By Tony Collins
Barnet and Chase Farm Hospitals NHS Trust is one of the most experienced Cerner Millennium electronic patient record user sites in England. It started using Cerner in 1999 for clinical documents, electronic orders and results, pathology, radiology and theatres.
In 2007 the trust became one of the first reference sites for the use of Cerner Millennium within the National Programme for IT.
With BT’s help, and what the trust calls “full” funding, Barnet and Chase Farm implemented Millennium to support A&E, track patient notes and provide a master patient index.
Millennium has also been used to support the production of waiting lists. So why is the trust, with its exceptional IT experience, given a special mention today by the National Audit Office for having technology problems with its 18-week waiting lists?
Trust loses track of 108 patients waiting more than a year
In a report published today on 18-week waiting times – the right of patients to receive consultant-led care within 18 weeks of being referred for treatment, usually by their GP – the NAO says:
“In May 2013, Barnet and Chase Farm Hospitals NHS Trust identified a failure to monitor more than 2,000 patients on the waiting list, of which 651 had waited between 18 and 51 weeks.
“The backlog developed as a result of a failure in an IT reporting system. At the time of the report to the board in May, there were no patients identified as waiting more than 52 weeks for treatment.
“However, further validation of the waiting list in July by trust staff identified 108 patients that had not been tracked and who had waited more than 52 weeks for treatment; these patients were subsequently reported to NHS England.
“In December 2013, Barnet and Chase Farm Hospitals NHS Trust had 181 patients who had waited more than 52 weeks for treatment…”
Responding to the NAO, officials at Barnet and Chase Farm said they had validated waiting times data, including for example: checks for missing services; changes in waiting list volumes; checks for missing clock starts; and reviewing a sample of patient files against recorded data.
But the full facts have not emerged. Two months ago the NHS Barnet CCG Board Governing Board Meeting decided to discuss in private Barnet and Chase Farm’s problems, which are not confined to meeting the 18-week list targets. The discussion went into the meeting’s “part two” section.
In the open part of the meeting, it was reported to Board members that the Trust had reported a serious incident relating to a breach of access to 18 week pathways.
“The backlog position was 2613, patients waiting between 18 to 51 weeks with a
further 214 patients waiting in excess of 52 weeks. A Clinical Harm Steering Group has been set up by the Trust to review all patients affected by the RTT [referral to treatment] backlog.
“This group is being chaired by Henrietta Hughes, NHSE London region Medical Director who will be advising on the assessment of clinical harm…”
Board directors of Barnet and Chase Farm have discussed the 18-week waiting list problems – but in private.
Keeping track of patients once the 18-week countdown starts is difficult for any trust and Barnet and Chase Farm is not the only trust mentioned by the NAO as having problems.
It’s not always clear in what circumstances – and when – the clock starts on the 18-week countdown. The clock may be paused, for example if the patient cannot make an appointment because of a work commitment; and patients may not attend appointments for other reasons.
What makes Barnet and Chase Farm different is its long IT-related experience, and the financial and technical support it has had from BT and the Department of Health under the National Programme for IT and later the London Programme for IT. Keeping track of patients requires the trust to be in full control of its IT systems.
Several trusts implementing patient record systems within the NPfIT have had protracted problems keeping track of patients on their waiting lists – Barts and North Bristol for instance. The details are rarely made public – and the problems recur.
Barnet and Chase Farm has held its discussions on the 18-week problems in private, as has the Barnet CCG. This flies in the face of the coalition’s promise of a duty of candour when things go wrong; and if officials know they can keep their IT-related problems secret they can adopt risky implementations without accountability.
The high-risk implementations continue – at Croydon Health Services NHS Trust, for example, where patients and the public have not been given the full story on what has gone wrong after the implementation of an NPfIT patient record system.
When safety is at risk – which it can be when a trust loses track of patients on their systems – the NHS has a duty to explain. At least so there is a chance lessons will be learned.
NAO report – NHS waiting times for elective care in England.