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IT problems put Enfield patients at risk, claims MP Joan Ryan

Royal Free London NHS Foundation Trust invests in patient management systems after Enfield Town MP Joan Ryan claims waiting times put patients at risk

Patients whose data went missing due to IT problems at a north London hospital trust have been put at risk, an MP claims.

Enfield Town MP Joan Ryan said 77 patients had been deemed as suffering moderate harm, while one had suffered “severe harm”, because of delays getting treatment.

Ryan said the Royal Free London NHS Foundation Trust reviewed 10,000 cases following the discovery that data from GP referrals had gone missing. 

In 2013-14, Barnet and Chase Farm Hospital in Enfield suffered “serious IT problems which resulted in thousands of patients going missing from the computer system following referrals for treatment by their GP to the trust”, she said.

The Royal Free took over the two hospitals in 2014 when it acquired the Barnet and Chase Farm NHS Trust. The Barnet and Chase Farm NHS Trust covered a population of 500,000 across two London boroughs.

In a statement to Computer Weekly, Royal Free said NHS trusts throughout the country were experiencing similar problems following changes to referral to treatment (RTT) rules, which govern waiting times for patients.

The patient administration database and Barnet and Chase – supplied by Cerner and hosted by BT – was too basic to comply with the changes.

“This, combined with shortcomings in some oversight and scrutiny procedures, means that a patient’s journey was not always visible as a whole, and breaches were not always reported,” said the Royal Free London NHS Foundation Trust.

Programme to review patients

Royal Free set up a programme board to identify the affected patients and review their cases.

By May 2015 experts had looked at 10,000 cases. Of these, 4,000 were deemed to have had suffered a low risk of harm due to the delays, with 6,000 considered to have suffered no harm. However, 77 patients experienced moderate risk of harm and one patient suffered severe risk.

The delays did not affect treatment, said the trust.

The trust’s chief operating officer, Kate Slemeck, said the patient concerned had been managed and investigated under the trust’s serious incident process.

According to an update Slemeck presented to the trust’s board in June 2015, a review by an independent expert had concluded that the delays had not led to severe harm to patients, because earlier treatment would not have changed the outcome.

The review established that, for two people who had died, “there was no connection between the delay in treatment and the patients’ death.”

“Twelve patients had contacted the trust having received a clinical harm letter, of whom eight had requested a meeting and four were satisfied with the telephone conversation,” she said.

One patient at risk of serious harm

By 10 September 2015, 776 patients had received clinical harm reviews, identifying a total of 380 patients classified as at low risk of harm, who were sent a written letter of apology, 90 as at moderate harm, and one at serious harm, according to a board update.

“Patients who have been waiting the longest for treatment and outpatient appointments continue to be prioritised and treated alongside those with an urgent clinical need,” the board was told.

Replacement IT system

The trust said it put a patient-tracking system in place to identify follow-up appointments and stitch together every part of a patient’s journey, from the GP referral date to the date the patient was treated.

“We have made a significant investment to establish a sustainable system, including a comprehensive training programme, which will ensure the trust continues to comply with referral to treatment rules,” said Slemeck.

Patients ‘deserve an apology’

In a letter to the trust’s chief executive David Sloman in August 2015, Labour MP Joan Ryan called for separate patient data to be published for each of the trust’s hospitals, and urged him to put in measures so that similar problems cannot occur again.

“All those affected deserve an apology and to know what happened and why”

Joan Ryan, Labour MP

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“This is a really important issue that has had implications for thousands of people in Enfield and elsewhere, particularly for those put at risk of clinical harm due to delays in their treatment,” she said.

“All those affected deserve an apology and to know what happened and why.”

'Advanced IT system'

Royal Free said patients at Barnet and Chase Farm Hopsitals had been waiting longer than 18 weeks for treatment, and that some had waited longer than a year before it acquired Barnet and Chase.

An analytics company helped managers and clinicians validate what procedures patients were waiting for, how long they had waited for and if they were still waiting for treatment.

As a result of this exercise Royal Free said it has invested in the most advanced IT system on the market.

“We are very sorry if any of our patients have to wait longer than is appropriate for their treatment,” it said.

Timeline: Countdown to waiting list delays and remedial action

  • August 2007: Barnet and Chase Farm Hospitals NHS Trust the first London hospital to go live with the Cerner Millennium patient administration systems under the government’s £12.7bn National Programme for IT (NPfiT).
  • September 2007: Barnet and Chase is left a top level IT vacancy after Remon Gazel, IM&T director, leaves the trust.
  • August 2008: Complaints from patients leap after Barnet and Chase Farm goes live with its Cerner Millenium patient administration system, following implementation difficulties. Dozens of patients were left untreated for at least six months. Staff, who had difficulties booking follow-on appointments, were unaware of the problem for up to five months.
  • May 2013: Barnet and Chase identifies a failure to monitor more than 2,000 patients on the waiting list, following a failure in its IT reporting system. Some 651 patients had waited between 18 and 51 weeks, a National Audit Office report reveals.
  • July 2013: Staff at Barnet and Chase identify 108 patients that had not been monitored, and had been waiting for more than 52 weeks for treatment, the NAO report reveals.
  • December 2013: Barnet and Chase Farm discloses to the National Audit Office that it has 181 patients that have waited more than 52 weeks for treatment, in breach of the government 18-week target.
  • June 2014:confidential board meeting at Royal Free NHS Trust, revealed in later minutes, discusses the 18 week Referral to Treatment backlog at Barnet and Chase Farm Hospitals.
  • June 2014: The Royal Free London NHS Foundation Trust completes a transfer of patient data from BT’s datacentre to Cerner’s UK datacentre. The trust said it had opted to migrate the centre early, in preparation for taking over running Barnet and Chase Farm Hospitals NHS trust.
  • 16 June 2015: Royal Free concludes that the correction and validation of 21,000 records on its patient administration system is sufficiently complete to re-start national reporting of referral to treatment times. However the board hears that it is highly likely there would be waiting time breaches of 18 and 52 weeks, at Royal Free and Barnet and Chase Hospitals, when national reporting resumes.
  • October 2015: Barnet and Chase Hospital NHS Trust plans to integrate its patient administration system and emergency department Cerner Millennium platform hosted by BT, with Royal Free Hospital’s Millennium patient administration system, hosted by Cerner. The project will create a single master index of patients across the trust. A separate project will integrate Barnet and Chase Farm’s Electronic Patient Record systems into Royal Free.
  • 2016: Timeframe for Royal Free London to roll out its electronic document records management (edrm) system to Barnet and Chase Farm. The aim is to create a single Cerner Millennium patient administration and electronic patient records system across the combined trust. Migration of electronic patient records is identified as a key risk as it is an activity that Cerner does not specialise in.

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