Connecting for Health, the NHS's National Programme for IT and a constrained form of openness

We’d asked Connecting for Health, which runs major parts of the NHS’s £12.4bn National Programme for IT [NPfIT], whether we could visit some of its NHS sites that have begun to use the Care Records Service based on the “Millennium” software from US supplier Cerner.

The Care Records Service is at the heart of the NPfIT, the idea being to provide an electronic health record for 50 million people that can be accessed by clinicians wherever the patient happens to be in England. Some NHS sites have begun working with basic versions of the system, which has yet to be integrated fully with the rest of the health service.

On 29 May 2007 we had suggested to Connecting for Health that we see for ourselves how issues are being overcome by NHS trusts, which could provide some interesting lessons for other user sites.

We proposed visiting Connecting for Health’s Care Records Service sites at Weston Area Health Trust at Weston-Super-Mare, Milton Keynes General Hospital and the Nuffield Orthopaedic Centre in Oxford.

Connecting for Health has now kindly offered a range of hospitals for site visits by Computer Weekly, none of which we had requested. When we asked why it was not possible to visit Weston General Hospital, Milton Keynes General Hospital or the Nuffield Orthopaedic Centre we had no reply.

It’s true that the North Somerset Primary Care Trust says in its performance report dated April 2007 that the “implementation of Cerner at Weston Area Health Trust has severely slowed down processes and the ability to progress the patients though the system within the four-hour time frame”.

And the Audit Committee at Nuffield Orthopaedic Centre reported earlier this year that weaknesses in the Cerner systems were being worked around.

“The [audit] committee enquired whether there was anything else the executive should be doing to facilitate a proper solution. The committee also enquired about the reasons given to the Trust for the lack of resolution, and was informed that a) there were resource issues with Cerner, and b) as the system was US-designed, it was not fit for purpose.”

And at Milton Keynes General Hospital, the Board thanked the large number of staff who had helped the trust go live with the Cerner Millennium system.

The Board’s minutes record that the system is working but “this is a very challenging time for the Trust as it continues to understand the operational issues, correct problems and get used to a new system”.

The minutes continued:”Mrs Reed [Director of Operations] added that the Trust is providing substantial support to the customer facing aspects of the system and acknowledged that they are not yet perfect, and that work is ongoing to improve them.

“She apologised to those patients who had been affected by this change.

Dr Butterworth [chairman, Medical Advisory Committee] raised concerns over some operational issues and ability of the super users to resolve all problems. Mr Baird [Director of Finance and Deputy Chief Executive] advised that whilst the super-users provide as much support as they can they will not be able to resolve every problem.

“The Board was also informed the system that [staff] had been trained on was not the same as the system that went live in the Trust. It was agreed that Mrs Reed will work with Dr Butterworth, outside the meeting, to understand and address the operational issues.”

Still we think there may be a positive story to be written on how managers at the trusts are overcoming the difficulties.

People about to make large purchases, from a new house to major IT systems, will usually want to see reference sites. They will not want to make choreographed visits of the only sites available. It’s the sites that aren’t easily accessible that the careful buyer will want to visit.

When in opposition Gordon Brown criticised the Tories in a speech to the House of Commons on 27 November 1996:

“They’ve tried to perform the conjuror’s trick of drawing attention to the things they want you to see, concealing what they don’t want you to see, and this is the Tories all the time.”

Surely this will not also apply to Gordon Brown’s policies on the NPfIT, or to Connecting for Health’s communications strategy?


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