Lord Hunt, Health Minister, full text of his speech on the NHS's National Programme for IT

Below is the full text of a speech by the Health Minister, Lord Hunt, on the NHS’s £12.4bn National Programme for IT [NPfIT].

The speech on Monday 19 March 2007 was at HC2007, the annual healthcare IT conference at Harrogate HC2007. The conference was organised by the British Computer Society Health Informatics Forum and the British Journal of Healthcare Computing and Information Management.

The text does not include Lord Hunt’s replies to audience questions. Being unscripted these were more interesting. A blog article on Lord Hunt’s speech, including the questions and answers session is here. Lord Hunt’s biography is here.

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Lord Hunt’s speech to HC2007 at Harrogate on 19 March 2007:

“Thank you. I am delighted to be here and to be back as Minister for the Department of Health. I am also delighted to have been given responsibility for IT. My title is Minister for Quality, and I am also responsible for patient safety and I see IT as playing an integral role in this. I was responsible for NPfIT when it was established and, having been away for 4 years as Minister in DWP, it is good to come back and see how it has progressed.


“I want to talk to you about where we are with IT, but this needs to be put into context – the context of the reform programme. This has been a subject of huge discussion. We have seen huge changes in the NHS over the last 10 years – major expansion in capacity, increased spending, increases in staffing, over 100 new hospitals, care pathways, a focus on integrating services. There has also been a greater emphasis on public health.

Alongside that, we have seen dramatic reductions in the time it takes for people to receive treatment, and better care. I would argue that much of this has been underpinned by the IT programmes we have in place, but we know that we can do more. There’s no question in my mind that we need to develop our systems. Without this, commissioners will not be able to assume their new and stronger role.

Our vision is of a joined-up NHS where care is delivered in a range of new settings, including the independent sector, the third sector and increasingly in primary care and community settings.

Most importantly, moving from paper to digital systems will lead to better, safer patient care. It will radically reduce drug prescribing errors, diagnostic waiting times, and empower patients. Patients will get the right treatment from the right professional at the right place and the right time.

This really sums up what we’re trying to do in the NHS. Next year will be 60 years since the NHS was established. It was set up in 1948 to deal with patchy provision of healthcare across the country. The essential principles of the NHS have stuck in the culture of the country. But nobody can be complacent and just expect the public to be ever grateful for this service. If the NHS is to remain a vital service it has to produce the kind of services that the public expects. And it is here that the critical importance of what we are doing in IT becomes demonstrated.

Of course, with a programme of this size it was inevitable that we would encounter challenges. When you are entering into such large-scale business change, it won’t always be perfect first time and you don’t expect it to show all the direct benefits immediately. And there are still hurdles to overcome for successful delivery of Connecting for Health – I’ll come back to that in a few minutes.

Notwithstanding those challenges, it is also important to recognise the progress that has been made. And thousands of patients every day are benefitting. This is my first speech on IT since I became Minister for IT and this is an opportunity for me to thank everyone who has been involved in this programme for the progress that has been achieved.

As I have said, I am Minister for Quality, and what gets me really enlivened is the opportunity IT brings to provide safer care for patients. In 2002, 1200 patients died each year from medical errors due to paper prescriptions and 5000 procedures were cancelled due to lost paper film. Appointments were missed due to letters being sent to the wrong address, and patients were not able to choose appointments to suit their needs. Records were duplicated as they were only stored on paper. An archaic, inefficient and chaotic system.

Already, 5 years later, we have seen a vast improvement. The EPS is improving safety and prescription errors, and reducing waiting times for patients. Patients will not have to visit their GP to collect repeat prescriptions and can have them sent electronically to their chosen pharmacy – much more convenient for both the GP and the patient. Every day, 100,000 prescriptions are transmitted electronically.

PACS is saving lives by allowing patients to be assessed and treated much more quickly in emergency care situations. And in conditions like cancer, where every day wasted counts, patients no longer need to wait for extended periods to receive results and start treatment. Almost all hospitals in London and the South have left behind the old technology of wet film and x-rays.

Currently, several of the tools of Connecting for Health have been fully rolled-out, such as the NHS Numbers for Babies and the Quality Management Analysis Scheme – Choose and Book is almost there. But of course, we still have some way to go in many areas so that by 2010, we will have seen full implementation of all pillars of Connecting for Health.

Let me also reflect on the changes we are having in the NHS – system reform. In 1997, the NHS was very much centrally directed. Now we are moving to providing the right incentives for hospitals and providers to provide care safely and efficiently. We are enhancing commissioning, including GP commissioning, so that services are sensitive to what GPs feel are right for their patients. We have moved towards a much more localised system.

So what is it that holds our concept of the NHS together? The first thing is national standards. Standards in terms of the way you are treated, with the NSF. Also NICE guidance and Healthcare Commission standards. Then there is regulation and all the work of the Healthcare Commission. Thirdly, there is money, and the introduction of payments by results. And finally there is IT.

