Examination of Witnesses (Question Numbers
80-99)
NHS
16 June 2008
Q80 Keith Hill: When will the trusts
in the south get meaningful clinical functionality?
Professor Thick: The start will
be the next implementation which I think is in Worcester, it is
certainly the West Country, and it will have order communications
in it.
Q81 Keith Hill: Finally, why is there
no realistic training environment for Trust staff to use prior
to deployment of the new care record system?
Mr Hextall: In the early deployments
there was certainly a mismatch between the training environment
that the Trusts were using to train and the system they eventually
got, and given that there are differences during the test cycles
with the release of software going in in little mini stages, it
was inevitable that the training system that was being delivered
to them for training, I do not know, three months in advance of
the implementation was slightly different to the system they eventually
got. With all of our suppliers we recognise that, and there is
much less of a mismatch now between the training environment and
the system that is being taken, and, where there is, then it needs
to be supported by notes explaining where those differences arise.
Q82 Dr Pugh: All my questions really
are about long-term running costs, value for money and lock-in,
but I want to talk about specific aspects of the Programme with
that focus on it. First, the national network itself. I note in
the NAO Report the service contract comes up for renewal every
three years, and is not a completely straightforward renewal because
presumably in the core services you need to buy your hospital
or whatever, and there are others you can choose to add on. I
am correct in that, am I?
Mr Nicholson: Yes.
Q83 Dr Pugh: Who is the contract
with?
Mr Hextall: The N3 broadband network
is with BT.
Q84 Dr Pugh: If I earmark a hospital,
I do not really have an option other than to go to BT for the
core services, do I?
Mr Hextall: Well, it is important
to recognise that the contract BT have to supply the N3 broadband
network is not for them to supply a BT network; it is for them
to act as an agent on behalf of the NHS and get the best price
they can. So they do not deploy BT networks everywhere; they buy
networks off the whole range of network providers.
Q85 Dr Pugh: What I am trying to
figure out is what scope there is for re-negotiation or negotiation
on the part of institutions when you are buying into the national
network—and you cannot not buy into the national network?
Mr Hextall: That is correct.
Q86 Dr Pugh: There is limited scope?
Mr Hextall: There is no scope.
Q87 Dr Pugh: On the national data
Spine, again you are using the Oracle database server platform
for that, and presumably at some point in time that might become
very expensive to use. Is it a realistic option to find another
supplier?
Mr Hextall: Bearing in mind that
we have an enterprise-wide agreement with Oracle to supply unlimited—within
the parlance it is all you can eat—so as much of the Oracle
products as you can buy at a fixed price.
Q88 Dr Pugh: That may be a very good
deal, but if you do not like the deal you are offering is it realistic
or sensible or highly disruptive to go elsewhere?
Mr Hextall: It would be disruptive.
That particular decision as to which database platform they use
is the supplier's, since they are getting it for nothing effectively.
Q89 Dr Pugh: So in one case you are
stuck with BT, in the other you are stuck with Oracle. I am satisfied
with those answers. In terms of the documents generated on the
data Spine and so on, they are all presumably in some open European
document format so if we did have to use Oracle or whatever, we
could. Is that the case?
Mr Hextall: Yes. They would typically
be XML documentation. You mention the servers and being open.
95% of the servers on the BT Spine are—some are Micro systems,
Open Solaris.
Q90 Dr Pugh: So you are not locked
into any particular format or suppliers. What is the running cost
of the national data supply as opposed to the cost of implementing
it?
Mr Hextall: I will have to give
you a note on that. [4]
Q91 Dr Pugh: Moving on to Choose and
Book, are there any central running costs to the NHS as opposed
to the costs to the PCTs of actually running Choose and Book?
Mr Hextall: The contract with
Atos is centrally funded so there are not any costs on the PCTs
other than providing the GP systems.
Q92 Dr Pugh: So what is the annual
year to year running cost of having Choose and Book?
Mr Hextall: The whole contract
for seven years was £64.5 million.[5]
Q93 Dr Pugh: Can I just turn to Fujitsu
for a second? One thing that is proven about Choose and Book is
that GPs are allowed to choose their own systems, and that has
been much appreciated by GPs. It did say, page 39, in paragraph
3.42 of our previous NAO Report that this had not been anticipated
in the Fujitsu contract. I am right in thinking that, am I not?
There is this kind of flexibility?
Mr Hutchinson: There was no demand
for GP in the Fujitsu contract so it was always expected we would
add that on later, and that was part of the re-set discussion.
Q94 Dr Pugh: The extra cost was estimated
at £105.9 million?
Mr Hutchinson: Yes.
Q95 Dr Pugh: But that was not the deal
breaker?
Mr Hutchinson: No.
Q96 Dr Pugh: So there was agreement
reached on doing that?
Mr Hutchinson: That would not
have been an issue, no.
Q97 Dr Pugh: After all this IT development—and
there is a great deal of it—does the NHS own any software?
Mr Hextall: We certainly own the
intellectual property rights, so the intellectual property rights
remain with the NHS.
Q98 Dr Pugh: Do you have any access
to the code of any software you license?
Mr Hextall: Yes, because we have
given a free licence to the Rest of the World for the Microsoft
common user interface, for example, because it is to the benefit
of patients everywhere if the same interface with clinical systems
is used.
Q99 Dr Pugh: You see, I am just thinking
what happens if you do not have a happy relationship with the
companies you currently have and you wish to find other companies.
Can we turn to patient administration systems? There are a number
of them, and obviously Millennium and Lorenzo are two of the better
known ones. If I am in a hospital in the north and I have this
very rich record listing all my ailments, prescriptions and so
on, but I move south and I want a similar record but it would
be sitting in a different patient administration system, is it
a relatively straightforward process to import all this data,
all these ones and noughts, from one system to another, and have
you ensured that is the case?
Mr Hextall: It is not at the moment
while both Cerner and Lorenzo are in development. Once both are
fully deployed we would hope to be able to achieve transfer of
patient records, in the same way we already do with GP records.
4 Ev 24 Back
5
The contract is for five years with an option to extend by two
years. The £64.5 million is the cost of the core contract
over 5 years. There was also a provision of £80 million over
the same period, made at the time of the contract, to purchase
services beyond the scope of the original contract, specifically
to deliver additional services to support the Department's new
policy requirements such as Extended Choice. Together these equate
to the £144 million shown in the C&AG's Report. Back
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