MR PATRICK O'CONNELL, MR ALAN SHACKMAN AND PROFESSOR NAOMI FULOP

7 JUNE 2007

  Q460  Sandra Gidley: Sorry, modified their what?

  Mr O'Connell: Their message formats. They have made their computer science stuff adapt to a common standard that we have to make sure that we can communicate, so it is already done.

  Q461  Sandra Gidley: That was not Connecting for Health, that was pragmatism because it was not working, so you are saying Connecting for Health did not set those clear standards to start with?

  Mr O'Connell: No, it had to do with the changing IT in the sense that on day one we had IDX which was a single vendor. Today we have three vendors and a best of breed and in creating three vendors, which was my decision to pursue that which was eventually accepted by Connecting for Health, one would have to do what I just did to make them talk together because I felt it was a better strategy, so we created a standard for these things to come together.

  Q462  Sandra Gidley: Excuse me for labouring this point but if Connecting for Health had set very, very clear standards to start with you would not have had to do that, would you, it would have worked anyway?

  Mr O'Connell: I think we may be speaking at different levels and at cross-purposes. I think the standards for single view are clearly set.

  Q463  Sandra Gidley: I am talking now about how everything will work together.

  Mr O'Connell: I think the standards for how things will work together are there and are clear. What I was speaking to (because I thought you were asking that) was a little bit how do I know when safeguards are in place and I moved into the implementation space and the fact that physically things have been changed to make sure that it comes together. So I think it may have been a "levels of discussion" issue more than it is not there. Sorry for the confusion.

  Chairman: There was an issue that was put to us by one of our earlier witnesses that standards had not been agreed across the piece before the whole national programme was set up but there are other people we have asked that question, although we will have some more at some stage in this inquiry as well, so we do not have to labour it particularly now.

  Sandra Gidley: I was just trying to—

  Chairman: That is fine.

  Q464  Dr Naysmith: A fairly quick question for Mr O'Connell. The N3 network provides fixed broadband connections across the National Health Service now. Will hospitals not also need wireless connectivity in order to take full advantage of detailed records systems?

  Mr O'Connell: I think they can all probably take advantage of it with the current fixed system but we are currently in the process of trying to voice enable the N3 system so that people can use it with either a fixed service or a mobile service and technically we are about there today and by the end of the year we should have that rolled out.

  Q465  Dr Naysmith: Are there plans to provide this then?

  Mr O'Connell: Yes.

  Q466  Dr Naysmith: And they are fairly well worked out and they are going to just follow in sequence when the time comes?

  Mr O'Connell: Yes, it was a matter of extracting more value out of the basic investment in capability that exists in terms of fixed service and now we are trying to move on to do greater things with it such as Voice Over IP which gives people the ability to use it with voice and wireless.

  Q467  Dr Naysmith: Presumably that will involve lots more money as well? Was it a different contract?

  Mr O'Connell: No, it is a levered circumstance versus a "from scratch" circumstance.

  Q468  Dr Naysmith: Fine. A question to Professor Fulop. Your research shows that hospitals feel they are—and I quote from your evidence—at the "bottom of the food chain" because decisions were taken about the national programme and local service providers without their involvement. We have talked about that a little bit already but how do you think this could be addressed if we want to try and make sure that it does not happen in the future?

  Professor Fulop: It means that Connecting for Health and the suppliers need to engage much more with local end users, as I have said, and I am pleased to hear that apparently in London that is happening more now because without it these systems will not work.

  Q469  Dr Naysmith: You say the new NPfIT Local Ownership Programme will help to address the problem?

  Professor Fulop: I hope so, although that was actually announced after we finished our fieldwork so I cannot say how that has gone down in the trusts.

  Q470  Dr Naysmith: It has been suggested that it might just be a token gesture or a recognition of the problem without doing all that much about it. Is it a bit too soon to say that?

  Professor Fulop: I think it is too soon to say. I would just say I very much hope that it is more than a token gesture.

  Q471  Dr Naysmith: Do you know anything about this, Mr O'Connell?

  Mr O'Connell: The NHS Local Ownership Programme, yes I do. From our perspective it is something that will help deployments of the capability to London.

  Dr Naysmith: I suppose we could explore that further.

  Chairman: Okay, the Summary Care Record.

  Q472  Dr Taylor: The Summary Care Record—to me this should be the simplest thing in the world and yet we went to a demonstration of it at Richmond House just a couple nights ago and it was impossibly complicated. Somebody seems to have got the whole system confused between the Summary Care Record and the Detailed Care Record. My first question to Naomi is as far as you know has there been end user involvement in deciding what should go on the Summary Care Record?

  Professor Fulop: What I can say is that from the perspective of the staff in the trust that we looked at, no, but I could not say there has been none from others. That is the most that I can say.

  Q473  Dr Taylor: That gives an impression. We are told that the roll-out has now commenced. They do not call them pilot sites now, they are early adopters, which is a nice euphemism that does not tie you into anything. We are told that that roll-out has commenced but nobody seems to be able to tell us what the exact content of the Summary Care Record is going to be so how has the roll-out commenced? Do you have a clear idea of what should be on the Summary Care Record that you are actually about to implement?

  Mr O'Connell: I guess the question to me is more along the lines of can I build what I am supposed to build in the Summary Care Record—

  Q474  Dr Taylor: Unless you know what it is on it?

  Mr O'Connell: Yes, we have a specification for what it is right now. We are putting that together and technically it works today.

  Q475  Dr Taylor: Right, so what is the specification that you have been given for the Summary Care Record?

  Mr O'Connell: I would have to get back to you on the specification itself in terms of data fields, you mean the data fields and the content of it?

  Q476  Dr Taylor: Why is it not a single screen with demographic data, alerts, allergies, medical problems and current treatment? Why does it have to be any more than that, all of you or any of you?

  Mr O'Connell: To be clear on the last question, you are asking what should it be, which is really a healthcare answer. I was saying that technically if healthcare has an answer we will build it.

  Dr Taylor: Yes, that is very clear, you are not the person to tell me what should be on it.

  Q477  Sandra Gidley: You said you had a spec regarding the data fields.

  Mr O'Connell: Yes.

  Q478  Sandra Gidley: I got the impression the other night that in the early adopter sites people were saying, "We would like this included, we would like something else included"—I do not particularly want to go in details—so are you having to adapt as you go?

  Mr O'Connell: That is the point, yes, of the early adopter. Your early adopter is trying to work out the issues from ethical to practical of what really should constitute this summary record, so what are the essential or key elements needed to have somebody from the South who has a car accident in the North, you pull up this summary record to see what allergies he has, like allergies to penicillin for example, just exactly what should that look that and how that should be arranged, that part is the purpose of the early adopter programme to work out the details of the various communities of interest, come to an agreement and work their way through it. Some of them are theoretical, some are ethical, philosophical and practical and we are working our way through it right now so, yes, we have a spec, I expect it to change over time, at some point I expect it to steady up and then we roll it out.

  Q479  Sandra Gidley: That is clear, so you are always expecting the data fields to change?

  Mr O'Connell: Yes.f