulance Services NHS Trust. It was formed in 1998, and for the past two months, it has exceeded its target of responding to 60 per cent. of life-threatening emergencies inside eight minutes. That is a result of substantial investment in staff and, especially, equipment. The service is meeting its targets and continues to improve. I am sure that the hon. Gentleman would appreciate some assistance from the Welsh ambulance trust.
The Barnett formula has worked well in delivering funding for Wales, and I have been taking every opportunity to discuss the forthcoming spending review with the Chancellor and with the Chief Secretary to ensure that it continues to do so.
Public expenditure per head of population in Wales is £1,000 more than in England, yet patients in Wales have to wait significantly longer for NHS treatment. Five thousand patients in Wales are waiting more than six months for an NHS operation—what has gone wrong?
The Prime Minister was asked—
Before listing my engagements, as the House will know there has been fierce fighting in the south of Afghanistan in which UK troops are being deployed with considerable courage and commitment on their part. I know that the whole House will want to join me in sending our profound condolences to the family and friends of those who have fallen: Guardsman Daniel Probyn of 1st Battalion the Grenadier Guards, Corporal Darren Bonner of 1st Battalion the Royal Anglican Regiment and Corporal Mike Gilyeat of the Royal Military Police. This country should be very proud of the sacrifice they have made.
This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings later today.
I associate myself and my constituents with the expressions of condolence for the families of the service personnel lost in action.
Will my right hon. Friend join me in congratulating the Northampton climate change forum, which has its first meeting tomorrow evening under the excellent chairmanship of Terry Smithson of our local wildlife trust? As my right hon. Friend heads off to the G8, what message does he have for climate change campaigners in Northampton and elsewhere on what he hopes will be achieved in Germany?
I congratulate the Northampton climate change forum on the work that it does, which shows the interest that is taken in this issue in constituencies and communities up and down the country. What will be important at the G8 is first, that for the first time we manage to get agreement on the science of climate change and the fact that it is human activity that is causing it; secondly, that we manage to get agreement that there should be a new global deal that involves all the main players, including America and China, when the Kyoto protocol expires in 2012; and thirdly, that at the heart of that has to be a global target for a substantial reduction in greenhouse gas emissions. That should be followed through via the United Nations process. Those are the key things that we need out of the G8 agenda. I hope that my hon. Friend does not mind my saying, however, that we should not forget the necessity of also keeping to our commitments on Africa.
I join the Prime Minister in paying tribute to Corporal Mike Gilyeat, Corporal Darren Bonner and Guardsman Daniel Probyn, who were all killed in Afghanistan. They died serving their country.
Tonight, the House of Lords will vote on proposals to help the 125,000 people who are suffering because their pension schemes went bust. The Government fund set up to support those people has so far helped only just over 1,000, and yet it has cost £10 million to administer. Will the Prime Minister confirm those figures?
The total amount of the fund over the years to come will be some £8 billion. There used to be no help available to people in this situation; there is help available now. The difficulty with the House of Lords amendment—we have had this exchange several times—is that unless we can be sure that we can keep to those commitments within the £8 billion that has been set aside by the Government, it is irresponsible to hold out the promise that we can go up to 100 per cent. if we are not able to do so.
The Prime Minister will not confirm the figures, but I have to say that they are unacceptable. Yes, we have had this exchange before. When I raised this with the Prime Minister two months ago, he promised a review of the unclaimed assets and said that he would try to get the maximum compensation level. What are the results of that review? Does he recognise that tonight’s vote is probably the last chance that he has as Prime Minister, without any long-term spending commitment, to right the wrong that has been done to those people?
First, let me make one thing clear to the right hon. Gentleman—more than 100,000 people will benefit from the scheme. There used to be absolutely nothing for those people. Secondly, let me point out to him that the reason why we have not gone beyond 80 per cent. is that it is wrong to promise that we can go further than that unless we can say how it will be paid for. We simply cannot, on the basis of the Treasury loan scheme or the idea of unclaimed assets, make future spending commitments outside the £8 billion. That is not sensible and it is not responsible. As for suggesting that we are not helping people, it is true that more than 1,000 people have already been helped, but in the years to come there will be tens of thousands more.
The reason the Government scheme was set up was because so many pension schemes went bust under the Prime Minister’s Government. That is the problem. What the pensioners involved need is help now as thousands of them have reached retirement age. I have to say to him that when the Maxwell crisis was sorted out—[Interruption.] Yes, when the Maxwell crisis was sorted out, the Government of the day used a Treasury loan to advance money to those affected without putting long-term costs on the Exchequer. Why does the Prime Minister not do the same thing now?
It is not possible to do what we propose unless we set aside the money now, because what we cannot do is promise people that we will pay them more for their pensions, over and above the £8 billion commitment, which has been given to people for the first time and which will allow us to compensate them for 80 per cent. To end up promising more without saying where the money will come from is an idea that I might describe as completely “delusional”.
Will my right hon. Friend join me in welcoming any decision by Edinburgh university to strip Robert Mugabe of his honorary degree, and will he ensure that neither Mugabe nor any of his henchmen are permitted to come to Britain with visas until democracy is fully restored to Zimbabwe?
I join the Prime Minister in his expressions of condolence and support for the relatives of those who have lost their lives in the service of our country.
With 200,000 people killed and 2 million displaced from their homes, what can the people of Darfur expect from the G8?
I hope that they can expect a recommitment to sanctions if the Sudanese Government do not abide by the peace accord that has been set out and do not stop bombing their citizens. The Sudanese Government should also welcome the hybrid African Union-United Nations force as that is the only way that we will keep the combatants apart. In addition to that, it is important that rebel groups abide by the peace accord. I am sure that Darfur will be raised in the course of the G8.
Is it not time not only for tougher sanctions against the Sudanese Government, but for a much more effective arms embargo and for much better logistical support for the African Union mission in Sudan? Will the Prime Minister tell the other members of the G8 that we cannot afford another Rwanda?
It is precisely for that reason that, in part as a result of pressure from this Government, we have an African Union force in Sudan. We are giving it logistic support, but it is true that we need to do more, as I have already said. I am afraid that the arms embargo will not, in this instance, meet the issue. What will do so is building up the African Union’s peacekeeping capability. One of the things that we will discuss at the G8 is the progress that we have made since Gleneagles—for example, the UK has been involved in training some 11,000 peacekeepers in Africa. However, the only solution is a strong African Union peacekeeping force that can be deployed in such situations. Darfur has not slipped into being a Rwanda yet, but the right hon. and learned Gentleman is right—it is a parlous situation and it is essential that we take action, and we will be pressing for that action.
I agree with what my hon. Friend said about the boycott and I very much hope that that decision is overturned because it does absolutely no good for the peace process or, indeed, for relations in that part of the world. He is right to emphasise that the only solution ultimately is to relaunch the framework for a negotiated peace with a two-state solution at its heart, and we will work on that.
The G8 agreed at Gleneagles that by 2010 everyone suffering from HIV/AIDS would have access to the medicines that they need. Will the Prime Minister confirm that, sadly, almost three quarters of sufferers still do not have access to that treatment?
There are 1 million more people who receive treatment, but the right hon. Gentleman is right to say that we need to go further. The commitment is to do that by 2010, and I hope that we will recommit to that at the G8 summit at Heiligendamm. In addition, the announcement by the Americans to double their HIV/AIDS spending from $15 billion to $30 billion is extremely important. The Germans have now committed an extra €3 billion of aid to Africa over the next four years, which is also important, and this country is making a huge contribution to fighting HIV/AIDS. Yes, we need to go further, but it is important to realise that, as a result of what was done at Gleneagles, 1 million more people are now receiving treatment.
Charities such as ActionAid believe that the specific proposals set out in the draft communiqué do not go nearly far enough, and they believe that the goal agreed at Gleneagles is on the verge of collapse, which would result in millions of preventable deaths. We have long argued for interim targets, as the Prime Minister knows. Does he agree that it would be a disaster if the current wording of the communiqué is allowed to stand?
We are trying to strengthen that language and put in some specifics, particularly in relation to HIV/AIDS treatment. For obvious and natural reasons, pressure groups always say that not enough is being done or that the situation is in danger of collapse. Since Gleneagles, however, there has been almost $40 billion of debt relief; there have been substantial increases in aid, including to Africa; millions more children are in primary education; and, as I said, 1 million extra people are receiving HIV/AIDS treatment. As I saw for myself last week in South Africa, the possibility, if we expand the use of drugs for those people, is that we can save millions of lives, so we have to do so. It is precisely to achieve those types of commitments that we will go to the G8 and negotiate.
I congratulate my right hon. Friend on engaging in dialogue with some of the most distinguished Muslim leaders and scholars around the world at a recent conference at Lancaster House. He rightly wants the authentic and true voice of Islam to be heard in Britain. How does he believe that he can achieve that?
I thank my hon. Friend for the work that he has done in that area. What is interesting, and what came out very strongly from the two-day conference, is the fact that the moderate, reasonable voice of Islam is the majority voice of Islam. It is not heard enough, but it was interesting that people around the world, including some of the most distinguished Islamic scholars, made it quite clear that they wanted no truck with extremism.
I think that the hon. Gentleman is exaggerating the situation a trifle. Of course, there are pressures on children today: pressures through exams and through the type of things to which they have access a lot earlier than generations past. The majority of young people whom I meet are working hard and are extremely responsible, decent members of society who behave very well. There is a minority who either misbehave or are socially excluded and we need specific measures to help them. However, I do not think that the debate is helped by that type of hyperbole, if the hon. Gentleman does not mind my saying so.
Because I have enormous respect for my hon. Friend and because this may be the last time that he asks me a question at Prime Minister’s questions, I do not want to disagree with him—but if I were pushed, I might. It is important—and this has been made clear—that on matters such as expenses, MPs continue to be very open. There is a consensus on that. A huge amount of scrutiny is given by the House about Members of Parliament and I do not think we should apologise for what we do in the House.
Of course, local decision making is important, but I hope that the hon. Gentleman agrees that if we are to deal with housing issues, we have to expand the availability of housing because of the expansion in the number of households. I agree that a balance needs to be struck, but that must include proposals that allow us to make sure that our people, particularly our younger people, have houses to buy.
