Information Technology (NHS)

Duncan Hames Excerpts

Tuesday 14th June 2011 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing this debate. I pay tribute to his tenacity in pursuing the subject. I know that he has a long-standing interest in it, and rightly so given the amount of money being spent on the project. I cannot compete with the way in which he articulated his case, or with his forensic and almost anorak-like knowledge of the subject, but I associate myself with the conclusions that he draws.

The project has always been over-ambitious. We would all agree that it has been poorly led and ineffectively delivered. As with many procurement projects in the public sector, the cost has escalated considerably. We have seen it happen too many times, and it is always entirely predictable. Indeed, senior leaders in the NHS were warned about that from the start.

The intention to ensure that health data should be made available at any time and anywhere was laudable, but delivering it has to be offset against the cost and whether it offers good value for money. Clinicians, practitioners and IT specialists throughout the NHS said that it would not work. Ultimately, clinicians will find their own way of doing things, and a top-down system will not work unless it is executed from the bottom up. As my hon. Friend explained, the decision to involve clinicians in the design of the system was not taken until late in the day and probably beyond the point when they could have had a useful input to ensure that the programme was fit for purpose.

Let me underline what my hon. Friend said. If we look at the initial programme of delivery and what we have achieved, we can see that we have not progressed far. Of the 4,500 sites that were contracted to receive the system, some two thirds have yet to receive anything. If we examine the progress made by Computer Sciences Corporation—my hon. Friend has outlined the history of its involvement with this case—we will see that it is contracted to deliver its systems to 97 hospitals, but so far it has delivered only four and none has been able to confirm that the system has been installed satisfactorily. Put simply, CSC has not delivered the goods against its obligations on the contract.

Once the contract is in place, everyone signs up even though it is quite clear that the company is not delivering what it promised. To be fair, in this case, the NHS started to renegotiate the contract in December 2009. None the less, more than 18 months later, no new contract or renegotiated contract is in place. CSC is still working on the same terms that it initially agreed to and we still do not have adequate delivery.

The NHS was quite clear when it said that it would not sign a new contract until it could see that Lorenzo was working. It is clear that we have to take some tough decisions because it simply is not working. As it is taking so long, we have to decide whether we are managing the project efficiently. Just how poorly does a contractor have to perform before a serious charge is made as to whether that contract should be maintained?

The NHS is an extremely powerful client. I know that suppliers have duties and obligations to their shareholders, but surely maintaining a good relationship with a customer that is as big as the national health service or even as the Government is important. We would expect suppliers to be slightly more conscious about what they are obliged to deliver.

[Duncan Hames (Chippenham) (LD)]

I listened very carefully to the initial speeches in this debate. The story that I heard was that there are suppliers and contractors who have fallen by the wayside and who have been shot and had their business fed to the others. That leaves us with the dilemma of what happens if we are left with only one supplier. Where does that leave the bargaining position of the NHS? My hon. Friend will find that there have been contractors who have found that they were not going to get paid because of their inability to deliver on their contracts.

[Jackie Doyle-Price]

My hon. Friend makes an extremely good point. To be fair, those suppliers have acted extremely honourably with regard to their obligations under the contract. When it became clear that they could not deliver the software under Lorenzo because it was not fit for purpose, they took the honourable action and negotiated their way out. Such behaviour shows a lot about those suppliers. It is increasingly worrying that CSC in particular is finding itself in a monopoly position because it has acquired and strengthened its shareholding in iSOFT. Who we negotiate with in the future is a long-term worry.

I associate myself with the conclusions of my hon. Friend the Member for South Norfolk about when we should take a decision on this project. Is it time for an emperor’s new clothes moment, or are we going to continue throwing good money after bad in a project that is clearly not going to deliver?

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

Thank you for calling me, Mrs Brooke. It is a pleasure to serve under your chairmanship and to take part in this important debate.

