When advisers to ministers write replies to Parliamentary questions they have no legal duty to be candid. Within reason they can say what they like. So for them answering written Parliamentary questions may be no more challenging than playing tennis with the net down.
Indeed, when asked about the NHS’s National Programme for IT [NPfIT], ministerial advisers can use Parliamentary replies to make light of the concerns of clinicians and others. And this is what happened when Worthing MP Peter Bottomley put a question about Cerner sites to Ben Bradshaw, who’s the latest in a series of ministers to be put in charge of the NPfIT.
Cerner’s “Millennium” software will be used to help NHS staff administer hospitals and keep records on the care and treatment of patients. It’s due to be installed at hospitals across London and the South of England as part of the NPfIT.
Bottomley asked Bradshaw what representations he’d received from clinicians in hospitals about Cerner Millennium go-lives. Bradshaw’s reply in January 2008 suggested that clinicians are concerned only about things such as the number of keystrokes to carry out certain functions.
Bradshaw said in response to a question from Worthing MP Peter Bottomley:
“While Ministers have not received any direct representations, we are aware that users in the early deployments expressed some concerns about the system’s management and statutory reporting functionality, and some of its usability features, for example the number of key strokes required for certain functions. Action has been taken to address these concerns and to enhance these areas. This is making a positive impact. Many users who have become familiar with Millennium over time have expressed satisfaction with the system.”
There have been some successes with Cerner go-lives. Barnet and Chase Farm Hospitals NHS Trust, for example, now has near a real-time overview of when beds are vacant and where. The reality, also, is that at some hospitals where Millennium has been installed there have been protracted difficulties, not necessarily through any fault of NHS trusts or Cerner, or the local service providers, Fujitsu and BT.
The Audit Commision, in the latest annual audit report on Weston Area Health NHS Trust, referred to the implementation of what it called the Cerner National Care Records System. The Commission said that remedial work continued for months. It said:
“Significant problems with the implementation of the Cerner system have resulted in poor data quality and a lack of robust information…Weston Area Health NHS Trust was included within the first deployment of the Cerner National Care Records Service (NCRS) and implemented the NCRS system in October 2006. However, it was soon recognised that the system was not providing the services required by the Trust and that significant remedial work would be required.Over the last nine months the Trust has been working with the suppliers and the SHA to resolve these issues…”
Bradshaw’s reply gave no hint that an independent organisation such as the Audit Commission had deemed as “significant” problems arising from a Cerner implementation.
Bradshaw’s answer did include statistics from Cerner sites including Weston. The system at Weston had 1,700 total users, 1,400 at peak times and an average of 450. Queen Mary’s Sidcup NHS Trust had 2,050 total users, 170 at peak time and [only] an average of 50. Buckinghamshire Hospitals NHS Trust had a total of 880 users, 700 at peak time and an average of 450. But do statistics mean anything?
Buckinghamshire Hospitals NHS Trust went live with the Cerner Care Records System on 25 September 2006. More than a year later, in November 2007, the trust’s board was told of some of the day to day difficulties. On the matter of keeping track of patients with MRSA and C Difficile, the Care Records System was “not working consistently” although Fujitsu, the supplier of Cerner’s Millennium system in the South of England, was working on a fix.
The trust board was told:
“CRS – which is not working consistently Fujitsu are working on a fix for this. In the meantime a ‘belt and braces’ approach is being taken by the Infection Control team to ensure patients are not missed. There is currently no functionality in CRS for flagging patients
with C. difficile. “
Last month Buckinghamshire Hospitals NHS Trust categorised the risk of the Cerner Care Records Service causing disruption to clinics, targets and workforce as “likely” to materialise, and it categorised the potential severity of the consequences as “major”.
Avon, Somerset and Wiltshire NHS Cancer Services has said that “Current opinion regarding Cerner is that it will not support cancer data collection and reporting requirements for at least 5 years, possibly nearer 10 years.”
And NHS South Central reported in November 2007 that “Deployment problems at those sites that have implemented the [Cerner] system has created concern amongst those organisations in the deployment pipeline. Regular communication is now taking place to rebuild confidence and keep organisations up-to-date with progress on the contract reset.”
It has been said before but if ministers and officials continue to play down the problems of NPfIT implementations they’ll carry on alienating clinicians and other NHS staff whose support they need to make a success of the programme. Ministers and NHS Connecting for Health, which runs part of the NPfIT, do not need to put the programme in a zoo enclosure marked “Say kind things only – this enclosure is for the worried and nervous”.
This is the question asked by Peter Bottomley MP and Ben Bradshaw’s answer:
“To ask the Secretary of State for Health which hospital trusts have installed Cerner’s Millennium system; on what date it was installed; which hospital trusts are expected to install the system and when; what the name is of the senior clinician on each hospital IT board; which Minister is responsible for the system roll out; what representations he has received from clinicians in hospitals using the system on their experience of using it; if he will ask a chief medical officer to consult clinicians using the system in (a) Kent, (b) Sussex, (c) Cheshire and (d) Buckinghamshire; and if he will update the figures provided previously in the answer of 23 July 2007.”
Reply by Ben Bradshaw, Minister of State, Department of Health:
“Nine health communities have to date gone live with the Cerner Millennium system provided through the national programme … In addition two London NHS hospital trusts, the Homerton University Hospital NHS Foundation Trust, and Newham University Hospital Trust, had initiated procurements of the Millennium system before the national programme. To date, some 2.7 million patient records have been entered in the systems currently in use.
“Four further trusts are currently expected to go live with the existing release (release 0) of the Millennium system by the early part of 2008. These are Taunton and Somerset NHS Trust in 2007, and the Royal United Hospital Bath NHS Trust, the Royal West Sussex Hospital Trust, and Barts and the London NHS Trust in 2008. Thereafter, release 1 of the system will form the basis for other implementations across both Local Service Provider areas in 2008-09 and beyond…”
“Details of clinical representation on bodies responsible for overseeing local implementation of NPfIT systems are not held centrally.
“While Ministers have not received any direct representations, we are aware that users in the early deployments expressed some concerns about the system’s management and statutory reporting functionality, and some of its usability features, for example the number of key strokes required for certain functions. Action has been taken to address these concerns and to enhance these areas. This is making a positive impact. Many users who have become familiar with Millennium over time have expressed satisfaction with the system.
“From the inception of the IT programme relevant and experienced clinicians have contributed to the effective identification of requirements, design and testing of all systems wherever across the NHS these are being delivered. This continues to be the case. NHS Connecting for Health has appointed a chief clinical officer to lead the clinical engagement and clinical contribution to the programme.”