The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee Contents


Examination of Witnesses (Question Numbers 100-119)

NHS

16 June 2008

  Q100  Dr Pugh: And you are insisting on it?

  Mr Hextall: We are insisting on interoperability between the systems so that patient information can be available where ever it is needed.

  Q101  Dr Pugh: That is a reassurance as well. In a sense, if you do get that kind of interoperability, there is not an enormous amount of merit in having everybody in the one area use the same system, is there?

  Mr Hextall: There are different justifications, I suppose, in that case because one of the values of using a common system that is of good quality is that it is going to be resilient and have disaster recovery built in, so that hospitals that are open 24 hours a day seven days a week can be assured of 99.9% availability, all but 45 minutes in a 31 day period, so high standards of resilience, but also, every time you come to upgrade it, the fewer systems there are to upgrade the cheaper it is, and the less risky it is.

  Q102  Dr Pugh: So the fewer people providing the care the fewer options you have got.

  Mr Hextall: Yes.

  Q103  Dr Pugh: NHSmail has not been taken up by everybody but it does say in the Report that "all will". Now, if they do not at the moment, how do you know all will?

  Mr Hextall: All are expected to because (a) it is free—

  Q104  Dr Pugh: They do not have to?

  Mr Hextall: They do not, no. So (a) it is free and (b) when the upgrade to the Microsoft Outlook platform takes place later this year that will remove a number of barriers that some large-scale campus sites are seeking—

  Q105  Dr Pugh: But if they do not wish to they can stay out. On GP to GP transfer, there are three firms at the bottom of the list on page 35 which are apparently quite small, and their accreditation is going to be much delayed. Why are you so prejudiced against small firms?

  Mr Hextall: We are definitely not prejudiced.

  Q106  Dr Pugh: Why are you delaying their accreditation then?

  Mr Hextall: They are not able to be accredited yet.

  Q107  Dr Pugh: That is only because you are not accrediting them.

  Mr Hextall: As soon as they are able to be accredited, they will be.

  Q108  Dr Pugh: But it says, " ... accreditation will be delayed until the other suppliers have successfully delivered GP to GP transfer". It does not say they are not able to; it says they are back in the queue.

  Mr Hextall: They get accredited the instant they are able to do it.

  Dr Braunold: They are not ready with the system.

  Q109  Dr Pugh: They have not proved they have done it.

  Mr Nicholson: Yes.

  Q110  Dr Pugh: Finally, I learnt there is a little firm called Graphnet in the Hampshire and Gwent areas who have implemented the electronic patient record to wholesale satisfaction. If that is the case, why has the National Programme had such difficulty?

  Mr Hextall: I think there is a completely different scale. We have examined the Graphnet system and it is on a different scale with different security entry criteria to the ones we are operating.

  Q111  Dr Pugh: It is less secure?

  Mr Hextall: I am saying they are using different security input mechanisms.

  Q112  Dr Pugh: But not worse, necessarily?

  Dr Braunold: It is not to e-GIF Level 3 standard. It is against different security methods, and it has different amounts of data on there as well.

  Q113  Dr Pugh: But you assume the system they are using at the moment is not necessarily the higher standard but safe?

  Dr Braunold: It has a lot of patient and clinician satisfaction with the system, and we have done a lot of learning from the Graphnet system in terms of how they have done patient participation and clinician participation, in particular, and how they have got patient buy-in in Gwent, which has been very interesting indeed.

  Q114  Mr Touhig: Mr Nicholson, I see that in January 2004 you were awarded the CBE for services to the NHS. That is fact.

  Mr Nicholson: I am sure—I think—

  Q115  Mr Touhig: I think it should be for courage because anybody who would go on Radio 4, the Today programme, as you did just before Christmas last year, and state that the NHS care record service would be considerably more secure than internet banking is recklessly courageous. Why did you make that statement? What does it mean?

  Mr Nicholson: It means the levels of security and the technical mechanisms we have make it more secure than internet banking.

  Q116  Mr Touhig: I do admire your courage too! It is an impressive claim to make but can you understand that doctors and patients will have some doubt and some concern about security of their records in view of the breaches that have taken place in the past?

  Mr Nicholson: Yes, I can perfectly understand why people will be concerned. That is why we have taken the time and the effort we have to get ourselves to where we are today.

  Q117  Mr Touhig: We are not quite sure where you are today, are we? The Care Record Guarantee summarised on page 35, Fig 15, of the C&AG's Report also seems very impressive but so did Revenue and Customs' policy on data security before a massive data loss last year, and the MoD's before they lost the details of 600,000 applicants who planned to join the Armed Forces. The policy always sounds good, does it not, but is it deliverable?

  Mr Nicholson: The NHS is a massive system, 1.3 million people work in it, a huge number of organisations; those organisations are responsible for the security of their data; it is hard-wired into people in the NHS around confidentiality, so it is one of the basic points that I think NHS staff operate under; we have a whole series of guidances and processes and procedures out there to ensure it; it is built in technically to the system we are developing through Connecting for Health, through the kinds of things that Gordon has been talking about in terms of the level of security: I think we are in a good place as far as security is concerned. There always will be circumstances, and when circumstances do take place then we need to make sure we react rapidly, and we do.

  Q118  Mr Touhig: Revenue and Customs' policy was: "We use leading technologies and encryption to safeguard your data and operate strict security standards to prevent any authorised access to it", yet they still managed to lose 25 million people's records not because of any failure of the system but because people failed to follow proper procedures. What are you doing to ensure people follow proper procedures that have nothing to do with actually managing the system?

  Mr Nicholson: You also need to make it easier to make the right decisions than the wrong decisions, so you need a set of technical systems and processes to underpin that to make that happen around encryption and all the rest of it, so it is not just about processes and procedures. We have issued a huge amount of guidance; we have put it high up on the responsibilities of all chief executives in the NHS; we have identified that if there are any kind of data breaches patients need to be told: we have said that people have to set it out in their annual reports if there are any and what lessons they have learned and what they have done about it, so we have significantly increased its significance to NHS organisations. We expect people to take action when it does go wrong.

  Q119  Mr Touhig: But things do go wrong, and how often are staff reminded and warned about following proper procedures? We are not clear what has happened just recently but it is clear people have not followed proper procedures and have taken secret information away from the Cabinet Office that should not have been removed under those circumstances. We do not know the details yet. What are you doing to ensure every day that people are reminded that there are certain procedures they must follow?

  Mr Nicholson: As I say, part of it is the design of the system itself so you cannot do the sorts of things you have described, but also training and education in the way in which we take forward the development of our people, and it is absolutely hard-wired into the kind of training and education that we have.



 
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