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The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to take part in this debate under your chairmanship, Mrs Brooke.
I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing this debate. His forensic analysis of what has happened over the past decade or so made it clear that he has a justifiable reputation as a leading expert in the House on the subject, and it is due to his tenacity that things are done and things are found out, and that we can be kept on our toes through the legislature holding the Executive to account. In a mood of bonhomie, I also congratulate the hon. Member for Leicester West (Liz Kendall) on her tribute to my hon. Friend. That was particularly magnanimous of her because, for the vast majority of his 40-minute speech, he was criticising her Government’s performance in creating the situation we are in, and for the mistakes and problems that have flowed from the decisions taken at the beginning of the century.
I agree that IT is crucial to a modernised NHS. We need to be able to record, store and exchange information if we are to realise our ambition of having health outcomes that are consistently among the best in the world. The previous Government’s centrally driven, top-down vision of NHS IT began in 2002, and the original title was “Delivering 21st century IT support for the NHS.” Sadly, however, the vision took an approach that was more akin to the early post-war years of the 20th century. It was clear to us, even before we took office, that the approach made little sense, and that to deliver a modern health service we needed a more flexible and locally driven approach—a view shared, ironically, throughout the NHS.
Last September, I announced that we should no longer talk about a “national programme for IT”:
“Improving IT is essential to delivering a patient-centred NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this. We will allow hospitals to use and develop the IT they already have”.
So, rather than the old “replace all” strategy of the previous Government, we favour a strategy of “connect all.” It makes no sense to rip out and replace systems that trusts already successfully use, and we have, therefore, put local NHS organisations in control of introducing new systems. Rather than a single national programme, we should view the strategy as a series of related projects, categorised under national infrastructure, national applications and local services.
It is clear that, over the years, the scope of the national programme expanded, but it is now vital that we focus our investment and energies on the things that will make a difference to the quality of care. We asked clinicians what they wanted from NHS IT systems and they came up with five things that they believed were critical to them and their ability to carry out their duties. They were: a patient administration system that integrates with other systems and provides sophisticated reports; order communications and diagnostic reporting; letters with coding for patient discharge, clinics, and accident and emergency; scheduling for beds, tests and theatres, and e-prescribing. In addition, we are focusing suppliers on key departmental systems, such as those needed to support maternity, child health and accident and emergency, which, taken together, will make a significant difference to the experience of patients and the working practices of clinicians and managers.
At the same time as changing the approach and scope of the programme, we have closely examined its costs. There is little we can now do about the money that has already been spent, but we have been able to reduce the cost forecast from 31 March 2010 by £1.3 billion— about 18%. The savings will come from the companies supplying services, from reduced local costs and from our internal overheads in managing the programme. Suppliers will reduce their costs by £670 million, local costs will reduce by £200 million and we expect to save £400 million on our internal central costs. That is a 25% saving of the total internal budget, and 40% of the amount that the previous Government expected to be spent from the end of March 2010 to the end of the programme.
We have asked local service providers—the companies delivering the contracts—to change their scope and their delivery model and to reduce their costs. We have reached agreement with BT but still have some way to go before we come to an agreement with CSC. We will absolutely maintain the principle that suppliers will get paid only when they deliver working systems. We are pushing harder for faster results, and have made it clear to suppliers that we will not tolerate further delays. It is important to state that every single penny saved will be reinvested in improving patient care.
When it comes to NHS IT, there are, I am afraid, no easy choices. Several Members have mentioned that we have just carried out another major projects review, the outcome of which we expect to know in two to three weeks’ time. Until we have had the opportunity to consider the review’s conclusions, we will not be making any decisions on future investment.
It should not be said, however, that nothing has been achieved over the past decade, as many essential elements have already been delivered. Regarding national infrastructure, there is the spine, which is the core service that connects all other systems at both national and local level and handles, among other things, more than 11 million daily queries made on the personal demographics service.
N3, the secure network that links all NHS organisations to each other, to outside data centres and to the internet, has almost 50,000 connections. The NHS internal e-mail service handles 2 million e-mails every day.
As for national applications, every day, choose and book processes about 30,000 appointments, the electronic prescription service sends about 660,000 prescription messages and about 2,000 records are transferred electronically using the GP2GP system. On the summary care record, as a result of the two reviews that I commissioned last summer, we now have agreement on the core data to be held and the approach to roll-out. More than 30 million patients have been contacted about the summary care record.
Systems implemented by the programme are making a difference to patients’ experiences and to clinical efficiency, safety and effectiveness. For example, at Morecambe Bay, infection prevention is now fully electronic, using the Lorenzo system. In St Barts, clinicians are alerted to all patients carrying MRSA through the Millennium system. The Royal Free hospital has also used Millennium to create safety procedure information, including for endoscopy data and bleeding guidelines.
