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Friday, April 29, 2005

Wells report discussed in the commons

I have just noticed that a question about the "Wells Report" was recorded in Hansard on the 21st March. I am unclear whether this relates to the report on the NHSu, publication of which I have been trying to obtain under the Freedom on Information Act.

Wells Report

Keith Vaz: To ask the Secretary of State for Health (1) what the cost of the Wells Report was; and for what reason he does not currently intend to publish the report; [219067]

(2) what the cost was to public funds of the Wells Report. [220094]

Miss Melanie Johnson: No specific budget was allocated to the Wells report work. Its compilation involved the input of many individuals in a number of different organisations. The cost to public funds of the report could therefore be estimated only at disproportionate cost. The report will not be published, as to do so would prejudice similar future examinations of the economy, efficiency and effectiveness with which other public authorities discharge their functions.

Part of Hansard for 21st March 2005

Wednesday, April 27, 2005

DH Internal review of my FOI request

I have today received a letter following the internal review by the department of health of their decision not to disclose the report by Sir William Wells into the NHSU.

There review has supported their original decision not to disclose the information - details set out below. I have forwarded this to the Information Commissioner who is already reviewing this decision.

Your ref:
Our ref: TO6011201

27 April 2005

Dear Mr Ward,

Thank you for your letter of 18th February 2005, requesting an internal review of the Department’s decision not to publish, under the Freedom of Information Act 2001 (the FOI Act), the Wells Report on the NHSU. Please accept my apologies for the length of time taken to respond to this and your original request. The Department of Health has received a high volume of requests under the FOI Act.

The internal review you requested has now been completed and has supported the original decision not to disclose the information. This letter sets out the reasoning behind this decision.

You are correct to say that for the exemption in section 33 of the FOI Act to apply, the Department needs to demonstrate that:
(a) disclosure is likely to prejudice the authority's auditing functions; and
(b) the public interest in avoiding that prejudice is greater than the public interest in disclosing the information concerned.

In your letter you indicate that you do not believe these points have been satisfactorily demonstrated.

Prejudice to the authority’s auditing functions

As stated in Annex A to the Department’s original response of 14th February, the likely prejudice to the authority’s auditing functions is caused by the concern that publication of the report would endanger the co-operation of individuals with future investigations. This view is confirmed by the Department for Constitutional Affairs' Guidance on the exemptions contained in the Act, which states in relation to s. 33 that:

(§2.5): Relations with audited bodies and audit third parties:

There may be information that originates from an audited body, which, if disclosed, could harm relations between the auditors and that body, and so affect the ability of the auditors to carry out their functions effectively. While auditors have statutory powers to demand access to information in order to carry out the audit it is better if information is made available voluntarily within the context of an open and effective relationship. Moreover, auditors may also rely on information from third parties which sometimes provide a more accurate assessment of a public authority's accounts, or the efficiency/effectiveness with which it carries out its functions. If the disclosure of information by the auditors would make it less likely that such information would be volunteered in the future it would be likely to prejudice the audit function.

As noted in the Department’s letter of 14th February, a number of other exemptions also apply.

Public interest in disclosing the information

You suggest that transparency in the way in which taxpayers’ money is spent is clearly in the public interest. This point was noted in Annex A and the Department does not dispute that there is public interest in disclosure of the information contained in the report.

Balance between public interest in withholding/disclosing the report

However, it is the responsibility of the Department to weigh the public interest in disclosure against the public interest in withholding disclosure. Annex A lists the factors for and against disclosure. It is the Department’s judgement that the factors in favour of withholding the report outweigh the factors in favour of disclosing the report.

Release of an amended report

You indicate that you would be happy if any names or comments which could identify an individual were removed. However, as stated in Annex A it is the Department’s view that it would be inappropriate to disclose only some parts of the report, which might give a misleading impression of its contents. Furthermore publication of any part of the report would tend to undermine the policy of encouraging candour.

Commitment to release the report

You refer to our commitment made by Rt Hon John Hutton, MP, Minister of State for Health on 9th November (Our Ref: PO5005693) to publish the findings of the ALB review process. The publication on 30 November 2004 of An Implementation Framework for Reconfiguring the DH Arm’s Length Bodies fulfilled this commitment.

If you are not content with the outcome of this internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at:

Information Commissioner’s Office
Wycliffe House
Water Lane
Cheshire SK9 5AF

If you have any queries about this letter, please contact me. Please quote the reference number above in any future communications.

Yours sincerely,

Jill Moorcroft
Freedom of Information Unit Head
Skipton House
80 London Road

Wednesday, April 20, 2005

Delivery delays mount across the national programme

Delivery delays mount across the national programme

E-HealthInsider today reports significant delays in the implementation of NPfIT projects accross the country.

"NHS Connecting for Health (CfH) has confirmed that there are delays in implementing the National Programme for IT (NPfIT) in four of the five regions in England, with the biggest slippages occurring in delivering new integrated clinical systems to acute hospitals."

