Hinchingbrooke Hospital

Duncan Hames Excerpts

Thursday 10th November 2011 Commons Chamber

[Mr Burns]

I am not. I am just being honest. If there is a loss, Circle will pick it up, up to the first £5 million. Hinchingbrooke is a struggling hospital with a deficit of £39 million. That is why we are having to take the actions that the Government that the hon. Gentleman supported instigated more than three years ago. There is a formula that gives an incentive for Circle to deliver, to raise the quality of care, to reduce and, we hope, over the 10-year period to remove the deficit altogether.

[Duncan Hames (Chippenham) (LD)]

When a hospital’s consultants have a financial interest in its performance, what safeguards will prevent their private interest in increasing the volume of treatments provided putting the hospital’s financial health ahead of that of the local national health service?

[Mr Burns]

Under the agreements that have been signed, the consultants are there to manage an NHS hospital treating NHS-only patients and to ensure the finest quality of care for the NHS. That is the safeguard.

Organ Donation

Duncan Hames Excerpts

Wednesday 9th November 2011 Westminster Hall

[Duncan Hames (Chippenham) (LD)]

I know time is short, Mr Davies, so I will be brief. I want to draw the Minister’s attention to the Sign Up, Speak Up, Save Lives campaign, which is currently featuring in Channel 4’s youth engagement “Battlefront” programme. I am grateful that the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), has agreed to meet me and Abby and Hope, the young women campaigning to increase the number of people registered on the organ donor register. Given the arguments made in the previous speech, I want to draw everyone’s attention to an alternative suggestion that I have been advocating with Abby and Hope, which is that we use the opportunity afforded by the introduction of individual electoral registration during this Parliament to give all adults the opportunity to join the organ donor register at the same time as they are asked to register to vote.

From the evidence I have seen, it is clear to me that the welcome news about the reduction in fatalities on our roads means that there is a particular need for us to attract young, healthy adults on to the organ donor register. If people get the opportunity to do that with the paperwork that they complete when they join the electoral register, that will be helpful in meeting the objective, which we all share, of encouraging more people to register as organ donors.

Oral Answers to Questions

Duncan Hames Excerpts

Tuesday 18th October 2011 Commons Chamber

The Secretary of State was asked—

[Duncan Hames (Chippenham) (LD)]

1. What plans he has to promote new initiatives to encourage organ donation.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Sustained work at national, regional and local level has seen an increase in donor rates by some 28% since 2008. We continue to work with a large number of organisations, such as the Give and Let Live initiative in schools, which is run by NHS Blood and Transplant. Other initiatives include requiring people to answer a question about organ donation when applying for a driving licence and to sign on the organ donor register when applying for a European health insurance card or for a Boots advantage card. We also have specific initiatives within the black and minority ethnic populations, such as working with faith groups and local radio stations.

[Duncan Hames]

I recently met young campaigners from Sign Up, Speak Up, Save Lives whose organ donation campaign features on Channel 4’s “Battlefront” programme. Will the Minister please meet Hope, Abby and me, together with the Minister responsible for constitutional reform, so that we may discuss with them both our idea of inviting people to join the organ donor register at the same time as they will soon be asked to join the electoral register?

[Anne Milton]

I congratulate Sign Up, Speak Up, Save Lives. I am happy to meet Hope, Abby and the hon. Gentleman, along with the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Forest of Dean (Mr Harper). The electoral registration form has been used as an opportunity. In 2000 there was a campaign called Vote for Life, which was stopped after about 15 months because of problems with the Representation of the People Act. I would be happy to revisit it and would enjoy an opportunity to discuss the matter further. Anything we can do to get those rates up matters.

Oral Answers to Questions

Duncan Hames Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

The answer to the first part of the right hon. Gentleman’s question is that the Government are already committed, through the spending review, to the provision of an additional £7.2 billion for social care over the next four years, which will involve an unprecedented transfer of resources from the NHS to social care. As for the second part of his question, the Dilnot report makes many recommendations, and the Government will work through them and present their conclusions next year.

