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NHS: Connecting for Health

Volume 703: debated on Tuesday 8 July 2008

asked Her Majesty’s Government:

What is their current assessment of progress made by the agency NHS Connecting for Health.

My Lords, the national programme for IT, which is being delivered by the department’s NHS Connecting for Health agency, is delivering front-line systems and services that are bringing major benefits for NHS organisations, staff and patients. The most recent National Audit Office report of May 2008 said:

“All elements of the Programme are advancing and some are complete”.

However, certain aspects still have some way to go.

My Lords, can the noble Baroness confirm that this IT scheme has already cost £12.7 billion and is five years late? What is the future? Really, I cannot see any. And what about Accenture and Fujitsu leaving?

My Lords, there is a lot of mythology about the cost of the national programme. However, it is not, and has never been, over budget. The recent NAO report confirms that the cost of the original contract at £6.2 billion has not changed, and that the overall programme cost is substantially unchanged from the figure in the earlier NAO report of £12.7 billion.

The fact that Fujitsu’s contract was terminated is in fact a sign of the programme’s strength. The programme is still on course, and our contractors are not paid until they have delivered. In that sense, no money has been lost.

My Lords, have the people who are involved in this work—NHS officials, clinicians, and so on—been consulted about the programme and, if so, what were their views?

My Lords, large numbers of clinicians were involved in the original specification. The programme continues to receive high levels of support among front-line and managerial staff. An overwhelming majority say that implementing it is very important. Sixty per cent of clinical support for the initiative is, we think, a reasonable consensus. Some clinicians have in the past been resistant to change and are nervous about the new technology, but the key way to change attitudes for the programme is to continue to demonstrate successful delivery and improved services.

My Lords, the 2004 NHS Improvement Plan said that in 2008, each patient,

“will have access to their own personal HealthSpace on the internet, where they can see their care records and note their individual preferences about their care”.

As at March 2008, just over 150,000 summary care records had been uploaded on to the spine, representing 0.24 per cent of UK medical records. Is that a satisfactory rate of progress?

My Lords, the noble Earl will be aware that the debate about summary care records has been rumbling along. My noble friend Lord Warner concluded that there were many compelling reasons to have a ministerial task force in 2006. So the gradual rollout is in early adopter sites; they are subject to independent evaluation by University College London, which reported on 6 May 2008. NHS Connecting for Health is currently considering the finding that the clinician treating patients should seek consent to view before accessing a summary care record. Patients can choose not to have a summary care record, but evidence from our early adopters is that under 1 per cent of people make that choice. We are very confident that, over time, this will roll out as a very successful programme.

My Lords, I think that my noble friend asked whether that was a satisfactory rate of progress. Will the Minister answer that?

Of course, we could always do better, my Lords, but, with new technology, it is better to get it right.

My Lords, large software systems are notoriously difficult to write correctly and impossible if the specifications are not stable. Can the Minister assure us that the specifications are stable?

My Lords, if that is a very technical question, I am probably not in a position to answer it. However, given the amount of consultation that went into the specification, and the time taken to make sure that we get it right and that data security and confidentiality are top priorities, we are confident that this is moving forward at the right speed.

My Lords, does the Minister agree that there is a considerable effect on privacy of medical data when the operating code for the system is not held by the NHS but is retained by the suppliers? If so, what is the department doing to ensure the integrity of private medical information?

My Lords, the IT systems implemented as part of the programme have high standards of security control, requiring a smart card that is issued only to staff providing NHS proof of identity along with a password. All moveable data must be encrypted to protect their confidentiality, and those are the property of the NHS. At local level, NHS trusts are accountable for applying security policies and standards. Where losses occur, they exclusively involve items such as local laptops or paper-based records and are based on human error rather than technical failures.

My Lords, the noble Lord, Lord Broers, asked a fairly simple question: is the specification stable? That is, are the authorities asking for something different from time to time as the system is developed? Can the Minister assure us that the specification has remained, and will remain, the same?

My Lords, the specification will not remain the same because medical progress happens. Therefore, the specification will have to change from time to time as medical progress takes place.

My Lords, does my noble friend not agree that this is a hugely ambitious project and that the NHS deserves some credit for attempting it?

My Lords, as of the end of June, a typical day in the NHS saw 320,000 prescriptions transmitted electronically, 25,000 choose-and-book electronic bookings made, more than 50 per cent of NHS referral activity being from GP surgeries to outpatient appointments, 2 million queries recorded and 1.5 million digital images such as X-rays kept to service NHS patients.