Tuesday, April 19, 2005

NHS IT: integration of legacy systems

NHS IT: Misconceptions about cost and disruption are barriers to modernisation

This report from describes a survey commissioned by WRQ, showing that significant improvement is required to educate healthcare IT professionals about how their existing systems can be integrated to support the new initiatives in the short, medium and in some cases long term.

A major finding was about the importance of integration of lagacy systems into NPfIT systems and the limited work which is underway in this area.

Monday, April 18, 2005

e-Health at Risk, MPs Warn | eGov monitor

e-Health at Risk, MPs Warn | eGov monitor

This story from eGov monitor covers a new report (5th April) "The Use of New Medical Technologies Within the NHS" by a cross-party Commons select committee on Health which says that lack of co-ordination in areas such as telecare and telemedicine is placing a "drain on resources" in the NHS and creating "the potential for mistakes".

The MPs note that despite the UK having a world-leading £5 billion health IT industry, the potential benefits of new medical technologies are not being realised in the NHS. The Committee cities figures showing that the UK, 4.8 per cent of total healthcare expenditure is spent on medical technologies, compared with 8.6 per cent in Germany and the European average of 6.4 per cent.

Sunday, April 17, 2005

Why the doctors' IT system won't see you now

Why the doctors' IT system won't see you now

This article in today's Independent highlights some of the difficulties with the National Porgramme for IT with suppliers and practictioners.

FOI request - response from Information Commissioner

Following my letter to the Information Commissioner complaining about the amount of time taken and the refusal by the Department of Health to disclose the report by Sir Alan Wells into the NHSU, I have received a response.

It is a receipt of correspondance (ReF: FAC0070878) and says that it will be allocated to an officer for action - but is in stark contrast to the delay and lack of response from the DoH.

Friday, April 15, 2005

Medical Usability: How to Kill Patients Through Bad Design (Jakob Nielsen's Alertbox)

Medical Usability: How to Kill Patients Through Bad Design (Jakob Nielsen's Alertbox)

This commentary from Jakob Nielson responds to a study in JAMA Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. Ross Koppel, PhD; Joshua P. Metlay, MD, PhD; Abigail Cohen, PhD; Brian Abaluck, BS; A. Russell Localio, JD, MPH, MS; Stephen E. Kimmel, MD, MSCE; Brian L. Strom, MD, MPH. JAMA. 2005;293:1197-1203 and highlights many of the risks associated with the design of order/entry systems in hospitals.

NHSU - Community - CHAIN

NHSU - Community - CHAIN

The CHAINs (Contact, Help, Advice and Information Networks) have been run for some years by the NHSu as online networks for people working in health and social care. They are based around specific areas of interest, and give people a simple and informal way of contacting each other via email and the web to exchange ideas and share knowledge.

I understand that these are to close, and are seeking alternative sponsors, although there is no mention of this on the web site.

A recent email to members, which included various messages of support, said;

"We heard last week that NILSI/The NHS Institute, (the successor to NHSU), will not be providing a home for CHAIN, and that the NHSU/Modernisation Agency/Leadership Centre Transition Team plans to take no steps to help us relocate elsewhere in the NHS/DoH. Furthermore, the Team expects us to have 'completed' our work by 30/6/05. We do not share the view that CHAIN should end then, and consequently our own campaign to find a new sponsor (or sponsors) has just begun in earnest."

Thursday, April 14, 2005

Think tank calls for review of NHS data spine plan - Computing

Think tank calls for review of NHS data spine plan - Computing

This report from "Computing" covers a report published by open market think tank Aediles and the Conservative Technology Forum, which suggests "the concept of a national spine of NHS patient records should be reconsidered and the £6bn-worth of National Programme contracts potentially renegotiated."

Wednesday, April 13, 2005

UK government silences online discussion about VLEs?

Auricle 13 April 05

This post on Derek Morrison's Auricle Blog highlights a rigid interpretation of UK election rules which has stopped an academic mailing list dicussing virtual learning environments (VLEs) until after the election.

healthcare imaging uk

healthcare imaging uk

This site provides a useful overview of development in digital imaging, particluarly related to Picture Archiving and Communications System (PACS).

Articles range from a basic overview and glossary to suggestions of the future direction in this field and product reviews.

Tuesday, April 12, 2005

He@lth Information on the Internet

He@lth Information on the Internet

The latest (no 44 April 05) edition of HeAlth Information on the Internet has been published.

It includes an interesting editorial on information prescriptions with some consideration of the practical implications of this.

There is also the second part of an article on dental resources on the Internet by Shuva Saha, an overview of online support groups, an interview with Dr Cesare Massone of and the regular "what's new?" column from Laurian Williamson of BIOME

There is also an interesting column from Dr Harry Brown which considers developments at Google including Google Scholar, the new Primary Care Question Answering Service and a consideration of webcams and instant messaging in the clinical consultation.

Friday, April 08, 2005

FOI request - DoH response

Minutes after posting my last entry on this blog I recieved the email below from the Department of Health & I think it is now referenced as "Complaint 84":

Dear Mr Ward,

Thank you for your email of 18 February 2005. Apologies for the delay in responding. This is to confirm that it is receiving attention and we will reply to you as soon as possible.

