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Health Committee
The Electronic Patient
Record
Sixth Report of Session 2006-07
Volume III
21621
HC 422-lll
This book is due for return on or before the last date shown below.
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House of Commons
Health Committee
The Electronic Patient
Record
Sixth Report of Session 2006-07
Volume Ill
Oral and written evidence
Ordered by The House of Commons
to be printed 25 July 2007
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M2162
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HC 422-Ill
Published on 13 September 2007
by authority of the House of Commons
London: The Stationery Office Limited
£20.5
The Health Committee
The Health Committee is appointed by the House of Commons to examine the
expenditure, administration, and policy of the Department of Health and its
associated bodies.
Current membership
Rt Hon Kevin Barron MP (Labour, Rother Valley) (Chairman)
Mr David Amess MP (Conservative, Southend West)
Charlotte Atkins MP (Labour, Staffordshire Moorlands)
Mr Ronnie Campbell MP (Labour, Blyth Valley)
Jim Dowd MP (Labour, Lewisham West)
Sandra Gidley MP (Liberal Democrat, Romsey)
Dr Doug Naysmith MP (Labour, Bristol North West)
Mike Penning MP (Conservative, Hemel Hempstead)
Mr Lee Scott MP (Conservative, I/ford North)
Dr Howard Stoate MP (Labour, Dartford)
Dr Richard Taylor MP (Independent, Wyre Forest)
Mr Stewart Jackson MP (Conservative, Peterborough) was a Member of the
Committee during the inquiry
Powers
The Committee is one of the departmental select committees, the powers of
which are set out in House of Commons Standing Orders, principally in SO No
152. These are available on the Internet via www.parliament.uk.
Publications
The Reports and evidence of the Committee are published by The Stationery
Office by Order of the House. All publications of the Committee (including press
notices) are on the Internet at www.parliament.uk/healthcom
Committee staff
The current staff of the Committee are Dr David Harrison (Clerk), Christine
Kirkpatrick (Committee Specialist), Ralph Coulbeck (Committee Specialist), Duma
Langton (Committee Assistant), Julie Storey (Secretary) and Jim Hudson (Senior
Office Clerk).
Contacts
All correspondence should be addressed to the Clerk of the Health Committee,
House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for
general enquiries is 020 7219 6182. The Committee’s email address is
[email protected].
Footnotes
In the footnotes of this Report, references to oral evidence are indicated by ‘Q’
followed by the question number, and these can be found in HC 422-lll. Written
evidence is cited by reference in the form ‘Ev’ followed by the page number; Ev x
for evidence published in HC 422-11 on 25 April 2007, and Ev x (HC 422-III) for
evidence published in HC 422-IIl on 13 September 2007.
Witnesses
Thursday 26 April 2007
Page
Richard Granger, Director General of IT for the NHS, Harry Cayton, National
Director for Patients and the Public, Department of Health, and Dr Gillian
Braunold, National Clinical Lead for GPs, Connecting for Health Ev 1
Dr Paul Cundy, Chair, General Practitioners’ Joint IT Committee, Dr Martyn
Thomas, visiting Professor of Software Engineering, University of Oxford,
and Andrew Hawker, NHS patient Ev 20
Thursday 10 May 2007
Professor Douwe Korff, Professor of International Law, London
Metropolitan University, Joyce Robins, Co-Director, Patient Concern, and
Jonathan Bamford, Assistant Information Commissioner, Information
Commissioner's Office Ev 35
Guy Hains, President, Europe Group, Computer Sciences Corporation,
Professor Brian Randell, Professor of Computing Science, University of
Newcastle, and Dr Rob Hale, Confidentiality Working Group, Royal College
of Psychiatrists Ev 51
Thursday 7 June 2007
Professor Simon Wessely, Academy of Medical Sciences, Dr Mark Walport,
Director, The Wellcome Trust, and Professor Carol Dezateux, Head of the
MRC Centre for Paediatric Epidemiology and Biostatistics, Institute of Child
Health Ev 64
Patrick O'Connell, Managing Director, BT Health, Alan Shackman,
Independent IT Consultant, and Professor Naomi Fulop, Chair of Health and
Health Policy, King’s College London Ev 74
Thursday 14 June 2007
Professor John Feehally, President, The Renal Association, Dr Gill Markham,