The 25p per week age addition to state pensions for the over-80s has remained at the same level since 1971. Does the Prime Minister agree that the time is right to review that derisory amount? Should the Government give consideration to, say, adding a £25 lump sum to the winter fuel allowance as an alternative?
Those are obviously decisions that have to be taken at the time of the Budget. Although I entirely understand the point that my hon. Friend makes, we are now spending, on an annual basis, about £11 billion a year extra for our pensioners. They have the winter fuel allowance, the free TV licences for the over-75s, and a substantial uplift in many of the payments that are made through the pension credit. There is one other thing that is worth pointing out: over the next few years we will move to a situation where the basic state pension is relinked to earning. That will benefit many of our pensioners to a far greater degree than even an extra £25.
Each of those decisions must be taken on the basis of local conditions, but they are driven by clinicians, not cost. In emergencies involving some of the most serious illnesses such as stroke or heart disease, it is better for people to be treated by paramedics in an ambulance and then taken to a specialised unit. The idea of changing accident and emergency, like maternity services or paediatrics, is therefore driven by the fact that there is increasing specialised provision that does the best for patients. I ask the hon. Gentleman to take account of that.
The Prime Minister will be talking with Mr. Putin at the G8 and discussing the Litvinenko case. We have other problems with Russia—the threat to target missiles at European cities, the fact that Shell and BP have effectively been renationalised there, and the boycott of trade with Poland. All those are grave and troubling signs of a different approach from Russia. Will the Prime Minister talk frankly to Mr. Putin about those problems? We want partnership with Russia on Iran, Kosovo and other issues. Will he also talk frankly with his European partners, because it is European unity and sticking together that will achieve that?
There will be an opportunity to talk to President Putin at the summit. I have always had good relations with President Putin. We want good relations with Russia, but that can be achieved only on the basis that there are certain shared principles and shared values. If there are not, there is no point in making hollow threats against Russia. The consequence is that people in Europe will want to minimise the business that they do with Russia if that happens. A closer relationship between Europe and Russia is important, but it will be a sustainable relationship only if it is based on those shared values.
The most important thing is that whoever is on the Policing Board and whoever is taking part in the politics of Northern Ireland does so on the basis of complete commitment to democracy and exclusively peaceful means. That applies to everybody. That is the central test, and it is a test monitored, as the hon. Gentleman knows, by the Independent Monitoring Commission.
The point that my hon. Friend has raised about coastal towns is very important. Because the focus is sometimes on inner-city regeneration, people forget that some coastal towns have large numbers of people who are either socially excluded or unemployed and that such local economies can be difficult. It is precisely for that reason that we are looking at what more we can do to support our coastal towns and to make sure that a fair proportion of the £20 billion that we are spending on regeneration gets to them to allow them to develop local economies that are sustainable in the future.
It is correct that there was a small rise here and, indeed, elsewhere in Europe. It is precisely for that reason that we have agreed a new framework for the European emissions trading system. I know that the right hon. Gentleman may find it hard to support anything with the word “European” in it, but it is none the less important to recognise that it is only through that trading scheme that we will make a difference. The fact that the European Council has now set very ambitious targets for CO2 emissions and greenhouse gas emissions is extremely important. Incidentally, this country will meet our targets under the Kyoto treaty.
I thought that there was a developing consensus, although it has faltered a little in the past few days. The academy programme is proving to be a real success story with parents, and it is providing excellent education for some of the poorest communities in the country. My hon. Friend is absolutely right: it is part of a change throughout schools in our country, where there has been massive capital investment and better results. As a result of investment and reform, we now have a situation totally different from that a few years back. The vast majority of our children are getting educated well. We need to go further—we know that we do—but the fact is that education in this country has been transformed in the past decade.
As I said to the hon. Member for North-East Milton Keynes (Mr. Lancaster) earlier, the green belt is being protected—we now have far more development on brownfield sites—and that is absolutely right, but we need to build more homes. If the Conservative party says that, in general, we need to give help to first-time buyers and those who need to get into the housing market, and help to ensure that we have proper housing, it cannot then, in particular, oppose every housing development in different parts of the country. That simply shows me that the Conservative party, in that area of policy as in many others, has still not worked it out.
My hon. Friend is absolutely right to say that the opportunities now exist because many hundreds of schools throughout the country have GCSE results that are well over 70 per cent. In addition, there have been thousands of refurbishments, some 2,500 extra sports facilities and we have the biggest school building programme under way that the country has ever seen. Consequently, standards are also improving. The great thing about many of the new schools—I have recently visited several—is that they are designed differently, their whole look is different, and the children feel that, for the first time, they are in an environment that will encourage them to do better and learn. That is all about our programme and our commitment to providing excellence not just for a few, but for all.
Sometimes, the best people to speak about Iraq are the elected politicians there. I refer the hon. Gentleman to the press conference—which, unsurprisingly, was not covered—that the President of Iraq gave here a few weeks ago. He said that however difficult the situation because of the terrorists, we should never forget what it was like under Saddam and that, if terrorists try to stop the country getting democracy, we should stand up and fight them, not give in to them.
My hon. Friend’s point is absolutely right and reasonable. We are putting a huge investment—some £2 billion—into supporting our post office network. However, as he rightly implies, changes are happening that mean that the way in which post offices operate must change if they are to be viable in future. We will try to identify as quickly as possible the post offices that are at risk and those that are not. However, my hon. Friend is right that there is no point in kidding ourselves—we must find new ways of making the network viable and ensuring that people can use it to carry out a further range of transactions, but not close our eyes to the inevitable fact that many more people now take their money through their bank account and not the post office. There is a viable future, but it has to be on the basis of the suggested changes.
I thank the hon. Gentleman for his opening remarks. As he knows, my belief is that we do not need a constitutional treaty and that we should have a simplified and amending treaty. I can assure him that all the red lines that we have set out will be protected for this country, but it is also in the interests of this country that we find a way for Europe to operate more effectively with 27 members than it can under rules designed for 15 or fewer members.
I congratulate my hon. Friend’s constituents on their work in the car industry and also on finding environmentally beneficial ways of ensuring that the car fleet is modernised to take account of the pressures of climate change. We are investing several million pounds in research into hydrogen fuel cell technology. I have no doubt that, partly as a result of agreeing that we will have a global target this week at the G8, there will be a big impetus behind those types of technologies for the future. I certainly hope that we can do so.
Point of Order
On a point of order, Mr. Speaker. I know you take very seriously the convention that Members should notify other Members when they go to their constituencies, so I wanted to ask for your advice about this matter. When the right hon. and learned Member for Camberwell and Peckham (Ms Harman) was conducting her deputy leadership tour on Friday 25 May, she not only appeared in my constituency, but featured in the local newspaper. My office has been in touch with hers to ask for an explanation of that oversight and still awaits a reply. Could you, Mr. Speaker, perhaps give me some advice about what I can do about it?
Perhaps the hon. Gentleman could contact the right hon. and learned Lady and find out why she was—[Interruption.] Let me finish. If it was on a Labour party matter, it is nothing to do with me or the House. It is only when an hon. Member makes an official visit—[Interruption.] The hon. Gentleman is showing me some papers, but if it is a Labour party matter, it is not a matter for the Chair. These matters should be sorted out between—[Interruption.] I hope that the hon. Gentleman is listening, because he might learn something. These matters should be sorted out between hon. Members and not drawn to the attention of the Chair.
Armed Forces (Federation)
I beg to move,
That leave be given to bring in a Bill to make provision for the establishment of a Federation for the Armed Forces; and for connected purposes.
I am pleased to have the opportunity to introduce this Bill today. Last year, I had the pleasure of serving on the Committee that considered the Armed Forces Bill. During consideration in Committee, I moved new clause 23, which would have established the formation of an armed forces federation open to serving and retired members of Her Majesty’s armed forces, both regular and reserve. I have to say that I was neither surprised nor disappointed that the new clause was not accepted, but our consideration of it allowed the Committee to discuss the issues surrounding it.
I now believe that there is a groundswell of opinion among the public as well as among members of the armed forces that it is time that those members should have an independent voice to represent their interests. Recent controversies surrounding accommodation, the treatment given in medical facilities to injured personnel returning from Iraq—and, of course, the scandal at Deepcut—have highlighted the increasing need for members of the armed forces to have an independent voice and to ensure that it is heard.
There is also increasing evidence that members of Her Majesty’s armed forces need to have access to independent legal advice. In the previous Parliament, I also served on the Committee that considered the Armed Forces (Pensions and Compensation) Act 2004. It was clear from those deliberations that members of Her Majesty’s armed services needed independent employment advice and advice about their pensions.
I propose not a trade union but a federation along the lines of the Police Federation. I want to build on the excellent work already done by the British Armed Forces Federation, which was set up in 2006, has recently been incorporated as a company limited by guarantee, and is now recruiting members. The work of Douglas Young and his team at the BAFF has been important in raising awareness of such issues among members of the armed forces. The Bill would put the federation on a formal recognised footing with the Ministry of Defence.
The aim of the Bill is to encompass the 10-point plan put forward by the BAFF, which states:
“The federation’s mission shall be to represent, foster and promote the professional welfare, and other legitimate interests of all members of the federation in their capacity as serving or retired personnel of the fighting services of the United Kingdom”.
That will help to maximise the operational efficiency of our armed forces and improve retention and training.
The activities of the federation would cover five main areas: first, professional and career development through the provision of education and information; secondly, liaison, monitoring and response to proposals or developments within the armed forces and in Parliament, and the provision of services in the public or commercial sector for armed forces personnel; thirdly, advocacy and consultation to protect and improve the conditions of service life, including pay, accommodation, medical and welfare services, resettlement packages and all other areas of support for armed forces personnel and their families; fourthly, support to personnel facing court martial or other legal proceedings in connection with their service; and finally, negotiation of commercial benefits for armed forces personnel and their families.
It is important that the federation is seen to be independent, and is not beholden to any political party, pressure group or defence interest. While the federation needs robust and adequate funding, it is important that it is not seen as just another pressure group for defence interests. The federation will not take a view on defence strategy or operational decisions, although it may raise individual, legitimate concerns affecting its members.
To clarify, I reiterate that the federation will not be a trade union for the armed forces. It will not conduct or condone any form of industrial action or insubordination within the armed forces. The federation will seek to work with the Ministry of Defence to put in place a form of understanding that could deal with such issues. It will also recognise the importance of the chain of command. If we look at the BAFF’s website, we see that it clearly reinforces the point that the chain of command is to be recognised, not overridden.
