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21 Feb 2008 : Column 148WH—continued
I have been on the Health Committee for quite some time and I thought that I had worked out how the Department arrives at its responses. I thought that if we put all our conclusions and recommendations in heavy type, that would make the Department respond to everything. However, there must be a little man or lady
somewhere in the Department who goes through all our conclusions and recommendations picking out the word “recommend”. That word appears in 23 of our 42 heavy-type pieces, and those 23 are the ones that have received detailed responses. The others are brushed aside very briefly in the introductory remarks to the Government’s response, and a lot is lost as a result, because some of our conclusions make valuable suggestions about what should be going on.
Let me give one example, where we missed out the vital letters “re” and merely commended, rather than recommended something to the Department. In paragraph 42, we set out half a dozen bullet points relating to vital issues that we had picked up on our trips around this country and around the world, which the Chairman mentioned. The Government mentioned one of those issues in their introduction, but I would have liked much more detail about many of the others.
I shall go through one or two of the conclusions that were not commented on, because I want to draw the Minister’s attention to them. On several occasions, we commented on the delays that have been experienced. The hon. Member for South Norfolk (Mr. Bacon) said that there were many excuses for those delays. Things changed all the way through following the first contract, and the Government’s response points to many of the things that were added. In that respect, I support what the hon. Gentleman said. The picture archiving and communications system existed in the early 1990s, and I went to view it in Dublin in about 1993, so it is nothing new, but it is absolutely marvellous and it is now so widely distributed that it is making a huge difference.
Paragraphs 113, 114 and 115—hon. Members do not need to refer to them now—deplored the delays with the summary care record. There is no excuse for those delays because wheeling out the summary care record does not depend on other factors. We saw a marvellous example of a summary care record in Canada, and I am delighted that the Department is at least introducing a single front page for the summary care record, with everything vital on it. However, there is a sting in the tail of its response to paragraph 116, because it is obviously looking at making the summary care record more complicated. That is just not needed, because we want the complications to be in the detailed care record; we want the summary care record to remain as simple as possible.
We have had mention of the trial in Bolton. As the Health Committee Chairman said, we were going to see some of the sites where the trials were going on, but the visits were cancelled at the last moment because things were not ready. I would therefore like the Minister to tell us where the Bolton trial has got to and how quickly the rest of the summary care record can be rolled out, because it is vital.
On the detailed care record, I want to take some small quotes from paragraphs 227 and 228, which, again, the Government did not comment on in any detail. Paragraph 227 called the detailed care record the “‘holy grail’ for NPfIT”. Paragraph 228 went on to say:
“Achieving the widespread uptake of DCR systems is therefore the single most important advance that the NHS can make towards the provision of faster, better integrated and more patient-centred care.”
I can illustrate that absolutely graphically. Nowadays, single district general hospitals do not do everything,
and people must go to different hospitals. A 92-year-old acquaintance of mine with severe, widespread cancer, who is very ill, was taken to her local district general hospital after a 999 call. Her treatment had been going on at the local oncology centre, which was not in the same hospital. She was so ill when she got into the district general hospital that even if the staff asked her anything she could not tell them anything; so she had another scan, having had one at the other centre days before. It is crucial that the detailed care record should be produced as quickly as possible, for safety, economy and quality of patient care. That instance, in which a poor, elderly 92-year-old lady, riddled with cancer, was let down by the fact that it was not available, is just one example.
Delays to the detailed care record follow on from delays to the patient administration system. I find that incredibly hard to understand. Most hospitals had pretty good patient administration systems long ago. I remember, in the early 1990s, helping to get people used to our patient administration system. I fail to see how the hold-ups have arisen in that very basic element. It is basic because not only does the DCR depend on it; electronic prescribing depends on it. The Select Committee Chairman has already mentioned what results can be obtained from electronic prescribing with respect to safety and economy, and how it can lead to a reduction in mistakes. The Department of Health is only too aware of that. Its initiative, which is called Coding for Success, is obviously being delayed because of the delay with the PAS. I believe that that is two years behind schedule; or it was. I would love to know—
3.21 pm
Sitting suspended for a Division in the House.
3.36 pm
Dr. Taylor: I was talking about delays with the patient administration system, and was about to mention some of the things that we were told about in the inquiry. We were told that there was some evidence of progress with Cerner, and I am interested in that because I gather that, since then, there has been dissatisfaction in various parts of the south coast and London. I would like to know what the position is with Cerner now, six months after our report. We were also told that there was no progress with Lorenzo, and we need to know how that is going.
Moving on to paragraph 235, in which we missed out the word “recommend”, I thought it gave some helpful comments. It states:
“The Committee recognises the need to maintain a balance between central and local input into the development of DCR systems.”
“The successful delivery of DCR systems depends upon the ability of Connecting for Health to harness the benefits from local as well as national input, something which it has not achieved so far.”
I wish that we had recommended that it should harness those benefits.
