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Connecting for Health is one of the largest civil IT projects in the world. It is not a catastrophe and has not fallen on its face, as the noble Lord, Lord Lucas, said; it is a highly complex 10-year programme aimed at rescuing the NHS from its position in 1997 as one of the last bastions of paper transactions and garage-designed computer systems. The one thing that you could guarantee about those systems was that GPs could not transfer information about patients electronically to another GP or healthcare provider.
Of course there have been problems, but the programme’s achievements have been remarkable. They follow a four-year programme of extensive user and public/professional consultation and piloting before the letting of contracts in 2003. There has continued to be a willingness to listen and adapt since, especially through the network of hard-working clinical champions interacting with professional users. One can always do better on user involvement, but the critics who claim lack of professional involvement are simply rewriting history. Indeed, the level of professional discussion and involvement has led to the two-year delay on the electronic patient record, and one of my jobs as a Minister was to unblock that logjam, which has now been done.
The contracts for this programme were an “exemplary example” of public procurement. Those are not my words, but those of the former chief executive of the Office of Government Commerce, supported by a June 2006 NAO report. Risk under those contracts rests with the contractors, not taxpayers as all too often has been the case in the past. Last year, Accenture learned that lesson the hard way and moved out of the programme, but without disrupting progress. The credit for the success of the contracts, worth nearly £7 billion over 10 years, goes not to Ministers but to the director of Connecting for Health, Richard Granger, and his talented team, including many doctors. The NAO in June 2006 found that the programme was well managed, was based on excellent contracts, was delivering major savings, had made substantial progress, and was on budget. Now that Richard Granger has announced that after five years running that huge project he will step down towards the end of the year, we should all pay tribute to a remarkable public servant who I hope will be given the recognition that he deserves.
The unfair and unrelenting criticism of the project, and by implication my staff—Ministers can take it but these are day in, day out, attacks on staff trying to do their best for the public and the NHS—becomes all the more extraordinary when one looks at the benefits to patients and to NHS staff that the programme is already producing. For the first time, there is a national spine that provides the capability to move information reliably and securely between 20,000—not 2,000—varied NHS sites, ranging from large acute hospitals to small chemists’ shops. The published reliability figures are impressive, with the NHS experiencing availability of at least 167.9 hours
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What has been achieved so far is stunning. Using the new secure e-mail system, the 250,000 registered users have now sent their 200-millionth e-mail, helping to speed up patient services. We are ending the ferreting around in hospital basements for old X-rays through the digital picture archiving and communications system—PACS. Some 6,000 new images a week are being generated by PACS, which is now in the majority of hospitals, with 260 million images stored and easily retrievable on the system. This is saving the NHS millions of pounds and reducing patient exposure to radiation.
Patient safety is being further improved by the rapid implementation of the electronic prescription service. More than 2,200 GP systems and 2,600 pharmacist establishment are now live and about 1 million prescriptions are being transmitted each week. EPS will not only make patients safer but will cut fraud and save millions of pounds for the NHS. Patients and their GPs can now book their hospital appointments electronically through Choose and Book. I acknowledge that there have been problems with that in some places, but nearly 4 million bookings have been made and the usage is about 90,000 bookings a month. Of course not everything has gone smoothly. Progress on new hospital patient administration systems has been too slow, with 200 new systems still to be installed. That is partly because we have been too inflexible over local systems—I acknowledge that point—but that is changing quite rapidly.
Finally, there is the big prize of a transferable electronic patient record, about which there has been much controversy. This record of individual patients will make patients safer, save lives, improve whole-population public health and aid medical research and training. I recognise that there are genuine concerns about patient confidentiality and privacy, but we cannot have the patient benefits of this IT system without networking local systems. It is possible to work our way through these concerns, as I and others—including my noble friend and successor Lord Hunt—have been doing. That is why I set up a taskforce with many of the professional critics and asked Connecting for Health to develop pilot schemes for electronically transferring patient records with a scope for people to opt out, but with the dangers of doing so properly explained to them. It is interesting that from these early adopter sites only 0.2 per cent of patients have so far wished to opt out.