The proposal might be seen as radical and dangerous by certain members of the armed forces, and possibly by some Opposition Members. But may I point out that many other nations, including the United States and Australia, already have such federations, which have the support of the military command in those countries? The proposal, however, is not to copy those, but to bring forward a British solution for the British armed forces. It will reflect the ethos and robust traditions of the three fighting services, but it will also meet the requirements of men and women who are serving in our armed forces.
The best example that I can give is that of the Armed Forces Federation of Australia. It is an independent voice on pay and allowances and represents members of the armed forces on employment issues. It also gives legal advice, financial assistance and advice, and allows for discounts and savings schemes nationally for all members of the Australian armed forces. The federation is controlled and structured by its members and is independent of the Australian military, although it has the backing of senior military figures. In the introduction to its latest handbook, Air Chief Marshall Houston says:
“As an independent representative body for military personnel, I welcome the Federation’s continued contribution to the development of personnel policies for the ADF”.
He acknowledged the federation’s “ongoing commitment and contribution” to the Australian armed forces.
The Bill would not set up an armed forces federation; it already exists. Instead, it would allow the BAFF to be recognised by the Ministry of Defence and be valued for providing a voice for ordinary members of our armed forces. The BAFF has already stated that if legislation, such as this Bill, were introduced, it would look to work with the Government and stakeholders to develop the appropriate structures for the representation of members of our armed forces. The Bill provides just that opportunity, and I urge the House to support it.
Question put and agreed to.
Bill ordered to be brought in by Mr. Kevan Jones, Mr. David Anderson, Mr. Iain Wright, David Wright, Helen Jones and Jim Sheridan.
Armed Forces (Federation)
Mr. Kevan Jones accordingly presented a Bill to make provision for the establishment of a Federation for the Armed Forces; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 117].
[13th Allotted Day]
NHS IT Programme
I beg to move,
That this House acknowledges the aims of the NHS National Programme for Information Technology (IT) and supports them in principle, recognising the potential benefits IT can bring to patients and NHS staff if implemented correctly; deplores the hasty conception of the National Programme under the noble Lord, Lord Hunt of Kings Heath, and the failure to consult adequately with service users; regrets the parallel failure by the Department of Health to implement successfully the Medical Training Application process; expresses concern about the impact of the Care Records Service on patient confidentiality; notes in particular the concerns of the Committee of Public Accounts, in the context of its criticisms of the Government’s mismanagement of IT projects at large about the cost, delays in the Care Records System, the lack of a firm timetable for delivery, the struggles faced by suppliers to the programme, and the lack of engagement with frontline NHS professionals; regrets the opportunity cost to patient care and the disillusionment caused by the Programme amongst NHS staff; seeks assurances on the supply chain, particularly regarding iSOFT and an explanation for the delays in Choose and Book; and therefore calls for a full and independent review of the NHS IT programme.
I draw attention to my entry in the Register of Members’ Interests.
Let me be clear from the outset: Conservative Members believe in ensuring that all patients in our NHS will get better care in future, from the expertise, dedication and wonderful work of NHS doctors, nurses, therapists and, yes, NHS managers, by harnessing information technology to improve the processes for patients’ treatments and their clinical outcomes. So, yes, we endorse the aims of the NHS national programme for IT, known as NPfIT and succeeded by Connecting for Health, which we support in principle, but—it is a big “but”—the reason for the debate, in Opposition time and in the absence of the Government bringing such an important and costly programme for debate on the Floor of the House, is to highlight, sadly, the woeful shortcomings of the way in which the Government have first designed and then sought to implement this vital programme.
The fact that the shortcomings were identified and predicted by us and many others over the past five years puts the onus on the Government not only to account for their delays, design U-turns and serial incompetence, but to accept that it is the official Opposition who now offer a constructive way forward in the interests of NHS patients—a constructive approach that is consistent with all that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) so expertly epitomises at all times in wanting to make our NHS better for all.
Members should not expect a speech from me focusing on which ministerial heads should roll. Nor should those so disillusioned by the Government’s amateurish cackhandedness in implementing their own policy through this IT programme that they would stop it in its tracks expect me to call for even an audit. That would imply, as audits do, that we want to look back at something that has stopped—finished. We do not. Rather, it is because we believe in the positive potential benefits of IT in the NHS, implemented correctly, for the good of patients and the morale and professionalism of all staff, that we now call for a full and independent zero-based review. We want to see a contrast with the Government’s performance to date: we want to see the programme put right, because that is the right thing to do.
The review—and this is the difference between a review and an audit—can and must be carried out while work on the programme is in progress, to prevent even more lost time and, potentially, lost lives. 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.
Why is the need for a review so urgent? It is because this is some remote, geeky, abstract topic, with IT experts arguing about the best platforms, protocols and data-sharing mechanisms and employing all the gobbledegook jargon that passes for language in the ethereal IT world, but because the Department of Health itself claims that the care records service—only one part of the programme—will prevent “thousands of unnecessary deaths”. As the programme is already at least two years late, by the Government’s own admission the consequences of its incompetent implementation must be those very thousands of unnecessary deaths. That is the real cost of the delays, the incompetence and the lost opportunity—let alone the estimated financial opportunity cost of £1.4 billion of taxpayers’ money. According to the National Audit Office, that was the cost last year, and it is rising.
I thank the hon. Gentleman, my constituency neighbour, for allowing me to intervene. Given that he does not want the system to be scrapped—and given that there are now 19,778 instances of IT deployment, the 250 millionth picture archiving and communication system record is now in existence, and the 22 millionth prescription since the last Conservative-initiated debate has been issued; the number has risen from 237 million to nearly 250 million—he must recognise that real progress is being made. Is not the motion merely a diversion? Is this not just political opportunism on the hon. Gentleman’s part?
On the contrary. The hon. Gentleman has made something of a speciality of trying to understand this issue. He has read out some of the statistics in the Government amendment, but if he looks at the measures that the Government have set themselves, he will realise that the statistics in the amendment are irrelevant even to those. Furthermore, the electronic prescriptions account for only 5 per cent. of all prescriptions, which is way below the Government’s own target. Those statistics are, in fact, a mark of the Government’s lack of progress. Although they may indicate the progress that the hon. Gentleman would like to see, they are woefully short of what was promised or what could be achieved.
I welcome my hon. Friend’s answer to the hon. Member for Ellesmere Port and Neston (Andrew Miller), but I caution him against the hon. Gentleman’s “Soviet tractor production statistics” approach. After all, what matters is not the total number of deployments, but the total number of deployment of facilities of major importance such as patient administration systems for acute hospitals. Will my hon. Friend confirm that in four years British Telecom has not managed to install a single one of those systems in its local service provider area, London?
Evidence does not support the progress that the Government and many others would claim. The evidence from my hon. Friend, who has conducted a dedicated study of the issue, is much more reliable.
Labour Members are wrong to regard our motion as smacking of anything other than a genuine wish to make the programme work. We are calling for a review, not an audit. The Government have never presented their case on the Floor of the House: they have never put themselves up for scrutiny.
The hon. Gentleman asks for a review. Does he think that the outcomes of various reviews conducted by the Office of Government Commerce at various stages of this mega-programme would help bring to public attention any flaws that it might contain? If an article in this week’s Computer Weekly is correct, the reports are being shredded rather than being brought into the public domain. That cannot be right, can it?
I also saw those reports, and I was distressed to read them. If that is what is happening, it must be wrong. I hope that those who are doing that are brought to account and to book.
There is another cost. Today we hear doctors formally declaring that they have lost confidence in the Government. Despite the fact that NHS professionals showed themselves to be open to the use of IT as soon as it became applicable to the health care setting decades ago, the Government have, according to the Labour-dominated Public Accounts Committee,
“failed to carry an important body of clinical opinion with it”.
According to a Medix survey, in 2002, 67 per cent. of general practitioners said that the IT programme was an important priority for the NHS. By November 2006, only 35 per cent. did.
I grant the Minister's boss, the Secretary of State for Health, one accurate prediction about the NHS IT programme. In September 2003, as Secretary of State for Trade and Industry, she said of ID cards:
“The principle, the civil liberties and the practicalities of great big IT projects and databases have a horrible habit of going wrong”.
Why she did not heed her own advice and act on her own predictions once she got to the Department of Health two years later, to preside over the Government's biggest IT project, I do not know.
I agree. All reviews should be published. It must be nice to see them, but we are calling for a zero-based, full and independent review because that is the only thing that is likely to carry the authority and respect that will win the day and help the professionals to get the thing right. I hope that we will see the hon. Gentleman join us in the Lobby to make such an endorsement.
As one newspaper leader yesterday put it, commenting on the most recent and excellent authoritative work of the Public Accounts Committee on the Government's ability to deliver IT projects generally,
“the Government's chronic inability to manage costly IT schemes effectively…has become one of new Labour's trademarks…At the heart of the problem is the slapdash approach to the management of high value projects that would not be tolerated in the private sector”.
Whether we are looking at the multi-billion pound fiasco of the Chancellor’s tax credit system, the potential ID card system or NHS IT, this is crass and amateur procurement on an industrial scale.
My hon. Friend is making an excellent case. Does he agree that confidence in NHS IT projects in my constituency has been fundamentally shaken by two failures in the past six months? First, because of an IT failure, ambulances were diverted from taking patients to Royal Surrey county hospital and took them to Frimley Park hospital. Secondly, a failure in the choose and book system made it difficult for GPs to book people into appointments at Royal Surrey county hospital, as opposed to neighbouring hospitals. What did they both have in common? They took patients away from Royal Surrey county hospital, which is currently threatened with closure.
I am grateful to my hon. Friend for making sure that the House is aware of those incidents, which caused concern, most importantly, for the patients themselves at the time. There is a lack of accountability and the lack of an explanation of why those incidents took place.
It is important to ensure that there is no misunderstanding among various Labour Members. To be constructive and to move forward, we must understand how we came to be here. Therefore, let us briefly track back. In 1998 the Government published their own information for health strategy. February 2002 saw the Prime Minister hold
“a seminar in information technology”,
another great headline-grabbing initiative, but how many clinicians were present at the meeting? Perhaps we shall soon learn, as the outgoing Prime Minister rushes his memoirs to the printers, but do not hold your breath, Mr. Speaker.