Paragraph 237 is an absolutely clear recommendation, and I shall read the whole paragraph. It states:
“Connecting for Health’s own role should switch as soon as possible to focus on setting and ensuring compliance with technical and clinical standards for NHS IT systems, rather than presiding over local implementation. Clear standards would allow systems to be accredited nationally but would also ensure that local trusts have a choice of system and control over implementation.”
It is not all gripes, and the response included something that we did not even put in, because it told us about the GP-to-GP transfer system, which is an electronic system to enable notes to get from one GP practice to another very quickly when someone changes GP. I would like to know whether that is working, because an acquaintance changed GP in October and saw the GP last week, but the transfer had not occurred.
That is enough of my gripes about the response. As has been alluded to, the Committee has been criticised for not making the report more condemnatory, and for not demanding a public inquiry. My reasons for not supporting demands for a public inquiry are that it would have led to further delay, and I have already said that the need for the summary care record and the detailed care record is extremely urgent.
I want to go through one or two of the problems. They have been addressed already, but I want to throw some more light on them.
Jeremy Wright (Rugby and Kenilworth) (Con): On the question of the review, may I ask the hon. Gentleman two things? First, does he consider that it is impossible for a review, such as the one that has been suggested to the Committee by various witnesses, to be carried out while work on the system continues? Secondly, does he think that against the background of the problems that the Government have had in the management of personal data, and concerns that the public will have about that in consequence, the case for a review is stronger than it was when the report was written?
Dr. Taylor: I find it hard to understand how a meaningful review can take place without at least having the chance of pulling the whole system, which is why I did not want to support it. I am going to come to the other point later on.
Obviously, public perception of security has not been helped by recent security breaches in various fields, including the loss of the smartcards. On 4 February, the chief executive of the primary care trust wrote a glowing article in the Worcester News about the benefits of the electronic patient record. He stated:
“The security of patient information is our highest priority. The new system will introduce a level of security higher than that expected in internet banking.”
In the same paper, there was an article reporting the comments of a neighbour of one hon. Member. I have not been able to warn him that I was going to raise the matter, so he will have to remain anonymous. However, he took exactly the opposite view to the chief executive. He stated:
“I think the collection of so much sensitive information in one place is plain daft and open to massive abuse. It is a fundamental attack on our right to privacy.”
Our Chairman has already mentioned votes of no confidence from our GPs.
On 16 February, the British Medical Journal contained two quite important articles. The first one was a report of an interview with Mike Pringle, professor of general practice in Nottingham, who said that he was recruited in 2004 with other doctors as the fourth attempt at clinical engagement. He stated:
“An even more pressing task, however, is resolving the confrontation between the NHS and medical professional bodies over summary care records shared through the NHS’s electronic data spine. At the programme’s outset, the government assumed that the benefits of shared records would be self evident and uncontroversial. As a result, Pringle says, ‘The fundamental building blocks of consensus weren’t put in place. I hold myself partly responsible. By the time we tried to build the consensus, there was also a head of steam behind the opinion that we had an unacceptable product.”
In the same edition of the British Medical Journal, Jonathan Gornall, an independent journalist, stated that he was very happy to use internet banking with sensible precautions. He went on to say:
“Likewise, I’m relaxed about the prospect of my medical records being available digitally throughout the National Health Service. In fact, as the NHS Summary Care Record pilot scheme approaches its first birthday and enters its evaluation phase, in anticipation of national roll-out I’m positively excited.”
Therefore, there are two opposing views.
I have also received a copy of a briefing from the Royal College of Nursing. I find it extremely sad that five or six years after the beginning of the project, it still has to make recommendations for involvement and development of the EPR. Six years after its inception, it is appealing for adequate resources and learning opportunities and for the nursing content of the EPR to be nationally agreed. Has it not been nationally agreed? How can it have to ask that so long after the start?
I want to end on a slightly positive note with what we can do. We need a huge publicity drive to demonstrate the benefits of the summary care record, the detailed care record, of electronic prescribing, of GP-to-GP transfer and the arrangements for security. In response to recommendation 119, the Department of Health goes into details about security, patient consent, patient ownership and the ability to limit access to sensitive information. All those things need to be spelled out. When we went to France, we were very impressed by the fact that the French people own their summary care record, which gives them absolute control over it. That is very attractive.
We need a publicity drive to demonstrate all those benefits to people. Again, Jonathan Gornall states:
“I find it reassuring to think that should I ever find myself in an emergency department, the complete strangers fighting to save my life will have access to any vital personal information that could govern how they treat me.”
I will conclude with the last bullet point from the sadly neglected recommendation 42:
“The support of the public must be obtained. The fact that EPR systems are essential for the delivery of modern health care and can improve communication between different health care staff and between staff and patients must be adequately publicised to users of the NHS. We believe this would help to convince people of the necessity and benefits of the EPR and reduce resistance where it exists.”
3.47 pm
Charlotte Atkins (Staffordshire, Moorlands) (Lab):
It is unfortunate that we are discussing electronic patient records at a time when we have had the high-profile
loss of personal data that was stored electronically. That means that people are both sceptical and fearful of agreeing to the electronic storage of confidential information.
