Comment and analysis
It’s often said that good results on IT-related projects and programmes rely on good communications.
This helps to explain why the NHS’s £12.7bn National Programme for IT [NPfIT] is such a good case study – an exemplar of how poor communications corresponds with poor results.
The point is underlined by the details which have emerged this week on the confusing and, as it turns out, overly optimistic public and internal communications over the go-live of the Cerner R0 e-records system at Weston Area Health Trust.
The Care Records Service is the most important part of the NPfIT and Weston was the second trust in England to go live with the R0 Cerner system, Nuffield Orthopaedic Centre being the first.
The idea of the Care Records Service is to give 50 million people in England an e-record that can be accessed wherever it’s needed. Doctors support the idea even if some have lost faith in the ability of the Department of Health and NHS Connecting for Health to make it happen.
The Department of Health’s public communications over Weston began in 2006 when it tried to use the trust for political advantage. This backfired.
In a memo in 2006 to MPs of the Public Accounts Committee, who were sceptical about the claimed successes of the NPfIT, the Department of Health quoted Weston as being particularly satisfied with its installation of the Cerner system.
In fact Weston came to regard its Care Records Service as disruptive and “never going to deliver what the NHS needed”, according to a paper this year to the Trust’s board of directors.
All trust boards need to report externally on how many patients they are treating, and for what, and how quickly. Patient administration systems such as Cerner Millennium should provide this information, at least to ensure that trust boards are paid for treating people.
But in an 18-month period since their go-live, Weston’s directors were never sufficiently certain of management information from the system to know the Trust would get paid.
A deleted section of a draft report of Weston’s Audit and Assurance Committee said in February 2008: “The fact remains that the trust is still not at a stage, despite 18 months of work, of having the certainty that we are able to communicate on activity [treating patients] and charge for all the work undertaken”. The Trust did not explain why sections of the draft report were deleted.
The Department of Health also miscommunicated when giving an assurance to the Public Accounts Committee in 2006 that mistakes from an earlier go-live of the Cerner system at Nuffield Orthopaedic Centre would not be repeated.
In fact Weston repeated some of the mistakes at Nuffield. Both Nuffield and Weston – and other trusts since – have had difficulties producing external statutory reports on their care and treatment of patients.
When the Audit Commission came to audit Weston’s 2007/8 accounts and work, it found that the Care Records Service had “resulted in significant disruption to service deliverability at the Trust”. The problems presented a “significant risk to the Trust’s services both in its ability to treat its patients on a day-to-day basis, and to the general administration of the hospital services”.
What has happened at Weston could answer the question so many in the NHS are asking: how is it that mistakes are unknowingly replicated every time a trust goes live with the Care Records Service?
The answer, from the facts at Weston, is that the board of a trust which is due to go live with Cerner is assured that problems at other trusts have been solved. But the team going live find out only too late that the problems are still there.
The draft copy of a report of Weston’s Audit and Assurance Committee said that the trust discovered only when it had taken the Cerner system that the product was unfinished. “The Trust took Release 0 when it was in its development stage,” said the paper.
The Committee added: “The assumption that problems at the Nuffield six months earlier had been resolved was incorrect”.
Another deleted passages from Weston’s draft report said there should have been a detailed risk assessment of the Cerner system at the time of implementation.
It is arguably time for the Department of Health to come clean about the NPfIT. Trust after trust has gone live with Cerner only to find that problems haven’t been fixed. But the Department cannot come clean.
It doesn’t have the information to ensure that trusts don’t repeat mistakes of other trusts. It collects abstruse statistics which can be converted to common currency for use by writers of NPfIT press releases and ministerial speeches.
But the NPfIT minister Ben Bradshaw has been unable to answer questions by Worthing West MP Peter Bottomley on the problems and extra costs locally of Cerner go-lives. He says the Department of Health doesn’t collect such information centrally.
Last week another Bottomley question on the costs locally of NPfIT-related problems went unanswered when Bradshaw told the House of Commons:
“I do not believe that any useful purpose would be served by attempting to cost the collation of information unless this were required for essential policy or operational purposes.”
It’s uncomfortable for Computer Weekly to criticise the NPfIT in this way. Many thousands of people are working on the programme or have a stake in its wished-for success. They want it to work. So do doctors. Paper-based records that go missing can cause lives to be lost unnecessarily. E-records make unequivocal sense.
But the NPfIT is demonstrably not the best vehicle to deliver e-records. There needs to be a thorough, independent published review of whether the NPfIT will meet the needs of NHS trusts.
Christine Connelly, a former chief information officer at Cadbury Schweppes and now CIO for Health, is doing a review of the NPfIT. Competent she may be. Independent she is not: she works for the Department of Health and reports to the NPfIT Senior Responsible Owner David Nicholson who’s chief executive of the NHS.
Ministers say ‘no’ to calls for a comprehensive, independent, published overview of the NPfIT, perhaps because they don’t want anything authoritative published which refers to the NPfIT in ways that they don’t approve of, which is the Kremlin’s approach to government PR.
Meanwhile money continues to be poured into the programme – before anyone really knows whether it’s being well spent or wasted on archeologically excavating ground which has little or nothing worthwhile beneath.
Department of Health memo about Weston to the Public Accounts Committee, 2006
Minister defensive over Cerner sites – IT Projects blog, Feb 2008
Evidence mounts for NPfIT review – Computer Weekly, Nov 2008
NHS head is content about rejecting NPfIT review – IT Projects blog, June 2008
Academics compile dossier of concerns about NPfIT, The Register, 2007
New demands for NPfIT review – call by Lib-Dems – ZDnet, July 2007
Lord Warner rejects NPfIT review – Digital Health, 2006
Long delays at Abu Dhabi after move to E-records – Arabian business.com, Nov 2008
Barriers to adoption of healthcare IT – US Study, November 2008, Healthcare IT News