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.
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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".