[Duncan Hames (Chippenham) (LD)]

The question of who benefits from the proposals, and by how much, depends on the assumptions made about the potential maximum outlay on care home residence under the existing arrangements. That may change as the length of time for which people live in care increases. Does the Minister accept that if the implementation of the proposals is to be progressive, both now and in the future, the Government will need to test, and keep under review, their assumptions about the longest likely duration of care in homes?

[Paul Burstow]

That is an important point. One of the factors that will change those assumptions is the extent of our effectiveness in preventing and postponing the need for such services. “A vision for adult social care”, which we published last year, emphasised the need for more investment in preventive measures. That is why we have provided, and continue to provide, additional resources for reablement, which not only does the individuals concerned a great deal of good but saves money for social services authorities.

Information Technology (NHS)

Duncan Hames Excerpts

Tuesday 14th June 2011 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing this debate. I pay tribute to his tenacity in pursuing the subject. I know that he has a long-standing interest in it, and rightly so given the amount of money being spent on the project. I cannot compete with the way in which he articulated his case, or with his forensic and almost anorak-like knowledge of the subject, but I associate myself with the conclusions that he draws.

The project has always been over-ambitious. We would all agree that it has been poorly led and ineffectively delivered. As with many procurement projects in the public sector, the cost has escalated considerably. We have seen it happen too many times, and it is always entirely predictable. Indeed, senior leaders in the NHS were warned about that from the start.

The intention to ensure that health data should be made available at any time and anywhere was laudable, but delivering it has to be offset against the cost and whether it offers good value for money. Clinicians, practitioners and IT specialists throughout the NHS said that it would not work. Ultimately, clinicians will find their own way of doing things, and a top-down system will not work unless it is executed from the bottom up. As my hon. Friend explained, the decision to involve clinicians in the design of the system was not taken until late in the day and probably beyond the point when they could have had a useful input to ensure that the programme was fit for purpose.

Let me underline what my hon. Friend said. If we look at the initial programme of delivery and what we have achieved, we can see that we have not progressed far. Of the 4,500 sites that were contracted to receive the system, some two thirds have yet to receive anything. If we examine the progress made by Computer Sciences Corporation—my hon. Friend has outlined the history of its involvement with this case—we will see that it is contracted to deliver its systems to 97 hospitals, but so far it has delivered only four and none has been able to confirm that the system has been installed satisfactorily. Put simply, CSC has not delivered the goods against its obligations on the contract.

Once the contract is in place, everyone signs up even though it is quite clear that the company is not delivering what it promised. To be fair, in this case, the NHS started to renegotiate the contract in December 2009. None the less, more than 18 months later, no new contract or renegotiated contract is in place. CSC is still working on the same terms that it initially agreed to and we still do not have adequate delivery.

The NHS was quite clear when it said that it would not sign a new contract until it could see that Lorenzo was working. It is clear that we have to take some tough decisions because it simply is not working. As it is taking so long, we have to decide whether we are managing the project efficiently. Just how poorly does a contractor have to perform before a serious charge is made as to whether that contract should be maintained?

The NHS is an extremely powerful client. I know that suppliers have duties and obligations to their shareholders, but surely maintaining a good relationship with a customer that is as big as the national health service or even as the Government is important. We would expect suppliers to be slightly more conscious about what they are obliged to deliver.

[Duncan Hames (Chippenham) (LD)]

I listened very carefully to the initial speeches in this debate. The story that I heard was that there are suppliers and contractors who have fallen by the wayside and who have been shot and had their business fed to the others. That leaves us with the dilemma of what happens if we are left with only one supplier. Where does that leave the bargaining position of the NHS? My hon. Friend will find that there have been contractors who have found that they were not going to get paid because of their inability to deliver on their contracts.

[Jackie Doyle-Price]

My hon. Friend makes an extremely good point. To be fair, those suppliers have acted extremely honourably with regard to their obligations under the contract. When it became clear that they could not deliver the software under Lorenzo because it was not fit for purpose, they took the honourable action and negotiated their way out. Such behaviour shows a lot about those suppliers. It is increasingly worrying that CSC in particular is finding itself in a monopoly position because it has acquired and strengthened its shareholding in iSOFT. Who we negotiate with in the future is a long-term worry.

I associate myself with the conclusions of my hon. Friend the Member for South Norfolk about when we should take a decision on this project. Is it time for an emperor’s new clothes moment, or are we going to continue throwing good money after bad in a project that is clearly not going to deliver?