Vice President, The Royal College of Radiologists, and Frank Burns, Former
CEO, Wirral Hospital NHS Trust Ev 90
Lord Hunt of Kings Heath, Minister of State for Quality, Richard Granger,
Director General of IT for the NHS, and Dr Simon Eccles, National Clinical
Lead for Hospital Doctors, Department of Health Ev 101
List of written evidence (HC 422-Ill)
1 Department of Health (EPR 01A) Ev 117
2 Department of Health (EPR 01C) Ev 123
3 Professor Brian Randell (EPR 20A) Ev 124
4 BT Health (EPR 51A) Ev 126
5 Dr Paul Cundy (EPR 73) Ev 128
6 Dr Paul Cundy (EPR 73A) Ev 130
7 Dr Chris Pounder (EPR 74) Ev 132
8 Professor Naomi Fulop, King’s College London (EPR 75) Ev. 133
9 Department of Health (EPR 01D) Ev 142
10 Department of Health (EPR 01E) Ev 147
List of written evidence (HC 422-II)
1 Department of Health (EPR 01) Ev 01
2 Academy of Medical Sciences (EPR 34) Ev 12
3 Alliance Boots plc (EPR 27) Ev 15
4 Association of the British Pharmaceutical Industry (ABPI) (EPR 39) Ev 17
5 ABDO, AOP and FODO (EPR 44) Ev 19
6 Association of Directors of Social Services (ADSS) and Association of Directors of
Children’s Services (ADCS) (EPR 21) Ev 20
7 Association of Independent Multiple Pharmacies, the Company Chemists
Association, the National Pharmacy Association and the Pharmaceutical Services
Negotiating Committee (EPR 22) Ev 23
8 Association for Clinical Biochemistry (EPR 36) Ev 27
9 Breakthrough Breast Cancer (EPR 32) Ev 31
10 British Association for Community Child Health (EPR 16) Ev 34
11.‘ British Computer Society (BCS) (EPR 66) Ev 36
12 British in Vitro Diagnostics Association (BIVDA) (EPR 33) Ev 40
13 British Medical Association (EPR 40) Ev 41
14 British Psychological Society (EPR 45) Ev 45
15 BT (EPR 51) Ev 47
16 Computer Sciences Corporation (CSC) (EPR 46) Ev 51
17. Computer Weekly (EPR 64) Ev 54
18 Diabetes UK (EPR 54) Ev 55
19 Dignity in Dying (EPR 49) Ev 58
20 ___—‘F aculty of Family Planning and Reproductive Health Care (EPR 18) Ev 62
21 Foundation for Information Policy Research (EPR 61) Ev 63
22 General Medical Council (EPR 69) Ev 66
23 ~—H ealth Protection Agency (EPR 31) Ev 68
24 Help the Aged (EPR 63) Ev 69
25 Information Commissioner (EPR 24) Ev 70
26 Intellect (EPR 67) Ev 73
27 Londonwide LMCs (EPR 41) Ev 75
28 Medical Protection Society (EPR 55) Ev 76
29 NHS Alliance (EPR 19) Ev 79
30 NHS Confederation (EPR 57) Ev 82
31 Patient Concern (EPR 11) Ev 85
32 Press For Change (EPR 060 Ev 87
33 Renal Association and the Renal Information Exchange Group (EPR 30) Ev 89
34 Royal College of General Practitioners (EPR 17) Ev 93
35 Royal College of Nursing (EPR 47) Ev 95
36 Royal College of Paediatrics and Child Health (EPR 59) Ev 99
C4 Royal College of Physicians (EPR 48) Ev 100
38 Royal College of Psychiatrists (EPR 25) Ev 103
39 Royal College of Radiologists (EPR 35) Ev 105
40 Royal College of Surgeons of England (EPR 26) Ev 106
41 Royal Pharmaceutical Society of Great Britain (RPSGB) (EPR 56) Ev 109
42 Socialist Health Association (EPR 62) Ev 111
43 South East Health Ltd (EPR 13) Ev 112
44 Stalis Ltd (EPR 05) Ev 114
45 Symantec (EPR 37) Ev 118
46 UK Clinical Research Collaboration (EPR 52) Ev 121
47 UK Computing Research Committee (EPR 29) Ev 124
48 Wellcome Trust (EPR 42) Ev 126
49 Nicholas Beale (EPR 14) Ev 129
50 Mr Tom Brook (EPR 70) Ev 131
51 Dr Gerard Bulger (EPR 28) Ev 137
52 Frank G Burns (EPR 60) Ev 141
53 Dr Sarah Dilks (EPR 10) Ev 145
54 Peter Fairbrother (EPR 43) Ev 146
ate Dr Peter Gooderham (EPR 08) Ev 149
56 Robin Guenier (EPR 23) Ev 153
57 Andrew Hawker (EPR 15) Ev 159
58 Ms A Jones (EPR 07) Ev 160
59 Jon Orrell (EPR 53) Ev 162
60 Ivor Perry (EPR 58) Ev 163
61 Professor Brian Randell (EPR 20) Ev 164
62 Dr Maurice H Rosen (EPR 12) Ev 168
63 Mr Norman Sanders (EPR 71) Ev 170
64 Alan Shackman (EPR 38) Ev 177
65 Dr Peter Smith (EPR 03) Ev 182
66 James Stuart (EPR 02) Ev 183
67 Dr Paul Thornton (EPR 50) Ev 186
68 Helen Wilkinson (EPR 65) Ev 190
List of unprinted written evidence
Additional papers have been received from the following and have been reported to the
House but to save printing costs they have not been printed and copies have been placed
in the House of Commons Library where they may be inspected by Members. Other copies
are in the Record Office, House of Lords and are available to the public for inspection.