April 2002 brought the Wanless report, which recommended that IT funding should be doubled and ring-fenced. By June, the national programme for IT was launched by Ministers with the title “Delivering 21st century IT support for the NHS”. The published version of that omitted both the high-risk scoring and the costs estimate included in the draft—then £5 billion, a figure brilliantly unearthed by my hon. Friend the Member for South Norfolk (Mr. Bacon), whose forensic and relentless work in that area has been, and remains, parliamentary scrutiny of the highest order. I pay tribute to him. Can the Minister tell us why that £5 billion cost estimate was left out of the document? I look forward to the answer.
In December 2005, the problems really began.
I will in one second.
The 100 per cent. choose and book target, and the original deadline on patient records were missed. By March 2006, as the recent National Audit Office review reported
“actual expenditure at £654 million (estimated outturn) spent against expected expenditure of £1,448 million, reflecting the slower than planned delivery”.
In April 2006 problems began at supplier iSOFT. In September, Accenture pulled out of the NHS IT programme, booking a £240 million provision for expected losses from the work. In March 2007, even the downgraded 90 per cent. choose and book target was missed, just as the electronic patient record pilots began. Pilots for care records were due to be in place by 2005.
I thank the hon. Gentleman for belatedly giving way. He has moved on from the point that I wanted to ask him about. If you allow me, Mr. Speaker, to catch your eye later, I will expand on some of the issues relating to proper management of information technology in both the public and private sectors, but I was concerned at the hon. Gentleman's rather naive view that the private sector is innocent in the matter. Has not he represented any constituents who use British Gas services and who are currently plagued by some of the difficulties arising from its change programme?
No doubt we look forward to the speech that the hon. Gentleman will make, if he catches your eye, Mr. Speaker, but this debate focuses on proper procurement and delivery, with the use of taxpayers’ funds, in the public sector of something that is really important: the health of our constituents and health care services. We must understand how the problem came about.
The only consultation to take place after the publication of “Delivering 21st century IT support for the NHS” in June 2002 looked at the care records element of the programme, and that was a consultation not on the substance of the programme, but on the technicalities of care records. There was no consultation on the other elements of the programme, namely choose and book, the electronic prescriptions service, the N3 broadband network, smartcard access, telecare, and the picture archiving and communications system, known as PACS. The latter and the N3 broadband network are the only bits so far that have been successful, so let us give credit where it is due. [Interruption.] As I have just said, PACS has been successful, if the hon. Member for Ellesmere Port and Neston (Andrew Miller) will listen for once. As Professor Peter Hutton said to the Public Accounts Committee during its review:
“key decisions were taken in the early period without proper clinical input”.
The seeds of the Department's failure to engage clinicians, condemned by the PAC, were sown at that time.
The hon. Gentleman makes a valid point. It has often been confirmed by our local expert, the surgeon commander on my right, my hon. Friend the Member for Westbury (Dr. Murrison), that that system was working perfectly satisfactorily and did not need to be hugely improved under the current system. However, there are still other systems that must be brought up to standard.
One of the major concerns with the NHS IT programme, and one which an independent review must address, is the seeming lack of an evidence base for it. In a recent British Medical Journal article on the subject, one trust director was quoted as saying
“One of the things they haven't done very well is to clarify some of the benefits...I haven't seen a good list of benefits”.
Cost-benefit analysis is basic to any capital project, let alone one of this scale, costing billions, and especially when it is taxpayers' money. The paucity of the evidence base testifies to the hurried planning and procurement of the programmes. With at least £12.4 billion of taxpayers’ money being committed, some cost-benefit analysis should have been done, and a robust business case established.
The growing cost of the programme has been the inevitable and wholly avoidable consequence. The programme was launched with the putative cost, as we know, of £5 billion, which was excised from the document. Once the contracts were signed, the ministerial line was that it would cost £6.2 billion over 10 years, although Lord Warner admitted on “Newsnight” that
“the full cost of the programme was likely to be nearer £20 billion”.
The NAO put the figure of £12.4 billion on the programme, and the PAC has suggested that even that massive sum may be surpassed. To October 2006, only £918.2 million-worth of that sum had been delivered.
Despite the highest paid civil servant being in charge of Connecting for Health, the programme has suffered from a lack of leadership. In two years, there were no fewer than six “senior responsible owners” of the NHS IT programme at Richmond House. Lack of leadership was one of the key themes of this week’s PAC report into Government IT. It highlighted the failure of Ministers across Government to meet the senior responsible owners of mission-critical and high-risk IT programmes, or to take a grip by meeting them sufficiently regularly. It also highlighted the low profile and high turnover of chief information officers and the lack of clarity about their roles.
To all of that we must add that one of the design flaws of the NHS IT programme has been its massive centralisation. The programme structure has, in effect, established several regional monopolies through local service providers. From the original four, there are now three providers serving five regions: the CSC Alliance in the north-west and west midlands, the north-east and the eastern clusters; Fujitsu Alliance in the southern cluster; and the Capital Care Alliance—CCA—in the London cluster. CSC took on two clusters from Accenture when it pulled out of the programme in September 2006.
Hospitals have been forced to accept the IT imposed on them by those local service providers, or in some cases have had to invest in costly interim solutions due to delays in the programme. A recent BMJ study into the implementation of the programme suggested that the Connecting for Health software is more expensive than software on the open market. One medical director said:
“A lot of things are being sold to us at a much higher price than we would have been able to get if we’d been in a real market situation, so the total costs to the NHS have been very high indeed”.
Those regional monopolies have caused serious supply-chain concerns. The exit of Accenture—at an estimated loss to it of £250 million—was a big blow to the credibility of the programme. The supplier that has been most in the public eye is iSOFT. Its share price has plummeted twice—that is public information—and on 6 April the shares fell a further 40 per cent. It appears that iSOFT’s previous accounting policy, which it has now had to abandon, was based on its receipt of letters of credit, centred around advance payments from NHS Connecting for Health. In evidence to the PAC on 26 June, Richard Granger of Connecting for Health stated that it would make an advance payment only when covered by a letter of credit from a bank. That is nice work if you can get it. [Interruption.] That completely undermines the Department’s claim that suppliers get paid only when they deliver. [Interruption.] But as the Minister cannot be bothered to listen, she will not understand that.
iSOFT is now looking for a buyer. Its main customer, CSC or Computer Sciences Corporation, has opposed a bid by an Australian firm. [Interruption.] The Minister says from a sedentary position that she finds what I am saying boring. The trouble is that she is so bored by IT that she has not bothered to have regular meetings, or to supervise or take a grip of the process. She needs to listen to a proper critique of where the Government are wasting taxpayers’ money, and to take control for once of a programme for which the Government are deeply responsible.
My hon. Friend is making a strong case. Is not the real issue that on a day-to-day, week-to-week basis Ministers do not know what they are doing? In May 2006, the Minister advised us that the programme was
“already the focus of regular and routine audit, scrutiny and review.”—[Official Report, 24 May 2006; Vol. 446, c. 1877W.]
In the same month, her colleague, Lord Warner, said that the likely costs of the project would be not £2.3 billion as originally envisaged, but £20 billion. Does that not sum up the Government’s mismanagement of the programme?
Absolutely. My hon. Friend makes a valid point, although the Minister would no doubt immediately say that the £20 billion was meant to encompass the total expenditure on IT across the NHS and not only the Connecting for Health programme. Either way, it is monumental incompetence to double one’s costs in a short period.
As I have said, iSOFT is now looking for a buyer. Its main customer, CSC, has opposed a bid by an Australian firm, IBA Health. It was announced yesterday that iSOFT is beginning legal proceedings against CSC; and CSC today said it was continuing to review its options
“and does not exclude the possibility of making an offer for iSOFT”.
I have tabled written questions to the Secretary of State asking what responsibility she has for the matter; typically, she has said that she has none.
The programme has been a masterclass in how not to do procurement. I expect that the Minister will stand up and crow about the speed of the procurement, which was begun in February 2003 and completed by February 2004, but what has it led to? Suppliers are leaving or collapsing, and the system is both dysfunctional and late, with costs burgeoning against minuscule delivery—despite the statistics in the Government amendment, which are, in any event, not measured against their own targets, showing that they dare not do that.
The hon. Gentleman mentioned iSOFT and the role of the private sector. Following on from the remarks of my hon. Friend the Member for South Derbyshire (Mr. Todd), may I caution the hon. Gentleman about IT projects in the private sector? IT projects across the piece—in both the private and public sectors—are notoriously difficult. This project comprises several programmes and we are all aware that it has not gone smoothly. However, it is wrong to have a rose-tinted view that things go smoothly in the private sector. The difference is that the private sector hides things. Moreover, when iSOFT was booking revenues and declaring them against future revenues, which is very dodgy accountancy practice—it has been caught doing that—the chair of its audit committee was that private sector champion, Sir Digby Jones.
Whether or not things were hidden or inefficient in the private sector, at least scrutiny was exercised by both competition and shareholders. It appears in the public sector that the Government have also been seeking to hide things. Why else have they not had a debate on this subject on the Floor of the House? The Opposition have had to secure this debate. Furthermore, taxpayers’ money has been used and the Government have created a series of monopolies for delivery, and they are not exposing that to the true test, which is competition. Competition is one of the best ways of making sure that things are not inefficient and not hidden.
The two most controversial elements of the programme are the care records service and choose and book. Under the care records service, the patient record was supposed to have been fully rolled out by December 2005. The first pilots went live only in March this year, and we are still awaiting a timetable for full roll-out. Above all, widespread and deep-seated anxiety about patient confidentiality has troubled many as they come to appreciate the Government’s design for their private and personal information.
The Government made a notable U-turn when they decided in December last year to allow individuals to opt out of the summary care record: we welcome that option. However, serious concerns remain. The Government insist on saying that
“only basic data will be held on the summary care record”.
However, that includes information about prescriptions, from which, as any doctor will confirm, any illness or range of illnesses being treated can be fairly easily extrapolated. Will the Minister remove prescription data from the summary care record, or at least stop using the word “basic”, which is deceptive in this context?
Moreover, when the Government announced the opt-out, they failed to make it clear that it is still not a full opt-out. Patients can opt out of having their medical details uploaded to the spine, but they still cannot opt out of having their demographic information updated, such as name, address, date of birth and NHS number. Will the Secretary of State come to the House to state that that will be made clear in the literature going out to patients at the pilot sites? Furthermore, the Government have not yet come clean on whether they intend to join up their identity cards programme with the NHS IT programme; this debate gives the Minister the opportunity to clear that up, and I hope that she will do so.