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

Thank you for calling me, Mrs Brooke. It is a pleasure to serve under your chairmanship and to take part in this important debate.

I want to start by paying tribute to the hon. Member for South Norfolk (Mr Bacon) for his tireless work on this issue. His determination and tenacity in highlighting the problems and difficulties of a national programme for IT have been second to none. He frequently made the life of the previous Government difficult and I am sure that he will also be a thorn—perhaps a constructive thorn—in the side of the current Government. In his work, he has demonstrated the importance of effective parliamentary scrutiny and the difference that a Back-Bench MP can make. As a new MP, I hope to learn from his experience and follow, at least in some ways, his example.

The reason for the debate’s importance is that effective IT can and must play a key role in improving both the quality and efficiency of health care. At its best, IT helps clinicians and patients share information about the quality of services that are available, which not only supports patient choice but improves standards of care. Good IT can also help patients to get care in different parts of the system without having to give the same information repeatedly about their conditions and treatments to different doctors and nurses. In addition, it can help clinicians and managers to develop more effective and efficient services, organising treatments and services around the needs of patients rather than vice versa.

As the hon. Member for Thurrock (Jackie Doyle-Price) rightly pointed out, one of the key challenges facing the NHS is to ensure that GPs, their primary care teams, social care professionals and specialists work much more closely together, so that care is more effectively co-ordinated. Indeed, the NHS Future Forum said yesterday:

“Better information systems and the development of more integrated electronic care records will be a major enabling factor for this.”

The national programme was meant to help the NHS secure those objectives. However, as the hon. Member for South Norfolk has eloquently outlined and as countless reports from the National Audit Office and the Public Accounts Committee have also shown, the programme has fallen far short of achieving them. There were poor specifications about what was required by Government and what suppliers could deliver in return. In addition, as the hon. Members for Thurrock and for Stroud (Neil Carmichael) have said, there was over-claiming by both sides about what could be delivered and by what date. Furthermore, there were poor lines of accountability and responsibility for the programme, at least in its initial stages. All of those problems have led to one delay followed by another and, crucially, to a lack of control over costs.

I do not intend to go over those problems in detail. My knowledge of the subject is nowhere near as comprehensive or forensic as that of the hon. Member for South Norfolk. Instead, I want to take a step back and suggest three broad lessons that need to be learned from the problems of the national programme, as part of a constructive contribution to the Minister that he can take forward in his thinking on this subject.

The first lesson is that any IT system, whether it is in the NHS or elsewhere, must be led by its users. In the case of the NHS system, it must be clinically led. That is not only about getting clinical “buy-in” but about ensuring that doctors and nurses directly shape and develop the IT system so that it helps them do their job properly for the sake of patients.

NHS clinicians have said that they want IT to achieve five key objectives: first, allowing information about appointments to move around within hospitals, and between hospitals and the rest of the NHS, so that appointments can be booked; secondly, communicating information about discharges from hospital to hospital, and from hospitals to GPs and community services, so that staff in all parts of the system know what conditions patients have; thirdly, allowing staff to book tests such as MRI scans, ultrasounds and so on, and to get the results back to the patient and their clinician at the right time and in the right place; fourthly, the ability to schedule all the different tests, treatments, operations and so on that a patient has in a way that meets the needs of the patient; and finally, enabling electronic prescribing of drugs and the gathering of necessary pharmaceutical information to ensure that patient care is as safe and effective as possible.

Those five key objectives emerged from a consultation exercise with clinicians in 2008. However, as the hon. Member for South Norfolk has said, that was too late; the consultation exercise should have happened before the contracts were signed and not halfway through the process.

Can the Minister say how the Government will ensure that clinicians continue to be involved in developing the IT strategy for the NHS? Did the NHS Future Forum consider the IT strategy as part of its recommendations to Government? I ask because there was only one small line on the IT strategy in that report. Also, have the Government received any specific responses on this issue and, if so, will the Minister publish them?

