NPfIT systems failing repeatedly

More than 110 major incident failures have been reported by hospitals and GPs over the past four months relating to systems provided by the NHS National Programme for IT.

The problems, which have affected dozens of hospitals across England, were serious enough to be logged by NHS managers as ‘major incidents’. The issues were revealed by an anonymous NHS IT director speaking to Computer Weekly.

The IT director told the magazine: "Some NHS trusts that have implemented Connecting for Health [centrally-bought] solutions are struggling to cope with poor system performance and service availability issues.

"The local service provider is working flat out to resolve the issues. However, a great deal of damage has been done in terms of deteriorating end-user confidence and satisfaction with respect to the systems."

E-Health Insider understands that the 110 serious incidents reported by Computer Weekly may actually understate the true number of problems. Industry sources say that some problems are routinely not reported or recorded or classified as less serious. For instance, the July data centre failure that affected 80 trusts is understood to have been counted as a single major incident.

EHI has also learned that a 9 September failure that resulted in the iSoft system delivered by Computer Sciences Corporation to Morecambe Bay Hospital NHS Trust becoming unavailable to all staff was only treated as an ‘amber’ incident, rather than a ‘red’ major incident.

The contractual specifications for services to be supplied under the NPfIT say that staff and clinicians will receive sub-second response times, with 99.99% availability. But in many cases staff have found systems can either be extremely slow, impossible to access or unavailable to them for hours or even days.

The extent of the problems raises basic questions about the architecture of the programme and the belief that only a highly centralised NHS IT programme – delivered at considerable cost by large international consulting firms – can deliver the reliability of systems needed in the NHS.

While the early problems will hopefully just prove teething problems, they raise the spectre that staff will not be able to fully rely on CfH systems and will still need to maintain old systems and paper records. The programme has yet to begin widespread delivery of clinical rather than administrative systems.

Some of the problems have occurred with failures with picture archiving and communications systems (PACS), resulting in clinicians not having access to digital x-rays and other essential diagnostic images, or unable to access work lists. In one incident reported to EHI, a trust still technically had ‘access’ to PACS but was unable to view or transmit images.

According to Computer Weekly, there have been occasions when PACS has gone down during the course of an operation in which clinicians needed a copy of an x-ray to refer to, forcing the surgeon to suspend the procedure until a hard copy could be found. In the future such a backup may not be available as digital x-rays are meant to completely replace ‘wet film’ images.

About 20 of the breakdowns caused simultaneous problems across several NHS sites. The most serious, triggered by a failure in a national data centre at Maidstone in Kent in July, led to systems at 80 hospitals and primary care trusts collapsing for up to four days.

Trusts have frequent failures with patient administration systems becoming unavailable and staff and clinicians losing access to their systems, leaving them without details of appointments or planned treatments.

Problems with the Cerner Millennium system at the Nuffield Orthopaedic Centre earlier this year led to a sharp increase in patients waiting times, breaking national targets, after patients were lost in the system or dropped from waiting lists. Other trusts have reported recurring problems with being unable to log on to systems or access patient information.

Other reported problems have led to vaccination rates in London dropping by up to 19% following failures in BT’s child health system. Patient records disappeared at trusts in the North-west region following a series of software errors. In July E-Health insider revealed that Birmingham Children’s Hospital NHS Trust had found outpatient appointment data for 800 children became unviewable to staff after a botched software upgrade.

Richard Bacon, a member of the Commons public accounts committee, said: “This is the latest evidence that there are serious and growing problems with the whole NPfIT in the health service.

“In many respects the NHS IT programme is making things worse not better, while sowing distrust and disillusionment across the health service. The tragedy is that if the NHS continues on its present course, a huge amount of money will be spent and much of it will be wasted.”

CfH said that the NPfIT was working well, and the errors that are being reported are being looked into before the whole project eventually goes live. The DH agency said that trusts could fall back onto manual systems if electronic systems became unavailable.

“Any interruption to service is unfortunate but trusts have tried and tested manual systems to provide continuity of care. Service availability is typically much higher than for systems procured before the NPfIT.”

CfH added: “We expect performance to compare favourably with any large-scale organisation that uses IT – especially in the first year of operations.”