Finally, we have not yet received the assurances we need about the security of the system. The Minister might stand up and rehearse arguments about “legitimate relationships”, “role-based access”, smart cards and audit trails, but we know that smartcards are shared in hospitals, and an audit trail—if it works—merely tries to shut the door after the horse has bolted.
I shall not give way to the hon. Gentleman; he has already had a go, and it did not work last time.
We must also not lose sight of the fact that the vast majority of people who go to hospital are at least lightly conscious even if they are very ill or seriously injured, and even if they are unconscious, doctors will still follow proper professional diagnostic procedures, rather than tap away at a laptop next to the patient to find out what has been wrong with them in the past. There seems to have been no consideration of that reality. If a proper business case had been submitted and consultation with front-line staff had taken place, the fundamental need for this type of IT base might have been reconsidered.
The choose and book service was supposed to be 100 per cent. delivered by the end of December 2005. When the Government missed that, they set a target of 90 per cent. delivery by March this year—a target they have missed by miles. A mere 38 per cent. of bookings are being made through choose and book, with some primary care trusts achieving rates as low as 8 per cent.
In an interview on “Newsnight” about the national programme for IT, broadcast a year ago, Lord Warner, the former Minister responsible for NHS IT, said that he would resign if choose and book was not delivered by this March. He got out well in advance—last December. So no Minister has taken responsibility for the delay, and—surprise, surprise—to replace Lord Warner the Government have re-appointed Lord Hunt, who designed the thing in the first place.
In addition, it transpires that half these bookings are done by patients themselves on the phone. Their doctor gives them a list of hospitals and their telephone numbers, and it is up to them to go home, choose their preferred hospital and try to make the booking, instead of its being done at the doctor’s surgery, as it should be. Choose and book, where it is working, is rarely working properly.
Does my hon. Friend agree that choose and book might have been a lot more successful had there been proper consultation with key stakeholders—namely, the GPs who use the system? They complain frequently that one of the main problems with choose and book is that they can book appointments only at particular hospitals and not with individual consultants. However, many GPs want to book an appointment with a consultant whom they know is particularly good at a given task.
My hon. Friend is absolutely spot on—such consultation is precisely the issue. Moreover, patients want choice as part of their freedoms and opportunities. At the same time, they want to continue to engage the expertise of those upon whom they rely.
So we have to ask, is choose and book, which is not yet working fully—far from it—as currently designed really the improvement in services that patients are crying out for? When will the Government give a proper timetable for choose and book, if it can be delivered? If it cannot, when will they abandon it?
To hear the hon. Gentleman speak, one would think that choose and book is a complete disaster. However, are not nearly 98 per cent. of GPs using live choose and book? Moreover, and as the hon. Gentleman has just indicated, surely the issue is whether the service to patients is effective. For example, are not hospital records, which were previously turned around in two to three weeks, now turned around in two to three days? Does the hon. Gentleman not count that as a success?
I am surprised to discover that the hon. Lady has not been listening, because that is certainly not what I said. Anybody relying on that 98 per cent. figure will discover on examination that even a doctor who has used choose and book once and found it to be totally useless has been included in that figure. The true figure—as shown in a parliamentary answer given by one of the Minister’s own colleagues—is about 38 per cent., although it might have gone up by one or two points since that answer was given. So the hon. Lady should rely on facts, rather than on the Whips’ handout.
I turn briefly to electronic prescriptions. In 2004, the Department of Health set an overall aim of “implementing a national service” of e-prescribing
“by 2005 for 50 per cent. of all transactions, with full implementation by 2007.”
However, just 0.1 per cent. of all prescriptions issued in the NHS in December 2005 were issued by that method. Although the latest available figures show that in the week to 28 May 2007, 5 per cent. of all prescriptions were issued using the electronic prescriptions service—that is a better measure than the one paraded in an earlier intervention and in the Government’s amendment—figures uncovered by us show that less than 2 per cent. of those prescriptions were downloaded by pharmacists for dispensing. So much for the boast in the Government’s amendment! Despite even this very low take-up rate, NHS Connecting for Health still insists that,
“By 2007, every GP surgery (for use by the GPs, nurses and other prescribers working from the surgery) and community pharmacy and other dispensers will have access to the service.”
We witnessed the sight in Woolwich as recently as 25 May of the incoming Prime Minister saying in his campaign—against nobody—to head the Labour party that
“we need prescriptions to be translated to people, directly to the chemist, in a way that you don’t have to queue up at the doctor’s for a repeat prescription”.
However, this is the very Chancellor who presided over a Treasury that explicitly provided the money, which he announced in his Budgets, to be spent to achieve all this by 2005. What monumental incompetence caused him not to know where that money had gone and that it had failed to achieve its stated goal—so much so that he had to announce that goal as the very first of his new ideas? The system was meant to have been in place for more than 18 months now.
Speaking of monumental incompetence, I shall leave the subject of the parallel scandalous failure of the Department to implement successfully the medical training application scheme for junior doctors to my expert colleague who will wind up for us today—the surgeon commander, my hon. Friend the Member for Westbury. [Interruption.] Yes, surgeon commander, and to be respected.
Today we are calling for a full zero-based independent review of the programme. To date, rather chippily, that has been ruled out by Ministers and by the chief executive of the NHS, yet the latter has acknowledged the “clash” between a national programme and the need for it to be delivered locally. He described the programme as
“too much, on far too big a waterfront”,
and referred to the “bunker mentality” that Connecting for Health has built around it. I cannot argue with his critique of the programme as far as it goes, but when are the Government going to make the necessary U-turn and devolve complete power to local hospitals? One of the original architects, Lord Hunt, who is now back in post, said just last month—[Interruption.] Ministers might like to listen to this. Their own colleague who is now back in post and in charge, said that now is the right time
“to make the shift towards local ownership”.
That is what we have called for all along—local contracting, with nationally set interoperability standards.
Indeed, and look what has happened in the interim. The Government have failed on the job. Above all, that is what the users—doctors, be they consultants or GPs, nurses, therapists and managers—really want. Then, they will buy into this and use IT to improve health care for patients. Only a full, zero-based independent review can bring us to that point, and the Minister should now have the grace to accede to having one.
It is in the interests of patients and our constituents, and of the morale and professionalism of the wonderful and dedicated staff in our NHS, that I urge the House to vote for the motion.
I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
‘recognises that a modern IT system is vital for delivering good healthcare; welcomes the NHS IT Programme which provides safer, faster and better healthcare for NHS patients, giving them more choice and control over their care; supports the objectives of modernising medical careers; further supports the aim of connecting over 30,000 GPs in England to almost 300 hospitals and giving patients access to their personal health and care information; congratulates the NHS on having already delivered 93 Picture Archiving and Communications Systems across the country including a 100 per cent. achievement in London, delivering faster results for patients; further congratulates the NHS for sending over 21 million electronic prescriptions so far, reducing inefficiencies and errors; welcomes the fact that over 85 per cent. of all GP practices have used Choose and Book to refer their patients to hospital and that almost 3.8 million Choose and Book bookings have been made so far, allowing patients to choose appointments that are at convenient times to fit in with their lives; and welcomes the news that approximately 1.2 million NHS employees now have access to the new broadband network N3.’.
It is laudable that the Opposition support, as the hon. Member for Eddisbury (Mr. O'Brien) acknowledged today, the aims of the national programme for IT. However, it is deplorable that they continue to condemn the delivery of this programme and the necessary investment to achieve the aims that they so loftily support. It is noteworthy that when the Conservatives were last in government, the NHS was one of the last bastions of garage-built computer and paper systems. Despite the Labour Government’s inheriting from the Conservatives in 1997 an NHS that was spending approximately 2 per cent. of its overall budget on computer systems, the one thing that unified almost all the systems bought for the NHS by that Conservative Government was their incompatibility and their inability to pass information from one site to another.
It should be noted that, despite our having led the world in the computerisation of GP practices, the one thing that we could guarantee patients was that their electronic records within a GP practice could not be transferred electronically to another practice—even between systems bought from the same vendor. That lamentable state of affairs is now viewed with a quaint 1950s nostalgia by Opposition Members as being more desirable than the successes delivered by this Government through the national programme for IT.
Far from being a “hasty conception”, the NHS’s national programme for IT learned from the mistakes that a Tory Government made. In 1998, we launched a well thought through four-year programme to develop pilots of electronic records. The electronic record development and implementation programme, known as ERDIP, led to a number of small-scale yet successful local installations. The key issues that contributed to this programme’s not being sustainable in itself were the need for it to be taken up on a national basis and to deal with the unaffordability created by this local development. Such affordability issues were driven by significant cost inefficiencies as a consequence of small-scale local procurements and a high degree of variability in the software from one NHS location to another. During 2001 and 2002, it was with these lessons in mind from the preceding three years that we established a strategy group under the auspices of Professor Sir John Pattison, then director of research analysis and information at the Department of Health, in order to pull together a strategy that we published in 2000, entitled “21st Century IT for the NHS”. It is therefore an act of gross revisionism to suggest that the Government hastily conceived the national programme under my noble Friend and Minister, Lord Hunt.
Bearing in mind what the Minister has said, I doubt she will be surprised that the mental health trust in Derbyshire has, certainly until recently, operated with 19 separate information systems and that it is virtually impossible to obtain appropriate management information in such a fragmented systems environment.
My hon. Friend is right. We are trying to catch up with the fragmented communications in the NHS, large as it is, and the essential requirement behind change is patient safety and better services. That might mean some inconvenience for staff, but that has to be faced if we are to put patients at the heart of our health service.
We are obviously trying to ensure that. I am happy to write to the hon. Gentleman to clarify that point, but we need to achieve step-by-step change. I shall come to how we have had to take stock of development and its timetable to ensure that we get it right.
The Opposition’s failure to recall the extreme difficulties that they experienced in government in specifying systems, many of which never went live and were a gross misuse of public money, contrasts sharply with this programme, which has been tightly managed—as endorsed by the National Audit Office. I will concede that there are unavoidably a number of users who have not been consulted, but during the four-year pilot process the NHS Information Authority, and predecessor organisations such as the information management group, undertook extensive consultation with end-users about the content of the national strategy. We now have a system in place through a rolling programme of service implementation, led by a veteran NHS manager, Richard Jeavons, to ensure that before the implementation of systems all users, especially those on the front line, are satisfied with what they are receiving and how it will be implemented.