Some of my puzzlement over hostility to the programme has been removed, since leaving office, by discovering people working together to campaign against this programme. The campaign seems to be made up of the Foundation for Information Policy Research, the Big Opt Out organisation, the Conservative Technology Forum, Computer Weekly, Medix surveys and the Worshipful Company of Information Technologists, which I only recently
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“The Big Opt Out org will be a separate campaign (which many of us help). The principal organiser is Helen Wilkinson”—
who I believe is a Conservative councillor. Another e-mail, of 13 February, talks about,
The IC is of course the Information Commissioner. Another e-mail, of 8 March, after Professor Anderson had been asked to be an adviser to the Health Select Committee, says:
Another e-mail which I particularly like is of 24 May 2007, sent after a lunch with Conservative Front-Bench spokesman Damien Green MP, who is quoted as saying,
Ross was asked to provide some other arguments—a little less principled, I assume. Finally, in a quote from an e-mail of 20 December 2006, we have something a little closer to home:
“After speaking to Andrew Lansley, Tim Loughton, Malcolm Harbour and Lord Lucas I’m maybe starting to get the message across”.
I have insufficient time to entertain the House with more extracts. I am willing to let them be seen on a private basis by my honourable friend in the other place who chairs the Health Select Committee. In a spirit of bipartisanship, I would encourage Conservative parliamentarians to look closely and sceptically at some of the sources of advice they appear to be using. The Connecting for Health IT programme should not be a political football. Too much is at stake for patients and the NHS.
3.24 pm
Baroness Walmsley: My Lords, I, too, am most grateful to the noble Lord, Lord Lucas, because in recent years there has been a proliferation of information databases on children. Indeed, a recent paper from the Information Commissioner lists 11 of them. They all raise issues of privacy, security and consent. I intend to restrict my remarks today to the proposed national child Information Sharing Index, now to be called ContactPoint, and the much smaller databases of biometric information that some individual schools compile, often without the permission of parents and with the tacit approval of the DfES.
The ContactPoint database is to be universal. It will cover more than 11 million children and will potentially have 330,000 to 400,000 users. We are told that it will cost £224 million, which I suppose must be seen as a bargain in the light of the £12 billion cost of the NHS database and the £18 billion cost of the proposed national identity database. The £41 million per year that the database will cost to run, according to the Government, is a considerable amount of money, but the Government’s figures are disputed by the Information Commissioner, who believes that it could cost up to £1 billion. Perhaps some of this
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The declared objectives of the database are to bring together the various professionals working with each child and to make early intervention easier. Those are both laudable. However, the database will cover every child in the country, including those who have no special needs, and it will have no professional input, save from the school and general practitioner. Thus, there will be many children on the database who do not need to be there.
When the database was first proposed, some of us suggested that the money could be better focused on ensuring that children’s services professionals, who work with the children who do need their services, had reduced caseloads and improved training, thus making sure that they had both the time and knowledge of how to interact with other professionals for the benefit of their young clients. The Government, however, did not agree, so we now need to know how they are getting on with addressing our concerns and when the database will go live. It is scheduled for next year. Is it on target?
Many parents have expressed the same concerns that I raised when we debated the legislation during the passage of the Children Act 2004. There is no such thing as a totally secure database, and a large number of people will be able to access it. Although there is to be a two-part security authentication, the Government have recently seen fit in guidance to advise users not to access it from an internet cafe and not to leave it logged on when not working on their computer. That indicates the potential for misuse. How do the Government propose to monitor this? The sensitive information on the database would be invaluable to the predatory paedophiles who stalk the internet intent on child abuse. Some of it, such as contact with sexual-health professionals, is also very private. In addition, there will be information about the parents—for example, whether they are separated or single, whether they offer positive role models, whether they give the child a healthy diet and whether there is a problem such as drug or alcohol abuse. Therefore, it is not just a database of innocuous information about where the child goes to school, who has parental responsibility and who the GP is; it tells you a lot about the whole family.
