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NHS Appointments

Let me start by congratulating my hon. Friend the Member for Hazel Grove (Andrew Stunell) on securing this important debate. I congratulate also my hon. Friend the Member for Cheadle (Mark Hunter) on his contribution, which was also important to the debate. Choose and book is part of the national programme for IT. It seems to me, and to most people who have looked into this issue, that the Government are in complete denial regarding the scale of the problems with that programme. The Minister is a reasonable man, and I suggest that he should take this opportunity to accept the problems that the programme has experienced. He is not responsible for instituting the system, as he has inherited this nightmare, and everyone would welcome his acceptance of the massive challenges that the national programme faces. My hon. Friend the Member for Hazel Grove has described the experiences of his individual constituents. I am sure that the Minister will agree that the situation in the first case that my hon. Friend described, that of Mr. I, is intolerable. We cannot accept a situation in which someone who experiences anxiety about hospital referrals has to go through such an experience. It should be incumbent on us all to realise that that is not acceptable and to find ways of changing things for the better. The national programme was centrally flawed from the start. I went to a fascinating seminar at which someone who has been heavily involved in the national programme spoke candidly about its whole design. He said that there had been no systems review at the start, which means that there had been no process by which the different people who were building and buying the system reached agreement with those who would be using it about what they were trying to achieve. He explained that although such a review is of fundamental importance to any IT project, it had been missed from that project because of the political imperative to drive it forward. He also said that we do not have sufficient skills in the UK to deliver the programme as it was originally designed. Many other people have made the absolutely valid point that it is stupid and wrong centrally to impose a system on a highly diverse health system without getting buy-in from the clinicians who are to use it. A small number of providers are involved: at first there were four, and now there are only two because the other two have deserted the project. Smaller IT providers, which have historically provided all the innovation, have been excluded from the project, and we now have the highly vulnerable situation in which the whole system depends on just two providers because the other two have left. We are told in a report in The Times this week that one of those that has left—Fujitsu—is pursuing a claim for some £600 million against the Government. I would be grateful if the Minister responded to that report and confirmed whether it is true. The national programme for IT is years behind schedule. We were told by the National Audit Office that completion was expected around 2014, but that now appears to be in doubt; it looks as if the time scale will be even longer. We also know that the whole programme is billions of pounds over budget. In a response to a parliamentary question that I recently tabled, it has been revealed that the number of severe faults in NHS computer systems has almost doubled in the past three years. That potentially puts patients and their care at risk. We have to take that matter very seriously. There are two particular problem areas in the national programme for IT. The first is the national care records system, which is the national database of all of our patient records. In this day and age, I do not know who on earth would trust the Government to look after sensitive patient records—I certainly do not. In its report this week, the Public Accounts Committee has highlighted its serious concerns about the scale of the crisis that the national care records system now faces. This debate is on the other matter that has caused real concern: choose and book. I want to start the analysis of where we are going wrong with choose and book by establishing some principles. First, I fully accept that the concept of electronic booking and someone being able to sit with their GP or someone else in the practice and make a booking—for example, for the Stepping Hill hospital in Stockport—is an attractive proposition. For the patient to know that an appointment has been booked when they leave the GP practice is a good concept and we should not lose sight of that. The second principle, which I absolutely support, is the concept of enabling patients to choose the clinician whom they want to see. Critically, that should be done on the advice of a person's GP, because they will often be guiding us in the decisions that we make. As my hon. Friend the Member for Hazel Grove pointed out, in the vast majority of cases the individual patient will want to choose their local hospital. However, there might sometimes be a good reason why someone does not want to choose their local hospital—for example, it could be that an elderly person wants to stay with a son or daughter somewhere else in the country, or that someone's local hospital has a poor record on hospital-acquired infections. There could be all sorts of reasons why an individual might choose to go elsewhere, and people should have the right to do so.