Unfortunately, I have to tell the hon. Member for Eddisbury and his supporters that the Opposition’s activities in fuelling negative media coverage often prejudice the opinions of end-users prior to their receipt of systems. Connecting for Health and the Government have had to answer misinformation provided by the Conservatives and others. Day by day, however, more and more staff are recognising the value of the new system and putting it into practice.
Opticians must be doing well because the Minister is wearing rose-tinted spectacles. What unique insight into the programme has been missed by the Health Service Journal, the BMA, GPs, 23 eminent IT specialists and parties in this House? It is not only the Opposition who question the implementation and efficacy of the programme; it is all those experts, who have all been disregarded by the Minister and her colleagues.
Nobody is being disregarded. We recognise that there have been delays because we need to be sure that what we are trying to achieve and the practical implementation of the programme are understood. I make no apology for that. I would rather spend a little time getting it right than do it wrongly. There is a difference between constructive engagement and that based on no real evidence but on speculation and misinformation put into the public arena. I will give specific examples on particular groups later.
The national programme for IT in the NHS has established a number of well respected national clinical leads, and recently appointed a full-time clinical director. It has also established user forums for live systems and continues to improve these systems in line with feedback from users. Perhaps the greatest example of the way in which the national programme for IT does listen to its end-users relates to the picture archiving and communication systems, or PACS. Today in London, every NHS hospital is now equipped with that type of system. That means that patients wait significantly less time for reports and follow-up consultations, that films are no longer lost and that care is delivered more safely and efficiently. Picture archiving was not part of the programme when the contracts were let in 2003. Those systems were added to the contracts in 2004 in direct response to feedback from front-line clinicians and groups representing patients, so the system has been updated and remains as flexible as possible to take account of new IT developments.
I have seen PACS in operation in the Homerton hospital. It had its teething problems, but it is now very welcome in London hospitals. I have a more personal point to make, which is that patients in Hackney who have an appointment with a hospital or a community service now receive a text message to remind them of their appointment. If we are to bring health care into the modern world, that is an improvement that should be welcomed on both sides of the House.
I agree. Would it not be wonderful if the media and other commentators talked more about where the system is working well for people? Then people in other parts of the country could ask their health chiefs and officials for the same service. That would be community engagement and patient engagement, which is what we want for people all over the country.
My hon. Friend correctly referred to the way in which PACS was added on the basis of consultation with end-users and clinicians. Will she also confirm—to correct misinformation from the Opposition—that the technology involved in PACS is such that it could not have been rolled out on a mass scale under the previous Administration or indeed before we did it?
Absolutely. We had to have national oversight and direction, as well as the resources to make that wonderful development happen. Money is really important. It is interesting to hear from the Opposition about how they want to stall the national programme—
Well, another inquiry would bring progress into question. The Opposition have never told us what they would have been prepared to spend to provide the service that is benefiting patients and assisting NHS staff. There is a difference between talking the talk and walking the walk and making the services that we should expect as a matter of course in the 21st century something that everyone can experience.
I acknowledge that in some cases we have had to take stock, delay implementation or adjust our thinking based on what we have been told by those on the front line. I am also willing to acknowledge that some of the systems that have been implemented under the programme have not proved popular with end-users as they introduce benefits to patients that may not be to the convenience of NHS staff on all occasions. One such example is the choose and book system. It benefits a patient nearly every second of any day. However, the additional work required by GPs to deliver this improved service to patients has been controversial and I recognise that the early versions of the software have been improved as a consequence of direct feedback from doctors.
Several hon. Members were present at an event hosted by Computer Sciences Corporation—CSC—last night in Portcullis House. They would have heard from Dr. Angela Rowland that far from the systems being unresponsive to the needs of end-users, her work environment as a doctor has now been radically improved as a consequence of the delivery of these new systems.
What advice can the Minister offer my constituent, Mr. Pegler, whose GP decided that he needs an urgent appointment as he has a family history of cancer? He was advised to use the choose and book system and given the telephone numbers of four hospitals, yet it has proved impossible to get an appointment from any of them. He subsequently contacted the patient advice and liaison service, but is still waiting for a response. Mr. Pegler has been trying to get an appointment for nine weeks. I do not know whether Hackney hospital was one of the four to which he was directed, but I should be grateful for any advice the Minister can give him.
I am very concerned to hear about that situation. If it had happened to one of my constituents, I should have been knocking at the GP’s door to ask what was going on. I shall be happy to take the information away and look into the matter because we know, and I hope the hon. Lady acknowledges, that the access times for diagnosis and treatment of cancer have improved enormously over the past 10 years. However, I am happy to talk to her about how best to represent her constituents.
It is the case that in some aspects of the programme extended consultation with end-users has led to some delays from the original timetable, which was established in 2002. One such example is the summary care record, where an extended consultation exercise with members of the public and professions working in the NHS was led by Harry Cayton, the national director for patient involvement at the Department of Health. It resulted in modifications both to the requirements and the consent model from what was proposed in 2002. Far from regretting that aspect of delay in the programme, I think it was a prudent course of action. In our opinion, to have proceeded hastily with the delivery of the system, in the absence of consensus for the consent model and the content of the summary care record, would have been ill advised.
With regard to front-line clinician support for the summary care record, I refer the House to coverage on BBC Radio Manchester on 31 March, when Dr. Natha of Kearsley medical centre in Bolton stated that patients would benefit greatly from the summary care record. For example, any doctor outside a GP practice who makes an emergency visit to a patient in the middle of the night would have an up-to-date and accurate summary of the patient record in front of them without having to put questions to an elderly patient who may or may not know the answers, or even be in a position to give them.
A point was made about the medical training application system. My right hon. Friend the Secretary of State for Health has already answered questions about MTAS and we have expressed our regret for the difficulties with the system. However, it should be noted that the security and end-user assurance arrangements within the systems deployed by the national programme for IT—at this point, about 19,500 systems used by more than 350,000 front-line NHS staff—have to date prevented such difficulties from occurring. We have avoided hostages to fortune through the provision of cast-iron guarantees in that respect.
We take patients’ concerns about the confidentiality of their records extremely seriously. We have established a consent model in the NHS in England that respects the wishes of patients to control the flow of their information, while establishing an arrangement that is administratively efficient and pragmatic. Although much may be heard within the confines of Westminster about the public’s concerns about confidentiality, it is the case that less than 0.2 per cent. of patients in the early adopter communities for the summary care record have so far expressed a wish to opt out of the summary care record as it is launched.
It would be wrong for Opposition Members to suggest that arrangements they oversaw in the NHS, which relied on post, faxes and phone calls, were something that a 21st-century Government would want to perpetuate. It is a necessity on the grounds of efficiency and safety that the NHS move from those islands of electronic information and a dependency on paper into the 21st century, with information moving on a secure basis to support patients as they are cared for in numerous locations.
My hon. Friend will acknowledge the excellence of the City and Hackney primary care trust, one of the top seven of the 32 in London. However, although that excellent PCT welcomes the community support system—the RiO system—which will, for example, track childhood immunisation and is vital in tackling public health, it says that it is “a massive task” and that we shall have to find lots of extra resources to support it. Can my hon. Friend expand—if not now, perhaps in writing—on how NHS IT services can help PCTs that are already as good as mine to ensure that we have decent public health IT systems as well as the acute systems that she has been describing?
I thank my hon. Friend for that contribution. As the Minister responsible for vaccination programmes and public health, I am concerned to ensure that we have joined-up systems in terms of vaccination. There are clearly real issues in London in respect of the movement of families from one side of the city to another. I have taken them up by holding meetings with Connecting for Health and Department of Health officials responsible for immunisation so that we can tackle some of the problems and make sure that the systems are fit for purpose. The issue is complex and it is a challenge tracking the movements of families with children, especially those who may be vulnerable and not in a steady residential situation. If my hon. Friend wants to talk to me further about the circumstances in her neighbourhood, I shall be happy to meet her.
We have put in place security standards known as e-GIF—electronic Government information framework—level 3, which provide the highest level of civilian security around users accessing systems. Furthermore, all staff in the NHS are bound by professional codes of conduct, and the wide area networks being used between NHS sites are, by civilian standards, secure. Clearly, it would be misleading of me to offer the House an absolute, cast-iron guarantee that there will never be leaks of information, but we have taken all reasonable precautions to ensure the security of information being stored and transmitted within the system. We take it very seriously if any member of NHS staff makes inappropriate use of their access to information.
Given the existing Lloyd George record system, which despite the incredible professionalism of NHS staff can only be described as extraordinarily vulnerable in security terms, it is worth bearing in mind the different context. In that system, the exposure to risk is within a relatively limited environment, whereas once information is placed on a network the exposure to risk is much wider. Can my hon. Friend expand on how that problem will be tackled?
We are of course looking at exposure risks in the networks—at issues relating to access, PINs and smartcards—as well as the offences that are appropriate if individual members of staff misuse their security access and clearance. Any organisation, whether in the public or private sector, faces such challenges when dealing with information about customers, patients or users, but I am pleased to say that we are operating at the highest standard of civilian security in terms of data—probably the highest anywhere in the public sector. In many respects, the national IT programme has learned from previous Government IT programmes; that is acknowledged and the system is being driven forward in a way from which other public and private sector systems could learn.
I am sure that Opposition Members will join me in congratulating NHS Connecting for Health, which was commended even in the recent Public Accounts Committee report on IT projects. The outgoing chief executive of the Office of Government Commerce, John Oughton, said:
“I think the procurement process for Connecting for Health was an exemplary example of procurement. It was run to a very tight and rapid time scale; it started when it was intended and completed when it was intended; and it produced a very good result. I do not think any of the suppliers were disadvantaged in that process.”
Furthermore, I am sure that Opposition Members will also join me in commending NHS Connecting for Health for what was described by the NAO at the conclusion of its 18-month investigation into the national programme as
“a very positive report, which confirms that the programme to modernise the NHS computer systems is…much needed…well managed…based on excellent contracts…delivering major savings…on budget…has made substantial progress”.