Although progress in delivering local systems has been slower than anticipated, BT has delivered community and mental health systems to all trusts in London and the south that requested them, and the Cerner Millennium system to just over half the London trusts that require it. CSC has delivered to 83 acute trusts in the north, midlands and east of England using upgraded interim systems. It has also delivered iSoft’s Lorenzo e-patient record system to 10 trusts and completed delivery of 137 prison health IT systems across the country.
The NHS needs local systems to be fully integrated with the core components supplied by the programme. The interoperability toolkit will help. It is a core part of the “connect all” strategy, enabling trusts to exploit their existing systems fully. There is a great deal of interest in the approach; 78 suppliers and 71 health organisations attended the last forum on the toolkit. It is already being used to good effect at Newham hospital to deliver a patient check-in kiosk, and at Liverpool Broadgreen hospital to provide a consolidated view of patient information across multiple care settings.
All but 14 of the more than 8,000 GP practices in England have a system supplied by either the national programme or the GP systems of choice scheme, which has allowed us to maintain several small and medium suppliers in the market. In the south, we have used the additional supply capability and capacity framework for community and mental health to bring together 10 trusts to leverage their combined buying power while increasing their choice.
Security must always be at the front of our minds when we consider NHS IT systems. Great care is taken to ensure that systems are secure, and we carry out regular tests to ensure that they cannot be penetrated inappropriately. My hon. Friend will have heard late last week about the hacking of the SHINE sexual health website run by the East London NHS Foundation Trust. The website was an information-only site that carried no patient data and a local service that was not connected to any data held nationally. The issue was dealt with promptly, and the trust urgently reviewed its local security arrangements and is satisfied that no further breaches are possible. We also operate a rigorous process of role-based access controls to ensure that only the clinicians treating a patient have access to sensitive clinical data.
Because NHS systems are so critical, they need to be far more robust and stable than those outside the programme. We invest a great deal of money in ensuring that if systems go down, each and every component can be automatically recovered. Should a whole system fail, it can be recovered and made available for clinicians to use within two hours. Of course, such a level of disaster recovery does not come cheaply, which helps explain differences in price between some systems in the programme and similar systems procured by some trusts outside the programme. Systems bought locally will need to meet the technical and data standards laid down by the national commissioning board in order to participate in the networked environment.
I turn to the points raised by the hon. Member for Leicester West and my hon. Friend the Member for Thurrock (Jackie Doyle-Price). The hon. Member for Leicester West asked about the role of the NHS Future Forum. There were no specific responses about NHS technology systems, but it is clear that information flows are essential to link interventions and outcomes. However, as she said, we concentrated on the information revolution through the document that flowed from the White Paper last summer. As she also said, a consultation was held. We have been considering the responses, and we will publish them in due course. At the moment, I cannot give her a definite time.
The reason for the delay—I hope that she will appreciate this—is that during the eight to nine weeks of the listening pause on NHS modernisation, a decision was taken not to publish the responses to the information revolution consultation, if only to help the hon. Lady, so that she could not accuse us of not pausing sufficiently to listen to people and of carrying on regardless of what was going on in the listening exercise. I hope that she will give us credit for holding a genuine listening exercise and appreciate why we did not publish during that period. It was not least to forestall her criticism of us for doing so.
The hon. Lady also asked about the transitional vehicle. As she will appreciate, it is required to manage the existing arrangements and support local systems. It will not determine what needs to be done; the shape, scale and timeline have still to be determined exactly. We are working on it as part of the response to the pause, and we will determine in due course how it will operate to provide that support and move forward under the auspices of the national commissioning board.
My hon. Friend the Member for Thurrock asked about ensuring value for money and checking everything. I can give her assurances on that, because it is crucial. There is little point continuing to talk about the past, partly because we were not responsible and would not have done things as the last Government did them. We are where we are. We must learn from our mistakes and move forward. I hope that my hon. Friend will accept from my comments that we have grasped the nettle, accepted that the approach was wrong and learned from our mistakes, and that we will continue to learn and to seek to ensure that we have the information system critical to a modernised NHS and improved and enhanced patient care and patient experience, while minimising the problems that have haunted this episode ever since its introduction a decade ago.
I hope that my hon. Friends and the hon. Member for Leicester West will accept that we are moving forward, learning lessons from the past and seeking to ensure that we have a system that meets the requirements of a modernised NHS and, above all, is fit for purpose and does what the NHS needs it to do.