Public Sector: IT Projects

Part of the debate – in the House of Lords at 3:14 pm on 21st June 2007.

Alert me about debates like this

Photo of Lord Warner Lord Warner Labour 3:14 pm, 21st June 2007

My Lords, I am grateful to the noble Lord, Lord Lucas, for starting the debate; it certainly provides me an opportunity to describe the reality of the Connecting for Health IT programme, and to contrast that with the fantasy and exaggeration presented by its extreme critics—parliamentary and otherwise. As the House will know, I was the Minister responsible for the programme until January, and I will draw on that experience.

Connecting for Health is one of the largest civil IT projects in the world. It is not a catastrophe and has not fallen on its face, as the noble Lord, Lord Lucas, said; it is a highly complex 10-year programme aimed at rescuing the NHS from its position in 1997 asone of the last bastions of paper transactionsand garage-designed computer systems. The one thing that you could guarantee about those systems was that GPs could not transfer information about patients electronically to another GP or healthcare provider.

Of course there have been problems, but the programme's achievements have been remarkable. They follow a four-year programme of extensive user and public/professional consultation and piloting before the letting of contracts in 2003. There has continued to be a willingness to listen and adaptsince, especially through the network of hard-working clinical champions interacting with professional users. One can always do better on user involvement, but the critics who claim lack of professional involvement are simply rewriting history. Indeed, the level of professional discussion and involvement has led to the two-year delay on the electronic patient record, and one of my jobs as a Minister was to unblock that logjam, which has now been done.

The contracts for this programme were an "exemplary example" of public procurement. Those are not my words, but those of the former chief executive of the Office of Government Commerce, supported by a June 2006 NAO report. Risk under those contracts rests with the contractors, not taxpayers as all too often has been the case in the past. Last year, Accenture learned that lesson the hard way and moved out of the programme, but without disrupting progress. The credit for the success of the contracts, worth nearly £7 billion over 10 years, goes not to Ministers but to the director of Connecting for Health, Richard Granger, and his talented team, including many doctors. The NAO in June 2006 found that the programme was well managed, was based on excellent contracts, was delivering major savings, had made substantial progress, and was on budget. Now that Richard Granger has announced that after five years running that huge project he will step down towards the end of the year, we should all pay tribute to a remarkable public servant who I hope will be given the recognition that he deserves.

The unfair and unrelenting criticism of the project, and by implication my staff—Ministers can take it but these are day in, day out, attacks on staff trying to do their best for the public and the NHS—becomes all the more extraordinary when one looks at the benefits to patients and to NHS staff that the programme is already producing. For the first time, there is a national spine that provides the capability to move information reliably and securely between 20,000—not 2,000—varied NHS sites, ranging from large acute hospitals to small chemists' shops. The published reliability figures are impressive, with the NHS experiencing availability of at least 167.9 hours out of a possible 168 hours each week. It is untrue that the system is insecure, because it is the only public sector IT system to use e-GIF level 3 requiring a smartcard and PIN issued only on production of ID and address, with serious disciplinary consequences—including prosecution—for malpractice.

What has been achieved so far is stunning. Using the new secure e-mail system, the 250,000 registered users have now sent their 200-millionth e-mail, helping to speed up patient services. We are ending the ferreting around in hospital basements for old X-rays through the digital Picture Archiving and Communications SystemPACS. Some 6,000 new images a week are being generated by PACS, which is now in the majority of hospitals, with 260 million images stored and easily retrievable on the system. This is saving the NHS millions of pounds and reducing patient exposure to radiation.

Patient safety is being further improved by the rapid implementation of the electronic prescription service. More than 2,200 GP systems and 2,600 pharmacist establishment are now live and about 1 million prescriptions are being transmitted each week. EPS will not only make patients safer but will cut fraud and save millions of pounds for the NHS. Patients and their GPs can now book their hospital appointments electronically through Choose and Book. I acknowledge that there have been problems with that in some places, but nearly 4 million bookings have been made and the usage is about 90,000 bookings a month. Of course not everything has gone smoothly. Progress on new hospital patient administration systems has been too slow, with 200 new systems still to be installed. That is partly because we have been too inflexible over local systems—I acknowledge that point—but that is changing quite rapidly.

Finally, there is the big prize of a transferable electronic patient record, about which there has been much controversy. This record of individual patients will make patients safer, save lives, improve whole-population public health and aid medical research and training. I recognise that there are genuine concerns about patient confidentiality and privacy, but we cannot have the patient benefits of this IT system without networking local systems. It is possible to work our way through these concerns, as I and others—including my noble friend and successor Lord Hunt—have been doing. That is why I set up a taskforce with many of the professional critics and asked Connecting for Health to develop pilot schemes for electronically transferring patient records with a scope for people to opt out, but with the dangers of doing so properly explained to them. It is interesting that from these early adopter sites only 0.2 per cent of patients have so far wished to opt out.

Some of my puzzlement over hostility to the programme has been removed, since leaving office, by discovering people working together to campaign against this programme. The campaign seems to be made up of the Foundation for Information Policy Research, the Big Opt Out organisation, the Conservative Technology Forum, Computer Weekly, Medix surveys and the Worshipful Company of Information Technologists, which I only recently discovered. An energetic presence in this network is a Cambridge professor called Ross Anderson. Some interesting e-mails of his have found their way to me. One e-mail of 27 November 2006 says:

"The Big Opt Out org will be a separate campaign (which many of us help). The principal organiser is Helen Wilkinson"— who I believe is a Conservative councillor. Another e-mail, of 13 February, talks about,

"how we might put the IC on the spot".

The IC is of course the Information Commissioner. Another e-mail, of 8 March, after Professor Anderson had been asked to be an adviser to the Health Select Committee, says:

"Well I said yes on the grounds that I can probably do more on the inside than on the outside".

Another e-mail which I particularly like is of 24 May 2007, sent after a lunch with Conservative front-bench spokesman Damien Green MP, who is quoted as saying,

"the Tories had taken an uncharacteristically principled line on the ID card and now felt exposed".

Ross was asked to provide some other arguments—a little less principled, I assume. Finally, in a quote from an e-mail of 20 December 2006, we have something a little closer to home:

"After speaking to Andrew Lansley, Tim Loughton, Malcolm Harbour and Lord Lucas I'm maybe starting to get the message across".

I have insufficient time to entertain the House with more extracts. I am willing to let them be seen on a private basis by my honourable friend in the other place who chairs the Health Select Committee. In a spirit of bipartisanship, I would encourage Conservative parliamentarians to look closely and sceptically at some of the sources of advice they appear to be using. The Connecting for Health IT programme should not be a political football. Too much is at stake for patients and the NHS.