I also regret that the whole debate about the important national programme for IT in the NHS has become so party political. It is strange to me that a programme that is focused on the delivery of a safer and more efficient health care system in the NHS in England has been politicised and attacked in such a way, possibly for short-term partisan reasons. I hope that we all agree that we need to rise above that. We need to use the full potential of modern, scientific and technological advances so that we can treat patients better, and give them more information, choice and control. We need to bring health care closer to patients’ homes and tailor it more to patients’ individual needs. Part of that process means empowering doctors, nurses, and other professionals to deliver that care. That means that those professionals must have appropriate training and appropriate access to IT.
I believe that the electronic patient record can play a very important role in encouraging that because it will encourage the appropriate sharing of patient information. That means that patients can be properly treated in community settings. Already, we see how the picture archiving and communications systems have meant shorter waits for reports and for follow-up consultations. I know that PACS is not new, but alongside the electronic patient record, it gives tremendous potential to improve patient care.
Last June, the Health Committee saw the system in operation at London’s Homerton hospital. There, as the Chairman of the Committee, my right hon. Friend the Member for Rother Valley (Mr. Barron), said, health professionals no longer have to wait for X-rays to arrive on their desks; the images can appear on screen in many different parts of the hospital. Therefore, clinicians do not have to wait for them in order to get together for a meeting. They can discuss the image without delay.
Also at the Homerton, we saw that the system allowed patients to have their clinic appointments booked electronically, with even consultants deigning to type from a keyboard on to the computer screen. That meant that patients could have information about their appointment in their hands before they were discharged. There was none of the nonsense of waiting for a letter to be typed—sometimes, I believe, even in India—before the patient could be informed of their appointments.
In the 21st century, it is vital that the national health service does not have to rely on paper, the post, faxes, phone calls and even taxis delivering X-rays to other care providers, which still occasionally occurs. With patients increasingly being treated at different locations, proper systems are vital. We must deliver properly networked systems for moving information electronically on a secure basis. That is basic.
Of course there are genuine concerns and anxieties about confidentiality and security. Those must be taken seriously, but let us not kid ourselves: that problem is not new. Various hon. Members have cited the Royal College of Nursing’s survey of its members. It found that two thirds of its nurses welcomed the introduction of the electronic patient record but, interestingly, 30 per cent. of them said that the security of the system would not be any better than that of the paper records currently
used in health care. They recognise that the present system is not secure. Anyone can access a paper record and leave no calling card. With a proper secure system in place, any access to an electronic record is logged and can be audited and accounted for. However, the public, patients and professionals are right to be concerned about whether proper safeguards will be put in place.
Not enough has been done to explain the benefits of EPR systems. They will deliver much. They will not only improve communication between different health care staff and between staff and patients, but help to reduce the number of errors. We have heard about that already. They will also assist doctors with diagnosis and treatment, which is an increasingly complex issue. We saw at Homerton hospital how having the various options on screen helped doctors to narrow down the alternatives. However, that can happen effectively only if there is sufficient buy-in by health care staff and patients, so increasing local ownership must be a key priority for the programme, and not just in hospitals.
The Health Committee saw how local negotiations with suppliers and the system designers at Homerton hospital paid dividends, with what appeared to be—at least this is what we were told—full buy-in by all professional staff. I appreciate that that will be difficult to replicate country-wide—this was a pilot—but if hospitals, health clinics or GP surgeries are left out of the loop, there will be no incentive or enthusiasm to make the system work, which will have predictably poor results.
The consent arrangements for creating and adding information to the summary care record and for patients to restrict access to particularly sensitive information in the so-called “sealed envelopes” have not been well handled. Concern about recent private information data losses have made that even more difficult, because everyone recognises that maintaining the security of patient records is a significant challenge, but as we have heard, that has been done in the banking sector. Of course there have been mistakes and some elements of fraud, but we must recognise the need to make progress. Although paper records are no more secure, I recognise that the potential for the loss of large numbers of patient records is much greater under any EPR system. Clearly, people will be worried about that. That has to be recognised. It is important that we address the difficult balance between the need to protect patient privacy and the opportunities for beneficial health research. In that situation, patient privacy must always be the greatest priority; secondary uses must come second to patient confidentiality.
We all want to see the end of the delays in the introduction of the EPR system, but we must ensure that any move forward is not made by cutting corners on procedures and on clinical and technical standards. Those must be absolutely paramount. Unless we can prove that patient confidentiality and the security of patient records will be the No. 1 priority, patients will not buy into the system and then it will not be as effective. That said, we must recognise the huge benefits that will come from the EPR eventually.
In the ePolitix selection of responses to the debate, the responses of two organisations—Help the Hospices and Homeless Link, one of which has been mentioned by the Chairman of the Committee—jumped out at me because they helpfully identified two vulnerable groups that will particularly benefit from the EPR. Help the Hospices stated:
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