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Public Sector: IT Projects

My Lords, I am sure that the House will be grateful to the noble Lord. He will be relieved to know that I am not going to make a strident attack on Connecting for Health. Indeed, I support its aims, for the most part enthusiastically. However, in April this year, the Public Accounts Committee in another place published a report on the current state of play. The largest single element of Connecting for Health—the Care Records Service—is running about two years behind schedule. The suppliers to the programme are struggling to deliver. Not only that, but the department has failed to win hearts and minds in the NHS, especially on the question of whether the system will be fit for purpose. Four years after the programme started, there is still huge uncertainty about its cost across the wider NHS and considerable woolliness about the value of the benefits that it will eventually provide. The noble Lord, Lord Warner, is right: this is not a picture of a disaster. However, the conclusions were nevertheless pretty disturbing. On the surface, the Government insist that everything is on course, albeit delayed. The Prime Minister was informed in February that there were no technical problems with the programme, only a certain amount of difficulty over winning hearts and minds. That advice was manifestly incorrect. In the southern cluster, Fujitsu is installing software supplied by Cerner Millennium. In April of this year, 79 doctors, nurses and secretaries at Milton Keynes General Hospital—one of the pilot sites—signed an open letter stating that, in their opinion, the new care records system is not fit for purpose and should not be installed in any further hospitals. They drew on numerous case studies and cited a catalogue of serious faults. That situation is worrying enough, but in three of the other clusters the position is, if anything, even worse. The software programme on which the system is to rely has not yet even been written. iSoft, the company responsible for writing it, is in severe financial difficulties as a result of its failure to deliver and is currently under investigation by the Financial Services Authority. As we have heard, Accenture, the main service provider for two of the clusters, resigned last year and in so doing made a provision in its books for $450 million. Its contracts are being taken over by CSC. In CSC there have been no fewer than 10 resignations at very senior management level in recent months. We may well be told that these are not significant, but such events do not serve to reassure the outside observer. Equally unreassuring is the fact that two other key suppliers to the programme—Commedica and IDX—have also fallen by the wayside. The line taken by Ministers, which we will probably hear again today, is that it is better to get things right than to rush. Fair enough, but where are we heading? One of the concerns expressed about the Care Records Service is its potential to blow patient confidentiality out of the water. How do you make someone’s medical details available to any NHS doctor in the country while at the same time giving that patient the cast-iron reassurance that there will be no unauthorised access to his file? This is a fundamental consideration, which was not properly thought through when the programme was commissioned. It is one that has come to the fore again in the context of the online application system for postgraduate doctors, MTAS. So insecure was this system that extremely personal details about individual doctors, including their sexual orientation, were accessed by reporters working for Channel 4. It has been said that if the Government cannot guarantee the security of 30,000 doctors, what hope is there for 50 million patients. It is not surprising that in a recent poll only a third of GPs said that they would advise their patients to allow their information go on to the national spine. The Government have agreed that any patient will be able to opt out of the spine, which is surely right. However, I believe that part of the Connecting for Health budget should be directed towards a public information campaign on that issue. Records held by a GP and made available to the local hospital present little or no difficulty, but when records are placed on a national spine there is a real problem of accountability for the security of the data. Who exactly is accountable? But there is a wider issue here. There are many who believe—I am one—that in a major respect this massive IT programme was not soundly conceived. None of us, I am sure, would argue that holding patient records in electronic format in a GP practice or at PCT level is a bad concept; far from it. But exactly what cost-benefit analysis was done to validate the central vision of a nationally accessible patient database? The answer to that, so it appears, is practically none. The underlying thought was, in truth, a pretty loose one: that it would be handy to have someone’s medical records freely available in an emergency at any hospital in the country. The evidence to support that idea was nil. The overwhelming majority of patients access NHS care within their local community. If you have a heart attack or you are in a car crash miles from home, there are established clinical protocols that should make access to your medical records almost irrelevant. It is telling that in Wales the Assembly has opted for a much less ambitious and much less costly IT solution. The original estimate for a Welsh equivalent of the Care Records Service was £1.5 billion. That option was rejected in favour of a system costing a mere £3 million. For that sum of money, the Welsh NHS will get a single patient record system available to GPs, local acute trusts and doctors performing out-of-hours duties. In other words, the vast majority of situations for the vast majority of patients will be covered. I am told that doctors in Wales are more than content with this approach. That is the key difference between Wales and England, where stakeholders feel resentful about not being more involved in the procurement process and, above all, lack a sense of ownership of a system that they are being asked to operate. How do the Government propose to remedy this, given that only one-quarter of GPs now say that they support the programme? In 2004, the figure was well over 50 per cent. I do not for a minute doubt the benefits that Connecting for Health will bring, especially those relating to patient safety; I acknowledge them fully. But there are serious question marks over the programme’s design and the benefits that it will offer at the margin measured against the marginal costs, both originally and now. All that points towards adopting two things that my noble friend Lord Lucas so eloquently argued for: honest and regular re-evaluation, and greater openness, including publication of gateway reviews. Surely that is how this vast and vital project, whose success we must all wish for, stands the best chance of reaching fruition both on time and on budget.