I want to talk about two of the most important parts of IT and the benefits they are already bringing to patient care: the summary care record and GP2GP.

One thing that would really make treating patients much easier is a universal patient record. And this is what the NHS Care Records Service will provide. Patient safety is at the heart of this scheme. Fast access to reliable information about patients to help treat them in emergencies, ‘out of hours’ and in different locations, should not be a luxury or a marginal extra. It is what people expect from their national health service.

It is worth bearing in mind that a populous poll carried out at the end of November found that 81% of people supported an electronic records system. Three quarters of those asked believed that an electronic system will be best way to make sure that medical staff can find the information they need about patients whenever and wherever they need treatment. The appetite is here.

We are starting with Early Adopter PCTS. Starting with Bolton PCT, we will make sure we listen to patients’ and clinicians’ concerns in these Early Adopter PCTs, and learn as we go. We see enormous potential in them being able to roll out the system.

As we continue to roll-out core elements of the original programme, we are looking for new ways to help NHS staff deliver the very best care to their patients. GP2GP allows electronic patient records to be transferred between GP practices for the first time. By the end of 2008, we aim to have rolled this out to 8000 GP practices – benefitting a massive 45 million patients.

Given that 3.5 million patients change GP each year, an extraordinary mobility of patients, this scheme will mean that instead of records taking an average of 6 weeks to be transferred, they will be there for the GP to see at the patient’s first appointment. This issue of slowness of transfer of records has been an historic problem and now we have a chance to tackle it.

The biggest challenge we face is local ownership. As Minister, I see one of my major areas of work to be engaging with clinicians. Greater involvement from NHS staff is vital if we are to offer a product that meets their needs, and supports their day-to-day working. Now as we move forward, our approach is very much about taking people with is – listening, learning and taking the time to explain.

It is now time for the local NHS to take ownership of the programme and its delivery on the ground. This is a priority for me, and it’s a priority for David Nicholson. But we cannot realise benefits to patients from the centre. Local health communities need to welcome these tools and make the best possible use of them to improve care for their patients locally.

One of the challenges we have had to future delivery is trying to deliver too much too quickly. This is one of the lessons that has been learnt over the previous year. In some cases we have not kept up with our own ambitious vision. Although much of the NHS Care Record Service was delivered on time and to budget, including the Personal Demographics System, Security and Authentication Systesm and Messaging Systems, the national Summary Care Record containing the clinical record has been delayed by around two years against the original plan. There are all sorts of reasons for this. It is partly due to its complexity, partly because of the need for secure consensus on its contents, and partly because of patient confidentiality.

Efforts are now being focussed on those areas that offer great potential such as electronic prescriptions, which will reduce inaccuracies in prescribing and will benefit patients. Electronic prescribing – providing decision support in the prescribing process. These things will have immediate impact. Deployment of patient administration systems supported by clinical orders and results into acute hospitals is equally critical. These have been the most difficult challenge to date. There are few common standards and multiple interfaces.

We have to focus on solving any problems we encounter, which is why we need to have chairs and chief executives of trusts involved.

I know there are some concerns around security and confidentiality among the profession and the public. Public confidence in arrangements to ensure the confidentiality of their personal health information is paramount – indeed this is one of the imperatives for a digital system.

It is important to have some powerful reassurances on these issues. The Care Record Guarantee sets out the commitment of the NHS in its use of patient information as we move towards a national electronic records system.

As part of the ongoing process to maintain public confidence, it is vital that we involve the public and health professionals in the development of digital information stores. I’ve no doubt that over the next few years this process of reassurance and communication with the public will be very important to ensure the public remain confident about the process.

Some of the media coverage on Connecting for Health has not been entirely positive. One of the things that I want to do is engage in that debate. There are challenges be we can face these with confidence. The more that ownership goes to the local level, the more confident people will be. It is important that we share this vision and that, despite it being a huge challenge, we are achieving progress. We’re on a hugely important voyage, one which will be hugely successful and will go hand in hand with the reform of the NHS as a whole.”

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No mention of my other questions to Lord Hunt:-

What is being devolved under NPfIT LOP? Ownership of IT or only the responsibility for enforcing CfH diktats?

and - even more important for me, as a GP -

What provision is being made for patients who have labelled themselves as "sensitive" on PDS (i.e. their addresses, home phone numbers and registered GP concealed) and therefore cannot make C&B appointments when the local hospital Trust(s) e.g. Milton Keynes and soon Bedford - will only accept C&B referrals?

It does seem like poor co-ordination of CfH programs: the need for some patients to conceal their demographics (think Huntingdon Life Sciences) is in the original documentation for PDS - even though GPs (who have to do it) haven't been told, as yet, how it is done...

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