If the NHS IT scheme, the NPfIT, were a jumbo jet, its frequent
crashes would have putfear-of-flying courses out of business.
But because the NPfIT is not an aircraft crash, there is no
wreckage. The damage is not visible. The Trust's undiagnosed, sick,
or injured patients have been on a hidden waiting list,lost in the
systems. As delays in their treatments are below the perception of
the general public they don't seem to matter.
The disorder we've highlighted this week at Barts and The
London NHS Trust, a yearafter it went live with the NPfIT Cerner
Millennium Care Records Service, is the most serious problem to
afflict the national programme.
The trust's managers are uncertain who among their patients have
gone untreated within the government's 18-week target. They have
been trying to reduce a waiting list of more than 2,100 patients on
their 18-week waiting list.
Some of the trust's patients have been discovered months after
they should have been treated. When patients go untreated they are
likely to get worse. Some might now be seriously ill because of the
delays. We don't know. Worse, Barts does not know.
Fortunately the NPfIT is not an aircraft crash. So there is
nothing unsightly for the the TV cameras to broadcast across the
world; there is no public clamour for information; no demand for
the common causes of all the crashes to be quickly established.
What there is, however, is the figure of NPfIT minister Ben
Bradshaw, announcing that he and his advisers can see clearly now,
and that the national programme is generally doing well. It should
rollout more quickly, he says.
But every time there is a crash Bradshaw is advised that the
lessons have been learned from earlier failures and improvements
have been made in the delivery model: trusts will be able to
"localise" and "tailor" the Cerner system; and there will be closer
working between clinicians and solution providers.
He is told that there are always challenges with early adopters
of complex IT solutions; they get over them; time heals. He is told
that the Royal Free in Hampstead lost some patients on its waiting
lists. But the London Acute Programme Board (no names are
mentioned)now has confidence in the stability of the systems.
But he is unlikely to have been told that doctors at the Royal
Free continue to express their concerns to the board about the Care
Records Service implementation.
The result of ministerial complacency is that accident
trouble-shooters now have clearance to drive to the next Care
Records Service implementations in Kingston, Bath, Bristol, and to
London's Imperial College and St George's.
The patients at these hospitals should welcome, and benefit
from, the influx of NPfIT experts. But if history counts for
anything, they have every reason to fear them.
The reason the effects of Thalidomide on babies went undetected
for so long was that the Department of Health did not want to know.
Each GP report of an infant deformity was treated as an isolated
case. When the Sunday Times began to investigate there were more
than 1,000 "isolated" cases.
At one level it's wrong to compare NPfIT delays with the
horrendous effects of Thalidomide.
On the other hand, thousands of patients had appointments lost
and delayed after the introduction of the Care Records Service
implementations at Barnet and Chase Farm, Weston, Milton Keynes,
the Royal Free and Barts and The London. Are all these isolated
cases?
It's one thing if nobody is held accountable for the failure of
a big IT project or programme. It's quite another if the
unaccountable government machine runs over the sick and injured,
stops for a moment to look back at the damage done, re-adjusts the
bumper, and then carries on much as before.
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The solution?
The small-scale NPfIT implementation at Morecambe Bay, where IT
specialists went live with part of the NPfIT Lorenzo system, was
exemplary. It was very small scale and planned on the assumption it
would fail.
Morecambe Bay is a small community: nurses told Computer Weekly
they know many of the patients or their families. They didn't want
anything to go wrong. They duplicated manually everything done on
Lorenzo. It was a lot of work for small gains. But it builds
confidence. It is safe.
Morecambe Bay is an example of a trust which would refuse to
test the Care Records Service on patients. Just one patient who
suffers as a result of an ill-tested implementation is one patient
too many. Yet thousands of patients in the London area might have
suffered. That's a disgrace the government and its advisers may
never live down.
We don't blame Barts and The London, or the other trusts which
implemented the Care Records Service to their cost. They were
pressed to implement the system, and given help and incentives as
early adopters. But political expediency on the NPfIT must never
again suppress reason.