On a related point, can the Minister say when he will publish the Government’s information strategy? In October 2010, the Government published “Liberating the NHS: an information revolution”. That document set out the Government’s plans to ensure that patients, the public, clinicians and managers have the information that they need to improve health and health care. I do not agree with some of the tone of that document; it seemed to suggest that the previous Government had done nothing on the matter. When Labour was in government, we acted on he issue. For example, if one considers a programme such as NHS Choices, to which there was quite a lot of opposition at the time, one can see that we moved the agenda forward. Having said that, I absolutely agree that we all need to go further.

My concern is that the consultation on the Government’s information strategy closed six months ago today. In that time, the Government could have provided more information to patients and the public to improve choice and quality. When will that strategy be published?

The second lesson that we can learn from the national programme is that we cannot have a one-size-fits-all IT system in the NHS, or indeed in any health care system. As Sir David Nicholson, chief executive of the NHS, told the PAC on 23 May, attempting to provide one type of medical record that covers everything for everybody everywhere in the country “has proved unworkable”. The challenge is striking the right balance between what—if anything—is delivered centrally and nationally, and what is delivered locally. That is a perennial challenge in all parts of the NHS and needs to be thought through.

The national programme is currently being reviewed by the Cabinet Office’s Major Projects Authority. On 18 May, the Minister told Radio 4’s “Today” programme that he wants to allow local hospitals to adapt their existing systems rather than to get rid of them altogether or, indeed, to scrap the national programme for IT. Last month, David Nicholson told the PAC that the Department of Health wants to move towards a situation whereby hospitals have their own direct relationship with software suppliers and where individual organisations take responsibility for their IT. However, he also said that, with all the reorganisation of the NHS that is going on, we need an interim step, a transitional body that will

“look very similar to Connecting for Health”.

He said that it was very important to have that body,

“to enable us safely to transit from where we are at the moment to a place where individual organisations take responsibility.”

I would like the Minister to explain a few things. What is that transitional body? Who will be responsible for running it? How much will it cost? How will it be different from Connecting for Health? At what stage will it disappear and how? Finally, if a national, centrally led programme has been part of the problem in the past, why will this new national, centrally led body somehow deliver the future when individual trusts are in control?

The final lesson that must be learned relates to a point that the hon. Member for Stroud made, which was about a much bigger problem for Government than the other problems that I have mentioned. How do the Government have an effective relationship with the private sector in contracting with it, not only in relation to IT projects but to all sorts of other projects? I am thinking, for example, about the problems that the Ministry of Defence has experienced with its contracting. Successive Governments have found it extremely difficult to negotiate effective contracts with the private sector, and not just IT contracts. It is fair to say that they have not exactly covered themselves in glory in that respect.

[Duncan Hames]

Will the hon. Lady reflect on whether one reason why Governments have such difficulty in controlling contracts with the private sector is that politicians routinely make policy changes that alter the specifications for what is required, and contracts are not able to accommodate that? I wonder what lessons she might learn if we looked, for example, at how the choice agenda was rolled out in the NHS during this period, and at the demands that that placed on changing requirements for private contractors.

[Liz Kendall]

The hon. Gentleman makes a very important point about the nature of the political process, with politicians frequently determined to fill the newspapers with headlines about new policies, while the difficult process of implementation takes far longer on the ground. When I had the privilege of working in the Department of Health, I saw the NHS Choices project and thought, “This doesn’t look like what I thought the politicians meant. It wouldn’t give me, as a patient, the information I needed about which consultant or hospital to choose.” There is, therefore, the problem of how about we go from a political idea to a policy on the ground, and how quickly that changes.

With the greatest respect to the civil servants sitting in this room, we have perhaps not thought through effectively what kinds of skills and experience are necessary in Departments. What steps has the Minister taken since the Government were elected to ensure that the Department of Health has people with the right skills and experience to deal with such high-level negotiations? Have the Government as a whole decided to look at that issue? Has the Cabinet Secretary, Sir Gus O’Donnell, considered how best to ensure that there are people across the whole civil service with the skills and experience that politicians urgently need to support them in their work?

I thank all Members for their contributions today. This is a very difficult subject, and we need to find a way through that does not waste more taxpayers’ money but understands that IT and information are crucial to improving health and health care. The key issue is how we get there.

