A group of London hospitals has lost track of patients who have
missed treatment under the Government's 18-week wait target, after
problems with pioneering NHS IT systems.
The difficulties are the most serious of any major
implementation under the NHS's National Programme for IT
[NPfIT].
Computer Weekly and The Guardian, in a joint investigation, have
learned that details of hundreds of patient appointments have lain
hidden or unrecorded in systems which were installed as part of the
NPfIT.
When the appointments were discovered, patients had already
missed their treatment within the Government's target wait time.
The Government's promise is that "everyone who chooses to be
treated within 18 weeks, and for whom it is clinically relevant,
will be treated in that timeframe".
Now the group of London hospitals - which are run by Barts and
The London NHS Trust and include the world-famous St Bartholomew's
Hospital in Smithfield - have stopped issuing reports on the number
of patients who have not been treated within 18 weeks, although
these reports are required by the Government.
Data too unreliable
The Department of Health and officials in London have said the
data in the trust's Care Records Service system is too
unreliable.
Staff at Barts, in trying to meet the 18-weeks target, have been
facing a backlog of more than 2,000 patients.
Separately the trust has apologised to 447 patients who waited
more than 13 weeks to see a specialist. Patients at Barts have also
waited longer than the four-hour wait target for A&E and for
inpatient treatment within 26 weeks.
Rollout resumes as problems worsen
Despite the problems the NPfIT minister Ben Bradshaw has
announced that the roll-out of the Care Records Service - the
system at the heart of the problems at Barts - is to resume rolling
out.
The rollout stopped last year because of the severity of
problems at London hospitals.
Plans and timetables are now being prepared for BT to install
the Cerner Millennium Care Records Service at Kingston, Bristol,
Bath, and at various hospitals in the London area.
Health officials in London have told Computer Weekly that
improvements to implementations are being made in the light of past
mistakes.
But they gave the same assurance after each troubled go live of
the Care Records Service at the
Nuffield Orthopaedic Centre, Weston, Milton Keynes, and Barnet
and Chase Farm. Despite the assurances, the problems have become
more serious.
Barts still breaching targets
Barts has directed patients on its backlog to other hospitals
including independent treatment centres. It has also set up
additional clinics. But the hospital concedes that it is still
breaching Government targets.
The problems at Barts are not with 18 and 13-week targets alone.
Tower Hamlets Primary Care Trust says its chief executive has
written to the head of Barts and The London to "raise our serious
concerns" about the non-availability of "data relating to maternity
care."
The Government target is for women to see a midwife or maternity
healthcare professional within 12 weeks of pregnancy. But Tower
Hamlets says. "We have now initiated the process of collecting data
manually, as the
Care
Records Service system at Barts and The London is unable to
produce the reports required."
Another government target is for patients to wait no more than
26 weeks for treatment as an inpatient. Tower Hamlets says the
latest data shows that Barts has "far exceeded the number of
allowable breaches".
PCT's formal warning to Barts
The PCT has "issued a Warning Notice to BLT [Barts and The
London Trust] in line with the performance process in the acute
contract".
Various official investigations are underway, including a
"
Serious Untoward Incident" inquiry because the details of
hundreds of Barts' patients who needed appointments and treatment
were left undiscovered in the systems.
Patients could be harmed by delays
Some doctors believe that the decision of officials and
ministers to resume the go-live of the Care Records Service in
London and parts of England is a triumph of politics over the
safety and welfare of patients.
Tower Hamlets Primary Care Trust says a breach of waiting time
targets at Barts "may have an impact on clinical outcomes".
Katherine Murphy, Director of the Patients Association, said:
"Cancelled and delayed operations can have a huge effect on
patients. The hospitals have stated that the patients have not come
to any clinical harm, but that doesn't mean patients aren't being
forced to wait whilst in pain or discomfort."
Several primary care trusts in London, which pay for patients to
be treated at Barts, report breaches in Government waiting time
targets because of the Care Records Service problems at Barts.
"Unfortunately Barts and The London's performance in this area
[meeting national targets] has impacted on our PCT partners," says
Barts.
Some NHS officials say the problems with go-live of the Cerner
Care Records Service are not because of the software but because of
the unreliability of data and the way the system is
implemented.
Clinical concerns at Royal Free
The Royal Free, whose Chief Executive Andrew Way has defended
the decision to resume the rollout of the Care Records Service,
said: "It's important to separate out the administrative processes
that may or may not be adequate and effective at Barts and the
London from the introduction of Care Records Service".
The Royal Free's board has been told that there are clinical
concerns about the Care Records Service although the technology is
now more stable. Difficulties with the Care Records Service at
Barnet and Chase Farm have been reported as "ongoing" by the board
this year, although the system there went live nearly two years
ago, in the summer of 2007.
There are reports in Australia, the US and the Middle East of
difficulties with similar technology.
Barts and LPfIT official respond
Helen Avery, a spokeswoman for the London Programme for IT,
said: "The health and safety of patients is of paramount importance
in any decision the London Acute Programme Board makes on behalf of
the NHS
"There are always challenges with early adopters of complex IT
solutionsThe approach being taken at the other trusts that are
currently planning to implement Cerner Millennium has been informed
from the lessons learnt from the improvement programmes at the live
sites and enables more localisation and tailoring of the system as
well as close working between clinicians and solution experts."
A spokesman for Barts and the London NHS Trust said: "Barts and
The London has some of the best quality clinical care in the
country. There are, however, some weaknesses in our information
management and administration systems, which we are addressing
through a comprehensive improvement programme Until this is
complete, we have agreed with the Department of Health, NHS London
and Tower Hamlets Primary Care Trust that our performance will not
be reported. As soon as we have validated our data, we will resume
our monthly reports in the usual way."
It added that no patient has come to clinical harm. It is
awaiting the results of a Serious Untoward Incident investigation
into the "root cause of the waiting list reporting concerns and why
management systems did not alert the organisation to it
sooner".
London trusts in chaos as NHS IT system 'loses' waiting lists - The
Guardian
Lessons from troubled go-live at Nuffield Orthopaedic
Centre