Barts and The London NHS Trust, as an early adopter of the NPfIT Care Records Service, has responded at length to an investigation by Computer Weekly and The Guardian into the Trust’s IT problems.
The Trust lost track of hundreds of patients. Gradually it is finding their details on a waiting list which had been hidden. By the time their details are discovered, patients have already missed the Government’s waiting time targets.
Barts has faced a backlog of more than 2,100 patients who should have been treated within 18 weeks. The Government has promised that patients would be treated within 18 weeks of being referred by a GP.
Several Primary Care Trusts in London, which pay for patients to be treated at Barts, have formally complained to Barts. The PCTs have themselves breached Government waiting time targets because their patients have gone untreated by Barts.
This is from a report to the board of Newham PCT on the problems at Barts:
“On 18 weeks, the PCT was not meeting the target due to the data problem at Barts and the London Trust [BLT]. BLT had the worst data backlog in London. The Director was looking at Newham University Hospital Trust capacity and whether transferring work from BLT was feasible for next year [2009/10] …”
Another comment by Newham PCT to its board:
“18 week – admitted and non-admitted pathways … “the backlog clearance issues at Barts is still a concern.. Outpatients 13 weeks wait – cumulative 235 breaches as of Jan 2009. We have failed to achieve the target… Forecast performance: RED.
“Reasons: Care Records Service implementation is uncovering previously unknown/reported breaches at BLT …
“Actions: Basically a large number of patients were discovered recorded on a spreadsheet, who had not been booked and had not been correctly recorded on Care Records Service , so were therefore ‘unknown’.
“There is a full investigation going on into this SUI [Serious Untoward Incident], and a task force has been set up to contact patients and book them into appointments. There have been a lot of additional clinics created to deal with this.
“Forecast Annual Health check performance: We have failed the target.”
This is response I received from Barts:
1. Breaches – 18 weeks and data validation exercise
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.
This includes measures to meet the 18-week referral to treatment national standard, including:
– Increased capacity – our specialties are working hard to undertake additional activity to treat patients more quickly
– Enhanced training of staff and upgrades to CRS software to close the gaps identified, including the system’s ability to alert managers when mistakes are made
– Improvements in management processes and standard operating procedures to ensure that we are managing our patient waiting lists effectively.
In parallel with the improvements we are putting in place to achieve this, we are conducting a detailed data validation exercise to ensure that we are capturing an accurate picture of our performance on 18-weeks.
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.”
Breaches – 13 weeks
Last November, Barts and The London NHS Trust apologised to 447 patients who waited an average of six weeks longer than the 13-week waiting time national standard for an outpatient appointment.
Owing to weakness in the Trust’s outpatients management systems, the Trust is still breaching this national standard. Addressing this standard is a top priority for the Trust’s managers and staff.
2. Health of patients
Specialties likely to have patients with the most urgent clinical need were dealt with first and patients booked into see a consultant as a matter of urgency. No patient has come to clinical harm.
3. SUI – waiting list report
The Trust launched a Serious Untoward Incident investigation, a very thorough process, to identify the root cause of the waiting list reporting concerns and why management systems did not alert the organisation to it sooner. The investigation is ongoing and will be reported to the Trust Board on completion.
4. Impact on PCTs
Barts and The London NHS Trust faces penalties for failing to reach national targets. PCTs are required to meet national standards for outpatient access for their resident population. Unfortunately Barts and The London’s performance in this area has impacted on our PCT partners.
5. Cancer waiting times standards
Notwithstanding issues referred to regarding the outpatients waiting list, nevertheless the Trust is meeting the cancer waiting targets. Cancer waiting time standards have been altered nationally from the 1st January. In common with other Acute Trusts, we are implementing new systems and processes to accommodate the new standards. We will be benchmarked against other Acute Trusts and Foundation Trusts.
Hundreds of patients lost in NPfIT systems – Computer Weekly
London trusts in chaos as NHS IT system loses waiting lists – The Guardian
NHS Trusts to have choice again – Computer Weekly
NHS CIO sets a November deadline for NPfIT suppliers – E-Health Insider