Queen Mary's Sidcup NHS Trust was an NHS IT trailblazer late last year when it became the first trust in London to use the new patient administration system from the £12.4bn National Programme for IT (NPfIT).
But alongside the technical challenge posed, trust chief executive Kate Grimes said last month that its commitment to tapping the NPfIT had also left it under financial pressure and facing an income loss of about £3m. This was due to problems encountered when rolling out the new systems from BT, which is the local service provider for national programmes in London.
"This is very serious for an organisation already in financial trouble," Grimes told an NHS IT conference organised by the Health Service Journal.
Last year the trust had the second worst deficit in England as a proportion of its turnover. But Grimes said that despite the initial financial pressures, being the first in London onto the NPfIT systems could help drive the trust out of financial difficulty.
Problems with the new system began as soon as it went live in November last year. Grimes said the system was sometimes unavailable and problems with logging in were adding 36 minutes to the time patients spent in the hospital, simply because of the time wasted gaining access. This contributed to the trust just missing its accident and emergency targets for the year.
The main threat to the trust's finances came from the drop in referrals because other hospitals in the area had started using the NPfIT's Choose and Book system to allow GPs to book appointments online.
However, the Sidcup trust found out just before it was due to go live with the Carecast patient administration system from IDX that the system was incompatible with Choose and Book.
Although the problem is now fixed, there has been a significant drop in referrals in the meantime, Grimes said. "If it had gone on for many more weeks the survival of the organisation would have been threatened by that."
Another fall in revenue came from the clinical coding systems introduced as part of the new software. Hospitals need to code their procedures so that they can be paid by the government.
"The new coding took a lot longer to do and a number of patients were not on the system - so you do not get paid for them," Grimes said.
This was due to system downtime, lack of training and a struggle with the new role-based access approach to the application, she said.
However, Grimes is determined that the new IT system that nearly killed the trust will also provide the cure. The system will give local GPs direct access to test results, not only for the ones they order, but also to tests ordered by the hospital's own doctors.
This should cut the number of repeated tests performed by the trust - a major cause of hospital inefficiency - and improve referral rates from GPs, which will boost revenue.
With the new digital imaging and archiving system, the trust will save about £300,000, while better management of the handover of care between day and night staff as a result of the system will save about £400,000, Grimes said.
The new coding system allows staff with a less detailed knowledge of the system to code their own patients, creating an improvement in data quality and improving revenue by about £1m, Grimes said. "We were a good way down that development when BT announced it was going to change supplier."
This illustrates the problem with an IT programme of this scale in the NHS. Although the Sidcup trust was adapting to a new system and beginning to reap benefits, BT decided to drop IDX in favour of rival health software supplier Cerner, leaving the trust facing another major IT upheaval.
As Computer Weekly revealed last week, trusts are having to live with the consequence of decisions made by NPfIT contractors, which they have no part in making, with limited means to seek recompense.
A lack of contractual control was a drawback to the design of the programme, Grimes said. "There is a lack of visibility of the contract or any power or control over it. If a delay increases my costs, I do not have any power to recover those costs."
She said that BT had "helped out", but it was not something that was automatic in the contract.
Another drawback to the structure of the programme, which is managed by Connecting for Health, is that problems take a long time to resolve because of the lengthy chain of command. Grimes said BT and Connecting for Health were working with the trust to try to solve these problems.
Overall, the trust was not prepared for the level of business change its IT overhaul involved, Grimes said. "Staff did not understand how much IT drives their clinical processes and they did not understand the changes they would need to make to their processes."
While successful IT programmes in business are careful to ensure technology and business processes are managed by, and accountable to, the same authority, the Health Service decided to separate the two when it created the NPfIT.
Whether other trusts feel the pain in changing their processes to fit technology they took no part in designing could well depend on what happens next at hospitals like Sidcup.
Steps to success
Queen Mary's Sidcup chief executive Kate Grimes on the effort to make a major software implementation a success.
- IT staff need to be exposed to the business function, advising the board on decisions and risks.
- The board must get involved with decisions regarding IT - IT is one of only three committees reporting directly to the executive board.
- Ensure your organisation is IT literate before roll-out.
- Money spent on end-user training in advance is less than the cost of a lack of training.
- Chief executives need to be IT role models and focus on benefits.
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This was first published in November 2006