By Tony Collins
When the Lord Mayor of Bristol presented a cheque for £20,000 to buy 10 cardiac monitors for local hospitals he could not have known that NHS officials were quietly spending more than 100 times that amount on an over-budget Cerner project.
A charity, the Frenchay Cardiac Support Group, raised the £20,000 through a shop and fund-raising events. It was 100th the amount of the overspent element on a project to install an NPfIT Cerner patient administration system at the North Bristol NHS Trust.
Officials at NHS Connecting for Health and the Trust may consider it unfair of Campaign4Change to compare a charity donation with the unplanned extra costs of an IT-enabled change programme. But whereas North Bristol is accountable to local patients and fund-raisers for the £20,000 donation, it has no duty to explain to its patients (or anyone) how or why it has spent £5m on a Cerner project that was expected to cost the Trust about £3m.
The figures are buried deep in the Trust’s latest board papers. There has been no discussion of the overspend during the public part of the Board’s March meeting. Nor was it mentioned on the Board’s agenda for the meeting.
What the Trust says
The Trust declined our invitation to explain the overspend saying that it has commissioned a review of the Cerner project by PWC. Its statement to us said:
“North Bristol NHS Trust has commissioned an independent review into the issues surrounding the implementation of its new electronic patient record system. This will be carried out by PricewaterhouseCoopers LLP. The outcome of the review will be published in due course. We do not feel it is appropriate to comment further until the conclusion of the review, which is expected to take several weeks.”
The Trust’s papers say that the majority of capital spending in January and February was on the Cerner project. The anticipated spending on the project will be more than £5m which would see the Trust considerably overspent because of the difficulties encountered, say the papers.
The same Board papers put the Trust’s IM&T overspending at about £2.3m. This is on top of the hundreds of millions of pounds that NHS Connecting for Health is paying BT to install Cerner at sites in the south of England, including north Bristol.
NHS Trusts across London and the south of England are expected to install new Cerner systems in the coming years. London is in the midst of a major procurement, as is the south. If the disruption is as serious as in some earlier implementations thousands of patients will be affected. So what?
At North Bristol the NPfIT implementation of Cerner has gone seriously awry. Besides the duplication of medical records, disruption to appointments, and, for the first time, the missing of a two-week wait target for cancer patients, there have been at least 16 clinical incidents; and the Trust’s papers say there has been a “significant increase in DNA [Did Not Attend an appointment] rates since the implementation of Cerner”.
Does it matter? It will all settle down in time say NHS officials.
Indeed some in the NHS and the scientific community in general have a view that taking known risks are part and parcel of achieving Progress. If lives are lost pushing back frontiers of knowledge it is for the greater good. Hence the justification for risks taken in launches of the Space Shuttle and building new designs of bridges, tunnels and aircraft.
The greater good
It’s a philosophy not lost on officials at NHS Connecting for Health. Go-lives of electronic patient record systems will be disruptive and may even affect the care and treatment of patients. But it’s for the greater good and the damage won’t last too long. Besides, if the health of any individual patients is affected, this will be supposition: no official evidence will exist.
So should patients fear the implementation of new hospital-wide systems? It’s a little like the early flights of commercial aircraft. Most flights will go without incident but now and again a passenger jet will crash.
One difference between aircraft crashes and hospital IT implementations is that crashes are usually investigated by law, and lessons applied by regulatory authorities to make flying safer. The NHS has no duty to investigate or apply lessons from its IT-related mistakes. Which is one reason that the lessons from the Cerner implementation at Nuffield Orthopedic Centre in Oxford in 2005 have still not been learned. For example there were important differences in the way the Nuffield’s staff and doctors worked, and the way the system was designed to work.
Who would want to fly in an aircraft that hasn’t been certified as safe? So should patients experience an NHS that has uncertified patient record systems?
In aircraft crashes deaths are obvious. There is often a clear cause and effect. In the NHS there is no certification of IT systems. A hospital can go live with whatever systems it wants, whatever the effect on patients. Indeed the reporting of any damage to patients is down to the Trusts. That’s a clear conflict of interest – like relying on the builders of a supertanker to report the effects on wildlife and fish of an oil spillage.
It’s time for a change.
It’s time for the NHS – and the Department of Health and particularly NHS Connecting for Health – to get professional about hospital-wide IT implementations.
It’s time for regulation and certification, minimum standards of safety and independent reporting of disasters.