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House of Lords

Wednesday, 21st October 1998.

The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.

Prayers--Read by the Lord Bishop of Blackburn.

Lord Christopher

Anthony Martin Grosvenor Christopher, Esquire, CBE, having been created Baron Christopher, of Leckhampton in the County of Gloucestershire, for life--Was, in his robes, introduced between the Lord Murray of Epping Forest and the Lord Merlyn-Rees.

National Health Service: Computerisation

2.38 p.m.

Lord Dean of Beswick asked Her Majesty's Government:

    What advice they have taken in connection with further substantial computerisation of the National Health Service to avoid a repetition of past experiences such as in the Wessex Regional Health Authority.

The Parliamentary Under Secretary of State, Department for Health (Baroness Hayman): My Lords, we have recently launched a new strategy for information within the NHS. This will provide the NHS with the most modern tools to improve the care and treatment of patients. Developing this strategy has involved extensive consultation with the NHS, professional organisations, suppliers, Her Majesty's Treasury and the NHS Executive. The strategy reflects lessons learned from past experience of poor management and procurement, and the lack of emphasis on supporting clinicians with the information and information systems they need.

Lord Dean of Beswick: My Lords, I am grateful to the Minister for giving such a detailed reply on this important subject. Is the Minister saying that advice of the highest order has been given on this matter to prevent any oversell, as in the case of the Wessex health authority, to make sure that the computers that are bought will be adequate for the job, and to ensure that we shall get maximum usage out of them and maximum value for money?

Baroness Hayman: My Lords, my right honourable friend the Secretary of State in his introduction to the document Information for Health stated explicitly that money had been wasted in the past; that procurement procedures had not been what they should have been; and that the whole system had been geared too much to churning out information for management and

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accountancy purposes rather than to supporting high quality patient care and ensuring value for money within the NHS. We believe that we now have a strategy that will ensure that we do just that.

Lord Avebury: My Lords, is the Minister aware that the document, Information for Health, has not been placed by her department in either the Library of this House or the Printed Paper Office, and that it was not available for reading before Question Time? Is she further aware that Computer Weekly has published a detailed criticism of the department? One of its main points is that the NHS Executive, which has been responsible for the failures referred to by the noble Lord, Lord Dean of Beswick, is to be responsible for spending the £1 billion of new money. What does she have to say about that?

Baroness Hayman: My Lords, if the document was not available in the Printed Paper Office or the Library, I apologise to the noble Lord. I was not aware of it and I shall certainly look into the matter. The document is available on the NHS website--appropriately perhaps! I will make sure that that is rectified.

On the major point raised by the noble Lord, we have examined the need to change the arrangements within the NHS Executive. The Information Management Group is to be disbanded and we will set up a new, separate special health authority with policy unit and performance management functions. We have made very clear that this is a strategy that has to be developed in co-ordination with other people, not in isolation. We have to take suppliers along with us and understand what can be supplied. Most of all, we have to take the clinical community who need to use this system with us; and we need to evaluate what we are doing. So we have built in some safeguards against the kind of criticisms raised by the noble Lord.

Lord Cledwyn of Penrhos: My Lords, is my noble friend aware of the general view that hospitals would be far more effective if we brought back matrons?

Baroness Hayman: My Lords, I never knew that my noble friend had so much in common with the right honourable Member in another place on this matter. It is probably one of the few things that they have in common. What is important is not the title we give to the heads of nursing units; it is that nurses have a key leadership role, whether in the new primary care groups, acute units or the work that they do within the community; and that we recognise that they need to be leaders and partners in the high-quality, responsive NHS that we are trying to build.

Baroness Gardner of Parkes: My Lords, in the safeguarding mentioned by the Minister have the Government now resolved the problem of patient confidentiality, which has been a major concern within the health service?

Baroness Hayman: My Lords, this was one of the issues that Mr. Frank Burns, a chief executive from

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the health service, took on board in developing this strategy. The issue was raised by the professional leaderships, for example, the BMA and the Joint College. I was pleased that representatives of both nursing and medical organisations welcomed the strategy, and explicitly welcomed the recognition that problems of patient confidentiality had to be addressed all the way through the implementation of the system. We have the framework right; we need to do more detailed work as each phase comes in.

Lord Clement-Jones: My Lords, as regards the new NHS information strategy, will the Minister detail the proportion of funding that is going towards information systems for patients and carers? In particular will she look closely at the "Start here" signposting system? Finally, in the light of the remarks of the NHS Confederation, will the Minister reassure the House that there will be the management capacity and skills to implement the NHS information strategy in the timescale envisaged?

Baroness Hayman: Yes, my Lords. On the general point, this is a 10-year programme; I cannot provide information for the full 10 years on the proportion that will be spent on supporting patient information. It is one of the key roles of the strategy that we use information that helps people both to promote their own good health and to understand ill health better and the services that they are being offered. The noble Lord kindly showed me details of the system to which he alluded. My colleague in another place, Paul Boateng, will examine the system and meet those who developed it. There are many kinds of fascinating and innovative ways to develop means of making information accessible to patients, and this is a very important and potentially useful one.

On the noble Lord's final point, the management capacity is extremely important. If we are to manage this process well, we need to have people who understand it, and specific account is taken of that in the first phase of implementation so that there is support for the people on the ground who will be implementing the strategy.

Lord Rea: My Lords, following the question asked by my noble friend Lord Cledwyn, does my noble friend not agree that the very model of a modernising matron should be one who understands how to use a computer and has great need of the information provided thereby?

Baroness Hayman: My Lords, I am sure that a thoroughly modern matron today would regard having information accessible as part of the tools of the trade. Nurses are too precious to spend their time looking for paper records that are lost or chasing test results. The importance of this system is not that we use technology because it is there but because it can support professionals in their day-to-day work and free them for the interface with patients which is particularly important.

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Provision of Refuges for Children

2.51 p.m.

Earl Russell asked Her Majesty's Government:

    Whether they are taking any steps to encourage the provision of more refuges for children under 16 under the provisions of Section 51 of the Children Act 1989.

Baroness Hayman: My Lords, we fully recognise the importance of refuges, which are designed to give a breathing space for young people who run away. Sir William Utting's Children's Safeguards Review drew attention to the importance of refuges and, as part of our consideration of the report, we are looking at the current provision. We shall publish our response to the Utting Report very soon.

Earl Russell: My Lords, I am grateful to the Minister for that reply. Is she aware that every year approximately 43,000 children under 16 run away from home but that there are at present only three refuges under the provisions of Section 51 of the Children Act 1989? Does she agree that there is an imbalance here which needs addressing?

Baroness Hayman: My Lords, I recognise that this is a serious problem and that the young people and children to whom the noble Lord refers are extremely vulnerable. We need better services for children who run away, and in that context we should look at the adequacy of refuge provision. I note that the Children's Society is planning to develop more refuges and hoping to secure funding of £1 million from the Millennium Children's Promise for that purpose. However, it is important that we do not focus only on services after children have run away; we must look at the causes of why children--particularly children in care--run away and try to stop it occurring.


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