I want to start by paying tribute to the hon. Member for South Norfolk (Mr Bacon) for his tireless work on this issue. His determination and tenacity in highlighting the problems and difficulties of a national programme for IT have been second to none. He frequently made the life of the previous Government difficult and I am sure that he will also be a thorn—perhaps a constructive thorn—in the side of the current Government. In his work, he has demonstrated the importance of effective parliamentary scrutiny and the difference that a Back-Bench MP can make. As a new MP, I hope to learn from his experience and follow, at least in some ways, his example.

The reason for the debate’s importance is that effective IT can and must play a key role in improving both the quality and efficiency of health care. At its best, IT helps clinicians and patients share information about the quality of services that are available, which not only supports patient choice but improves standards of care. Good IT can also help patients to get care in different parts of the system without having to give the same information repeatedly about their conditions and treatments to different doctors and nurses. In addition, it can help clinicians and managers to develop more effective and efficient services, organising treatments and services around the needs of patients rather than vice versa.

As the hon. Member for Thurrock (Jackie Doyle-Price) rightly pointed out, one of the key challenges facing the NHS is to ensure that GPs, their primary care teams, social care professionals and specialists work much more closely together, so that care is more effectively co-ordinated. Indeed, the NHS Future Forum said yesterday:

“Better information systems and the development of more integrated electronic care records will be a major enabling factor for this.”

The national programme was meant to help the NHS secure those objectives. However, as the hon. Member for South Norfolk has eloquently outlined and as countless reports from the National Audit Office and the Public Accounts Committee have also shown, the programme has fallen far short of achieving them. There were poor specifications about what was required by Government and what suppliers could deliver in return. In addition, as the hon. Members for Thurrock and for Stroud (Neil Carmichael) have said, there was over-claiming by both sides about what could be delivered and by what date. Furthermore, there were poor lines of accountability and responsibility for the programme, at least in its initial stages. All of those problems have led to one delay followed by another and, crucially, to a lack of control over costs.

I do not intend to go over those problems in detail. My knowledge of the subject is nowhere near as comprehensive or forensic as that of the hon. Member for South Norfolk. Instead, I want to take a step back and suggest three broad lessons that need to be learned from the problems of the national programme, as part of a constructive contribution to the Minister that he can take forward in his thinking on this subject.

The first lesson is that any IT system, whether it is in the NHS or elsewhere, must be led by its users. In the case of the NHS system, it must be clinically led. That is not only about getting clinical “buy-in” but about ensuring that doctors and nurses directly shape and develop the IT system so that it helps them do their job properly for the sake of patients.

NHS clinicians have said that they want IT to achieve five key objectives: first, allowing information about appointments to move around within hospitals, and between hospitals and the rest of the NHS, so that appointments can be booked; secondly, communicating information about discharges from hospital to hospital, and from hospitals to GPs and community services, so that staff in all parts of the system know what conditions patients have; thirdly, allowing staff to book tests such as MRI scans, ultrasounds and so on, and to get the results back to the patient and their clinician at the right time and in the right place; fourthly, the ability to schedule all the different tests, treatments, operations and so on that a patient has in a way that meets the needs of the patient; and finally, enabling electronic prescribing of drugs and the gathering of necessary pharmaceutical information to ensure that patient care is as safe and effective as possible.

Those five key objectives emerged from a consultation exercise with clinicians in 2008. However, as the hon. Member for South Norfolk has said, that was too late; the consultation exercise should have happened before the contracts were signed and not halfway through the process.

Can the Minister say how the Government will ensure that clinicians continue to be involved in developing the IT strategy for the NHS? Did the NHS Future Forum consider the IT strategy as part of its recommendations to Government? I ask because there was only one small line on the IT strategy in that report. Also, have the Government received any specific responses on this issue and, if so, will the Minister publish them?

On a related point, can the Minister say when he will publish the Government’s information strategy? In October 2010, the Government published “Liberating the NHS: an information revolution”. That document set out the Government’s plans to ensure that patients, the public, clinicians and managers have the information that they need to improve health and health care. I do not agree with some of the tone of that document; it seemed to suggest that the previous Government had done nothing on the matter. When Labour was in government, we acted on he issue. For example, if one considers a programme such as NHS Choices, to which there was quite a lot of opposition at the time, one can see that we moved the agenda forward. Having said that, I absolutely agree that we all need to go further.

