MR GUY HAINS, PROFESSOR BRIAN RANDELL AND DR ROB HALE

10 MAY 2007

  Q251 Chairman: I welcome you to the second session of our inquiry into the Electronic Patient Record. For the record, perhaps you would introduce yourselves and the positions you hold.

  Mr Hains: I am chief executive of Computer Sciences Corporation. My responsibilities span Europe. Ours is of the order of £2½ billion organisation in Europe. We are part of a global organisation. I also have specific executive responsibility for CSC's work in this programme and that is a role I have held since its inception. I personally spend a considerable amount of time on the programme.

  Professor Randell: I have been a professor of computer science at Newcastle since 1969 following a career in industry in Britain and America. I have been notionally retired for five years, but professors do not really retire. My particular research interest over many years has been to do with system reliability, security architectures and the like. Only in the past year have I taken an interest as an outsider, not as a medical specialist, in the National Programme for Information Technology.

  Dr Hale: I am Dr Rob Hale. I am consultant psychiatrist and psychotherapist working at the Tavistock and Portman Clinics in London. I am also a member of the Royal College of Psychiatrists' working party on confidentiality.

  Q252  Chairman: Mr Hains, Computer Sciences Corporation has taken over two of the five local service provider contracts from Accenture after it withdrew from the programme.

  Mr Hains: Yes, in January.

  Q253  Chairman:. As an opening question, why do you believe that you will succeed where clearly Accenture felt it was failing?

  Mr Hains: First, obviously I cannot comment on Accenture's ultimate motives for leaving the programme, but I think I can give some good insights on the basis of comparisons. In our execution in the North West and West Midlands, which was our original contract award, our strategy was very much to address the key secondary care environments that we felt would create the central nucleus for the sharing and interoperability that this programme strives to achieve. In the main GPs have reasonable levels of technology. They have chosen multiple systems. Certainly, some of them need better management and security, but generally it is a pretty well automated environment, whereas in the hospital environment in secondary care it has been a very mixed picture. If one is looking for the essence of Connecting for Health that is a very good place to start. We made very good progress in terms of making more than 70 patient administration system deployments in the North West and West Midlands, including 11 acute settings one or two of which were on a very large scale. The most notable among them was University Hospital Birmingham. If we compare that with Accenture's path and plan in the other two clusters in which we now operate, it addressed and made good progress in the primary care and GP sector. In terms of getting energy behind the programme and starting to deliver on the Connecting for Health aspect of the programme, they were not able to make as much progress. Second, within our own contract and supply chain—I am sure this will be relevant to some of the architectural discussions—we are delivering both the functionality and operations, whereas Accenture were relying on other parties to run the operations in the computer centres that supported that programme. That gave them some issues of latency in their deployment and management. Third, as has been commented upon, we have had a longer change management commitment as we move to a change of a major hospital. We have deployed much more assistance in terms of supporting administrative and clinical staff in making the change. I believe that that approach, whilst it has added time at the front end, has helped to industrialise the deployment and allowed us to make more deployments than anybody else. If we can combine the excellent work that Accenture did in primary care with the progress that we are now making in their clusters in secondary care we will get the best of both worlds. Since our take-over in January we have made a further 51 GP deployments and have just brought on three of the largest hospitals in Ipswich, Bradford and Northampton. Progress is good and we feel that we can succeed where clearly they drew the conclusion they could not.

  Q254  Chairman: Professor Randell, in total CSC now holds three of the five local service provider contracts. Do you think this is a serious problem? If so, how do we get more competition in this field?

  Professor Randell: I believe that the whole issue of architecture and the role of local service providers needs to be addressed before that more narrow question is considered. When we talk about a local service provider we mean a provider that is providing a service to a number of patients which is equivalent to the population of a medium-size European country. That is not very local in my terms. In this morning's discussions there was a good deal of debate about locally and nationally held data and at times it appeared that "local" almost meant "GP" or possibly "hospital" and "national" meant the entire English nation.

  Q255  Chairman: We will move on to that in this session. I am just thinking in terms of the number of LSPs that CSC is now running. Do you think there is anything difficult or wrong with that, not the state of the architecture adopted by them or anybody else running the LSPs at the moment.

  Professor Randell: One can say only that from the point of view of reliability in very general terms one likes diversity and a number of independent things on which one can rely if something goes wrong. One can say that the ability to step in in place of Accenture is an example of that. In that sense the fact there were multiple suppliers had some merits. Clearly, one would lose those merits if and when one got down to one supplier, but that is almost a philosophical answer in the context of reliability.

  Q256  Chairman: Mr Hains, you are reliant on iSoft's Lorenzo product as your main hospital administration system. When do you expect Lorenzo to be widely available? The obvious question on the back of that is: why has there been such a delay?

  Mr Hains: It is absolutely correct that Lorenzo is our kernel; it is the centrepiece and enterprise part of our solution. We chose it originally because of its wide deployment and acceptability in the North West and West Midlands. We also chose it because its future direction was very much tailored to the operating model and forward vision of the NHS. It is not the sole product. Many of the solutions that we have are more best of breed models. We have products called Map of Medicine, Liquid Logic, TPP (for the GP and Primary Care Market) and Medusa. I believe that to characterise it as a sole dependence or the only component of the solution is incorrect. In terms of its delays, I point to a number of factors. There is no question that the ambition of Connecting for Health, in terms of the care pathways and advance vision that the UK has, is demanding in terms of software building. We will guarantee the highest levels of software quality and this procurement has raised the bar considerably within the healthcare provision software industry. It is frankly a much higher bar to jump over. The rigorous testing that is going into even the early development is very different from the way software providers in this market have rolled out systems in the past. That is proving to be demanding. It is a product that will have more and wider use than purely the UK, and I believe that to be a real plus point. In terms of our international work effectively we do the spine in Holland. iSoft is the predominant software in the Dutch environment in terms of healthcare. We think that to have a product that is built for more than the UK has advantages. That adds some more development work to make sure it can be internationalised. Whilst it would be inappropriate today to comment on its financial position, there is no doubt that the uncertainty regarding iSoft and its future ownership has proved an unwelcome distraction. What I can say is that we are fully supportive of iSoft and since the departure of Accenture, which was another interested party in the development, we are very much more focused on Lorenzo. We have 100 people working in the iSoft organisation co-developing that product, and the NHS has also dedicated 23 clinical and healthcare professionals to work full time to ensure that the requirements are optimum for the early delivery. It is getting an awful lot of support to get the fastest timing and delivery is due in the middle of next year.

  Q257  Chairman: You have told us why you believe you do not want to move away from iSoft. As you rightly point out, there are other suppliers, but presumably they have to reach the higher bar as well that has been set for the National Health Service. But you still believe that you took the right decision?

  Mr Hains: Yes, we do. There are over 103 product and solution providers accredited and certified by the NHS. In terms of areas of specialism, this is not a one size fits all; it is a best of breed-type solution set. We are making good progress with iSoft and believe that it is a very good solution for the NHS.

  Q258  Dr Taylor: Mr Hains, I want to turn to some of the detail of the system design because you should be in a position to tell us. Turning to the Detailed Care Record, what will be in it?

  Mr Hains: Building on the discussion that preceded this, I should try to make it clear where some of the records are and what the vision is in terms of how they will be made secure and accessed.

  Q259  Dr Taylor: Before you go to security, what are they and where will they be?

  Mr Hains: The Detailed Care Record is variously at the GP and a secondary care setting like a hospital where your treatment record will be held.