Yours sincerely,

Sarah Otto
Freedom of Information Unit

letter to Information Commissioner re FOI request - DoH - Wells report on NHSU

As I have still not received a response from the Department of Health following my appeal, under the Freedom of Information Act, against their refusal to disclose the report written by Sir William Wells into the NHS University see: entry on 18th Feb

I have now written to the Information Commissioner to complain - a copy of the letter is below:

FOI/EIR Complaints Resolution
Information Commissioner’s Office
Wycliffe House
Water Lane

Dear Sir/Madam,

I wish to complain about and appeal the actions of the Department of Health (DoH) in respect to my application for disclosure, under the Freedom of Information Act, of the report written by Sir William Wells into the NHS University (NHSu).

I enclose a letter (dated 9th Nov 2004 Ref: PO5005693) from John Hutton, minister of state at the DoH in which he states an “intention to publish the findings shortly”.

As this had not been published I submitted a letter to the DoH on 1st Jan 2005 (copy enclosed) requesting disclosure of this report.

I did not hear from the DoH until I received a letter dated 14th Feb (ref: TO6011201, copy enclosed) stating they had decided not to disclose the report and citing section 33of the Act – Audit functions as the reason for non disclosure.

I then wrote (copy enclosed) to Jill Moorcroft (FOI officer at the DoH) on 18th Feb requesting an internal review of the decision.

I have not received any acknowledgement or decision from her, and it has now been more than the six weeks I understand is considered a reasonable time to respond.

I wish to complain, both about the time taken to respond to my request and the original decision by the DoH not to disclose the information requested.

Yours sincerely,

Rod Ward

Thursday, April 07, 2005

NHS FOI survey

NHS FOI survey

This page reports a survey by of 66 NHS organisations and reports that they had received few requests, with clinical performance being the most common subject, and that they were coping with them well.

The full report is available in PDF

Wednesday, April 06, 2005

The NHS-HE Connectivity Project

The NHS-HE Connectivity Project

I have recently been invited to a meeting of the NHS-HE Connectivity Project, which aims to "Co-ordinate and support network connectivity between the NHS and Universities involved with education and research in medicine and professions allied to medicine".

The site includes some interesting architecture papers & case studies of closer working between JANET the HE network and the NHS network which has the potential to overcome many of the access problems for our students.

JMIR - TOC Vol 7 (1) (Jan-Mar 2005)

Journal of Medical Internet Research - Table of Contents Volume 7, Issue 1 (Jan-Mar 2005)

The latest issue of the Journal of Medical Internet Research is now available.

It includes articles on:

The Role of an Online Community for People With a Rare Disease: Content Analysis of Messages Posted on a Primary Biliary Cirrhosis Mailinglist

What Is eHealth (4): A Scoping Exercise to Map the Field

The Law of Attrition

They are all available freely in HTML & for members in PDF

Information Services in the NHS – Staff questionnaire

Information Services in the NHS – Staff questionnaire

“The National Library for Health ('NLH') is carrying out a survey of the information needs of staff working for the NHS in England.

Please help them by completing the survey at

The survey, which covers all NHS staff, is designed to identify the information needs people experience in the daily course of their jobs. The results of the survey will be used to develop the content and services available via the NLH and through local NHS library and information services, with the aim of supporting not only clinical and management decision making, but also continuing professional development and skills training. The survey should take no more than 10 minutes to complete.

Report on 'Every Child Matters'

MP committee concerned by Government plans for IT-based ‘child indexes’

This report from sets out the findings of the House of Commons Education and Skills Committee into Government plans for IT-based ‘child indexes’ in its Green Paper 'Every Child Matters'.

Several issues are discussed including training and the balance between cost and potential benefit;

“Joint training is crucially important – both in terms of breaking down barriers between professionals and upgrading the skills of in-service staff working in education, health, social services, the voluntary and community sector, and elsewhere. Yet this is expected to be funded, in the main, locally, and this may be very difficult where there are other pressures on budgets.”

“Another area we have concerns about is the creation of a series of linked IT-based ‘child indexes’ or databases. Child indexes are likely to be costly, yet the research evidence currently available does not prove that they will be worthwhile, or that serious operational obstacles can be overcome. The Government has agreed that there is a need to progress very slowly in this area, and we strongly agree. Pending further research and analysis, the possibility remains that money allocated to child indexes could be more usefully spent elsewhere.”

Monday, April 04, 2005

The Informatics Review

The Informatics Review

In the latest issue of the Informatics Review there are links to several interesting articles. Chief among these is one from Business Week entitled, "The Digital Hospital -- How info tech saves lives and money at one medical center. Is this the future of health care?"

In addition, there are links to the following Clinical Computing and Informatics News items:

* Taking a Walk on the Supply Side: 10 Steps to Control Health Care Costs

* A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit

* A great site for medical informatics and health IT-related jobs

* Report to the 73rd Legislative Assembly: Electronic Health Records & Data Connectivity