My concern is that the consultation on the Government’s information strategy closed six months ago today. In that time, the Government could have provided more information to patients and the public to improve choice and quality. When will that strategy be published?

The second lesson that we can learn from the national programme is that we cannot have a one-size-fits-all IT system in the NHS, or indeed in any health care system. As Sir David Nicholson, chief executive of the NHS, told the PAC on 23 May, attempting to provide one type of medical record that covers everything for everybody everywhere in the country “has proved unworkable”. The challenge is striking the right balance between what—if anything—is delivered centrally and nationally, and what is delivered locally. That is a perennial challenge in all parts of the NHS and needs to be thought through.

The national programme is currently being reviewed by the Cabinet Office’s Major Projects Authority. On 18 May, the Minister told Radio 4’s “Today” programme that he wants to allow local hospitals to adapt their existing systems rather than to get rid of them altogether or, indeed, to scrap the national programme for IT. Last month, David Nicholson told the PAC that the Department of Health wants to move towards a situation whereby hospitals have their own direct relationship with software suppliers and where individual organisations take responsibility for their IT. However, he also said that, with all the reorganisation of the NHS that is going on, we need an interim step, a transitional body that will

“look very similar to Connecting for Health”.

He said that it was very important to have that body,

“to enable us safely to transit from where we are at the moment to a place where individual organisations take responsibility.”

I would like the Minister to explain a few things. What is that transitional body? Who will be responsible for running it? How much will it cost? How will it be different from Connecting for Health? At what stage will it disappear and how? Finally, if a national, centrally led programme has been part of the problem in the past, why will this new national, centrally led body somehow deliver the future when individual trusts are in control?

The final lesson that must be learned relates to a point that the hon. Member for Stroud made, which was about a much bigger problem for Government than the other problems that I have mentioned. How do the Government have an effective relationship with the private sector in contracting with it, not only in relation to IT projects but to all sorts of other projects? I am thinking, for example, about the problems that the Ministry of Defence has experienced with its contracting. Successive Governments have found it extremely difficult to negotiate effective contracts with the private sector, and not just IT contracts. It is fair to say that they have not exactly covered themselves in glory in that respect.

[Duncan Hames]

Will the hon. Lady reflect on whether one reason why Governments have such difficulty in controlling contracts with the private sector is that politicians routinely make policy changes that alter the specifications for what is required, and contracts are not able to accommodate that? I wonder what lessons she might learn if we looked, for example, at how the choice agenda was rolled out in the NHS during this period, and at the demands that that placed on changing requirements for private contractors.

[Liz Kendall]

The hon. Gentleman makes a very important point about the nature of the political process, with politicians frequently determined to fill the newspapers with headlines about new policies, while the difficult process of implementation takes far longer on the ground. When I had the privilege of working in the Department of Health, I saw the NHS Choices project and thought, “This doesn’t look like what I thought the politicians meant. It wouldn’t give me, as a patient, the information I needed about which consultant or hospital to choose.” There is, therefore, the problem of how about we go from a political idea to a policy on the ground, and how quickly that changes.

With the greatest respect to the civil servants sitting in this room, we have perhaps not thought through effectively what kinds of skills and experience are necessary in Departments. What steps has the Minister taken since the Government were elected to ensure that the Department of Health has people with the right skills and experience to deal with such high-level negotiations? Have the Government as a whole decided to look at that issue? Has the Cabinet Secretary, Sir Gus O’Donnell, considered how best to ensure that there are people across the whole civil service with the skills and experience that politicians urgently need to support them in their work?

I thank all Members for their contributions today. This is a very difficult subject, and we need to find a way through that does not waste more taxpayers’ money but understands that IT and information are crucial to improving health and health care. The key issue is how we get there.