‘Sealed envelopes’ on hold as policy debate continues

Local service providers (LSPs) are unable to deploy sealed envelope functionality because a clear specification looking at how the policy should work is not yet available, the Commons Health Select Committee heard today.

Computer Science Corporation’s president of the Europe Group, Guy Hains told the committee that the LSP to the North-west and West Midlands, North-east and Eastern clusters was ready to add in sealed envelopes functionality to its deployments, but was unable to do this because Connecting for Health has not decided on how the system will work.

“There is an issue of a specification for sealed envelopes. Technology-wise we understand how to add in the functionality, but we need a clear specification, and we don’t have that. We need to know how it will be used, when it should be deployed and an idea of the data-sets involved with this addition.”

Hains said that CSC had a timetable to implement the sealed envelopes functionality, but they have to wait to hear exactly what was wanted before the LSP can complete and deploy such a system.

“We have a timetable for this addition, but on this particular programme [the National Programme for IT] we have to wait due to the complex decision making in the NHS. We have to look from the policy point of view as to how they [sealed envelopes] will work, the consent levels required and so on.

“We have built-in capabilities for explicit or informed consent and we have come up with an overview of how to do sealed envelopes but until we have a clear specification of sealed envelopes and a clear idea of what’s wanted, we will continue to timetable and wait for that policy.”

Quizzed on whether the delay in a specification was connected to Richard Granger’s comments a fortnight ago to the committee, that sealed envelopes would only be used if the demand equalled the cost of the system, Hains said that there was a difference between local and national sealed envelopes.

“Richard Granger was referring to sealed envelopes for the spine, but ours is to do with local-based envelopes, the undertaking of which is scheduled following the spine implementation. But again I stress that we need this more detailed specification to implement within the LSP environment and I think that we won’t be able to begin implementing these until 2008-09.”

Hains said that discussions were being held with professional bodies to decide on the sealed envelopes policy and come up with arrangements to determine the circumstances in which they are required. Dr Rob Hale of the Royal College of Psychiatrists rebutted this, however, saying to the best of his knowledge, no such invitation has been received by the college.

CSC is confident that the technology they are deploying will bring great benefits to the NHS and iSoft’s Lorenzo will bring the NHS into the next generation, Hains said.

He said that the delays in Lorenzo pointed to a number of factors: “Firstly, the ambition of CfH in terms of care pathways is demanding in software terms. We demand the best quality software with rigorous testing, different to the way software is made now and enables us to use it more widely than just the UK, like for the spine in Holland perhaps.

“Secondly, there is no doubt that the uncertainty regarding iSoft and its future ownership is an unwelcome distraction, but we are duly supportive to iSoft and Lorenzo, which is why we have sent 100 of our people to work on it and 23 NHS clinical professionals are also working on it. We expect delivery in the middle of next year.”

Hains attempted to allay security concerns, but was interrupted by Professor Brian Randell, professor of computer science at Newcastle University, who said that Richard Granger [NHS IT director-general] has told him that there are no written security measures for NPfIT.

Hains replied: “It is true to say we don’t have any specific statements on security but we do have targets and we have targets and an environment with a 100% no data loss requirement. All trusts deploy systems on a voluntary basis and we have to support them with the change management. Our experience has been positive though, and we are deploying faster than ever before.”

He said that CSC had been working hard to ensure the system was as robust as possible.

“We’ve had to meet some very exact standards. Under the supervision of the NHS and the DH we do regularly undertake ethical hacking to see if they can breach the system, it has not been achieved to date but as more functionality goes in, we will continue to try and allay fears with our ‘hacking’ tests.”

Hains said lessons have been learnt since the Maidstone data crash last year which left 80 NHS trusts across the North West and West Midlands, including eight acute trusts, without access to patient data on their clinical and administration computer systems, http://www.e-health-insider.com/news/item.cfm?ID=2036 , adding that he was confident that new measures would prevent similar problems at other trusts.

“We have learnt several things from Maidstone. We now know it is better to have four back-up centres, instead of just two and we have tightened our targets and expectations for how quickly systems get brought back up from 72 hours to 24 hours and much shorter times for critical environments.”

Today’s hearing was the second evidence session by the parliamentary select committee into the electronic patient record. Two further sessions will be held in June.