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. Undiagnosed, sick, or injured
patients have been on a hidden waiting list,lost in the systems. As
delays in their treatments are below the radar of the general
public they don't seem to matter.
The disorder wehighlighted last 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.
Uncertainty
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 backlog 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. A spokesman for Barts says that the trust can
be certain that no patients have suffered any harm to their health
as a result of the delays. But we don't know how the trust can be
so certain.
Fortunately the NPfIT is not an aircraft crash. So there is
nothing unsightly for 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.
Trouble-shooters
The result of ministerial complacency is that accident
trouble-shooters now have clearance to drive to the next Care
Records Service implementations at 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 is 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.●