Whitehall officials pledge not to repeat troubles at Nuffield hospital - but problems have occurred

The Department of Health has given MPs on the Public Accounts Committee an assurance that problems following a troubled go-live of nationally-bought systems at an Oxfordshire hospital will not be repeated elsewhere in the NHS.

However, evidence has emerged that some of the same problems experienced by staff at Nuffield Orthopaedic Centre have already occurred at Buckinghamshire Hospitals NHS Trust, which went live with the same version of the Cerner Millennium Care Records Service as Nuffield.

Nuffield Orthopaedic Centre lost its status as a top-performing hospital following problems which included an inability to report some of its management activity and progress towards meeting waiting list and other targets.

These reporting problems were set out in a letter by the Comptroller and Auditor General Sir John Bourn to Richard Bacon MP, a member of the House of Commons’ Public Accounts Committee. Sir John had investigated the aftermath of Nuffield’s introduction of the Care Records Service. His letter to Bacon in June 2006 said of Nuffield’s Care Records Service:

“Reporting – the system at the time of our visit [about four months after go-live] was unable to generate performance reports and reports of activity in the way the Trust needs to be able to manage its activity effectively. As a result the Trust had been unable to report externally for three months …”

Last week the Public Accounts Committee published a report – The Department of Health – The National Programme for IT in the NHS – that was highly critical of the NHS’s £12.4bn National Programme for IT (NPfIT). In the report, MPs attacked the credibility of some of the Department of Health’s assurances over the progress of aspects of the programme.

As part of the committee’s research, Richard Bacon, had asked the Department of Health whether any of the problems encountered by the Nuffield Orthopaedic Centre were expected to occur at future Cerner deployments. The department’s response, revealed in the committee’s report, was: “No. We will support the local NHS and ensure that problems are not repeated.”

But Computer Weekly has received evidence that Buckinghamshire Hospitals NHS Trust, which went live with the NPfIT Care Records Service more than six months after Nuffield’s deployment, also ran into difficulties with reporting.

Anne Eden, chief executive of Buckinghamshire Hospitals NHS Trust, said in a letter to Computer Weekly that reporting was an issue. She said, “All trusts need to provide reports on areas such as inpatient, outpatient, day-case activity, etc to our funding primary care trust. In addition, we can use this information to monitor and learn from our own performance.”

She added that there were “some difficulties in completing some aspects of reporting”.

This evidence raises questions about the credibility of assurances given by the Department of Health over the NPfIT. The Care Records Service is the main part of the programme. The aim is to give 50 million people in England a medical record that can be made available to any authorised clinician.

My comment:

It is remarkable that the Department of Health could have told the Public Accounts Committee that the problems encountered at the Nuffield Orthopaedic Hospital would not occur at future Cerner deployments. After going live with the Cerner-based Care Records Service, Nuffield’s staff had serious difficulties producing useful management reports on what the trust was doing well and where it wasn’t meeting targets.

The same problem occurred months later at Buckinghamshire Hospitals NHS Trust. Both trusts had deployed the same Release 0 of the NPfIT Care Records Service based on Cerner’s Millennium product.

The Chief Executive of Buckinghamshire even says that a

reporting taskforce has been set up, consisting of experts from the NHS, NHS Connecting for Health, Fujitsu and Cerner. The aim of this group is to fully ascertain where there are still reporting issues and close them down, not just by the use of tactical arrangements (which they have already developed for use in the short term) but by fully understanding the root cause and by making robust changes to ensure that this is fully mapped, understood and resolved.”

We hope the Department of Health simply made a mistake in its reply to Bacon, or that it was oversight. Or it could have been extreme over-optimism. It would not surprise us if officials gave an assurance to Parliament that problems at Nuffield would not be repeated in the hope they wouldn’t be. Over-optimism blighted the Rural Payments Agency’s SIngle Payment Scheme.

And it could yet prove to be a deep-rooted flaw in the work to rescue the NPfIT.