NHS Future Forum

Duncan Hames Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I have a mission for the hon. Gentleman— he should head to Wales. In England, this coalition Government have committed to increasing the NHS budget in real terms in the life of this Parliament. The King’s Fund reported the other week that in Wales, a Labour Government intend to reduce the NHS budget in real terms by over 8%.

[Duncan Hames (Chippenham) (LD)]

I believe that the very act of listening to patients and the public will have done a lot to improve these proposals—as, I suspect, once the dust has settled, it will have done for the Health Secretary’s reputation, too. Given the requirement for greater local accountability in these proposals, will the right hon. Gentleman make the same recommendation to local clinical commissioners in the changes they are yet to make for health services in their areas?

[Mr Lansley]

I am grateful to my hon. Friend for his kind remarks, but I have to tell him that I am not looking to achieve anything in terms of reputation; I just want a positive outcome for the NHS. I have said before that this is not about me; it is about achieving for the NHS the opportunity to deliver better services for patients. That is all I am interested in.

The proposals on public and patient involvement illustrate what we needed to do—and will now do in response to the Future Forum—as many people wanted to see set out in detail in the legislation how patient and public involvement would work in the respective NHS bodies. The legislation had set out the fact that these bodies existed, but the detail was not prescribed. There is always a balance to be struck in legislation between the degree of prescription and the degree of freedom. Clearly, through engagement with the NHS, we have approval for putting much more of the detail into the Bill, now that it is clear that it will engage patients and the public.

Winterbourne View Care Home

Duncan Hames Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

Again, those are all matters that need to be properly considered and weighed up in the reviews and that the Department will want to make sure is part of the overall report. When that work concludes, we will report to the House and make sure that the information is available to all hon. Members so that they can assess it and make their own judgments. It is certainly the Government’s intention to strengthen the protections on whistleblowing. We are consulting on how that might be given effect, and I urge the hon. Gentleman to contribute to the consultation.

[Duncan Hames (Chippenham) (LD)]

Does the Minister envisage that putting safeguarding adults boards on a statutory footing would help care home residents, their families and all those concerned; and would bring these incidents to light and, indeed, to a halt sooner in future?

[Paul Burstow]

It is essential to establish a statutory basis for safeguarding adults boards, but it is not sufficient, as other issues must be addressed in the review, which is why various aspects of the work are progressing. However, it is right that we should respond quickly to the Law Commission, which recommends that we should put the boards on a statutory basis, and that is what we will do when legislation is introduced.

Oral Answers to Questions

Duncan Hames Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.

[Duncan Hames (Chippenham) (LD)]

T2. I am wearing neither sandals nor flip-flops, Mr Speaker. Given that local GPs typically charge £500 a day, what action is the Minister taking to ensure that GP consortium board members do not cost the NHS as much as £25,000 each a year for just one day’s work a week?

[Mr Lansley]

Among the intentions that we have made clear from the outset is our intention to reduce the running costs of management in the NHS. We propose to cut administration costs by a third in real terms, including the running costs of the commissioning consortia when they are established. There will be a constantly tight envelope for running costs, which means that whoever is working for a commissioning consortium, it must deliver value for money.

Oral Answers to Questions

Duncan Hames Excerpts

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman is absolutely right, because this strategy must contain four elements; it must be about prevention, earlier diagnosis and appropriate self care, and we also have to have world-class research. Discussions with the Northern Ireland Assembly are ongoing.

[Duncan Hames (Chippenham) (LD)]

Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?

[Mr Lansley]

I am grateful to my hon. Friend for that. The Health and Social Care Bill establishes the commissioning consortia as public statutory bodies and, as such, that Act will apply to them.

NHS Reform

Duncan Hames Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I do not think I dismiss anybody; I might not agree with people, but I do not dismiss them. If I recall correctly, I did not agree with the hon. Gentleman’s suggestion because he misunderstood the fact that the consortia are separate statutory bodies, not private bodies, and separate from GP practices, which are individual contractors to the NHS. The confusion between those two things meant that his point was not valid.

[Duncan Hames (Chippenham) (LD)]

My constituents, who have watched primary care trusts halve the number of community hospital medical beds in Wiltshire, know that NHS reform is needed to make decision makers accountable, so how does the Secretary of State propose to strengthen the public and patient voices on the boards of the GP consortia that will replace them?