Requests for inspection should be addressed to the Record Office, House of Lords, London
SW1. (Tel 020 7219 3074). Hours of inspection are from 9:30am to 5:00pm on Mondays to
Fridays.
Breakthrough Breast Cancer (EPR 32A)
Computer Sciences Corporation (CSC) (EPR 46A)
Dr Thornton (EPR 50A)
Dr Thornton (EPR 50B)
Robert Erskine (EPR 68)
Rachel Gould (EPR 72)
Sufferers of latrogenic Neglect (EPR 77)
Action on Rights for Children (EPR 80)
Patient Information Advisory Group (EPR 81)
The Electronic Patient Record: Evidence Ev1
Oral evidence
Taken before the Health Committee
on Thursday 26 April 2007
Members present:
Mr Kevin Barron, in the Chair
Charlotte Atkins Mr Stewart Jackson
Jim Dowd Dr Doug Naysmith
Sandra Gidley Dr Richard Taylor
Witnesses: Mr Richard Granger, Director General of IT for the NHS and Mr Harry Cayton, National
Director for Patients and the Public, Department of Health; and Dr Gillian Braunold, National Clinical Lead
for GPs, Connecting for Health, gave evidence.
QI Chairman: Good morning. Could I first generally do not just get cared for in one place. There
apologise for the few minutes’ lateness of the are a number of people who would say that there
Committee. It looks a bit thin around this side oft he have been enormous successes in the 1990s in
table but you are probably aware we have a Mental investment in IT in the NHS. I would say, having
Health Bill in standing committee at the moment come from a background of having worked in social
and members of this Committee have been heavily security computerisation, the progress that had been
involved in it, in different forms, for the last eight made was lamentable—and yet at very significant
years now. We have got some members up there who cost of about a billion pounds a year at 2002. The
are currently doing standing committee work, but I revisionists are busy at work now trying to make out
suspect we will be joined at some stage this morning the progress that had been achieved before 2002 was
by one or two members. For the sake of the record, extremely good and has somehow been retarded by
would you introduce yourselves and the positions the introduction of national systems; but the
you hold. Could I start with you, Dr Braunold? evidence does not substantiate that viewpoint.
Dr Braunold: 1 am Gillian Braunold. I am a GP in Where you have 33,000 or so GPs in nearly 9,000
Kilburn, and I hold the position of GP National locations, and you have none of them able to move
Clinical Lead. patient records electronically between sites and yet
Mr Granger: | am Richard Granger. I run national over three million patients a year change the GP they
IT systems for the NHS in England. are registered with, I do not see how that mess could
Mr Cayton: | am Harry Cayton, I was the Chair of be described as a success; and yet some eminent GP
the Care Record Development Board and I am IT advisers have described it as a success. One of the
Chair of the Ministerial Taskforce on the Summary other things I found extremely quaint when I started
Care Record. delivering this programme was most of the people
working in the delivery of clinical systems in the
NHS have what would generally be considered to be
Q2 Chairman: Welcome back again. I think I said
serious conflicts of interest. They are the owners of
last time you were sat there you were better attended
software companies, have a financial interest in
than some members of the Committee and it is
absolutely the case this morning! I understand you them, or advise them whilst also undertaking clinical
practice. It has the benefit of them being closely
want to make a short statement to us before we start
this morning’s evidence session. associated with the solutions they deliver, and the
disbenefits of them having certain conflicts they have
Mr Granger: | want to cover three things: firstly, the
to manage. We introduced a process as part of the
general progress we are making; secondly, to give
procurement which was Civil Service standard stuff
you a snapshot of the typical transaction volumes
that benefit patients every day in the NHS in that we required people to declare these conflicts of
England today; and, thirdly, I want to finish with a interest, and we would not allow them to work on
comment on the general environment around the procurement activities if they had involvement with
introduction of new technology into health care. any of the potential bidders. That caused some
When the Government announced its investment distress for some of the so-called experts in this
programme in IT in the NHS in England in 2002 domain. It is what has been described by many as “a
there was already a considerable quantity of bit of an alligators’ playground”. In the last four
computers in use in the NHS, and almost all of them years we have doubled the availability of network
were characterised by being nothing more than connectivity to the NHS. We now have 19,000 places
glorified electronic filing cabinets. If you wanted to connected up, so we have one of the biggest virtual
move any information between buildings you private networks on the planet and people take that
typically had to move it using word of mouth or for granted. In some locations it does not work as
paper; there was very, very little movement of quickly as the end users would like—usually because
information between buildings. Of course patients their equipment is badly configured when we go to
Ev2 The Electronic Patient Record: Evidence
26 April 2007 Mr Richard Granger, Mr Harry Cayton and Dr Gillian Braunold
investigate. We are now computerising, to deliver character are foreign and opposed to all our habits
prescriptions safely, 200 GP practices a week with and associations. It is just not going to get used”.
