London trust may claim after NPfIT problems

The Royal Free Hampstead NHS Trust is preparing for a possible compensation claim after a troubled go-live under the £12.7bn National Programme for IT [NPfIT]. 

The trust’s staff have been struggling to cope with bugs and downtime since the go-live of the “Millennium” system from US supplier Cerner in June.

The trust’s board has been told that all problems continue to be logged so that it is ready should a claim prove possible.

The trust was the first in London to go live with Release “LC1” of the Millennium Care Records Service. One objective of the government in launching the Care Records Service is to give 50 million patients in England an electronic health record.

But go-lives have led to operating theatres and clinics being unused at times while patients have had treatment delayed because bookings have not been scheduled correctly. Some hospitals have lost income because they are paid largely on the basis of how many patients they treat. Appointments have been delayed or lost for months  Several trusts have reported that implementations have raised “clinical risks”.

The Royal Free’s board of directors was told in August: “Some individual clinics have genuinely struggled to manage the implementation of Cerner. In the main these clinics tend to be those with the largest “volume of patients”

Officials at NHS Connecting for Health, which is part of the Department of Health, say that the problems at the Royal Free and at other trusts where NPfIT systems have gone live are “teething”.

Although the system at the Royal Free is said to be improving gradually, staff have complained of weeks of chaos. Appointments are said to have been lost in the system and one clinician has said he spent more time on booking appointments than on treating patients.

Now the trust’s board has considered a possible claim for compensation. It was reported to the trust’s board on 28 August 2008 that “the trust is continuing to log all the problems which had been encountered to be used in the event that a claim proves possible”.

The board was also told that another trust was “known to be seeking compensation and it would be interesting to see what the outcome of the claim would be”.

But NHS trusts cannot claim compensation directly from their local service providers because they have no contract with them. In London the contract is between the Secretary of State for Health and BT, the capital’s local service provider. Trusts could make a claim for compensation to the Secretary of State.

A spokesman for NHS Connecting for Health was unaware of any claims as yet for compensation. He said: “There are no trusts seeking compensation in relation to the NPfIT.” He added: “NHS CFH and London hospital Trusts are enthusiastic and committed to the timely programme of go-lives of the Cerner Millenium system, given the beneficial effect to patients and healthcare staff.” 

A spokesman for BT said that no London trust is seeking compensation. Asked if it was a good idea continuing with go-lives of the Cerner system given the effect on trusts and patients of the go-lives, the spokesman said: “The system is already bringing benefits to patients so we have no plans to change our deployment strategy. That’s not to say there haven’t been issues, we’ve made no secret of that, but it would be unusual for this not to be the case with what is essentially a massive change management programme.”

The Royal Free treats about 700,000 people a year, employs about 4,600 people and has a turnover of about £450m

Royal Free Hampstead NHS Trust board paper – minutes dated 29 July 2008, reported to trust board on 28 August 2008:

“Care records system (CRS) implementation progress report

“Dr Bruce [Dr Charles Bruce, Director Clinical Service Improvement] provided an update on the implementation of the Cerner system for which a series of workshops had been held to understand both administrative and clinical issues. Training needs were being identified and the stability of the system was improving, though there continued to be down time requiring paper data collection. The call centre had been particularly challenged for which additional resource had now been identified.

“Mr Way [Mr Andrew Way, Chief Executive] reported that an additional expenditure of £300,000 from reserves had been used to increase administrative support time and that there may be further budget pressure in 2009/2010.

“In response to Mrs Pam Chesters’ [Mrs P Chesters, Chair] question regarding the cause of system down time, Dr Bruce explained that diagnostics had shown the cause to be multi-factorial though there were some bugs in the system.

“With regards to compensation, Mr Way reminded members that the contract was with the Secretary of State and that currently it was considered the NHS as a whole was failing to deliver more substantially than BT.

“One trust was known to be seeking compensation and it would be interesting to see what the outcome of the claim would be. The trust is continuing to log all the problems which had been encountered to be used in the event that a claim proves possible.

“In response to Mr Bernstein’s [Mr Danny Bernstein, non-executive director] question regarding the impact on income, Mr Fleming [Mr Kim Fleming, Director of Service Development] confirmed that problems relating to the clinical coding of admitted patients were being addressed and that potential contract risks were being managed.”

Links:

London trusts plot action over new IT system – The Guardian, 1 September 2008  

Big problems hit Royal Free’s Cerner Care Records Service roll-out – Computer Weekly, Aug 2008  

Pioneering London hospital hit by crashes and delays – IT Projects blog, August 2008

Patients in jeopardy? – Evening Standard  

Patients left untreated at Barnet and Chase – G&G Recruitment quoting Computer Weekly’s article

New NHS IT leaders – good news for the NPfIT? – IT Projects blog

BBC and Evening Standard on NPfIT problems at Barts and The London – IT Projects blog  

 

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The BT spokesperson is absolutely right that this is a massive change programme.

However I strongly disagree that major problems are always inevitable with major change; careful design, a truly systematic approach, rigorous risk management and intelligent implementation can, in appropriate combination, provide effective mitigation.

It seems to me that some of these essentials must be weak or absent although I realise that the overall programme (NHSpfIT) has its own strategic influences [IT-centric approach and Poliitcal reputations] that appear to be overwhelming imperatives towards unnecessary difficulty.

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I work for the Royal free (RFH) and I use Cerner on a daily bases; I like the system and find it easy to use when the software is working correctly. I work on a ward and have a ward clinic so I not only admit & discharge patients I run my own clinic.

now for the problems.

Every time they upgrade the system they change the format that work properly. Instead of just fixing one problem the try to fix all the problems at once, which causes more problems. we were given a system that was designed for a 200 bed private hospital in Texas, Instead of starting from scratch. I was involved at the beginning with telling them what we wanted and we thought we get a system that is user friendly. They went away and didn't listen to us and gave us a system that is alien to the NHS. No when we transfer patients from Barnet to the RFH then the data should migrate over to us but this doesn't happen and we have to load all the data onto the system again.

The next problem is when we do the patients demographics and add the NOK's details to the system we have to add their address using the postcode but as we never can remember our own postcodes how can we remember our sisters, also we never write to the NOK but only phone them. We find when we print out front sheet for the medical notes the NOK info not there. the other main problem is that when we check the detail after which I do now I find that the details I just added is missing, the system doesn't save the details. There is no save button so it should do this automatically but it doesn't, this is an intermittent fault an doesn’t happen to every patient. Other problem is that when we print out a wristband for the patient the ward is missing and we have to add this using a pen. I could go on and on but to many silly problems to remember.

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