Far from being badly run and over budget, the national programme for IT has been independently reviewed already by the NAO, which found that the
“previous model of IT procurement was haphazard”
and that this
“programme has the potential to deliver substantial financial, safety and service benefits for patients and the NHS”.
I am sure that Members of the Conservative Opposition are familiar with the content of the report because it was laid before Parliament on 16 June 2006. I am sure that they do not rely only on the opinions of such people as Tony Collins of Computer Weekly, who has, I understand, provided briefings solely to members of the Conservative party and produced material for publication by Conservative party think-tanks.
It is interesting that the hon. Lady says that Mr. Tony Collins of Computer Weekly has provided briefings solely to the Conservative party. I happen to know that David Nicholson, the chief executive of the NHS, invited Tony Collins to a seminar, which he agreed to attend. How can that be consistent with what the Minister just said?
Does that not demonstrate that we are open to listening to all voices in the debate? We do not approach this from a narrow, partisan point of view. I suggest to the hon. Gentleman that it is useful if people are transparent about who they are providing advice to and the parties for which they are writing IT policy.
In our opinion, it is lamentable that a programme that is focused on the delivery of safer and more efficient health care in the NHS in England has been politicised and attacked for short-term partisan gain when, in fact, it is to the benefit of everyone using the NHS in England that the programme is provided with the necessary resources and support to achieve the aims that Conservative Members have acknowledged that they agree with.
Owing to delays in some areas of the programme, far from it being overspent, there is an underspend, which is perhaps unique for a large IT programme. The contracts that were ably put in place in 2003 mean that committed payments are not made to suppliers until delivery has been accepted 45 days after “go live” by end-users. We have made advance payments to a number of suppliers to provide efficient financing mechanisms for their work in progress. However, it should be noted that the financing risk has remained with the suppliers and that guarantees for any advance payments have been made by the suppliers to the Government. That contrasts sharply with the policy of the Conservatives when they launched the now abandoned policy of financing IT projects through the private finance initiative. The national programme for IT in the NHS has successfully transferred the financing and completion risk to its suppliers.
It is untrue that there is not a firm timetable for delivery. It is sadly the case that extended consultation and a knock-on effect regarding delays in specification led to two years’ delay in the delivery of the summary care record functionality. However, each software delivery from BT, the contractor concerned, has been on time for more than 12 months. Similarly, the quality management analysis system for GP payments was delivered on time. The picture archiving system is on time. The core software for choose and book and the electronic prescription service has been delivered on time, and the network underpinning all those applications was delivered—[Hon. Members: “On time?”]—early.
I find it perplexing that Conservative Members have suddenly developed a deep relationship with some struggling IT suppliers. Are they suggesting that the Government should indulge in a little bit of dodgy state aid, or perhaps bung a few tens of millions of pounds to failing suppliers as a consequence of a supplier’s failure to fulfil its obligations? It would be interesting to hear what the Public Accounts Committee would think about such a policy.
My hon. Friend is absolutely right and underscores the fact that the official Opposition do not really understand the computer industry. I do not claim to be an expert on it, but I spent some of the previous Parliament as a member of the Work and Pensions Committee, which produced a report on computers. The Conservative motion calls for a “full and independent review”, but the NAO has already carried out a review. Given that the nature of the industry is such that there are few suppliers, where on earth would the Conservatives get an independent body to conduct such a review? It does not exist. If there were a big enough body with sufficient expertise to carry out a review, it would certainly be in the system of government already.
I agree with my hon. Friend. The review is a red herring and part of the attempt constantly to undermine the good progress that is being made under the national programme. The Conservatives are trying to build in more stalling mechanisms, instead of constructively engaging on delivery.
When the Department of Health published the principles of the procurement arrangements for the national programme in January 2003, it stated clearly that it intended to transfer financing and completion risk to the supplier community. All suppliers bid voluntarily for the delivery of services to the NHS under those contracts, and in a small number of cases there have been significant supplier failures. While that is unfortunate in itself, it is fortunate that the costs of those failures have not been borne by the taxpayer. Simply pouring further funds into inefficient and often paper-based administrative processes might be what is recommended by the experts advising Conservative Members, but the Labour Government believe that a properly supported and financed national programme for systems in the NHS is absolutely essential to how we deliver health services in the 21st century.
There is strong evidence pointing to the fact that the chaotic and ad hoc procurement of local systems delivers poorer care as a consequence of tests being unnecessarily repeated, patients’ treatments being delayed and appointments having to be rebooked when information is not available. Properly networked systems operating across multiple locations with a high degree of standardisation are the common-sense solution.
Far from there being a significant opportunity cost to patient care, efficiencies are delivering significantly better patient care as a consequence of the NHS having a universal wide-area network, an online demographic service that is accessible from more than 7,000 locations and used by more than 50,000 front-line staff each day, and a picture archiving system, the deployment of which throughout the whole country is nearing completion. It would be naive to imagine that the implementation of such long overdue and complex systems would not be without disruption. Many end-users are far from disillusioned; they are delighted to have modern tools available. That is especially the case in community settings, where staff, especially nurses, were frequently dependent on paper and often needed to visit offices to obtain notes and details of further visits.
The NHS IT programme has already been subjected to a number of reviews, including an 18-month full and independent review by the NAO. I note with some sadness that 23 individuals, some of whom are well respected academics, have called for a review of the programme. As was mentioned earlier, I understand that representatives of the group met David Nicholson, the chief executive of the NHS. Unfortunately, Professors Ross Anderson and Martyn Thomas were unable to articulate any firm grounds to substantiate an independent review, other than the existence of a large volume of negative media coverage—I have seen it—some of which they generated. Is that really a basis for a review when so many of our patients are already benefiting from a better NHS? We, the Government, think not.
Thousands of NHS staff and many thousands more patients are already benefiting from the national programme for IT. In the trusts covering the constituency of the hon. Member for Eddisbury, Connecting for Health systems are already used by 645 GPs and 335 pharmacists. To date, more than 20,000 direct bookings have been made through choose and book in his area, which is already benefiting from the picture archiving and communications system. Our ambition is that all NHS staff and the public throughout England will gain from the enormous benefits that the national programme for IT is enabling. With pride and confidence, I commend the Government amendment to the House.
It is extraordinary to listen to Ministers talking about this subject because there seems to be a complete disconnection between the world that they inhabit and that inhabited by most people working in the NHS whom I meet. If one talks to a room full of doctors, whether they are GPs or consultants, one hears a universal groan when one mentions Connecting for Health and the national programme.
The hon. Gentleman’s experience must be completely different from mine because I have noted a remarkable loss of confidence in the system among NHS professionals. The same mindset that we have seen regarding MTAS seems to exist for this system. The hon. Gentleman at least acknowledged that there had been problems with the programme. Indeed, he went a little further than the Minister’s tentative acknowledgement of some sort of discontent. He has been forthright in his concerns about MTAS. I suggest that he listens more to the many health professionals with genuine concerns about aspects of the programme that we are considering. I fully understand and acknowledge that many of the constituent parts of the programme have real merit. However, several of its aspects cause genuine concern.
Of course, I accept that change brings about resistance, and that that is sometimes because of a conservative refusal to move on—[Hon. Members: “With a small “c”.] I readily acknowledge that I meant a small “c”. However, everything that I have read and that I have heard from the clinicians to whom I have spoken shows that people’s concerns go beyond that. My plea to Ministers and to Labour Back Benchers is that they should acknowledge that there are genuine anxieties and problems. What winds up health professionals most is Ministers simply refusing to acknowledge that there is a problem. The Minister did tentatively acknowledge that there were concerns among some health professionals, but with very carefully chosen words. That is exactly what happened with MTAS. There should be a greater willingness to recognise people’s concerns.
Is not the more fundamental problem the lack of information that is available to Ministers in the Department of Health in making decisions? I refer the hon. Gentleman to the hon. Member for St. Ives (Andrew George), who, when he challenged the Minister on 24 April, elicited from her the answer that the Department did not collect data on the local efficacy or otherwise of choose and book. If that sort of information is not collected, how can we possibly know whether it is working?
That is a fair point. This is far too centrally imposed and grandiose a scheme. If one goes for a centrally imposed, grandiose scheme, of course one has to collect data from everywhere, which makes the whole thing rather unworkable. A better approach would have been to go for something much simpler and more locally based, as has happened in other European countries and the United States.
Does the hon. Gentleman accept that Ministers and Labour Back Benchers have acknowledged that things have not necessarily gone according to plan in a major IT operation of this scale? Does he also accept, however, that there are examples of progress to be applauded in areas such as mine? Luton and Dunstable hospital was having to hire taxis to take X-rays and scans down to Harefield hospital, but those imaging facilities are now available within Luton and Dunstable hospital, infinitely improving in-patients’ quality of service and life.
I am pleased that we have yet another acknowledgement from a Government Member that there have been problems—we are making progress. I accept that there is a powerful case for investment in appropriate IT. I also accept the Minister’s assertion that there had been a failure adequately to invest prior to this. However, that does not make the whole package right.
Let me deal quickly with the motion itself. Liberal Democrat Members agree with most of its content, particularly its call for an independent review. In fact, we called for an independent review in March. I will return to the case that we made then and the aspects that we think should be included in it. However, I have concerns, which I think may be shared by the hon. Member for South Norfolk (Mr. Bacon), about the opening assertion of the motion. It says that the aims of the programme are supported in principle. That prompts the question of what the aims are, because they have not been clearly articulated and have changed as time has gone on. The National Audit Office itself was pretty vague about defining them in the section of its report that dealt with the objectives. It made one wonderful assertion:
“The Programme is intended to enable the NHS to become more effective in treating patients.”
I suspect that we can all agree with that. If that is the aim of the project that the Conservatives support in principle, I am fully with them on that. However, one begins to have a problem when one gets into greater detail. The Public Accounts Committee said:
“The central vision of the Programme is…to introduce an integrated system called NHS Care Records Service”—
or the national spine. That is where we have a problem. We do not believe that the case has been made to demonstrate that the benefits of a national spine outweigh either the costs to the NHS, given all the other priorities in the service, or the civil liberties and privacy concerns that have been expressed by many people, including the Information Commissioner. I will come back to the concerns that he raised within the past few months in his written evidence to the Select Committee on Health.