Most parents and children will not know what is on the database, whether it is accurate, how to change it if it is not, and who is being given access to it and so on. Although parents and their children will have the right to ask to see the information about them and challenge it if it is wrong, I am sure that few will do so. Can the Minister say how parents will be informed about their rights in this respect and whether he will report to Parliament about how many exercise those rights? There has been some media excitement about the fact that information concerning the children of some high-profile parents will be electronically shielded if they are considered to be at increased risk, but surely the Government can see the potential of
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There are also serious concerns about “function creep” into the proposed national identity register and other databases since the police have had new powers to access information on any database. It is clear to me that this information will be shared much more widely than any of us feared when we were debating the Bill that set it up.
There are also concerns that the database will give rise to self-fulfilling prophecies, where children with a number of “flags of concern”, as they are coyly called, will be treated as potential delinquents. The database will require enormous restraint and professionalism from those who access it. I hope they will all understand its potential for harm as well as good. The sheer size of the database is also a cause for concern. Some commentators are afraid that serious cases might be overlooked because of the amount of time spent inputting and accessing trivia. The same skill of identifying priority cases will be required with this electronic database as has always been required when dealing with a set of paper files. The computer will not replace professional judgment.
Government IT projects have an appalling track record of breaking down. That was even admitted by Margaret Hodge when she told MPs on the Education Select Committee on 9 February 2007 that this gave her cause for concern. So, if professionals are relying on this database to alert them to signs of neglect or abuse, a breakdown could place vulnerable children at even greater risk.
On another closely related matter, I should like to ask the Minister about the much smaller databases of unique biometric information that are being held by schools. As the Minister may know, I have for some time been expressing serious concern about the fact that some schools are taking children’s fingerprints for trivial uses such as registration, school dinners and use of the library, all of which can be better done in other ways. Most of this is done without the express permission of the parents, or even their knowledge in many cases. When I asked about this on 19 March, the noble Lord, Lord Adonis, said that schools receive “fair processing guidance” as to how to comply with the Data Protection Act, in which parents should be consulted about the collection and use of all information about their children.
There is much evidence that that is not happening. How are the Government monitoring whether schools are complying with the Act? However, it has become clear that, in response to concerns, the DfES is working with Becta to produce guidance for schools. I have looked hard and can find no such guidance yet, despite the fact that, on 5 February, in answer to a Written Question from my colleague in another place, the Member for Leeds North-West, the Minister, Jim Knight, promised that the guidance would be available on the Becta website by the end of March 2007. As of this morning it still was not there.
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In the mean time, there have been disturbing press reports suggesting that the guidance will not insist that schools obtain express permission from parents or guardians before taking fingerprints. On any interpretation of the fair-processing rules, that cannot possibly be compliant. This is a different kind of vulnerability: vulnerability to identity theft. These databases are not kept on stand-alone computers; they are on the ordinary school computers that are connected to the internet and are therefore vulnerable to attack by hackers. If I were an identity thief, I would get the data about 15 year-olds and wait patiently for a year until they got their first credit card. Then I would pounce. The risk is severe and yet the Government do not seem at all bothered. Besides, if there is nothing wrong with taking children’s fingerprints, why do the Government not ensure that schools are asking parents or at the very least informing them? They are not doing so and that is a disgrace.
3.33 pm
Lord Birt: My Lords, I congratulate the noble Lord, Lord Lucas, on raising this important issue and applaud the thoughtfulness and balance of his contribution. Although our emphasis is different on some matters at least, as he will hear—possibly to his surprise—we are in accord. I also declare two interests: I am a former member of the Cabinet Office Strategy Board, and my wife is the managing director of a technology company supplying to government.
