For tonight’s R4 File on 4 programme, the BBC interviewed the Conservative Shadow Health Minister Stephen O’Brien who is well informed on the progress and problems of the NHS IT scheme, the NPfIT.
Now that a general election is approaching, and one the Conservatives may win, O’Brien must choose his words particularly carefully when answering questions on what the Tories will do about the NPfIT.
He was asked by File on 4 what the Conservatives will do on the local service provider contracts [with BT and CSC]. O’Brien made the point that the LSP contracts haven’t been published and until he sees them it is difficult to say whether the agreements can be halted and renegotiated.
BBC: What would the Conservatives do if you become the next government? Would you simply scrap the programme?
Stephen O’Brien: “We have said in the absence of the government being prepared to makeavailable copies of the contracts with the LSP’s ( local serviceproviders) that we would have to halt and renegotiate contracts.
“It’s of vital public interest that we know what those contractscontain and that we should therefore know what our scope is, both interms of what can be the future and indeed what we need to make the future for good IT well applied in the NHS, so that patients andtheir their health-care outcomes can benefit.”
The BBC asked O’Brien what has gone wrong with the NPfIT.
“Against the forecast plan and expenditure … we have got no obvious healthcare improvements for patients that can be attributed to the success of the government ‘s IT programme in the NHS, and that’s more or less largely attributable to the fact that it ]the NPfIT] didn’t really take into account or consult with the doctors in the first place in any meaningful way.”
BBC: No meaningful benefits? What about [PACS] x-rays, imaging and GP-to-GP record transfers?
Stephen O’Brien: “What’s been very interesting is that the things that were already on course to produce good benefits like imaging [were] captured by the programme – the new things the programme was meant to deliver have not produced the results that were proclaimed for it.”
BBC: Some of these contracts are knee high. Do you think you’ll just be able to get out of them?
O’Brien: “Well I’m sure they are knee high as we’ve had parliamentary answers telling us how much has been spent on lawyers who negotiated them.
“For the millions of pounds that have been spent on these contracts I imagine a lot of paper was produced.
“What really matters is the ambition that you have for improving health-care outcomes and IT to support that…”
BBC: Do you think you’ll be able to get out of the contracts?
O’Brien: “Well we have said until we can see them I can’t give you a clear answer on that.
“I do think it’s wrong that I should not be given the sight of the contracts. We have asked both under the Freedom of Information Act and in Parliamentary Questions.
“We’ve got a government saying it’s [the NPfIT’s] vital for healthcare yet at the same time the Chancellor is saying £600m can be saved… it’s absolutely vital we see these contracts to know exactly where they [the local service providers] are able to deliver what they say they can deliver …”
BBC: Do you have an ambition as to how much money you could save on the National Programme for IT?
O’Brien: “To be really clear, straight and honest, I really can’t give you a number because, until I see the contracts, it would be speculation.
“… It stands to reason, to change the approach, to really base your IT to deliver improving health-care outcomes for patients, [IT-led change] is best done locally where people can … access good IT products from a catalogue that has been approved to good standards, where the development of the product has taken place at the risk of the private sector, not taxpayers.
“Funding that and [ensuring] that those products are all interoperable … is suitable for your local health economy, whether its in my constituency in Cheshire or anywhere else in the country…
“… the patients themselves …can access their records and at the same time the doctor can have the confidence that they have a system of records that they can rely on, that have neither been tampered with or are difficult to use.”
BBC: Last August the Conservative Party said it would seek to dismantle the IT central infrastructure of the NHS IT?
O’Brien: “That is still our policy … to put the decision-making and the choice at local level..
“We would then have, as we have proposed, a catalogue of good products – already proven and tested for value but functionality as well; and that are inter-operable…
“So yes there would be a dismantling – but we would keep of course the benefits …”
BBC: But you’d dismantle the central infrastructure?
O’Brien: “There’d be no need to have what is called The Spine, both as its both currently proposed and is not really being delivered …”
The BBC pointed out that Dr Glyn Hayes, who helped compile a report for the Conservatives on the future of NHS IT, had said that the next government shouldn’t dismantle the whole of the central infrastructure because a central directory is needed to store local registers and care records.
O’Brien: “Of course I have accepted the Dr Glyn Hayes independent report …”
BBC: Do you accept his view that you would need a central directory to show where care records are?
O’Brien: “… we would keep central/essential elements of what is currently called the spine.”
BBC: So when you say you would seek to dismantle the central infrastructure what you actually mean is you would dismantle parts of it and keep other parts of it?
O’Brien: “The current top-down, one-size-fits-all infrastructure is neither needed nor [has] it been proven to be of benefit …”
BBC: You wouldn’t dismantle all of it?
O’Brien: “…Actually what would happen is that the parts that would remain would then not belong to the centre. There would be what’s necessary for the interoperability of products that are sourced and chosen locally.”
BBC: You’re on shifting ground here aren’t you?
O’Brien: “No, no. I don’t believe that we are shifting ground here. We have been very clear to make sure we look at this …on the evidence…
“Glyn Hayes has made it very clear to us, and indeed others, that the overall architecture the government has with its central one-size-fits-all, top-down central programme for IT is not the way forward.
” … the way forward is to give the ownership of this choice and the products to local professionals …”
BBC R4 File on NHS and Government IT projects – BBC Online
Tories plan access to medical files – BBC Online
Minister to sew up NPfIT deals before the election? – IT Projects Blog
Minister to sign new deals before an election? – ComputerWeekly.com
Come clean says O’Brien – Conservatives