The Government reject the call for a review out of hand, but I fail to understand why. They are keen to quote independent reviews when they are positive about the Government. Reviews that say that 90 per cent. of patients are satisfied are great, but when a review is suggested that they find uncomfortable, they resist the proposition. However, given the scale of the concerns that have been expressed by a wide range of people, it would be in their long-term interests to agree to an independent review in order to work out properly where the whole project is going and how best to adjust it given the problems that have occurred.
I am grateful for that intervention; I intend to deal specifically with what the review should cover.
Let me first explain why I reached the conclusion that a review was necessary. One of the leading people centrally involved on the private sector side of the project made two assertions to me, which were equally horrifying given that this is the biggest ever IT health care project anywhere in the world. First, he asserted that when the project was launched, there were insufficient numbers of adequately skilled people to implement it, and that that is still the case. Secondly, he asserted—
I cannot say who it was, because the discussion was on Chatham House rules and it would be wrong for me to do so, but he is a very senior person who is heavily involved in the project.
His second assertion was equally shocking—that there has never been a thorough systems review. The Minister said that end users are now being consulted all over the place, but that is supposed to happen at the start, not much later on.
I am pleased to see the hon. Gentleman nodding; I assume that he is agreeing with me.
The person told me that it is necessary to bring together at the start the builders of the system, the purchasers of the system—the people who will be spending the money—and the users of the system to ensure that there is a common understanding of what it is supposed to achieve. It was remarkable to hear that there had never been an adequate process of that sort. It is absolutely scandalous to embark on the biggest IT health care project in the world without it. I suspect that the hon. Member for Wolverhampton, South-West (Rob Marris), who is remaining remarkably still and not demonstrating any body language at all, is quietly agreeing with me.
In April 2006, some 23 computer academics—experts in IT—sent an open letter to the Health Committee. The Minister referred to that submission, and she accepted that some of those people—she said some, not all—were highly respected. They called for an independent technical assessment of the project, and they said:
“the programme appears to be building systems that may not work adequately and—even if they worked—may not meet the needs of many health trusts.”
That is precisely why we need a thorough systems review at the start. We are building systems that may not work, or that may not be what is wanted, and that is of concern.
We are struggling with an unacceptable degree of secrecy, too. We have heard that reviews have been undertaken, both internally by the Department, and by the Office of Government Commerce. Why can we not see them? Why not publish them?
I have raised the issue of the availability of OGC gateway reviews in the House on many occasions. The standard answer, which I do not entirely accept, is that if they were published, it would ruin the confidentiality of the process and make it difficult for suppliers and other participants in a project to communicate frankly about it. I do not entirely accept that argument, but it does at least deserve recognition.
Indeed, it was noble. I note that the hon. Member for South Derbyshire (Mr. Todd) does not entirely accept the argument for secrecy. Earlier, he asked what the proposed review should cover. In March, we put it that first there should be an assessment of whether it is still possible to achieve the original stated objectives, and if so, within what time scale. I shall return to this point later, but given that many IT experts state clearly that it is not possible to achieve those objectives, there is a powerful case for including that consideration in the review. Secondly, the review should consider the impact on health trusts and on general practitioners’ surgeries of the delays in completing delivery of the project. The hon. Member for Eddisbury (Mr. O'Brien) made the point that hospital trusts are having to acquire interim solutions because they cannot wait any longer. That is pretty crazy, and it is an extraordinary waste of resources.
Let me complete the points about what should be included in the review. Thirdly, there should, for the first time, be a proper cost-benefit analysis to determine whether the scale of the project can be justified. To my knowledge, that has not properly been undertaken; if it has, it certainly has not been made public. Fourthly, there should be a full assessment of the civil liberties implications of the national spine. I hope that Labour Members share our concern about ensuring that people’s rights are not undermined or compromised because of the risk, even with summary records, of very sensitive information getting into the wrong hands.
I agree with the hon. Gentleman’s observation—it is important that records are properly protected, but conversely, does he accept that in years to come, when the system is fully flowing, if the No. 73 bus hit him, it would be rather a good idea for the first responder instantly to blood-match him, identify his allergies and so on? There are costs and benefits to be traded off, and we need to work carefully on that.
The hon. Gentleman proves my point: a cost-benefit analysis has to be done, so that we can balance the potential benefits. On the example that he gives, when I talk to clinicians, they are somewhat resistant to the idea that it would be valuable for them, if I got knocked over by a bus in Cornwall, readily to access my records on-screen in Cornwall. They say that there are protocols that they would follow in those circumstances, and that if there was any error in the national records, mistakes could be made. I repeat that the hon. Gentleman makes the case for me that a cost-benefit analysis needs to be conducted.
Finally on the review, there should be a proper and thorough consideration of where we go from here. If there are genuine concerns about whether the programme can achieve its original objectives, surely we should determine together how best to move the project forward so that we can achieve the objectives that are achievable. An enlightened Government would announce a review in response to this debate. Alongside that review, the Secretary of State, or the Minister, should acknowledge the scale of the problems, rather than seek to deny them.
On the hon. Gentleman’s complaint about delays with the project, is not one of the problems with his proposal the fact that it will cause injury to patients, as his review would further lengthen the time needed for the implementation of valuable projects? Reviews have taken place, not only at the gateway stage but throughout the project, and that has indeed caused delay. On the gateway reviews, is it not important that there be a degree of confidentiality, so that consumers, end-users and suppliers can be honest in any dialogue about what works and what does not? Surely that is more important than the hon. Gentleman being able to read gateway reviews, if he so chooses.
I pray in aid the Minister’s comments: she said in her speech that it was better to get it right than to rush ahead. That is precisely what she said in justifying the delays that had occurred. The experts whose opinion I have read who have argued the case for review say that it would be possible to conduct a review quite quickly; it would be a matter of weeks, and not months. Surely it is in the Government’s long-term interests to conduct such a review, and to make sure that wherever we go from here, we have the backing of clinicians and, hopefully, everyone in the House. That would be better than the Government simply pressing on, with their head in the sand, without acknowledging the scale of the problems.
If the hon. Gentleman does not mind, I would like to make a little progress. I am sure that he planned to make a helpful intervention, so I shall be happy to return to him later.
In arguing the case for a review, I want to deal with three key areas: technical concerns, costs and delays, and the civil liberties implications. On the technical side, I refer again to the 23 IT academics who raised concerns. I refer, too, to the written evidence of Tom Brooks, who submitted a paper to the Health Committee. He has substantial experience in the NHS and with the national programme, so we should take his evidence seriously, as I am sure that Labour Members will agree. He focuses on the central infrastructure for the national patient data, and he highlights the fact that Connecting for Health has not published any details of the calculations that it made to demonstrate that implementation on the scale envisaged is technically achievable. He says that Connecting for Health has not presented that evidence to us. He asks what records clinicians should rely on if there is a difference between the records on the national register and those held locally. It is quite possible that there may be a difference between the two because of inputting errors. Who is accountable for clinical or care errors resulting from reliance on the national summary record? He has direct experience of the national programme, and his conclusion is that the Government should acknowledge that the original goal is unattainable. He says that work on the national records system should be suspended, because that is his particular area of concern. I am not an expert, but I take the concerns of someone with that experience extremely seriously, and I hope that the Government do so, too.
Turning to the history of the problems that have occurred, Queen Mary’s hospital in Sidcup was one of the first to introduce a patient records system, but it found that it was frequently unavailable. In November last year, E-Health Insider reported hospital plans to replace the patient administration system just 18 months after it had been introduced. The Nuffield orthopaedic centre reported problems with the installation of Cerner software, with patient records disappearing. We cannot be happy about such experiences. An insider described the system as a “white knuckle ride”. Is that something that should give us confidence? In September last year, Computer Weekly, which has already received a fair airing in our debate, referred to the fact that there had been 110 major incidents—incidentally, Tony Collins has spoken to me, too, so it is not just the Conservatives to whom he is talking—that impacted on patient care. In July last year, the Computer Sciences Corporation data centre broke down, leaving 80 trusts without admin systems for several days.
Does the hon. Gentleman agree that under previous systems, particularly before 1997, there were numerous examples of systems breaking down, not for days but for weeks? The paper system, as well as a system in which computers could not even communicate from one GP practice to another or from one hospital to another, left much to be desired in terms of patient safety. I acknowledge the fact that there have been some breakdowns, but it is wrong to distort the problem by failing to compare it with the systems that the NHS operated in the past, both electronic and paper.
I fully accept there were many problems, but that is no reason for failing to be concerned about the situation or failing to acknowledge the concerns of people working in the system about the problems that are occurring here and now. In April this year, 79 doctors and admin staff in Milton Keynes hospital wrote that the patient administration system was “not fit for purpose”. It was reported in May this year that the Royal United hospital in Bath had still not had its Cerner software installed. The system was supposed to go live in November 2005, but the hospital was still waiting in May. In the same month Manchester reported hundreds of inaccurate patient records in the online booking system. The Minister ought to be concerned that those problems are still occurring.
All those technical problems have led to extra costs and delays. Reference has been made to the fact that many of the costs arising from the problems have been incurred by the private sector—I acknowledge that that has been a feature of the contractual arrangements—but it would be naive to believe that that does not have an impact on the delivery of the system. The private sector appears to be in a mess financially: Accenture is in all sorts of financial difficulty, and it has withdrawn from the system. Those problems have an impact on the delivery of the system, and I am pleased that the Government acknowledge that.
The plan was hatched in February 2003. Despite Government claims, there was no proper analysis of need or of the purpose of the whole scheme. The original budget was £2.3 billion, but it was adjusted to £6 billion, and the National Audit Office referred to £12.4 billion. We have heard estimates from insiders of a total budget of £20 billion to £40 billion—the figure keeps going up. Targets have been missed. The Minister referred to all the targets that had been hit, but what about the fact that 155 of the 176 acute trusts, according to Connecting for Health, should have been operating systems by the end of 2006-07? Only 16 of the 155 got there. We heard about the problems with iSOFT and the fact that it is under investigation by the Financial Services Authority. That is fine—we can say that it is iSOFT’s problem, but iSOFT was a key player in this whole thing, and it has an impact on the delivery of systems, so we ought to be concerned.
The Foundation for Information Policy Research says that the reason for the delay in the care records service is that it is the wrong system to build in the first place. It says that it is not how the rest of the world works. It says:
“Connecting for health is watched with appalled fascination by colleagues overseas”.
Finally, may I deal with civil liberties and privacy issues?