When there are NHS IT problems don't mention Cerner

Barts and The London faced the worst 13-week waiting list in England – more patients waiting than the whole of the rest of the rest of the country put together – in March. 

It reports 834 breaches of the 13-week elective outpatient access target. Most trusts in England reported “zero” breaches of the target in March.

It has become clear that not all the breaches a real. Some are duplicate records: when patients have been seen, this hasn’t been recorded on their duplicate record. In other cases patients have given up waiting and have asked their GPs to book their appointments elsewhere. This hasn’t been recorded on their records either.

The Department of Health has insisted that all apparent breaches of target be reported whether they are known to be actual breaches or not.

Barts says the number of breaches includes

“all patients whose need for an outpatient appointment remained unresolved. This change had been made following advice from the Department of Health. It was noted that a proportion of these patients would not actually breach the 13-week target”.

But hundreds of the 834 cases are real: flesh-and-blood patients who have been waiting months more than they should for their appointments.

The real breaches show if nothing else how political the NPfIT has become. Whitehall officials want to resume the roll-out of the Cerner Millennium system in London and elsewhere and so wish to portray the problems at Barts and at other Cerner trusts as isolated.

Trust board papers, when referring to difficulties with e-records, have begun adding the words “not related to Cerner”. Indeed a spokesman at Barts emphasised that the problems with the 13-week waiting list breaches were “not related to Cerner”.

There were several emailed exchanges between Barts and Computer Weekly over what had caused the 13-week breaches if not the Cerner Care Records Service, and nobody at Barts was able to explain the breaches, other than to say there had been a change in the way the breaches were reported.

This explanation would have been of little comfort to those waiting months for their first outpatient appointment having been referred by their GP. “Sorry you have been waiting for eight months for the appointment you should have had within 13 weeks but this reflects a change by the Trust in the way outpatient waits are reported.”

I get the impression that staff, doctors and IT executives at Barts are doing all they can to return to normality. But they have been dropped in it by Whitehall’s insistence that the NPfIT and the LPfIT must be seen to succeed.

Arguably the problems are not directly related to Cerner. The system requires changes in the way people do things. It requires firm and coherent management. More tightly organised processes and regular training. More than anything the existing data has to be reliable.

Yet some officials would like to portray the problems at Barts and elsewhere as a matter of paperwork and reporting protocols. But sometimes real patients pay the price of political machinations.

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