the relevant software. We typically move 120,000 That was The Times writing about an invention from
prescriptions electronically now on any given day. 1816 which I do not think we generally consider to
About every ten seconds a patient gets a booking be adverse to medical practice now. They were
completed electronically, not at the target we would writing about the stethoscope. I think the adoption
like it to be at but, nevertheless, a significant volume. of IT systems that move information between care
I think you heard in your audiology hearing how settings and serve patients as they move around the
Choose and Book is being used regularly now to NHS is in a similar position, of a great deal of
enable accelerated patient flows, and is also anxiety because of the introduction of the new
introducing a greater degree of transparency about technology. People will look back on this in a couple
where the bottlenecks are in the system. We have of hundred years’ time and wonder what all the fuss
about 50,000 people go onto our national was about.
demographic database every day and access two
million patient records. That is something that did
Q3 Chairman: Thank you for that. Many of the
not exist three years ago; something that most major
issues that you have highlighted, Mr Granger, we
organisations and most government departments in
will obviously be pursuing in the course of this
the UK have had since the early 1990s—an online
investigation, this being the first evidence session of
customer index so that you can send letters to the
the investigation. Could I welcome you and your
right place. In fact we see a reduction, as a
colleagues as well. Going back 12 months or more
consequence of that, from about three-quarters of a
now, most of the debate in the media (without the
million patients having a letter sent to the wrong
detailed things you have pointed out there) was
place down to probably around a couple of hundred
people thought what was going to happen was that
thousand. The hospitals that are hooked up to this
their patient record (and we assume by that, and I
system say the number of letters returned, having
assume by that, it was one patient record) was going
been sent to the wrong place, has come down
to go on the national spine and be accessible for
massively, which is a significant concern around
people who wanted to know about my medical
confidentiality with a paper-based set of letters going
history. Actually we have got both a separate
out to patients, and inefficiency where an
national and local electronic patient record now in
appointment gets sent out to them, for example, and
they do not even get notification of it. We have got front of us. Does this represent a failed compromise
between the two different approaches? After all the
an e-mail service that has: a quarter of a million
users; sends over a million messages a day; is talk about having one national record that was
going to be all-singing and all-dancing for us, why
encrypted; and over a third of those contain patient
identifiable information. We have a system which have we ended up with two? Why is that?
has very efficiently paid GPs money under a “pay for Mr Granger: That is not a change of direction; that
quality mechanism” under their new contact. There is the details of plans which were documented in
were a few problems for a couple of days at the Spring 2002 in a document published by the NHS
beginning of the new financial year as they Information Authority, which I am sure one of your
stampeded into submitting their returns to get their advisers is familiar with, which was called the
money quickly. However, that system (apart from a NCRS, National Care Record Service. That
couple of days) has worked very well since it was document set out very clearly that there needed to be
introduced. We have a major secondary uses more widely accessible summary information and
database working as well. In closing I just want to detailed local information; and the reasons for that
reflect on how difficult it is to introduce new relate to the ability of computer equipment to move
technology into health, because it is personal for all large quantities of information around, and
of us; we care about it; and a lot of people have concerns about the need or absence of need for
anxieties. In the North-West we are about to detailed information to be available outside of an
introduce the Summary Care Record which will individual care setting. We are trying to strike a
provide information about patients outside of the balance between having nothing available
GP setting in which the best information is currently everywhere, and everything available everywhere.
held. Around 0.2% of the public, where we have sent Over the past three years my colleagues have
information leaflets to their homes addressed to undertaken a very extensive consultation exercise
them in person, have concerns about this. You might with clinicians and patients to strike what we think
not think that is the case if you spend a lot oft ime in is the right balance there and to introduce that
this part of London, but that is the kind of data that through a staged early adoption process. The delays
comes from other areas of the UK, and the North- we have had in doing that are a mixture of software
West where we are bringing this system in. However, complexity and an extended consultation period
there are a lot of people very concerned. In 1834 The about how to do that.
Times said, regarding a significant piece of medical
technology, that, “it will never come into general use Q4 Chairman: Presumably the bulk of mine will be
notwithstanding its value. It is extremely doubtful on the Detailed Care Record, and that will be what
because its beneficial application requires much time my GP and anybody in the South Yorkshire locality
and gives a good bit of trouble to both the patient where I live most of the time will have. What added
and the practitioner; and because its hue and value will the national Summary Care Record add?
