Hundreds of Londoners have waited longer than they should have
for their first hospital appointment, as staff at Barts and The
London NHS trust struggle to keep track of patients on their IT
systems.
The waiting list delays during March at Barts and The London
were the worst in the country.
The Government has set a target that all patients should see a
consultant or doctor within 13 weeks of a referral by a GP.
Most trusts in England reported to the Department of Health
"zero" patients in March who had waited longer than 13 weeks for
their first outpatient appointment.
But the latest papers presented to the Board of Barts and The
London said that it had 834 patients who were still waiting in
March - and 675 of these had been waiting more than 17 weeks.
The number of patients waiting was
higher than all the trusts in England put together.
Computer Weekly understands that some of the patients have shown
up incorrectly on the waiting list - they had duplicate e-records
and were actually seen but not recorded as being seen on their
duplicate file. Other patients gave up waiting and were referred by
their GP to another trust.
Still, hundreds of Barts' patients were still waiting for their
first appointment after a GP referral, for weeks and sometimes
months beyond the Government's 13-time limit.
Staff at Barts and The London have struggled to keep track of
patient appointments since implementing the Cerner Millennium "Care
Records Service" last April. Their difficulties have been
compounded by inefficient management information systems.
Last year Barts reported that patients with
suspected
cancer were not receiving urgent appointments to see
specialists within the government's two-week target. The trust said
this was "directly attributable to the erroneous migration of
outpatient clinics [data] at the change-over to [the] Care Records
Service".
For Barts, one challenge has been to attune management processes
and train staff to work differently since the introduction of the
Care Records Service.
The trust's board says it is of "extreme concern" that Barts has
been unable to report on the number of patients who have or have
not been treated within
18 weeks of being referred by a GP. The trust is having trouble
keeping track on its systems of patients who are due to be treated
and by when.
The problems at Barts have hit the performance ratings of London
primary care trusts - particularly Tower Hamlets - which pass their
patients to Barts for care and treatment.
But the difficulties are not confined to Barts. Several trusts
have been trying to return to normal after the introduction of new
systems under the £12.7bn National Programme for IT [NPfIT].
The Royal Free Hospital in Hampstead was the first in London to
use Release 1 of the Cerner Millennium Care Records Service which
requires staff, doctors and nurses to access NPfIT systems by
smartcard.
Andrew Way, the then Chief Executive at the Royal Free,
told the
BBC in February: "I have personally apologised for the decision
to implement the system before we were really clear about what we
were going to receive. I had been led to believe it would all
work."
He said technical problems had cost the trust £10m and meant
fewer patients could be seen. "Many of the medical staff are
incredibly disappointed with what we have got."
At the British Medical Association's annual representative
meeting in London Dr Paul Flynn of the BMA's Central Consultants
and Specialists Committee said he had been brought to help doctors
at the Royal Free Hospital at Hampstead after the implementation of
Cerner Millennium.
"I saw doctors who were enthusiasts for IT turning to complete
despair. I have seen doctors almost in tears because of how
frustrated they are at being prevented from doing their jobs by the
IT system," he said.
Dr Gordon Matthews, a consultant orthopaedic surgeon at
Buckinghamshire Hospitals NHS Trust, told the meeting that doctors
at his trust were still having difficulties with the Care Records
Service system three years after its installation, according to
E-Health Insider.
He said: "We are now struggling to install a piecemeal system to
run in parallel with CRS [Care Records Service] to provide some
clinically useful data."
As a counter to the difficulties with the NPfIT Care Records
Service, NHS Connecting for Health is to allow trusts in the south
of England to buy hospital patient administration systems from a
range of suppliers.
A competition is now being run to choose suppliers under an
"Additional Supply Capability and Capacity" framework contract
Barts and The London declined to give Computer Weekly any clear
explanation why it had reported in March the largest number of
patients in the country who had waited well beyond government time
limits for their hospital appointments.
It said: "In March, we reported an unfortunate and significant
number of breaches of the 13-week waiting time standard for a first
outpatient appointment
"The Trust has contacted those patients to ensure that anyone
that still wanted to be seen in outpatients at the Trust was given
an appointment during May and June. All patients were treated as a
matter of urgency.
"The Trust reported 10 breaches of this standard for May 2009,
and there is no evidence from our review that any patient has been
harmed by waiting longer than the waiting time standard."
It added: "As we improve our administrative and management
systems, patients are able to access our services in a timely
manner and therefore fewer of them will breach the waiting time
standard."
Barts confirmed that it is "currently not reporting 18-week
performance" but " is expecting to begin progressively reporting"
it in the coming months.
A spokeswoman for the Department of Health declined to comment
on the patients at Barts who waited longer than 13 weeks for
appointments. The spokeswoman commented instead on the inability of
Barts to report on patients who have, or might not have, been
treated within 18 weeks.
She said: ""We should not let the problems at one hospital
undermine the fantastic achievement by NHS staff in meeting the 18
weeks commitment nationally five months early."
She added that there is no indication that the "current
difficulties that the trust [Barts] is experiencing in reporting,
are adding to referral to treatment waiting times or affecting
patient care".
Barts' board has "instigated a root and branch review of the
trust's waiting list systems to ensure each and every patient's
waiting time is accurately recorded".
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