– New system presents the “most significant” new risk to Barts since the start of the 2008/9 financial year
The new Care Records Service at Barts and The London NHS Trust has led to patients with suspected cancer not receiving urgent appointments to see specialists, Computer Weekly has learned.
This breach of the government’s guarantee that patients with suspected cancer will receive an appointment with a specialist within two weeks is among the problems at Barts and The London NHS Trust after the go-live of the Care Records Service under the NHS’s £12.7bn National Programme for IT [NPfIT].
With the help of BT, Barts went live in April with the biggest implementation so far under the NPfIT. It has installed LC0, a version of Cerner’s Millennium system, which been tailored for use by the London Programme for IT.
The Trust Board of Barts was told this week that the impact of the implementation of the Care Records Service [CRS] across the trust presents the most significant new risk since the start of the 2008/9 financial year.
At their June board meeting, the directors of Barts learned that:
– Breaches of the two-week urgent access guarantee to patients with suspected cancer were “directly attributable to the erroneous migration of outpatient clinics [data] at the change-over to [the] Care Records Service.
– The trust is not receiving income for treating patients and does not have reliable reports of patient activity “due to ongoing recording issues arising from the implementation of the Care Records Service”.
– The Trust is “behind trajectory” on meeting the government’s target for seeing emergency patients within four hours. Reasons include “staff familiarity with, and functionality of, the Care Records Service.
– There was a sharp increase in formal complaints from patients in the month the Care Records Service went live. In April there were 95 formal complaints, more than double the number in the same month in 2007.
– Complaints included patients being booked into closed clinics and appointments being cancelled repeatedly. “These issues and related Care Records Service problems are being addressed and extra resources and staff being deployed,” the Trust board was told
– Data errors mean that some patient activity might have been overstated
– Reporting errors are continuing – and there could be delays in reporting how the trust is performing
– Problems with the Care Records Service have led to duplicate outpatient attendances and the creation of spurious events for some specialities, which have “falsely inflated patient activity”
– There are “significant risks” to the trust being able to report its first-quarter activity by the end of August.
– Ongoing recording issues arising from the implementation of the Care Records Service “may impact on [patient] activity and associated income”.
– Data quality has not been fully assessed and “we may encounter a high level of queries from primary care trusts when the data is shared”.
– Given the known CDS [common data set] errors in some areas e.g. maternity, it is very probable that acitvity in the Care Records Service data warehouse has been overstated in some areas and may create significant underperformance when these errors have been corrected.
The Board also learned that “delays in clinical coding, due to problems with [the] Care Records Service and lack of coder capacity, will increase the risk of being unable to monitor activity and income on a monthly basis with primary care trusts, resulting in breaches of agreed freeze and flex dates and further loss of income.” Freeze and flex dates are part of the means by which trusts are paid for the care and treatment of patients.
We were told weeks ago that Barts was making its statistical returns
Earlier this month, when we asked Barts whether it was making all its statistical returns, its spokesperson said it was.
The problems show how patients can be directly affected by difficulties after go-lives locally of the NPfIT – the systems are not tools for administration only.
The government has guaranteed to patients that “everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they need to be seen urgently and requesting an appointment”.
But the introduction of systems installed at Barts under the local ownership arrangements of the NPfIT led to 11 patients with suspected cancer not being seen within two weeks. The delays ranged from two to 31 days.
Suspected cancer patients not at risk from delays says Barts
But Barts and The London NHS Trust has told Computer Weekly that more than half the 11 patients have been seen and “found not to have cancer”.
Barts said: “The appointments of 11 patients referred to the Trust under the two week urgent cancer access target were delayed as a consequence of the introduction of CRS. The delays ranged from 2 to 31 days. More than half of these patients have been seen and found not to have cancer. The remainder have their appointments booked and despite being offered sooner dates have chosen to stick with the original date.”
The trust’s statement for Computer Weekly quoted Professor John Toy, lead cancer clinician at Barts and The London NHS Trust, who said: “While we fully support targets to ensure patients are seen in a timely fashion, it is important to recognise that the two week wait [where a patient is suspected of having cancer] is to impart a sense of urgency but not necessarily emergency. I am confident that none of these patients will have suffered clinical harm.”
Primary Care Trust agrees to extend deadlines for Barts’ financial reports
Meanwhile estimates are being made on what it is owed for treatment to patients. The trust’s directors have been told that there are “significant risks to the income position due to the implementation of the Care Records Service”.
Tower Hamlets Primary Care Trust has agreed, on behalf of other commissioners, to change the deadlines for reports from Barts on patient activity from monthly to quarterly while the “Care Records Service beds into the Trust”.
In its statement Barts said that “outstanding issues resulting from the implementation of Care Records Service are in the process of being resolved.”
Barts not the first London trust to struggle after NPfIT go-live
Barts and The London comprises world-renowned hospitals – St Bartholomew’s Hospital in the City, The Royal London in Whitechapel and The London Chest in Bethnal Green.
Barts is the oldest hospital in Britain – it was founded in 1123. In 2006 and 2007 the NHS watchdog, the Heathcare Commission, awarded Barts the top rating for its services. It’s unclear whether Barts’ reputation for excellence will be affected by the introduction of NPfIT systems.
Barnet and Chase Farm Hospitals NHS Trust, also in the London area, has had lengthy difficulties with the Cerner “Millennium” Care Records Service installed under the NPfIT – though its directors also point to advantages such as knowing which beds are vacant in real-time.
Some trusts such as Weston Area Health NHS Trust have spent more than 18 months trying to resolve problems with the Cerner system, in part because the US software needs adapting to the UK market.
Will problems at Barts have any knock-on for BT, the London service provider?
The local service provider in London is BT which is expected to take over some NHS sites in the south of England where Fujitsu has already installed Cerner. Fujitsu, the local service provider in the south, is to withdraw gradually from the NPfIT.
The problems at Barts may give other NHS trusts in London a reason not to take up “slots” for going live with BT’s adaptation of the Cerner system. This could place the NHS in breach of the NPfIT contract with BT – and put BT in the position of levying penalties against the Department of Health.
Connecting for Health not directly involved in go-live at Barts
NHS Connecting for Health, which runs part of the NPfIT, has had no say on when the systems at Barts went live, responsibility having been delegated to the London Programme IT under the NPfIT Local Ownership Programme. It therefore made no comment on the implementation at Barts.
BT said it took the decision to go live at Barts with executives working on the London Programme for IT. They decided the first weekend in April was the best date for the go-live at Barts.
A BT spokesman said: “The system was fully tested and all parties agreed it was appropriate to go live in early April. Installing a system at an acute hospital is a highly complex matter requiring months of technical deployment activity and training for staff.
“Intensive testing of the system is carried out many months before a system goes live and, in this case, all parties agreed that the system had been extensively tested and was sufficiently stable to go-live.”
He denied that any of the problems at Barts were due to difficulties adapting an American system for use in the NHS in England.
“The version of Cerner Millennium being deployed in London is to a specification that was agreed between BT and NHS London to meet the special and specific requirements of the London trust community.
“With any system of this size and complexity you would expect that some issues will arise and that it will take a few months for the new system to bed down.
“That’s not to say that we take these issues lightly and we are working with the LPFIT to continue to support Barts and the London NHS Trust in resolving any problems they have.”
Barts is due to take the Cerner “LC1” version of the Care Records Service before April 2009. Cerner is still developing the LC2 release.