Information technology can transform the effectiveness of almost any major institution. For government, it offers the prospect of new products and services for the citizen, with previously unimaginable speed and convenience. It brings mobility, enhanced capability in the field and services available anywhere at any time. It enables policy-makers to collect and analyse massive amounts of data and to acquire new and penetrating insights. It can facilitate a step change in operational productivity and effectiveness. Technology can enable us to fight crime more effectively, to deliver better health and education outcomes or to improve our overburdened transport system.
Yet no one should underestimate the awesome difficulty of introducing new IT systems in practice. I have been closely involved as a non-executive director with companies that have been among the most successful in the world at deploying technology. I have witnessed at first hand what a herculean task it can be and how much capability is needed to do it well. At the BBC, I oversaw the transition of the corporation from an analogue rustbelt to a digital pioneer. That long journey, with plenty of stumbles and trip-ups along the way, demonstrated to me just how difficult it is to make the right decisions on infrastructure, how hard it is painstakingly to re-engineer core processes and to integrate different systems and what a challenge it is for any organisation and its people to acquire wholly new skills and capabilities.
Whitehall came a little late to a full and rich understanding of how the true power of technology can be unleashed to achieve better public outcomes. Decades of underinvestment in the UK public sector
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Ian Watmore, John Suffolk and their colleagues have professionalised the IT function within Whitehall. Alongside the Office of Government Commerce, they have sought to improve the procurement process. The technology market is very competitive, and government is undoubtedly striking hard bargains. The CIOs have begun to wrestle with cross-governmental issues such as identity and interoperability. They have championed the importance of improving the service to the citizen. If you renew your motor vehicle licence online, sort out your pension entitlements in minutes, not months, or navigate your way to some critical piece of information on Directgov, you will appreciate the improvement that they have wrought.
Most technology in the public sector works seamlessly—it is not a disaster—and we never hear about it, which is the way of the world. However, it is plain that some technology does not work well and some projects have not gone well. We need to learn the lessons of that and improve. Many thoughtful people in the system, and there are many of them, believe that success on large projects would be more assured if the specification process were far more sophisticated than it is now. They believe that can best be achieved by a far more intensive dialogue between the purchaser and potential providers in advance of the formal bidding process and before the specification is carved in stone. Such a Green Paper dialogue would need to involve all practitioners, not just technologists. The line managers and the policy makers must also own the specification, and, eventually, the procurement. The dialogue should cover outcomes and the means of delivering them; it should identify what is deliverable and not just desirable; and it must be a true partnership and joint venture involving all parties.
Once the dialogue is over, the Government need to settle the specification far more speedily than they sometimes do, and to a previously declared timetable. Many suppliers justifiably complain about the length and expense, as well as the limitations of the current process.
I have one last point on procurement. This is not aimed at anybody present. Ministers have sometimes made unachievable demands of systems and have as a result launched a ship holed below the waterline that will never float. OGC needs—and here is the echo of what the noble Lord, Lord Lucas, said earlier—an independent gateway process to vouchsafe that the scope is truly deliverable before the bidding process begins; and, while I am at it, if, wholly commendably, Gus O’Donnell can publish the departmental reviews, could he not, with benefit, extend transparency to the gateway process too?
I have already said that most technology projects in the public sector succeed—they do. None the less, I suspect that the failure rate is higher than in the
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These skills are not yet widely available in Whitehall. Successive Cabinet Secretaries have identified this issue, and Gus O’Donnell is running hard with this particular ball. His vision is to add modern business disciplines to the silky private office skills of the old mandarinate. That process of training has long begun. But until it is complete the driving of many large projects in government will remain significantly underpowered.
There is much to be pleased with. Public sector IT in the UK is undergoing a fundamental transformation. It is a job not yet done, but one very much begun.
Lord Evans of Temple Guiting: My Lords, before we hear from the next speaker I remind all noble Lords that this is a time-limited debate. When “9” comes up on the clock, would you please finish your remarks? Otherwise you will be eating into the Minister’s time, because there is no slack.
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