The chief executive of the first NHS trust in Southern
England to go live with a key part of the health service's £6.2bn
IT-based modernisation has warned that problems with the deployment
have created a backlog of work that means patient care may have to
be moved to other hospitals.
Ed Macalister-Smith, chief executive of Nuffield Orthopaedic
Centre in Oxford, also said, in a letter leaked to Computer Weekly,
that the trust had organised "extra clinic and operating time".
The trust has implemented a basic "version zero" of the Care
Records Service, which includes a system that may eventually allow
electronic patient records to be shared with other hospitals.
The difficulties encountered by Nuffield are among the most
serious hospital staff anywhere in the UK have experienced after
the implementation of a major new system. Some operations have been
cancelled and treatments for patients delayed.
The Care Records Service is a pivotal part of the NHS national
programme for IT. It includes a patient administration system that
records details of the care and treatment of patients and is
supposed to produce statistics on whether government targets on
waiting times for operations and other treatment are being kept. It
also helps to schedule patients for operations and treatments.
But since going live with the Care Records Service the trust has
been unable to produce some statistics on its waiting times, has
been in danger of breaching government targets on when patients are
treated and, according to internal papers, some patients might have
been "lost in the system".
The leaked letter, dated 10 April 2006, said that some parts of
the system were working well - better than the trust's old patient
administration system. But "major difficulties" needed to be
overcome if the trust was to "ensure that we can pull consistently
accurate reports from the system".
The letter said the aim now was "to catch up with patient
treatment" by the end of April.
After going live on 20 December 2005, the trust and Fujitsu, the
supplier of the Care Records Service to trusts in southern England,
have worked hard to resolve the difficulties by the end of
February.
But a report to a meeting in April of the board of Thames Valley
Strategic Health Authority, in whose area the Nuffield operates,
said that the Oxford hospital had received software fixes "for all
known major issues, but several have not resolved their technical
problems and there is an ongoing process of developing new
technical fixes".
In the leaked letter, Macalister-Smith thanked staff for their
"extraordinary efforts" in tackling the problems and for "sticking
with the system".
He added, "I can confirm that our experience at Nuffield
Orthopaedic Centre has been used to substantially change and
improve the next stages in the implementation of the Connecting for
Health programme across the south of England," though he accepted
that this may be "a small comfort".
Macalister-Smith's letter said its purpose was to update
colleagues on the implementation of the Care Records Service and
"delayed patients".
It said, "Some patients waiting for in-patient or out-patient
care at Nuffield Orthopaedic Centre have unfortunately been delayed
as a result of the problems that we have had.
"In order to catch up with their treatments by the end of this
month we are taking all necessary actions in-house and with our
primary care trust colleagues. This is already involving extra
clinic and operating time and may involve moving some patient care
to other hospitals. I apologise for the extra work involved, but
these delays are, after all, not the patients' fault and we need to
maintain our reputation with them."
In a statement to Computer Weekly, Nuffield made no reference to
the extra clinics or Macalister-Smith's warning that patients may
be moved to other hospitals.
It said, "No patient's clinical care has been compromised as a
result of the difficulties that have been experienced with the
implementation of the new IT system. Unfortunately, there have been
some patients who have experienced some delays or been
inconvenienced and we are working hard to resolve these
issues."